Complicated grief: A systematic review of the last 20 years

Abstract

Background:

Grief is a common reaction to the feeling of loss and it is considered a physiological and instinctive response. The ‘normal’ grief evolves into an ‘integrated’ phase within 1 year from death, and it is a non-pathological condition, that do not require specific therapeutic interventions. When this ‘integrated phase’ does not occur, the subject could reach pathological manifestations related to the grief. The Persistent Complex Bereavement Disorder (PCBD) is a new DSM5 clinical category characterized by symptoms related to the detachment and to the post-traumatic distress and it differs from normal and uncomplicated grief, for the disability caused by these reactions and their persistence and pervasiveness.

Aim:

The purpose of this work is the analysis of the pathways that led to this new definition, through a review of the main studies published in the last 20 years, with the aim to clarify the clinical utility of this new diagnostic category.

Method:

Relevant publications done in the last 20 years were identified via electronic searches of Pubmed, Embase, and Elsevier databases using the terms ‘complicated grief’ AND ‘persistent’, according to PRISMA guideline and PICO study design.

Results:

PCBD results a new important clinical category showing specific symptoms, diagnostic criteria, and treatment. It presents many differences with other pathologies, that goes into differential diagnosis with PCBD, and it and can be treated with targeted therapeutic approaches. Diagnostic criteria for PCBD could allow an early diagnosis and a correct treatment avoiding underdiagnosis and misdiagnosis.

Conclusion:

Further researches could focus on the evaluation of more neurobiological aspects, new psychometric tools, for assessing susceptibility to this pathology, and on the cultural aspects that may influence mourning reactions, in an ethno-psychiatric perspective.

Keywords

Grief bereavement death

Introduction

The loss of significant ones is a natural occurrence of the life cycle. Everyone will experience this sooner or later, and yet it is one of the most difficult events that human beings experience.

Linked to the experience of loss, the terms grief, mourning, and bereavement have different shades of meaning, since they refer to different aspects of the phenomenon of loss, thus they are not interchangeable (Buckley et al., 2019; Carmassi et al., 2016; Geng et al., 2019; Levine, 2017; Shear, 2012; Tullis, 2017).

‘Grief’ refers to the emotional suffering concerning the loss, ‘mourning’ is the process by which people adapt to a loss and it is the external expression of grief, including rituals and being influenced by spiritual, religious, and cultural beliefs and practices; ‘bereavement’ is the period after having suffered the loss of a loved one, it is the time after a loss during which grief is experienced and mourning occurs.

However, in current literature all these terms indicate the phenomenon of loss, as we will do in the present work; in DSM-5 and in ICD-10, for example, ‘bereavement’ and ‘grief’ are used for clinical conditions that overlap in terms of symptoms, prevalence, and health correlates (Persistent and Complex Bereavement Disorder and Prolonged Grief Disorder) (DSM-5; ICD-11).

Grief is a common reaction to the feeling of loss; many people experience this kind of event during the course of their lives. It is a complex phenomenon and it transversally affects many cultures; while the experience of grief is unique the whole grief process is personally, relationally, and culturally defined.

In the greatest number people adequately address the loss, but a significant percentage of subjects develops a syndrome characterized by a prolongation of the psychological suffering related to the loss. For this reason, the Persistent Complex Bereavement Disorder (PCBD) appears as a separate pathological entity in the third section of the DSM 5 (2013), in order to study and analyze this new topic. A slightly different conceptualization, named Prolonged Grief Disorder (PGD), has been introduced in the 11th edition of the International Statistical Classification of Diseases and Related Health Problem.

PGD and PCBD strongly overlap in terms of symptoms, prevalence, and health correlates; pathological grief, treated in this article, so refers to PCBD and PGD in an overlapping manner. Loss is often a dramatic event that alters the psychic balance and the well-being of the subject, especially in the acute phase. Grief, as painful as it is, is considered a physiological and instinctive response (Carmassi et al., 2014). It is difficult to judge as pathological the reactions of a subject in the early stages of mourning, mainly considering that the experience of detachment is different from one to another, and it can also change in relation to the cultural group of belonging.

It could be useful to analyze the differences between ‘normal’ and ‘pathological’ grief in order to understand where the research that led to the definition of Persistent Complex Bereavement Disorder has started.

