Complicated Grief and Its Correlates in Patients With Bipolar Disorder

Naomi M. Simon, M.D., M.Sc.; Mark H. Pollack, M.D.; Diana Fischmann, B.A.; Carol A. Perlman, Ph.D.; Anna C. Muriel, M.D.; Cynthia W. Moore, Ph.D.; Andrew A. Nierenberg, M.D.; and M. Katherine Shear, M.D.

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 disorder.

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.

(J Clin Psychiatry 2005;66:1105-1110)

Received Jan. 20, 2005; accepted April 21, 2005. From Massachusetts General Hospital and Harvard Medical School, Boston (Drs. Simon, Pollack, Perlman, Muriel, Moore, and Nierenberg and Ms. Fischmann), and University of Pittsburgh Medical Center, Pittsburgh, Pa. (Dr. Shear).

Work on this study was supported by a Massachusetts General Hospital Claflin Distinguished Scholar Award and by a National Institute of Mental Health Career Development Award MH01831-01 to Dr. Simon.

Financial disclosure appears at the end of this article.

Corresponding author and reprints: Naomi M. Simon, M.D., Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Simches Research Building, 2nd Floor, 185 Cambridge Street, Boston, MA 02114 (e-mail: nsimon@partners.org).