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Published in: Annals of General Psychiatry 1/2011

Open Access 01-12-2011 | Primary research

Adult separation anxiety in patients with complicated grief versus healthy control subjects: relationships with lifetime depressive and hypomanic symptoms

Authors: Liliana Dell'Osso, Claudia Carmassi, Martina Corsi, Irene Pergentini, Chiara Socci, Angelo GI Maremmani, Giulio Perugi

Published in: Annals of General Psychiatry | Issue 1/2011

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Abstract

Background

Around 9% to 20% of bereaved individuals experience symptoms of complicated grief (CG) that are associated with significant distress and impairment. A major issue is whether CG represents a distinctive nosographic entity, independent from other mental disorders, particularly major depression (MD), and the role of symptoms of adult separation anxiety. The purpose of this study was to compare the clinical features of patients with CG versus a sample of healthy control subjects, with particular focus on adult separation anxiety and lifetime mood spectrum symptoms.

Methods

A total of 53 patients with CG and 50 healthy control subjects were consecutively recruited and assessed by means of the Structured Clinical Interview for DSM-IV Axis-I disorders (SCID-I/P), Inventory of Complicated Grief (ICG), Adult Separation Anxiety Questionnaire (ASA-27), Work and Social Adjustment Scale (WSAS) and Mood Spectrum-Self Report (MOODS-SR) lifetime version.

Results

Patients with CG reported significantly higher scores on the MOODS-SR, ASA-27, and WSAS with respect to healthy control subjects. The scores on the ASA-27 were significantly associated with the MOODS-SR depressive and manic components amongst both patients and healthy control subjects, with a stronger association in the latter.

