Grief is Complicated I had no idea that there was such a thing as Complicated Grief (CG). About 9 percent of bereaved older women experience CG, a serious and debilitating mental health problem associated with functional impairment and increased suicide risk.

The symptoms can include prolonged grief, frequent thoughts and memories of the deceased, and difficulty imagining a meaningful future. Typically grief is handled as a depressive disorder and well-known treatments for depression are used.

A study in JAMA suggests that that is not enough. Observations suggest that CG symptoms do not respond well to this treatment. Instead a treatment designed to help older individuals deal with complicated grief 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 enrolled 151 patients (average age 66 years) from the New York metropolitan area into a treatment program. For approximately half, they developed a targeted CG treatment (CGT) based on something called an attachment therapy model. The aim was to resolve grief complications and facilitate natural mourning. The model focused on loss and restoration. The others received depression treatment in which they 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 average time since the loss of a spouse, partner, parent, child or another relative or friend was 3.2 years. Both treatments helped improve CG symptoms. However, the response rate for CGT was more than twice that of standard treatment. There was a greater change in illness severity and symptom reduction per week also was greater in the CGT group. ‰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 noted the researchers.