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Treatment of Complicated Grief in Elderly Persons: A Randomized Clinical Trial
Open accessAbstract
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 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 ICD‐11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder (2022) · cites this paper as [126]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“-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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“-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
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Malhi, G. S., Bell, E., Bassett, D., Boyce, P., Bryant, R., Hazell, P., Hopwood, M., Lyndon, B., Mulder, R., Porter, R., et al. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867420979353 · Cited by 614
Shear, M. K. (2015) · New England Journal of Medicine · doi:10.1056/nejmcp1315618 · Cited by 533
Self-citationOptimizing Treatment of Complicated Grief: A Randomized Clinical Trial
Shear, M. K., Reynolds, C. F., Simon, N. M., Zisook, S., Wang, Y., Mauro, C., Duan, N., Lebowitz, B., & Skritskaya, N. (2016) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2016.0892 · Cited by 349
Self-citationMeaning reconstruction in bereavement: Development of a research program
Neimeyer, R. A. (2019) · Death Studies · doi:10.1080/07481187.2018.1456620 · Cited by 242
Johannsen, M., Damholdt, M. F., Zachariae, R., Lundorff, M., Farver-Vestergaard, I., & O'Connor, M. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.04.065 · Cited by 214
Metadata
- 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)
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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