Disclosures: Simon reports that in the past 3 years, she has received grant funding from the American Foundation for Suicide Prevention, DoD, the Highland Street Foundation, Janssen, NIH and the Patient-Centered Outcomes Research Institute; has served on speaking/CME/consulting boards for Aptinyx, Axovant Sciences, Genomind, MGH Psychiatry Academy, Praxis Therapeutics, Springworks and Vanda; served as deputy editor for Depression and Anxiety at Wiley Periodicals, LLC; and received royalty from Wolters Kluwer, and her spouse has equity in G1 Therapeutics. Please see the study for all other authors’ relevant financial disclosures.
May 27, 2021
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Posttraumatic stress symptoms common among bereaved adults with prolonged grief disorder

Disclosures: Simon reports that in the past 3 years, she has received grant funding from the American Foundation for Suicide Prevention, DoD, the Highland Street Foundation, Janssen, NIH and the Patient-Centered Outcomes Research Institute; has served on speaking/CME/consulting boards for Aptinyx, Axovant Sciences, Genomind, MGH Psychiatry Academy, Praxis Therapeutics, Springworks and Vanda; served as deputy editor for Depression and Anxiety at Wiley Periodicals, LLC; and received royalty from Wolters Kluwer, and her spouse has equity in G1 Therapeutics. Please see the study for all other authors’ relevant financial disclosures.
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Bereaved adults with prolonged grief disorder commonly experienced bereavement-related posttraumatic stress symptoms, according to study results published in Journal of Clinical Psychiatry.

These symptoms appeared common in the context of both violent and nonviolent death and were linked to poorer functioning.

Simon infographic with quote about grief and posttrauamtic distress

“Prolonged grief disorder has only recently been recognized as a diagnosis in the psychiatric nomenclature with formal criteria included in ICD-11 and recently approved by the American Psychiatric Association for inclusion in an update to the DSM-5,” Naomi Simon, MD, MSc, professor of psychiatry at NYU Grossman School of Medicine and director of the Anxiety, Stress and Prolonged Grief Program at NYU Langone Health, told Healio Psychiatry. “The death of a loved one is one of life’s most challenging experiences, yet whether significant traumatic distress symptoms occur only in people with prolonged grief disorder who are bereaved due to deaths currently defined as PTSD-qualifying traumas in DSM-5 was poorly understood. This study aimed to examine the presence of posttraumatic stress symptoms in adults with prolonged grief disorder after violent or non-violent deaths, and to evaluate the impact of two types of treatment approaches, the antidepressant medication citalopram and a targeted evidence-based psychotherapy, complicated grief treatment, on these symptoms.”

In the current secondary analysis of a randomized controlled trial, Simon and colleagues analyzed data of 395 adults with prolonged grief disorder, defined as an Inventory of Complicated Grief score of 30 or higher plus confirmation via structured clinical interview. Between March 2010 and September 2014, participants were randomly assigned to either complicated grief treatment (CGT) with citalopram, CGT plus placebo, citalopram or placebo. Simon and colleagues used longitudinal mixed-effects regression to assess the presence of posttraumatic stress symptoms according to the Davidson Trauma Scale at baseline and change in posttraumatic stress symptoms with treatment, and they also assessed the effects of violent vs. nonviolent deaths.

Results showed high baseline levels of posttraumatic stress symptoms regardless of loss type. The researchers noted an association between these high levels and increased functional impairment (P < .001). Further, they observed efficacy of CGT with placebo for posttraumatic stress symptoms compared with placebo in both threshold (OR = 2.71; 95% CI, 1.13-6.52; P = .026) and continuous (P < .001) analyses. The analyses suggested a greater effect for CGT plus citalopram compared with citalopram alone; however, citalopram and placebo did not differ, and CGT plus citalopram did not differ from CGT plus placebo, according to the researchers.

“This study clearly demonstrated that posttraumatic distress symptoms at the level validated in the past as a severity threshold for PTSD are present in the vast majority (78%) of treatment seeking patients with prolonged grief disorder regardless of whether the death meets current DSM-5 criteria for a trauma,” Simon said. “Further, these posttraumatic distress symptoms were more likely to remit with a grief-focused psychotherapy, complicated grief treatment, than a medication commonly used to treat patients with PTSD, citalopram. This suggests clinicians should assess for posttraumatic stress symptoms in patients with prolonged grief, and that grief-specific psychotherapy may be more helpful than antidepressants to address both prolonged grief disorder and associated posttraumatic distress symptoms.”