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The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief
Open accessAbstract
Background Complicated grief (CG), variously called pathological or traumatic grief, is a debilitating syndrome that is not currently included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) nomenclature. One issue that remains under debate is whether this condition can be clearly distinguished from other psychiatric disorders, such as major depression and posttraumatic stress disorder, with which CG frequently coexists.Methods Using a structured clinical interview for CG and the Structured Clinical Interview for DSM-IV, trained experienced raters conducted careful diagnostic assessments of individuals seeking treatment of bereavement-related distress. All study participants met criteria for a current CG syndrome. Liberal criteria were used to diagnose DSM-IV disorders, making no attempt to decide if symptoms could be explained by grief.Results Of 206 who met the criteria for CG, 25% had no evidence of a current DSM-IV Axis I disorder. When present, psychiatric comorbidity was associated with significantly greater severity of grief; however, even after adjustment for the presence of comorbidity, severity of CG symptoms was associated with greater work and social impairment.Limitations It is likely that our study underestimated the rate of CG without comorbidity because fewer DSM diagnoses would have been made if a judgment about grief had been taken into consideration.Conclusions Our data provide further support for the need to identify CG as a psychiatric disorder.
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“Another potential limitation was that articles solely focusing on grief as the primary outcome were excluded, as grief and depression may co-occur [63].”
From Depression, anxiety, PTSD, and OCD after stillbirth: a systematic review (2021) · cites this paper as [63]
In the citing paper
“However, NESARC-III response rates compare favorably with other recent national health surveys.[86][87][88]”
From Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States (2018) · cites this paper as [88]
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“There is also overwhelming evidence that persistent grief reactions are associated with elevated rates of other mental disorders and symptoms, including depression 62,63 , PTSD 52 , suicidality 64,65 , and panic 66 .”
In the citing paper
“However, research has also shown that for a significant minority of bereaved individuals the grieving process is particularly complicated (e.g., Lichtenthal et al., 2011; Prigerson et al., 2009; Simon et al., 2007).”
From Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis (2017) · cites this paper as Simon et al., 2007
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Metadata
- Authors
- Simon, N. M., Shear, K. M., Thompson, E. H., Zalta, A. K., Perlman, C., Reynolds, C. F., Frank, E., Melhem, N. M., & Silowash, R.
- Affiliations
- Harvard University (US)
- Columbia University (US)
- University of Pittsburgh (US)
- Corresponding author
- Simon, Naomi M.
- Venue
- Comprehensive Psychiatry
- Publisher
- Elsevier BV
- Published
- 2007-09
- Volume
- 48
- Issue
- 5
- Pages
- 395-399
- ISSN
- 0010-440X (ISSN-L)
- OpenAlex
- W2039969250
- Cited by
- 333
- References
- 32
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 23 · 2023: 22 · 2022: 22 · 2021: 22 · 2020: 30 · 2019: 24 · 2018: 34 · 2017: 24 · 2016: 9 · 2015: 21 · 2014: 20 · 2013: 18 · 2012: 20
- FWCI
- 6.88
- Type
- journal article
- Language
- en
- Open access
- green
- escholarship.org
- Licence
- Locations
- Comprehensive Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- National Institute of Mental Health (P30-MH 71944, MH60783, R01MH060783, P30MH071944, MH30915)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- complicated grief, pathological grief, psychiatric comorbidity, major depressive disorder, post-traumatic stress disorder, grief severity
- MeSH terms
- Adolescent, Adult, Major Depressive Disorder, Female, Grief, Humans, Male, Severity of Illness Index, Social Behavior, Stress Disorders, Post-Traumatic, Observer Variation, Comorbidity, Prevalence, Panic Disorder, Diagnostic and Statistical Manual of Mental Disorders
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