Conclusions

A major limitation of the present study is the small sample size that may reduce the generalizability of the results. Moreover, lifetime MOODS-SR does not provide information about the temporal sequence of the manic or depressive symptoms and the loss. The frequent comorbidity with MD and the association with both depressive and manic lifetime symptoms do not support the independence of CG from mood disorders. In our patients, CG is associated with high levels of separation anxiety in adulthood. However, the presence of lifetime mood instability, as measured by the frequent presence of depressive and hypomanic lifetime symptoms, suggests that cyclothymia might represent the common underlying feature characterizing the vulnerability to both adult separation anxiety and CG.
Literature
1.
go back to reference Prigerson HG, Frank E, Kasl SV, Reynolds CF, Anderson B: Complicated grief and bereavement-related depression as distinct disorders: preliminary empirical validation in elderly bereaved spouses. Am J Psychiatry. 1995, 152: 22-30.CrossRefPubMed Prigerson HG, Frank E, Kasl SV, Reynolds CF, Anderson B: Complicated grief and bereavement-related depression as distinct disorders: preliminary empirical validation in elderly bereaved spouses. Am J Psychiatry. 1995, 152: 22-30.CrossRefPubMed
2.
go back to reference Prigerson HG, Bierhals AJ, Kasl SV, Reynolds CF, Shear MK: Complicated grief as a disorder distinct from bereavement-related depression and anxiety: a replication study. Am J Psychiatry. 1996, 153: 1484-1486.CrossRefPubMed Prigerson HG, Bierhals AJ, Kasl SV, Reynolds CF, Shear MK: Complicated grief as a disorder distinct from bereavement-related depression and anxiety: a replication study. Am J Psychiatry. 1996, 153: 1484-1486.CrossRefPubMed
3.
go back to reference Horowitz MJ, Siegel B, Holen A, Bonanno GA, Milbrath C, Stinson CH: Diagnostic criteria for complicated grief disorder. Am J Psychiatry. 1997, 154: 904-910.CrossRefPubMed Horowitz MJ, Siegel B, Holen A, Bonanno GA, Milbrath C, Stinson CH: Diagnostic criteria for complicated grief disorder. Am J Psychiatry. 1997, 154: 904-910.CrossRefPubMed
4.
go back to reference Prigerson HG, Bierhals AJ, Kasl SV, Reynolds CF, Shear MK, Day N, Beery LC, Newsom JT, Jacobs S: Traumatic grief as a risk factor for mental and physical morbidity. Am J Psychiatry. 1997, 154: 616-623.CrossRefPubMed Prigerson HG, Bierhals AJ, Kasl SV, Reynolds CF, Shear MK, Day N, Beery LC, Newsom JT, Jacobs S: Traumatic grief as a risk factor for mental and physical morbidity. Am J Psychiatry. 1997, 154: 616-623.CrossRefPubMed
5.
go back to reference Boelen PA, Van den Bout J, de Keijser J: Traumatic grief as a disorder distinct from bereavement-related depression and anxiety: a replication study with bereaved mental health care patients. Am J Psychiatry. 2003, 160: 1339-1341. 10.1176/appi.ajp.160.7.1339.CrossRefPubMed Boelen PA, Van den Bout J, de Keijser J: Traumatic grief as a disorder distinct from bereavement-related depression and anxiety: a replication study with bereaved mental health care patients. Am J Psychiatry. 2003, 160: 1339-1341. 10.1176/appi.ajp.160.7.1339.CrossRefPubMed
6.
go back to reference Boelen PA, Van den Bout J: Complicated grief and uncomplicated grief are distinguishable constructs. Psychiatry Res. 2008, 157: 311-314. 10.1016/j.psychres.2007.05.013.CrossRefPubMed Boelen PA, Van den Bout J: Complicated grief and uncomplicated grief are distinguishable constructs. Psychiatry Res. 2008, 157: 311-314. 10.1016/j.psychres.2007.05.013.CrossRefPubMed
7.
go back to reference Dillen L, Fontaine JR, Verhofstadt-Denève L: Are normal and complicated grief different constructs? A confirmatory factor analytic test. Clin Psychol Psychother. 2008, 15: 386-395. 10.1002/cpp.590.CrossRefPubMed Dillen L, Fontaine JR, Verhofstadt-Denève L: Are normal and complicated grief different constructs? A confirmatory factor analytic test. Clin Psychol Psychother. 2008, 15: 386-395. 10.1002/cpp.590.CrossRefPubMed
