Department of Psychiatry, UC San Diego, 9500 Gilman Dr, La Jolla, CA 92093.
Department of Psychiatry, University of California San Diego, La Jolla, California, USA.
J Clin Psychiatry. 2018 Mar/Apr;79(2). doi: 10.4088/JCP.17m11592.
Suffering associated with complicated grief (CG) is profound. Because suicide loss survivors are susceptible to developing CG, identifying effective treatments for suicide loss survivors with CG is a high priority. This report provides data on the acceptability and effectiveness of antidepressant medication and complicated grief therapy (CGT), a CG-targeted psychotherapy, for suicide loss survivors with CG identified by an Inventory of Complicated Grief score ≥ 30.
This is a secondary analysis of data collected from March 2010 to September 2014 for a 4-site, double-blind, placebo-controlled randomized trial comparing the effectiveness of antidepressant medication alone or in combination with CGT for participants with CG (score ≥ 30 on the Inventory of Complicated Grief) who were bereaved by suicide (SB; n = 58), accident/homicide (A/H; n = 74), or natural causes (NC; n = 263). Using mode of death as a grouping factor, we evaluated acceptability of treatments by comparing 12-week medication and 16-session CGT completion; we evaluated effectiveness by comparing response at week 20, defined by a score of 1 or 2 on the Complicated Grief Clinical Global Impressions-Improvement scale (CG-CGI-I), and additional secondary response measures.
Among participants receiving medication alone, SB medication completion rates (36%) were lower than rates for A/H (54%) and NC (68%; χ² = 11.76, P < .01). SB medication completion rates were much higher for SB individuals receiving CGT (82%; χ² = 12.45, P < .001) than for SB individuals receiving medication alone. CGT completion rates were similar in the 3 groups (SB = 74%, A/H = 64%, NC = 77%; χ² = 2.48, P = .29). For SB participants receiving CGT, CG-CGI-I response rates were substantial (64%), but lower compared to the other groups (A/H = 93%, NC = 84%; χ² = 8.00, P < .05). However, on all other outcomes, changes from baseline for SB participants were comparable to those for A/H and NC participants, including number and severity of grief symptoms, suicidal ideation, and grief-related impairment, avoidance, and maladaptive beliefs.
These results raise concern about the acceptability of medication alone as a treatment for complicated grief in treatment-seeking suicide-bereaved adults. In contrast, CGT is an acceptable and promising treatment for suicide-bereaved individuals with complicated grief.
ClinicalTrials.gov identifier: NCT01179568.
与复杂悲伤相关的痛苦是深刻的。由于自杀丧失幸存者易患复杂悲伤，因此确定针对自杀丧失幸存者的复杂悲伤的有效治疗方法是当务之急。本报告提供了使用抗抑郁药和复杂悲伤治疗（CGT）的数据，这是一种针对复杂悲伤的心理治疗方法，用于通过复杂悲伤量表（ICG）评分≥30 识别出的自杀丧失幸存者的 CG。
这是对 2010 年 3 月至 2014 年 9 月期间为 4 个地点，双盲，安慰剂对照随机试验收集的数据进行的二次分析，该试验比较了抗抑郁药单独或与 CG 联合治疗的有效性（CGT）对于患有 CG（ICG 评分≥30）的参与者，他们因自杀（SB），意外/凶杀（A/H）或自然原因（NC）而丧失亲人（n = 58）。使用死亡方式作为分组因素，我们通过比较 12 周的药物治疗和 16 节 CGT 疗程来评估治疗方法的可接受性；我们通过比较第 20 周的反应来评估有效性，定义为复杂悲伤临床全球印象改善量表（CG-CGI-I）的 1 或 2 分，以及其他次要反应措施。
在接受单独药物治疗的参与者中，SB 药物完成率（36％）低于 A/H（54％）和 NC（68％；χ² = 11.76，P <.01）。接受 CGT 的 SB 个体的 SB 药物完成率（82％；χ² = 12.45，P <.001）远高于单独接受药物治疗的 SB 个体。3 组的 CGT 完成率相似（SB = 74％，A/H = 64％，NC = 77％；χ² = 2.48，P =.29）。对于接受 CGT 的 SB 参与者，CG-CGI-I 的反应率很高（64％），但低于其他组（A/H = 93％，NC = 84％；χ² = 8.00，P <.05）。但是，对于 SB 参与者，与基线相比，所有其他结果的变化均相当，包括悲伤症状的数量和严重程度，自杀意念以及与悲伤相关的损害，回避和适应不良的信念。
这些结果令人担忧，因为寻求治疗的自杀丧亲成年人中，单独使用药物治疗复杂悲伤的方法可能无法被接受。相比之下，CGT 是一种针对自杀丧亲者的复杂悲伤的可接受且有前途的治疗方法。
ClinicalTrials.gov 标识符：NCT01179568。