‘Normal’ grief is a process that develops through different phases. It has been studied in psychology and there are several theories derived from different authors. ‘Normal’ grief could present severe psychological reactions (anguish, anger, shock, etc.), but it evolves into an ‘integrated’ phase within 1 year from death, configuring itself as a non-pathological condition that do not require specific therapeutic interventions. As observed by Lombardo et al. (2014), the integrated grief is a condition characterized by a quiet memory of the deceased and when this ‘integrated phase’ does not occur, the subject could reach grief-related clinical conditions.

In the last 20 years the scientific debate has led to a gradual definition of diagnostic criteria for various pathological patterns, named from time to time as ‘pathological grief’, ‘complicated grief’, and ‘traumatic grief’, up to the Persistent Complex Bereavement Disorder present in the DSM-5 as a new clinical category. This pathology differs from normal and uncomplicated grief, for the distress and disability caused by these reactions, and their persistence and pervasiveness.

Materials and methods

Protocol and registration

This review has been registered at the PROSPERO database for systematic review with number 138976 on 03/07/2019. This review has been conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline (Hutton et al., 2015; Liu et al., 2019; Tian et al., 2015) and PICO study design (Da Costa Santos et al., 2007).

Eligibility criteria

Inclusion and exclusion criteria are listed below:

Inclusion:

Studies about Grief and Complicated Grief

Diagnostic methods and therapies for CG

English language and full text

Exclusion:

Case report, case series, commentaries, PhD thesis

Older than 20 years study

Not accessible data or title or abstract

Preclinical studies and animal models

Information sources

The results of the review in analysis were obtained through research in the following scientific databases: Pubmed, Embase, Elsevier. The databases have automated the work and provided useful information for screening through integrated search filters.

Search

The keywords used in the scientific databases (see section ‘Information sources’) are the following: ‘complicated grief’ AND ‘persistent’. The keywords were chosen by the authors in order to provide the highest number of results possible and limit the risk of bias. Furthermore the main question of the study, according to the PICO (Population/Intervention/Comparison/Outcome) study design (Da Costa Santos et al., 2007) is:

Is there any the difference between normal and pathological grief on grief patients?

Study selection

A manual screening and study selection was performed to obtain 22 results with enough information as reported in PRISMA (Hutton et al., 2015; Liu et al., 2019; Tian et al., 2015) Flow Chart (Figure 1).

Figure 1.

PRISMA flow diagram.

Data collection process

Two authors (CC, CM) independently assessed the results obtained and clarified any disputes in the presence of a third expert reviewer (MRAM). The results were subsequently re-evaluated by the auditors and the salient results were shown.

Data items

Authors (Year) – Authors and Year of publication

Sample – Sample size and type

Data Items – outcome of the study (showed in summary at Table 1)

Table 1.

Summary of evaluated measures in results.

Rostral anterior cingulate cortex activity, Structured clinical interview for Complicated Grief (CG) (SCI-CG), grief severity; general psychological distress and in comorbidity, Healing Emotions After Loss (HEAL), Montreal Cognitive Assessment (MoCA), Anxiety sensitivity (AS), Inventory for Complicated Grief-Revised for Children (ICG-RC), Catecholamines dosage, Beck Depression Inventory-Second Edition, Bereavement hallucinations (BHs), Emotional reactions, Preferred social distance, integrative cognitive-behavioral therapy for PGD, The Work and Social Adjustment Scale (WSAS), Inventory of Complicated Grief (ICG), Biopsychosocial-spiritual approach, self-reported emotional response, heart rate, respiratory sinus arrhythmia (RSA), and skin conductance level.

Results – Main results

Statistic – Significant or not data (Table 2)

Table 2.

Synthesis of significant or not data.

