Clinical Trial Examined Treatment for Complicated Grief in Older Individuals

Bottom Line: A treatment designed to help older individuals deal with complicated grief (CG) after the loss of a loved one appeared to be more effective than using a treatment designed for depression.

Authors: M. Katherine Shear, M.D., of the Columbia University School of Social Work, New York, and colleagues.

Background: About 9 percent of bereaved older women experience CG, a serious and debilitating mental health problem associated with functional impairment and increased suicidality. The symptoms can include prolonged grief, frequent thoughts and memories of the deceased, and difficulty imagining a meaningful future. Interpersonal psychotherapy (IPT) is a well-known treatment for depression but observations suggest that CG symptoms do not respond well to IPT.

How the Study Was Conducted: The study was a randomized clinical trial that enrolled 151 patients (average age 66 years) from the New York metropolitan area from August 2008 to January 2013. The authors developed a targeted CG treatment (CGT) based on an attachment therapy model. The aim was to resolve grief complications and facilitate natural mourning. The model focused on loss and restoration. IPT discussed bereavement effects on mood, encouraged realistic assessment of the deceased, talked about the death and worked to enhance relationships and activities in the present. The 151 individuals were divided into CGT (n= 74) or IPT (n=77) to receive 16 sessions delivered about weekly. The average time since the loss of a spouse, partner, parent, child or another relative or friend was 3.2 years.

Results:  Both treatments helped improve CG symptoms. However, the response rate for CGT was more than twice that for IPT (CGT, 52 individuals [70.5 percent] vs. IPT, 24 individuals [32 percent]). There was a greater change in illness severity (22 individuals [35.2 percent]) in the CGT group vs. (41 individuals [64.1 percent]) in the IPT group who were still at least moderately ill. Symptom reduction per week also was greater in the CGT group.

Discussion: “Complicated grief is an under recognized public health problem that likely affects millions of people in the United States, many of them elderly. … Given a growing elderly population, increased rates of bereavement with age, and the distress and impairment associated with CG, effective treatment should have important public health outcomes.”

(JAMA Psychiatry. Published online September 24, 2014. doi:10.1001/jamapsychiatry.2014.1242. A