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Cited by 276Grief, Bereavement, and Mental HealthDeath, Funerary Practices, and MourningPsychotherapy Techniques and Applications

Treatment of Complicated Grief in Elderly Persons: A Randomized Clinical Trial

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Shear, M. Katherine, Wang, Yuanjia, Skritskaya, Natalia, Duan, Naihua, Mauro, Christine, Ghesquiere, Angela·2014·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2014.1242PMC PMC5705174
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Abstract

IMPORTANCE: Complicated grief (CG) is a debilitating condition, most prevalent in elderly persons. However, to our knowledge, no full-scale randomized clinical trial has studied CG in this population. OBJECTIVE: To determine whether complicated grief treatment (CGT) produces greater improvement in CG and depressive symptoms than grief-focused interpersonal psychotherapy (IPT). DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial enrolling 151 individuals 50 years or older (mean [SD] age, 66.1 [8.9] years) scoring at least 30 on the Inventory of Complicated Grief (ICG). Participants were recruited from the New York metropolitan area from August 20, 2008, through January 7, 2013, and randomized to receive CGT or IPT. The main outcome was assessed at 20 weeks after baseline, with interim measures collected at 8, 12, and 16 weeks after baseline. INTERVENTIONS: Sixteen sessions of CGT (n = 74) or IPT (n = 77) delivered approximately weekly. MAIN OUTCOMES AND MEASURES: Rate of treatment response, defined as a rating from an independent evaluator of much or very much improved on the Improvement subscale of the Clinical Global Impression Scale. RESULTS: Both treatments produced improvement in CG symptoms. Response rate for CGT (52 individuals [70.5%]) was more than twice that for IPT (24 [32.0%]) (relative risk, 2.20 [95% CI, 1.51-3.22]; P < .001), with the number needed to treat at 2.56. Secondary analyses of CG severity and CG symptom and impairment questionnaire measures confirmed that CGT conferred a significantly greater change in illness severity (22 individuals [35.2%] in the CGT group vs 41 [64.1%] in the IPT group were still at least moderately ill [P = .001]), rate of CG symptom reduction (1.05 ICG points per week for CGT vs 0.75 points per week for IPT [t633 = 3.85; P < .001]), and the rate of improvement in CG impairment (0.63 work and Social Adjustment Scale points per week with CGT and 0.39 points per week with IPT [t503 = 2.87; P = .004]). Results were not moderated by participant age. CONCLUSIONS AND RELEVANCE: Complicated grief treatment produced clinically and statistically significantly greater response rates for CG symptoms than a proven efficacious treatment for depression (IPT). Results strongly support the need for physicians and other health care providers to distinguish CG from depression. Given the growing elderly population, the high prevalence of bereavement in aging individuals, and the marked physical and psychological impact of CG, clinicians need to know how to treat CG in older adults. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01244295.

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  • There is convergent evidence from multiple controlled trials that grief-focused psychotherapy is the treatment of choice for prolonged grief disorder, with most patients responding positively.

    “There is now convergent evidence from multiple controlled trials that grief-focused psychotherapy is the treatment of choice, with most patients responding positively to this intervention 125-128 .”

    From Emerging experience with selected new categories in the <scp>ICD</scp>‐11: complex <scp>PTSD</scp>, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder (2022) · cites this paper as [126]

    The Results (Primary Outcome Analyses; page unavailable) report that most older adults receiving complicated grief treatment (CGT) responded (70.5%), compared with 32.0% receiving grief-focused interpersonal psychotherapy (IPT). The Discussion describes low IPT response in two randomized studies, supporting a preference for CGT specifically—not the broader claim that grief-focused psychotherapy generally is the treatment of choice. (LLM, conf=0.86)

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  • Complicated grief therapy achieved a greater decrease in anxiety and depression symptoms, including negative thoughts about the future and grief-related avoidance, compared with bereavement-focused Interpersonal Therapy in older bereaved adults.

    “-Complicated grief therapy had a significantly greater effect and greater tolerability compared with bereavement-focused Interpersonal Therapy in older adults who have experienced bereavement and achieved a greater decrease in anxiety and depression symptoms including negative thoughts about the future and grief-related avoidance (Shear et al., 2014;Glickman et al., 2016;Simon, 2015).”

    From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Shear et al., 2014

    The Results (Secondary Treatment Outcome Analyses; page unavailable) show significantly faster improvement with complicated grief treatment than with interpersonal psychotherapy on depression and grief-related avoidance measures. The paper does not report a comparative reduction in anxiety or specifically in negative thoughts about the future. The Discussion also says dropout rates did not differ, so it does not support the citing sentence’s claim of greater tolerability. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Complicated grief therapy had a significantly greater effect and greater tolerability compared with bereavement-focused Interpersonal Therapy in older adults who have experienced bereavement.

    “-Complicated grief therapy had a significantly greater effect and greater tolerability compared with bereavement-focused Interpersonal Therapy in older adults who have experienced bereavement and achieved a greater decrease in anxiety and depression symptoms including negative thoughts about the future and grief-related avoidance (Shear et al., 2014;Glickman et al., 2016;Simon, 2015).”

    From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Shear et al., 2014

    The Results (Primary Outcome Analyses; page not provided) show a significantly higher response rate with complicated grief treatment than with interpersonal psychotherapy. The Discussion reports that treatment was well tolerated, but dropout rates did not differ between groups (18% versus 19%); it does not support greater tolerability. (LLM, conf=0.91)

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  1. [22]Rosengren DB Building Motivational Interviewing Skills: A Practicioner Workbook New York, NY Guilford Press 2009

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Authors
Shear, M. K., Wang, Y., Skritskaya, N., Duan, N., Mauro, C., & Ghesquiere, A.
Affiliations
  • Columbia University (US)
  • City University of New York (US)
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2014-11-01
Volume
71
Issue
11
Pages
1287
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2014.1242
PMC
PMC5705174
OpenAlex
W2100507918
Cited by
276
References
56
Citations by year
2026: 18 · 2025: 16 · 2024: 32 · 2023: 28 · 2022: 21 · 2021: 21 · 2020: 28 · 2019: 26 · 2018: 22 · 2017: 27 · 2016: 22 · 2015: 15
FWCI
25.17
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH070741)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
complicated grief, older adults, bereavement, depressive symptoms, treatment response, grief severity, psychotherapy comparison, Inventory of Complicated Grief, work and social adjustment, number needed to treat
MeSH terms
Affective Symptoms, Aged, Aging, Depression, Female, Grief, Humans, Male, Middle Aged, Psychotherapy, Treatment Outcome

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