Author (year)	Sample	Data items	Results	Statistics
Kokou-Kpolou et al. (2018)	98 perinatally bereaved mothers	Negative cognitions	Increased depressive symptoms when death occurred after birth and life cognitions when it occurred before birth.	Significant
Kliem et al. (2018)	1,445 grief people	The Inventory of Complicated Grief-Revised (ICG-R)	Taxometric analyses suggest a dimensional latent structure of prolonged grief that should be considered regarding assessment and communication	Cronbach’s α = .95
Eisma (2018)	379 adults	Emotional reactions, Preferred social distance	PGD people presented negative characteristics and a higher social distance	Significant
Bartl et al. (2017)	51 patients	Integrative cognitive-behavioral therapy for PGD	PG Cognitive Behavioral Therapy favored patients with PGD	Significant
Mauro et al. (2017)	240 partecipants	The Structured Clinical Interview for Complicated Grief (SCI-CG), The Work and Social Adjustment Scale (WSAS)	New criterion is necessary to PCBD diagnosis	Significant
Kotoucova et al. (2017)	232 patients	Inventory of Complicated Grief (ICG)	ICG provides grief symptom profiles that help an understanding of patients’ needs.	Significant
Lee et al. (2016)	99 students	Biopsychosocial-spiritual approach	Biopsychosocial-spiritual approach could be efficacy in studying adolescent grief	Significant
LeBlanc et al. (2016)	23 bereaved adults with CG and 26 healthy bereaved adults	Self-reported emotional response, heart rate, respiratory sinus arrhythmia (RSA), and skin conductance level	CG patients show a different response from the parasympathetic nervous system	Not significant
Cozza et al. (2016)	1,732 family members of U.S. military service members	Inventory of Complicated Grief and the Work and Social Adjustment Scale, Complicated Grief Questionnaire	DSM-5 persistent complex bereavement disorder criteria identified 53%, prolonged grief disorder criteria identified 59%, and complicated grief criteria identified more than 90% of putative clinical cases.	Significant
Arizmendi et al. (2016)	28 subjects: Complicated Grief (n = 8), Non-Complicated Grief (n = 9).	Rostral anterior cingulate cortex activity	Activity in the orbitofrontal cortex (x = 6, y = 54, z = –10) was significantly elevated in the Non-Complicated Grief group when compared to Nonbereaved controls	Significant
Bui et al. (2015)	281 patients	Structured clinical interview for Complicated Grief (CG) (SCI-CG)	The SCI-CG can now be used as a validated instrument in CG	Significant
Rosner et al. (2014)	51 patients	Grief severity; general psychological distress and in comorbidity.	PG-CBT was found to be effective with an acceptable dropout rate.	Significant
Zetumer et al. (2015)	345 participants with Complicated grief (CG)	Healing Emotions After Loss (HEAL).	Parents, caregiver with CG have higher levels of CG and suicidability	Significant
Hall et al. (2014)	335 subjects with Complicated grief (CG) 250 control	Montreal Cognitive Assessment (MoCA)	Two groups did not differ according to MoCA score percentage.	Not Significant
Robinaugh et al. (2014)	Review	Anxiety sensitivity (AS)	AS is associated with CG symptom severity	Significant
Simon (2013)	Review	Comorbid condition risk	Antidepressant drugs and targeted psychotherapy may be helpful	Review
Melhem et al. (2013)	Parentally bereaved children and adolescents, 8 through 17 years of age, were assessed at 9, 21, and 33 months after parental death.	Inventory for Complicated Grief-Revised for Children (ICG-RC)	ICG-RC was gound to have high sensitivity and specificity	Significant
O’Connor et al. (2013)	16 patients	Catecholamines in plasma pre and post psychotherapeutic treatment	Patients with highest catecholamines levels have highest CG too	Significant
O’Connor et al. (2013)	/	Immunologic and neuroimaging biomarkers	The regional brain activation to grief cues frequently includes the dorsal anterior cingulate cortex and insula, and also the posterior cingulate cortex.	/
Meert et al. (2011)	138 parents of 106 children completed surveys at 6 and 18 months.	Inventory of CG, Grief avoidance, attachment, caregiving, and social support	Parents with one or two surviving children had more improvement in ICG score than those with no surviving children	Significant
McCarthy et al. (2010)	58 parents	Inventory of Complicated Grief-Revised, Beck Depression Inventory-Second Edition	Time since death and parental perception predict grief symptoms.	Not Significant

Bias Risk – Bias Risk evaluation (Table 3)

Table 3.

Risk of bias table.

Author (year)	Risk of bias
Author (year)	U	L	M	H
Kokou-Kpolou et al. (2018)			/
Kliem et al. (2018)			/
Eisma (2018)			/
Bartl et al. (2017)		/
Mauro et al. (2017)		/
Kotoucova et al. (2017)		/
Lee et al. (2016)			/
LeBlanc et al. (2016)				/
Cozza et al. (2016)		/
Arizmendi et al. (2016)		/
Bui et al. (2015)		/
Rosner et al. (2014)		/
Zetumer et al. (2015)		/
Hall et al. (2014)		/
Robinaugh et al. (2014)	/
Simon (2013)	/
Melhem et al. (2013)				/
O’Connor et al. (2013)				/
O’Connor et al. (2013)	/
Meert et al. (2011)		/
McCarthy et al. (2010)		/

Note. U = unclear; L = low; M = moderate; h = High.