8.
go back to reference Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, Goodkin K: Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11. Plos Med. 2009, 6: e1000121-10.1371/journal.pmed.1000121.PubMedCentralCrossRefPubMed Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, Goodkin K: Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11. Plos Med. 2009, 6: e1000121-10.1371/journal.pmed.1000121.PubMedCentralCrossRefPubMed
9.
go back to reference Chen JH, Bierhals AJ, Prigerson HG, Kasl SV, Mature CM, Jacobs S: Gender differences in the effects of bereavement-related psychological distress in health outcomes. Psychol Med. 1999, 29: 367-380. 10.1017/S0033291798008137.CrossRefPubMed Chen JH, Bierhals AJ, Prigerson HG, Kasl SV, Mature CM, Jacobs S: Gender differences in the effects of bereavement-related psychological distress in health outcomes. Psychol Med. 1999, 29: 367-380. 10.1017/S0033291798008137.CrossRefPubMed
10.
go back to reference Prigerson HG, Shear MK, Jacobs SC, Raynolds CF, Maciewski PK, Davidson JR, Rosenheck R, Pilkonis PA, Wortman CB, Williams JB, Widiger TA, Frank E, Kupfer DJ, Zisook S: Consensus criteria for traumatic grief. A preliminary empirical test. Br J Psychiatry. 1999, 174: 67-73. 10.1192/bjp.174.1.67.CrossRefPubMed Prigerson HG, Shear MK, Jacobs SC, Raynolds CF, Maciewski PK, Davidson JR, Rosenheck R, Pilkonis PA, Wortman CB, Williams JB, Widiger TA, Frank E, Kupfer DJ, Zisook S: Consensus criteria for traumatic grief. A preliminary empirical test. Br J Psychiatry. 1999, 174: 67-73. 10.1192/bjp.174.1.67.CrossRefPubMed
11.
go back to reference Bonanno GA, Kaltman S: The varieties of grief experience. Clin Psychol Rev. 2001, 21: 705-734. 10.1016/S0272-7358(00)00062-3.CrossRefPubMed Bonanno GA, Kaltman S: The varieties of grief experience. Clin Psychol Rev. 2001, 21: 705-734. 10.1016/S0272-7358(00)00062-3.CrossRefPubMed
12.
go back to reference Lichtenthal WG, Cruess DG, Prigerson HG: A case for establishing complicated grief as a distinct mental disorder in DSM-V. Clin Psychol Rev. 2004, 24: 637-662. 10.1016/j.cpr.2004.07.002.CrossRefPubMed Lichtenthal WG, Cruess DG, Prigerson HG: A case for establishing complicated grief as a distinct mental disorder in DSM-V. Clin Psychol Rev. 2004, 24: 637-662. 10.1016/j.cpr.2004.07.002.CrossRefPubMed
13.
go back to reference Simon NM, Shear K, Thompson EH, Zalta AK, Perlman C, Reynolds CF, Frank E, Melhem NM, Silowash R: The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief. Compr Psychiatry. 2007, 48: 395-399. 10.1016/j.comppsych.2007.05.002.CrossRefPubMed Simon NM, Shear K, Thompson EH, Zalta AK, Perlman C, Reynolds CF, Frank E, Melhem NM, Silowash R: The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief. Compr Psychiatry. 2007, 48: 395-399. 10.1016/j.comppsych.2007.05.002.CrossRefPubMed
15.
go back to reference Jacobsen JC, Zhang B, Block SD, Macejewski PK, Prigerson HG: Distinguishing symptoms of grief and depression in a cohort of advanced cancer patients. Death Stud. 2010, 34: 257-273. 10.1080/07481180903559303.PubMedCentralCrossRefPubMed Jacobsen JC, Zhang B, Block SD, Macejewski PK, Prigerson HG: Distinguishing symptoms of grief and depression in a cohort of advanced cancer patients. Death Stud. 2010, 34: 257-273. 10.1080/07481180903559303.PubMedCentralCrossRefPubMed
16.
go back to reference Van Doorn C, Kasl SV, Beery LC, Jacobs SC, Prigerson HG: The influence of marital quality and attachment styles on traumatic grief and depressive symptoms. J Nerv Ment Dis. 1998, 186: 566-573. 10.1097/00005053-199809000-00008.CrossRefPubMed Van Doorn C, Kasl SV, Beery LC, Jacobs SC, Prigerson HG: The influence of marital quality and attachment styles on traumatic grief and depressive symptoms. J Nerv Ment Dis. 1998, 186: 566-573. 10.1097/00005053-199809000-00008.CrossRefPubMed
