Indirect Self-Destructive Behavior and Overt Suicidality in Patients With Complicated Grief.
J Clin Psychiatry 2006;67:233-239
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Complicated grief is
associated with increased suicidal ideation in samples
of bereaved individuals; however, suicidal
behavior has not been assessed in these patients.
Additionally, there are no reports of suicidality
among help-seeking individuals with complicated
grief. Therefore, we examined suicidal behavior and
its correlates in 149 patients who signed informed consent statements to participate in a
National Institute of Mental Health-funded treatment
study of complicated grief.
Method: All patients met criteria for
complicated grief (Inventory of Complicated Grief
score > = 25). Suicidality was assessed using a
structured clinical interview administered prior to
beginning treatment. Participants also completed self-report questionnaires and interview
assessment measures rating the presence or absence
of DSM-IV Axis I diagnosis and symptom severity. Data were gathered between April 2001 and
Results: Thoughts of wanting to die
following the death of a loved one were reported by 65%
of participants. More than half of this group (38%
of the study sample) engaged in self-destructive
behavior, including 9% who made a suicide attempt and 29% who engaged in indirect suicidal
behavior. In a multiple logistic regression model,
only the severity of complicated grief symptoms (p < .0001) and history of a suicide attempt
(p < .02) were significantly associated with postloss
Discussion: Consistent with reports of
non-help-seeking bereaved people, a high rate of
individuals seeking treatment for complicated
grief endorsed a wish to die. Notably, 13% of this group made at least 1 suicide attempt, and
44% engaged in indirect self-destructive behavior. Given its frequency, this behavior should be
included in assessment of bereaved people.