Summary measures

Results

Study selection

Authors initially obtained 49 results, on 10 years 45, 35 on humans, full text 31. Following a reading of the titles and abstracts, the authors selected, based on the information contained, a number of 21 articles (Figure 1).

Study characteristics

Kokou-Kpolou et al. (2018) in a cross sectional study on 98 bereaved mothers (mean age = 33.9 years) showed a significant interaction between depressive symptoms increasing or life cognitions in mothers and death of the child after or before the birth. Kliem et al. (2018), using an Inventory of Comlicated Grief-Revised (ICG-R) on 1,445 bereaved individuals showed a latent structure of PGD.

Eisma (2018), evaluated 379 adult patients from general population by a vignette-based experiment, aimed at evauating stigmatizing reactions (i.e. negative attributions, negative emotional reactions, and larger preferred social distance) in response to people diagnosed with a PGD diagnosis, especially when developed in response to the loss of a friend, instead of a partner. Bartl (2018), in a RCT on 51 patients, evaluated Integrative Cognitive-Behavioral Therapy (CBT) of PGD. CBT is significantly useful in PGD patients with a Cohen’s d = 0.60, the effect of therapy remained stable for 1.5 years of follow up. Mauro et al. (2017) diagnosed 70% of Complicated Grief patients using PCBD criteria; 59.6% using PGD criteria and 99.6% using CG criteria. This study evaluated rate of diagnosis on two groups of patients. Kotoucova (2017) evaluated the effect of a United States member’s death on family member. This study has been conducted on 232 military family members, comparing these results with a non-military-related sample. Despite demographic characteristics similarity was present between groups. Lee et al. (2016) tried to recognize neuroticism as a risk for CG. Authors obtained data from 99 students finding that social isolation and spiritual struggles could have contributed to the grief for a percentage of students. LeBlanc et al. (2016) recruited 49 patients (two groups with CG or healthy bereaved) and conducted an investigation between CG and heart rate, respiratory sinus arrhythmia and skin conductance levels. According to authors, despite the modest sample size, were rare to highlight differences between patients. According to Cozza et al. (2016) DSM-5 helped to identify 53% of PGD, and Complicated Grief Criteria identified 90% of clinical cases. All criteria accurately excluded non clinical grief cases. In this study, Cozza et al. (2016) recruited 1,732 patients as US family member. Arizmendi et al. (2016) through a Functional Magnetic Resonance Imaging methods evaluated cortical activity on three groups of patients. Activity of the Rostral anterior cingulate cortex was higher on CG sample. Bui et al. (2015) standardized the Structured Clinical Interview for CG (SCI-CG); the 31-item instrument revealed a satisfactory internal consistency (alpha = .78). According to Rosner et al. (2014), RCT, CBT could improve PG symptoms, this therapy produced a 89% improving on sample patients with a follow up of 1.5 years and a 8 to 14 dropouts. Zetumer et al. (2015) enrolled 345 patients evaluated by the Healing Emotion After Loss (HEAL). Parents who experienced the loss of a child demonstrated higher levels of CG (p = .025) when compared with caregivers (p = .007) and non-parents with CG. Parents who had lost younger children were exposed to a with of dead (p = 0.041). Hall et al. (2014) with their exploratory and descriptive study, evaluated global and specific cognitive functioning in a sample of 335 patients compared with a control group of 250 subjects by the Montreal Cognitive Assessment (MoCA). CG partecipants had lower MoCA values thus. Robinaugh et al. (2014), conducted a review on CG, evaluating physiological reactivity to reminder of loss. Authors examined results of individual studies whose results showed that anxiety sensitivity (AS) could contribute to CG development. The review on differential diagnosis and management of CG by Simon (2013), supported the efficacy of targeted psychotherapy for CG healing. Furthermore, preliminary study had suggested that antidepressant medications may be helpful. According to a study by Melhem et al. (2013), on parentally bereaved children aged between 8 and 17 years old, Complicated Grief-Revised for Children had an higher sensitivity (0.942) and specificity (0.965) in differentiating PG reaction from healthy cases at 9 months follow-up. DSM-5 criteria, according to authors, differentiated only 20% to 41.7% of cases with PGR at different time points (9, 21, and 33 months). O’Connor et al. (2013) presented two studies about catecholamines in plasma pre- and post-psychotherapeutic treatment, and another one about immunologic and neuroimaging biomarkers O’Connor et al. (2013). They showed that CG patients had high catecholamines levels and how the dorsal anterior cingulate cortex, insula, and posterior cingulate cortex were frequently activated in CG patients. Meert et al. (2011) evaluated 138 parents and 106 children with CG symptoms using the ICG, attachment, caregiving, demographic, and social support. According to Meert et al. (2011) ICG scores were 33.4 ± 13.6 at 6 month and 28 at 18 month, representing an improvement in ICG (p < .001). McCarthy et al. (2010) evaluated 58 patients who had lost child for cancer with self-report questionnaires for the assessment of CG (ICG-R) and depression (Beck Depression Inventory-Second Edition (BDI-II)). Twenty-one percent of parents reported depressive symptoms.