17.
go back to reference Silverman GK, Johnson JG, Prigerson HG: Preliminary explorations of the effects of prior trauma and loss on risk for psychiatric disorders in recently widowed people. Isr J Psychiatry Relat Sci. 2001, 38: 202-215.PubMed Silverman GK, Johnson JG, Prigerson HG: Preliminary explorations of the effects of prior trauma and loss on risk for psychiatric disorders in recently widowed people. Isr J Psychiatry Relat Sci. 2001, 38: 202-215.PubMed
18.
go back to reference Fraley RC, Bonanno GA: Attachment and loss: a test of three competing models on the association between attachment-related avoidance and adaptation to bereavement. Pers Soc Psychol Bull. 2004, 30: 878-890. 10.1177/0146167204264289.CrossRefPubMed Fraley RC, Bonanno GA: Attachment and loss: a test of three competing models on the association between attachment-related avoidance and adaptation to bereavement. Pers Soc Psychol Bull. 2004, 30: 878-890. 10.1177/0146167204264289.CrossRefPubMed
19.
go back to reference Wijngaards-de Meij L, Stroebe M, Schut H, Stroebe W, van den Bout J, van der Heijden PG, Dijkstra I: Patterns of attachment and parents' adjustment to the death of their child. Pers Soc Psychol Bull. 2007, 33: 537-548. 10.1177/0146167206297400.CrossRefPubMed Wijngaards-de Meij L, Stroebe M, Schut H, Stroebe W, van den Bout J, van der Heijden PG, Dijkstra I: Patterns of attachment and parents' adjustment to the death of their child. Pers Soc Psychol Bull. 2007, 33: 537-548. 10.1177/0146167206297400.CrossRefPubMed
20.
go back to reference Vanderwerker LC, Jacobs SC, Parkes CM, Prigerson HG: An exploration of associations between separation anxiety in childhood and complicated grief in later life. J Nerv Ment Dis. 2006, 194: 121-123. 10.1097/01.nmd.0000198146.28182.d5.CrossRefPubMed Vanderwerker LC, Jacobs SC, Parkes CM, Prigerson HG: An exploration of associations between separation anxiety in childhood and complicated grief in later life. J Nerv Ment Dis. 2006, 194: 121-123. 10.1097/01.nmd.0000198146.28182.d5.CrossRefPubMed
21.
go back to reference Silove D, Slade T, Marnane C, Wagner R, Brooks R, Manicavasagar V: Separation anxiety in adulthood: dimensional or categorical?. Compr Psychiatry. 2007, 48 (6): 546-53. 10.1016/j.comppsych.2007.05.011.CrossRefPubMed Silove D, Slade T, Marnane C, Wagner R, Brooks R, Manicavasagar V: Separation anxiety in adulthood: dimensional or categorical?. Compr Psychiatry. 2007, 48 (6): 546-53. 10.1016/j.comppsych.2007.05.011.CrossRefPubMed
22.
go back to reference Perugi G, Akiskal HS: The soft bipolar spectrum redefined: focus on the cyclothymic, anxious-sensitive, impulse-dyscontrol, and binge-eating connection in bipolar II and related conditions. Psychiatr Clin North Am. 2002, 25: 713-737. 10.1016/S0193-953X(02)00023-0.CrossRefPubMed Perugi G, Akiskal HS: The soft bipolar spectrum redefined: focus on the cyclothymic, anxious-sensitive, impulse-dyscontrol, and binge-eating connection in bipolar II and related conditions. Psychiatr Clin North Am. 2002, 25: 713-737. 10.1016/S0193-953X(02)00023-0.CrossRefPubMed
23.
go back to reference Toni C, Perugi G, Frare F, Tusini G, Fountoulakis KN, Akiskal KK, Akiskal HS: The clinical-familial correlates and naturalistic outcome of panic-disorder-agoraphobia with and without lifetime bipolar II comorbidity. Ann Gen Psychiatry. 2008, 7: 23-10.1186/1744-859X-7-23.PubMedCentralCrossRefPubMed Toni C, Perugi G, Frare F, Tusini G, Fountoulakis KN, Akiskal KK, Akiskal HS: The clinical-familial correlates and naturalistic outcome of panic-disorder-agoraphobia with and without lifetime bipolar II comorbidity. Ann Gen Psychiatry. 2008, 7: 23-10.1186/1744-859X-7-23.PubMedCentralCrossRefPubMed
