Understanding the impact of complicated grief on combat related posttraumatic stress disorder, guilt, suicide, and functional impairment in a clinical trial of post‐9/11 service members and veterans
Open accessAbstract
BACKGROUND: Complicated grief (CG) is a bereavement-specific syndrome distinct from but commonly comorbid with posttraumatic stress disorder (PTSD). While bereavement is common among military personnel (Simon et al., 2018), there is little research on the impact of CG comorbidity on PTSD treatment outcomes. METHODS: To evaluate the impact of comorbid CG on PTSD treatment outcomes we analyzed data from a randomized trial comparing prolonged exposure, sertraline, and their combination in veterans with a primary diagnosis of combat-related PTSD (n = 194). Assessment of PTSD, trauma-related guilt, functional impairment, and suicidal ideation and behavior occurred at baseline and weeks 6, 12, and 24 during the 24-week trial. RESULTS: CG was associated with lower PTSD treatment response (odds ratio (OR) = 0.29, 95% confidence interval (CI) [0.12, 0.69], p = 0.005) and remission (OR = 0.28, 95% CI [0.11, 0.71], p = 0.007). Those with CG had greater severity of PTSD (p = 0.005) and trauma-related guilt (<0.001) at baseline and endpoint. In addition, those with CG were more likely to experience suicidal ideation during the study (CG: 35%, 14/40 vs. no CG 15%, 20/130; OR = 3.01, 95% CI [1.29, 7.02], p = 0.011). CONCLUSIONS: Comorbid CG is associated with elevated PTSD severity and independently associated with poorer endpoint treatment outcomes in veterans with combat-related PTSD, suggesting that screening and additional intervention for CG may be needed.
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Prolonged grief disorder worsens the severity of co-occurring conditions after bereavement, including PTSD and depression.
“Evidence is also emerging that prolonged grief disorder worsens the severity of co-occurring conditions after bereavement, including PTSD 86 and depression 87 .”
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 [86]
The Results and Discussion (page unavailable) associate comorbid complicated grief with greater PTSD severity and lower odds of treatment response or remission in service members and veterans with combat-related PTSD. They do not establish that grief causes PTSD to worsen: PTSD symptom reductions during treatment were comparable between groups. The sentence cites a separate source for depression, so that portion is not attributed to this paper. (LLM, conf=0.88)
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Reed, G. M., First, M. B., Billieux, J., Cloitre, M., Briken, P., Achab, S., Brewin, C. R., King, D. L., Kraus, S. W., & Bryant, R. A. (2022) · World Psychiatry · doi:10.1002/wps.20960 · Cited by 182 · see citing works
Bryan, C. J., & Bryan, A. O. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102414 · Cited by 38 · see citing works
- Authors
- Simon, N. M., Hoeppner, S. S., Lubin, R. E., Robinaugh, D. J., Malgaroli, M., Norman, S. B., Acierno, R., Goetter, E. M., Hellberg, S. N., Charney, M. E., Bui, E., Baker, A. W., Smith, E., Kim, H. M., & Rauch, S. A. M.
- Affiliations
- NYU Langone Health (US)
- Harvard University (US)
- University of California San Diego (US)
- Medical University of South Carolina (US)
- Massachusetts General Hospital (US)
- Department of Psychiatry Massachusetts General Hospital Boston Massachusetts
- University of Michigan (US)
- Emory University (US)
- Corresponding author
- Simon, Naomi M.
- ORCID
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2020-01
- Volume
- 37
- Issue
- 1
- Pages
- 63-72
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- PMC
- PMC7433022
- OpenAlex
- W2999720645
- Cited by
- 42
- References
- 54
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 11 · 2023: 5 · 2022: 11 · 2021: 7 · 2020: 3
- FWCI
- 2.60
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-07-01)
- Open access
- bronze
- doi.org
- Licence
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Medical Research and Materiel Command (W81XWH‐11‐1‐0073)
- National Center for Advancing Translational Sciences (UL1TR000433)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- complicated grief, combat-related posttraumatic stress disorder, trauma-related guilt, suicidal ideation, functional disability, prolonged exposure therapy, sertraline, veterans, bereavement, comorbidities
- MeSH terms
- Adult, Bereavement, Combat Disorders, Female, Grief, Guilt, Humans, Male, Mass Screening, Military Personnel, Stress Disorders, Post-Traumatic, Suicide, Veterans, Comorbidity, Sertraline, Suicidal Ideation
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