Synthesis of results

Risk of bias

Risk of bias analysis has been conducted according to Whiting (2018), Savovic (2018), and Higgins (2011) and results have been classified in the Table 3.

Discussion

Summary of evidence

The data collected according to the materials and methods section show different results, for which it is not possible to perform a univocal statistical analysis. In this section the results were discussed in such a way as to offer an overall picture. Kokou-Kpolou et al. (2018), showed how negative cognitions are associated with the symptoms of post-perinatal loss and change if death occurs before or after birth, the main limitation of this article is the small sample size. Kliem et al. (2018), conducted article has shown how a latent dimensional structure of PGD is evident. Eisma (2018), evidenced that stigma and its negative consequences seem to be a valid concern for the establishment of pathological mourning disorders in diagnostic manuals. Bartl (2018) showed as PG-CBT could improve posttraumatic growth in PGD patients, this could be an useful instrument for the clinician. Mauro et al. (2017), in their study concluded that PCBD actual criteria are not adequate, since they fail to capture this pathology; in the Authors’ opinion, this could be resolved by using Complicated Grief criteria. According to Lee et al. (2016), social isolation and spiritual struggles contribute negatively to the pain of emotionally sensitive students. The results also support the effectiveness of a biopsychosocial-spiritual approach to the study of adolescent pain. LeBlanc et al. (2016), observed evidence of blunted parasympathetic nervous system reactivity. Cozza et al. (2016) shows that DSM-5 persistent complex mourning disorder criteria accurately exclude non-clinical regulatory pain, but also exclude almost half of clinical cases, while complicated pain criteria exclude non-clinical cases identifying more than 90% of cases clinicians. The authors conclude that a significant modification is needed to improve the identification of cases by persistent diagnostic criteria of DSM-5 complex mourning disorder. Complicated mourning criteria are superior in accurately identifying clinically impaired pain. Arizmendi et al. (2016), Post hoc analysis evidenced activity in the dorsal ACC in the Complicated Grief. Bui et al. (2015), presented a SCI-CG for CG diagnosis, with significant results. This Interview could help clinicians during CG diagnosis. Rosner et al. (2014) showed how integrative cognitive behavioral therapy for prolonged grief could be useful in these patients with clinical relevance; however, in this study, no long term follow-up was performed. Zetumer et al. (2015) in their study showed that parents who had lost younger children were near to suicide or death thoughts. Comparison between parents who lost younger children with parents who lost older children was limited by a small sample size. Hall et al. (2014), investigated cognitive functioning in complicated grief. Authors demonstrated lower cognitive and attentional performances in patients with CG. Robinaugh et al. (2014), examined anxiety sensitivity (AS, i.e. the fear of anxiety-related sensations) in two studies of grieving adults with and without CG. In both studies, mourning adults with CG showed elevated AS values compared to those without CG. Simon (2013), demonstrated that individuals with CG have a greater risk of adverse health conditions, so it should be diagnosed for suicide or comorbid condition preventing. Melhem et al. (2013) proposed a short screening scale that, if validated, could help to identify PGR children and adolescents, being useful for the development of prevention and intervention strategies. O’Connor et al. (2013), with this study provided evidence of the hypothesis that catecholamine levels are affected by grief and, in turn, can affect the ability of those who have complicated grief to benefit from psychotherapy. Cervino (2019) supposed to find biomarkers useful for early diagnosis as in other medicine fields. According to O’Connor (2012), biomarkers could be helpful to predict CG and, possibly, also to orient treatments toward effective strategies. Meert et al. (2011) showed how complicated grief symptoms decrease among parents between 6 and 18 months after their child’s death. Complicated grief will allow parents at risk for persistent distress to receive professional support. McCarthy et al. (2010) showed how time since death is a significant predictor of distress and how they may be need palliative care to ensure best outcomes. According to the results of the individual studies discussed above, it is clear that the therapeutic techniques developed for the CG are different. However, the most adequate diagnostic technique is discussed. Many studies are of a comparative type, and tend to highlight which is the instrument with greater sensibility and sensitivity for CG diagnoses. In addition, instrumental diagnostic methods are still present, experimental, which show different serum levels in patients affected by CG. Other methods involve instrumental imaging investigations, these have shown abnormalities in different brain areas in patients with or susceptible to CG. Surely the future prospects of this pathology concern a rapid, safe, and fast diagnostic approach, and a therapeutic tool, with as many features; the articles in question repeatedly propose CBT, as a treatment for the patient with CG.