24.
go back to reference Perugi G, Toni C, Maremmani I, Tusini G, Ramacciotti S, Madia A, Fornaro M, Akiskal HS: The influence of affective temperaments and psychopathological traits on the definition of bipolar disorder subtypes: A study on Bipolar I Italian National sample. J Affect Disord. Perugi G, Toni C, Maremmani I, Tusini G, Ramacciotti S, Madia A, Fornaro M, Akiskal HS: The influence of affective temperaments and psychopathological traits on the definition of bipolar disorder subtypes: A study on Bipolar I Italian National sample. J Affect Disord.
25.
go back to reference Dell'Osso L, Shear MK, Carmassi C, Rucci P, Maser JD, Frank E: Validity and reliability of the Structured Clinical Interview for the Trauma and Loss Spectrum (SCI-TALS). Clin Pract Epidemiol Ment Health. 2008, 4: 2-10.1186/1745-0179-4-2.PubMedCentralCrossRefPubMed Dell'Osso L, Shear MK, Carmassi C, Rucci P, Maser JD, Frank E: Validity and reliability of the Structured Clinical Interview for the Trauma and Loss Spectrum (SCI-TALS). Clin Pract Epidemiol Ment Health. 2008, 4: 2-10.1186/1745-0179-4-2.PubMedCentralCrossRefPubMed
26.
go back to reference Dell'Osso L, Carmassi C, Rucci P, Conversano C, Shear MK, Calugi S, Maser JD, Endicott J, Fagiolini A, Cassano GB: A multidimensional spectrum approach to post-traumatic stress disorder: comparison between the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) and the Self-Report instrument (TALS-SR). Compr Psychiatry. 2009, 50: 485-490. 10.1016/j.comppsych.2008.11.006.CrossRefPubMed Dell'Osso L, Carmassi C, Rucci P, Conversano C, Shear MK, Calugi S, Maser JD, Endicott J, Fagiolini A, Cassano GB: A multidimensional spectrum approach to post-traumatic stress disorder: comparison between the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) and the Self-Report instrument (TALS-SR). Compr Psychiatry. 2009, 50: 485-490. 10.1016/j.comppsych.2008.11.006.CrossRefPubMed
27.
go back to reference Prigerson HG, Maciejewski PK, Reynolds CF, Bierhals AJ, Newsom JT, Fasiczka A, Frank E, Doman J, Miller M: Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res. 1995, 59: 65-79. 10.1016/0165-1781(95)02757-2.CrossRefPubMed Prigerson HG, Maciejewski PK, Reynolds CF, Bierhals AJ, Newsom JT, Fasiczka A, Frank E, Doman J, Miller M: Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res. 1995, 59: 65-79. 10.1016/0165-1781(95)02757-2.CrossRefPubMed
28.
go back to reference First MB, Spitzer RL, Williams JBW, Gibbon M: Structured Clinical Interview for DSM-IV-Patient Edition (SCID-P). 1995, Washington, DC: American Psychiatric Press First MB, Spitzer RL, Williams JBW, Gibbon M: Structured Clinical Interview for DSM-IV-Patient Edition (SCID-P). 1995, Washington, DC: American Psychiatric Press
29.
go back to reference Manicavasagar V, Silove D, Wagner R, Drobny J: A self-report questionnaire for measuring separation anxiety in adulthood. Compr Psychiatry. 2003, 44: 146-153. 10.1053/comp.2003.50024.CrossRefPubMed Manicavasagar V, Silove D, Wagner R, Drobny J: A self-report questionnaire for measuring separation anxiety in adulthood. Compr Psychiatry. 2003, 44: 146-153. 10.1053/comp.2003.50024.CrossRefPubMed
30.
go back to reference Mundt JC, Marks IM, Shear MK, Greist JH: The work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry. 2002, 180: 461-464. 10.1192/bjp.180.5.461.CrossRefPubMed Mundt JC, Marks IM, Shear MK, Greist JH: The work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry. 2002, 180: 461-464. 10.1192/bjp.180.5.461.CrossRefPubMed
31.
