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

• Type of Material: Article
• Authors: Naomi M. Simon, Massachusetts General Hospital; Susanne S. Hoeppner, Massachusetts General Hospital; Rebecca E. Lubin, New York University; Donald J. Robinaugh, Massachusetts General Hospital; Matteo Malgaroli, New York University; Sonya B. Norman, National Center for PTSD; Ron Acierno, Ralph H. Johnson Veterans Affairs Medical Center; Elizabeth M. Goetter, Massachusetts General Hospital; Samantha N. Hellberg, Massachusetts General Hospital; Meredith E. Charney, Massachusetts General Hospital; Eric Bui, Massachusetts General Hospital; Amanda W. Baker, Massachusetts General Hospital; Erin Smith, VA Ann Arbor Healthcare System; H. Myra Kim, VA Ann Arbor Healthcare System; Sheila Rauch, Emory University
• Language: English
• Date: 2020-01-01
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: 2020
• Final Published Version (URL): http://dx.doi.org/10.1002/da.22911
• Title of Journal or Parent Work: DEPRESSION AND ANXIETY
• Volume: 37
• Issue: 1
• Start Page: 63
• End Page: 72
• Grant/Funding Information: This work was supported by the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command (MRMC; Randomized Controlled Trial of Sertraline, Prolonged Exposure Therapy, and Their Combination in OEF/OIF Combat Veterans with PTSD); (Award #W81XWH-11–1-0073; PI: Rauch); the National Center for Advancing Translational Sciences of the National Institutes of Health (Award #UL1TR000433). This material is the result of work supported with resources and the use of facilities at Massachusetts General Hospital, the VA Ann Arbor Healthcare System, Ralph H. Johnson VA Medical Center, and VA San Diego Healthcare System.
• Keywords: treatment; Psychology; BEREAVEMENT; COMORBIDITY; PTSD; Social Sciences; Psychology, Clinical; Psychiatry; PHYSICAL HEALTH; INDIVIDUALS; outcomes; PREVALENCE; INVENTORY; DEPRESSION; death; bereavement; VALIDATION; military; SCALE; Science & Technology; DIAGNOSTIC-CRITERIA; complicated grief; Life Sciences & Biomedicine
• Research Categories: Psychology, Clinical; Psychology, General

Abstract

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.