Limitations

The main limitation of this study is represented by the fact that many results cannot be compared with each other, and therefore a univocal statistical analysis cannot be performed.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Antonio Bruno

References

Arizmendi

Kaszniak

A. W.

O’Connor

M. F.

(2016). Disrupted prefrontal activity during emotion processing in complicated grief: An fMRI investigation. NeuroImage, 124, (Pt A), 968–976. https://doi.org/10.1016/j.neuroimage.2015.09.054

Bartl

Hagl

(2018). Does prolonged grief treatment foster posttraumatic growth? Secondary results from a treatment study with long-term follow-up and mediation analysis. Psychology and Psychotherapy, 91(1), 27–41. https://doi.org/10.1111/papt.12140

Buckley

G. L.

Hall

L. E.

Lassemillante

A-C. M.

Ackerman

K. E.

Belski

(2019). Retired athletes and the intersection of food and body: A systematic literature review exploring compensatory behaviours and body change. Nutrients, 11(6), 1395. https://doi.org/10.3390/nu11061395

Bui

Mauro

Robinaugh

D. J.

Skritskaya

N. A.

Wang

Gribbin

Ghesquiere

Horenstein

Duan

Reynolds

Zisook

Simon

N. M.

Shear

M. K.

(2015). The structured clinical interview for complicated grief: Reliability, validity, and exploratory factor analysis. Depression and Anxiety, 32(7), 485–492. https://doi.org/10.1002/da.22385

Carmassi

Gesi

Simoncini

Favilla

Massimetti

Olivieri

M. C.

Conversano

Santini

Dell’Osso

(2016). DSM-5 PTSD and posttraumatic stress spectrum in Italian emergency personnel: Correlations with work and social adjustment. Neuropsychiatric Disease and Treatment, 12, 375–381. https://doi.org/10.2147/NDT.S97171

Carmassi

Shear

M. K.

Massimetti

Wall

Mauro

Gemignani

Conversano

Dell’Osso

(2014). Validation of the Italian version Inventory of Complicated Grief (ICG): A study comparing CG patients versus bipolar disorder, PTSD and healthy controls. Comprehensive Psychiatry, 55(5), 1322–1329. https://doi.org/10.1016/j.comppsych.2014.03.001

Cervino

Fiorillo

Herford

A. S.

Romeo

Bianchi

Crimi

D’Amico

De Stefano

Troiano

Santoro

Laino

Cicciù

(2019). Molecular biomarkers related to oral carcinoma: Clinical trial outcome evaluation in a literature review. Disease Markers. Advance online publication. https://doi.org/10.1155/2019/8040361

Cozza

S. J.

Fisher

J. E.

Mauro

Zhou

Ortiz

C. D.

Skritskaya

Wall

M. M.

Fullerton

C. S.

Ursano

R. J.

Shear

M. K.

(2016). Performance of DSM-5 persistent complex bereavement disorder criteria in a community sample of bereaved military family members. The American Journal of Psychiatry, 173(9), 919–929. https://doi.org/10.1176/appi.ajp.2016.15111442

Da Costa Santos

C. M.

De Mattos Pimenta

C. A.

Nobre

M. R.

(2007). The PICO strategy for the research question construction and evidence search. Revista latino-americana de enfermagem, 15(3), 508–511. https://doi.org/10.1590/s0104-11692007000300023

10.

