Increasing support for the treatment of complicated grief in adults of all ages.

Abstract

The loss of a lovedone is inevitable yet remains one of themost intenseandpainfulstressorsapersonwillexperience.Nonetheless,most people navigate through the pain and intensity of acute grief without clinical intervention. As individuals adapt to loss, the level of distress generally diminishes over time with a return to an altered but meaningful lifewithout thedeceased.Aminority,approximately7%,1 will continue to have amore severe and persistent form of grief, referred to as complicated grief. Recently, complicated grief was included in the Diagnostic and Statistical Manual of Mental Disorders (FifthEdition)2asapersistentcomplexbereavementdisorder requiring additional research, but also within trauma and stressor-related disorders, consistent with the notion that complicated grief is a stressor-relatedcondition.3Althoughproposeddiagnosticcriteriasets havesomedifferences (eg, requiring6or 12monthssince thedeath), the core constructs are shared. Common symptoms include yearningor longing for thedeceased,difficultyacceptingoradaptingtothe loss, self-blame,avoidanceof remindersof thedeceased, andpreoccupationwith the circumstances of the death. Complicatedgrief ismore common inolder adults (variablydefined as older than 55 or 61 years), with prevalence estimates from 9% to 25%.1,4 Complicated grief is associated with functional impairment, medical morbidity, cognitive impairments, and suicidal ideation.3,4 It is thus a condition in need of identification and treatment by health care professionals, yet relatively limited research is available toguide the treatmentofcomplicatedgrief,5withdataspecific to older adults particularly lacking. In a recent article in JAMAPsychiatry, Shear andcolleagues6 reported a randomized clinical trial of a 16-week targeted psychoJAMAPSYCHIATRY