go back to reference Dell'Osso L, Armani A, Rucci P, Frank E, Fagiolini A, Corretti G, Shear MK, Grochocinski VJ, Maser JD, Endicott J, Cassano GB: Measuring mood spectrum: Comparison of interview (SCI-MOODS) and self-report (MOODS-SR) instruments. Compr Psychiatry. 2002, 43: 69-73. 10.1053/comp.2002.29852.CrossRefPubMed Dell'Osso L, Armani A, Rucci P, Frank E, Fagiolini A, Corretti G, Shear MK, Grochocinski VJ, Maser JD, Endicott J, Cassano GB: Measuring mood spectrum: Comparison of interview (SCI-MOODS) and self-report (MOODS-SR) instruments. Compr Psychiatry. 2002, 43: 69-73. 10.1053/comp.2002.29852.CrossRefPubMed
32.
go back to reference Beck AT: Depression: Clinical, Experimental, and Theoretical Aspects. 1967, London, UK: Staples Press Beck AT: Depression: Clinical, Experimental, and Theoretical Aspects. 1967, London, UK: Staples Press
33.
go back to reference Faschingbauer T, Zisook S, DeVaul R: The Texas revised inventory of grief. Biopsychosocial Aspects of Bereavement. Edited by: Zisook S. 1987, Washington, DC: American Psychiatric Press, 111-124. Faschingbauer T, Zisook S, DeVaul R: The Texas revised inventory of grief. Biopsychosocial Aspects of Bereavement. Edited by: Zisook S. 1987, Washington, DC: American Psychiatric Press, 111-124.
34.
go back to reference Jacobs SC, Kasl SV, Ostfeld AM, Berkman L, Kosten TR, Charpentier P: The measurement of grief: bereaved versus non-bereaved. Hosp J. 1986, 2: 21-36.CrossRefPubMed Jacobs SC, Kasl SV, Ostfeld AM, Berkman L, Kosten TR, Charpentier P: The measurement of grief: bereaved versus non-bereaved. Hosp J. 1986, 2: 21-36.CrossRefPubMed
35.
go back to reference Cassano GB, Dell'Osso L, Frank E, Miniati M, Fagiolini A, Shear K, Pini S, Maser J: The bipolar spectrum: A clinical reality in search of diagnostic criteria and an assessment methodology. J Affect Disord. 1999, 54: 319-328. 10.1016/S0165-0327(98)00158-X.CrossRefPubMed Cassano GB, Dell'Osso L, Frank E, Miniati M, Fagiolini A, Shear K, Pini S, Maser J: The bipolar spectrum: A clinical reality in search of diagnostic criteria and an assessment methodology. J Affect Disord. 1999, 54: 319-328. 10.1016/S0165-0327(98)00158-X.CrossRefPubMed
36.
go back to reference SPSS Inc: SPSS for Windows, Rel. 16.0. 2007, Chicago, IL: SPSS SPSS Inc: SPSS for Windows, Rel. 16.0. 2007, Chicago, IL: SPSS
37.
go back to reference Melhem NM, Rosales C, Karageorge J, Reynolds CF, Frank E, Shear MK: Comorbidity of axis I disorders in patients with traumatic grief. J Clin Psychiatry. 2001, 62: 884-887. 10.4088/JCP.v62n1108.CrossRefPubMed Melhem NM, Rosales C, Karageorge J, Reynolds CF, Frank E, Shear MK: Comorbidity of axis I disorders in patients with traumatic grief. J Clin Psychiatry. 2001, 62: 884-887. 10.4088/JCP.v62n1108.CrossRefPubMed
38.
go back to reference Simon NM, Pollack MH, Fischmann D, Perlman CA, Muriel AC, Moore CW: Complicated grief and its correlates in patients with bipolar disorder. J Clin Psychiatry. 2005, 66: 1105-1110. 10.4088/JCP.v66n0903.CrossRefPubMed Simon NM, Pollack MH, Fischmann D, Perlman CA, Muriel AC, Moore CW: Complicated grief and its correlates in patients with bipolar disorder. J Clin Psychiatry. 2005, 66: 1105-1110. 10.4088/JCP.v66n0903.CrossRefPubMed
39.
go back to reference Akiskal HS, Akiskal KK, TEMPS: Temperament evaluation of Memphis, Pisa, Paris and San Diego. J Afffect Disord. 2005, 85: 1-2. 10.1016/j.jad.2004.12.003.CrossRef Akiskal HS, Akiskal KK, TEMPS: Temperament evaluation of Memphis, Pisa, Paris and San Diego. J Afffect Disord. 2005, 85: 1-2. 10.1016/j.jad.2004.12.003.CrossRef
Metadata
Title
Adult separation anxiety in patients with complicated grief versus healthy control subjects: relationships with lifetime depressive and hypomanic symptoms
Authors
Liliana Dell'Osso
Claudia Carmassi
Martina Corsi
Irene Pergentini
Chiara Socci
Angelo GI Maremmani
Giulio Perugi
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Annals of General Psychiatry / Issue 1/2011
Electronic ISSN: 1744-859X
DOI
https://doi.org/10.1186/1744-859X-10-29

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