Center for Anxiety and Traumatic Stress Disorders and Complicated Grief Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
JAMA. 2013 Jul 24;310(4):416-23. doi: 10.1001/jama.2013.8614.
The death of a loved one is one of life's greatest, universal stressors to which most bereaved individuals successfully adapt without clinical intervention. For a minority of bereaved individuals, grief is complicated by superimposed problems and healing does not occur. The resulting syndrome of complicated grief causes substantial distress and functional impairment even years after a loss, yet knowing when and how to intervene can be a challenge.
To discuss the differential diagnosis, risk factors for and management of complicated grief based on available evidence and clinical observations.
MEDLINE was searched from January 1990 to October 2012. Additional citations were procured from references of select research and review articles. Available treatment studies targeting complicated grief were included.
A strong research literature led to inclusion of complicated grief in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (termed persistent complex bereavement disorder as a subtype of other specified trauma and stressor-related disorders), although it is a condition for which more research is formally recommended, and there is still ongoing discussion about the optimal name and diagnostic criteria for the disorder. Reliable screening instruments are available, and the estimated prevalence rate is 7% of bereaved people. Randomized controlled data support the efficacy of a targeted psychotherapy including elements that foster resolution of complicating problems and facilitate the natural healing process. Preliminary studies suggest antidepressant medications may be helpful.
Individuals with complicated grief have greater risk of adverse health outcomes, should be diagnosed and assessed for suicide risk and comorbid conditions such as depression and posttraumatic stress disorder, and should be considered for treatment.
亲人的离世是人生中最普遍、最重大的压力源之一，大多数丧亲者在没有临床干预的情况下成功适应。但对于少数丧亲者来说，悲痛会因叠加问题而变得复杂，并且无法愈合。由此产生的复杂悲痛综合征会导致严重的痛苦和功能障碍，即使在失去亲人多年后也是如此，但何时以及如何进行干预可能是一个挑战。
根据现有证据和临床观察，讨论复杂悲痛的鉴别诊断、风险因素和管理。
从 1990 年 1 月到 2012 年 10 月，在 MEDLINE 上进行了搜索。从选定的研究和综述文章的参考文献中获取了其他引文。纳入了针对复杂悲痛的现有治疗研究。
强有力的研究文献促使复杂悲痛被纳入《精神障碍诊断与统计手册》（第五版）（作为其他特定创伤和应激相关障碍的一种亚型，称为持续性复杂丧亲障碍），尽管它是一种需要更多研究的疾病，并且对于该疾病的最佳名称和诊断标准仍在进行讨论。现已有可靠的筛查工具，估计丧亲者中有 7%患有这种疾病。随机对照数据支持包括促进解决复杂问题和促进自然愈合过程的要素的靶向心理治疗的疗效。初步研究表明抗抑郁药物可能有帮助。
患有复杂悲痛的个体有更大的不良健康结果风险，应进行诊断和评估自杀风险以及抑郁和创伤后应激障碍等共病情况，并应考虑进行治疗。