Eisma

M. C.

(2018). Public stigma of prolonged grief disorder: An experimental study. Psychiatry Research, 261, 173–177. https://doi.org/10.1016/j.psychres.2017.12.064

11.

Geng

Wang

Cheng

Zhang

Shen

(2019). Mindful learning improves positive feelings of cancer patients’ family caregivers. International Journal of Environmental Research and Public Health, 16(2), 248. https://doi.org/10.3390/ijerph16020248

12.

Hall

C. A.

Reynolds

C. F.

III. Butters

Zisook

Simon

Corey-Bloom

Lebowitz

B. D.

Begley

Mauro

Shear

M. K.

(2014). Cognitive functioning in complicated grief. Journal of Psychiatric Research, 58, 20–25. https://doi.org/10.1016/j.jpsychires.2014.07.002

13.

Higgins

J. P. T.

Altman

D. G.

Gotzsche

P. C.

Juni

Moher

Oxman

A. D.

Savovic

Schulz

K. F.

Weeks

Sterne

J. A.

(2011). The cochrane collaboration’s tool for assessing risk of bias in randomized trials. BMJ, 343, d5928. https://doi.org/10.1136/bmj.d5928

14.

Hutton

Salanti

Caldwell

D. M.

Chaimani

Schmid

C. H.

Cameron

Ioannidis

J. P.

Straus

Thorlund

Jansen

J. P.

Mulrow

Catala-Lopez

Gotzsche

P. C.

Dickersin

Boutron

Altman

D. G.

Moher

(2015). The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Annals of Internal Medicine, 162(11), 777–784. https://doi.org/10.7326/m14-2385

15.

Kliem

Lohmann

Mossle

Kroger

Brahler

Kersting

(2018). The latent nature of prolonged grief - A taxometric analysis: Results from a representative population sample. Psychiatry Research, 260, 400–405. https://doi.org/10.1016/j.psychres.2017.11.087

16.

Kokou-Kpolou

Megalakaki

Nieuviarts

(2018). Persistent depressive and grief symptoms for up to 10 years following perinatal loss: Involvement of negative cognitions. Journal of Affective Disorders, 241, 360–366. https://doi.org/10.1016/j.jad.2018.08.063

17.

Kotoucova

Pfoh

Rosner

Fisher

J. E.

(2017). Examination of factor structure of the Inventory of Complicated Grief (ICG) in a sample of bereaved military family members with persistent and elevated grief. Psychology and Psychotherapy, 26(3), e1571. https://doi.org/10.1002/mpr.1571

18.

LeBlanc

N. J.

Unger

L. D.

McNally

R. J.

(2016). Emotional and physiological reactivity in complicated grief. Journal of Affective Disorders, 194, 98–104. https://doi.org/10.1016/j.jad.2016.01.024

19.

Lee

S. A.

Callan

S. M.

Gibbons

J. A.

(2016). School and religious factors impact the neuroticism-grief link in adolescents. Death Studies, 40(10), 601–606. https://doi.org/10.1080/07481187.2016.1198843

20.

Levine

M. G.

(2017). Between grief and grievance: Memories of Jews in France and the Klaus Barbie Trial. Humanities, 6(4), 93. https://doi.org/10.3390/h6040093

21.

Liu

Zhou

Sun

(2019). The effects of the PRISMA statement to improve the conduct and reporting of systematic reviews and meta-analyses of nursing interventions for patients with heart failure. International Journal of Nursing Practice, 25(3), e12729. https://doi.org/10.1111/ijn.12729

22.

Lombardo

Lai

Luciani

Morelli

Buttinelli

Aceto

Lai

D’Onofrio

Galli

Bellizzi

Penco

(2014). Bereavement and complicated grief: Towards a definition of prolonged grief disorder for DSM-5. Rivista di Psichiatria, 49(3), 106–114. https://doi.org/10.1708/1551.16903

23.

Mauro

Shear

M. K.

Reynolds

C. F.

Simon

N. M.

Zisook

Skritskaya

Wang

Lebowitz

Duan

First

M. B.

Ghesquiere

Gribbin

Glickman

(2017). Performance characteristics and clinical utility of diagnostic criteria proposals in bereaved treatment-seeking patients. Psychological Medicine, 47(4), 608–615. https://doi.org/10.1017/S0033291716002749

24.

