Complicated Grief and Its Correlates in Patients With Bipolar Disorder
J Clin Psychiatry 2005;66(9):1105-1110
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: While the recent loss of a loved
one has been identified as a risk factor for suicide in
patients with bipolar disorder, and complicated
grief (CG) has been associated with elevated rates of
suicidality compared with loss without CG, little is
known about the frequency or impact of CG in bipolar
disorder. We investigated the frequency and implications
of loss of loved ones in an ongoing study of bipolar
Method: We conducted a survey of 120
patients with well-characterized DSM-IV bipolar disorder
participating in Systematic Treatment Enhancement
Program for Bipolar Disorder (STEP-BD), a large
naturalistic study, in order to identify frequency of loss and
to examine the presence of CG and its clinical
correlates. Survey data were gathered from October 2003
to March 2004.
Results: A lifetime history of a significant loss
was reported by 86% (103/120) of participants; 24.3%
(25/103) of those met criteria for CG, defined as a
score > = 25 on the Inventory of Complicated Grief
(ICG), with a mean ± SD ICG score of 33.7 ± 6.9. The
presence of CG was associated with elevated rates of
panic disorder and alcohol abuse comorbidity, as well
as other measures of panic symptoms and phobic
avoidance. CG was also associated with a higher rate of
lifetime suicide attempts, greater functional
impairment, and poorer social support.
Conclusion: Our findings suggest the presence of
a substantial burden of comorbid grief-related
illness and impairment in patients with bipolar disorder.
Further research is needed to understand the overlap
of anxiety disorders and phobic avoidance in bipolar
patients with complicated grief.