Department of Psychological and Brain Sciences, University of Louisville, Louisville, USA.
Aging Ment Health. 2012;16(1):39-56. doi: 10.1080/13607863.2011.605054. Epub 2011 Sep 6.
The construct of complicated grief (CG) has garnered increased empirical attention since it has been proposed as a diagnostic category for the upcoming Diagnostic and Statistical Manual of Mental Disorders-V. The aim of this article is to critically examine construct validity in light of a proposed conceptual framework, with special emphasis on understanding late-life bereavement.
This is a review article that critically examined current bereavement and grief models. We explored discriminant and convergent validity between CG and uncomplicated grief (UG) and other psychopathological constructs in terms of symptom intensity, symptom trajectories, bereavement outcomes, and treatment response.
The findings from this review show mixed support for differentiating CG from other outcomes of bereavement for the following reasons: (1) a clear boundary between CG and UG has not been adequately supported, (2) symptoms of CG and bereavement-related depression and anxiety overlap, although there is some evidence of incremental validity in that CG symptoms predict global functioning above and beyond symptoms of depression, and (3) the treatment literature demonstrated that general grief interventions and treatment targeted for improving depression are ineffective at treating symptoms of CG, whereas interventions specially tailored to treating CG have been moderately effective. The findings also emphasize the importance of considering pre-bereavement circumstances, such as preexisting depression, in the conceptualization of broader bereavement outcome.
There were mixed findings supporting the construct validation of CG. A comprehensive framework that emphasizes pre-bereavement circumstances was proposed in order to better predict various grief trajectories and outcomes of late-life loss.
自提出将复杂悲伤（CG）作为即将到来的《精神障碍诊断与统计手册-第五版》的诊断类别以来，其构建已引起越来越多的实证关注。本文旨在根据提出的概念框架，批判性地检查其结构效度，特别强调对晚年丧亲的理解。
这是一篇综述文章，批判性地检查了当前的丧亲与悲伤模型。我们从症状强度、症状轨迹、丧亲结果和治疗反应等方面，探讨了 CG 与非复杂悲伤（UG）和其他心理病理结构之间的区别和收敛效度。
本综述的研究结果表明，由于以下原因，区分 CG 与丧亲的其他结果存在混合支持：（1）CG 和 UG 之间的明确界限没有得到充分支持，（2）CG 症状与丧亲相关的抑郁和焦虑症状重叠，尽管有一些证据表明，CG 症状在全球功能方面预测效果优于抑郁症状，（3）治疗文献表明，一般悲伤干预和针对改善抑郁的治疗对 CG 症状无效，而专门针对治疗 CG 的干预措施则较为有效。这些发现还强调了在更广泛的丧亲结果概念化中考虑丧亲前情况（如先前存在的抑郁）的重要性。
有一些混合的发现支持 CG 的结构验证。提出了一个强调丧亲前情况的综合框架，以更好地预测晚年丧亲的各种悲伤轨迹和结果。