McCarthy

M. C.

Clarke

N. E.

Ting

C. L.

Conroy

Anderson

V. A.

Heath

J. A.

(2010). Prevalence and predictors of parental grief and depression after the death of a child from cancer. Journal of Palliative Medicine, 13(11), 1321–1326. https://doi.org/10.1089/jpm.2010.0037

25.

Meert

K. L.

Shear

Newth

C. J.

Harrison

Berger

Zimmerman

Anand

K. J.

Carcillo

Donaldson

A. E.

Dean

J. M.

Willson

D. F.

Nicholson

, & Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. (2011). Follow-up study of complicated grief among parents eighteen months after a child’s death in the pediatric intensive care unit. Journal of Palliative Medicine, 14(2), 207–214. https://doi.org/10.1089/jpm.2010.0291

26.

Melhem

N. M.

Walker Porta

Payne

Brent

D. A.

(2013). Identifying prolonged grief reactions in children: Dimensional and diagnostic approaches. Journal of the American Academy of Child and Adolescent Psychiatry, 52(6), 599–607.E7. https://doi.org/10.1016/j.jaac.2013.02.015

27.

O’Connor

M. F.

(2012). Immunological and neuroimaging biomarkers of complicated grief. Dialogues in Clinical Neuroscience, 14(2), 141–148.

28.

O’Connor

M. F.

Shear

M. K.

Fox

Skritskaya

Campbell

Ghesquiere

Glickman

(2013). Catecholamine predictors of complicated grief treatment outcomes. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology, 88(3), 349–352. https://doi.org/10.1016/j.ijpsycho.2012.09.014

29.

Robinaugh

D. J.

McNally

R. J.

LeBlanc

N. J.

Pentel

K. Z.

Schwarz

N. R.

Shah

R. M.

Nadal-Vicens

M. F.

Moore

C. W.

Marques

Bui

Simon

N. M.

(2014). Anxiety sensitivity in bereaved adults with and without complicated grief. The Journal of Nervous and Mental Disease, 202(8), 620–622. https://doi.org/10.1097/NMD.0000000000000171

30.

Rosner

Pfoh

Kotoucova

Hagl

(2014). Efficacy of an outpatient treatment for prolonged grief disorder: A randomized controlled clinical trial. Journal of Affective Disorders, 167, 56–63. https://doi.org/10.1016/j.jad.2014.05.035

31.

Savovic

Turner

R. M.

Mawdsley

Jones

H. E.

Beynon

Higgins

J. P. T.

Sterne

J. A. C.

(2018). Association between risk-of-bias assessments and results of randomized trials in cochrane reviews: The ROBES meta-epidemiologic study. American Journal of Epidemiology, 187(5), 1113–1122. https://doi.org/10.1093/aje/kwx344

32.

Shear

M. K.

(2012). Grief and mourning gone awry: Pathway and course of complicated grief. Dialogues in Clinical Neuroscience, 14(2), 119–128.

33.

Simon

N. M.

(2013). Treating complicated grief. JAMA, 310(4), 416–423. https://doi.org/10.1001/jama.2013.8614

34.

Tian

J. H.

(2015). The PRISMA extension statement. Annals of Internal Medicine, 163(7), 566–567. https://doi.org/10.7326/L15-5144-2

35.

Tullis

J. A.

(2017). Death of an ex-spouse: Lessons in family communication about disenfranchised grief. Behavioral Sciences, 7(2), 16. https://doi.org/10.3390/bs7020016

36.

Whiting

Savovic

Higgins

J. P. T.

Caldwell

D. M.

Reeves

B. C.

Shea

Davies

Kleijnen

Churchill

(2018). ROBIS: A new tool to assess risk of bias in systematic reviews was developed. Recenti Progressi in Medicina, 109(9), 421–431. https://doi.org/10.1701/2990.29928

37.

Zetumer

Young

Shear

M. K.

Skritskaya

Lebowitz

Simon

Reynolds

Mauro

Zisook

(2015). The impact of losing a child on the clinical presentation of complicated grief. Journal of Affective Disorders, 170, 15–21. https://doi.org/10.1016/j.jad.2014.08.021