Posttraumatic Distress Symptoms and Their Response to Treatment in Adults With Prolonged Grief Disorder

Peter J. Na, MD, MPH^a ; Samrachana Adhikari, PhD^b ; Kristin L. Szuhany, PhD^a ; Alan Z. Chen, MSc^b ; Rebecca R. Suzuki, BA^a ; Matteo Malgaroli, PhD^a ; Donald J. Robinaugh, PhD^c ; Eric Bui, MD, PhD^c ; Christine Mauro, PhD^d ; Natalia A. Skritskaya, PhD^e ; Barry D. Lebowitz, PhD^f ; Sidney Zisook, MD^f ; Charles F. Reynolds III, MD^g ; M. Katherine Shear, MD^e ; Naomi M. Simon, MD, MSc^a

J Clin Psychiatry 2021;82(3):20m13576

ABSTRACT

Objective: Posttraumatic stress disorder and prolonged grief disorder (PGD) arise following major life stressors and may share some overlapping symptomatology. This study aimed to examine the presence and response to treatment of posttraumatic stress symptoms (PTSS) in bereaved adults with a primary diagnosis of PGD.

Methods: A randomized controlled trial of 395 adults with PGD (defined as an Inventory of Complicated Grief score ≥ 30 plus confirmation on structured clinical interview) randomly assigned participants to either complicated grief treatment (CGT) with citalopram, CGT plus placebo, citalopram, or placebo between March 2010 and September 2014. This secondary analysis examined the presence of PTSS (per the Davidson Trauma Scale) at baseline and change in PTSS with treatment using longitudinal mixed-effects regression and examined the role of violent compared to nonviolent deaths (loss type).

Results: High levels of PTSS were present at baseline, regardless of loss type, and were associated with increased functional impairment (P < .001). CGT with placebo demonstrated efficacy for PTSS compared to placebo in both threshold (OR = 2.71; 95% CI, 1.13–6.52; P = .026) and continuous (P < .001; effect size d = 0.47) analyses, and analyses were suggestive of a greater effect for CGT plus citalopram compared to citalopram alone (threshold analysis: OR = 2.84; 95% CI, 1.20–6.70; P = .017; continuous analysis: P = .053; d = 0.25). In contrast, citalopram did not differ from placebo, and CGT plus citalopram did not differ from CGT plus placebo.

Conclusions: Bereavement-related PTSS are common in bereaved adults with PGD in the context of both violent and nonviolent death and are associated with poorer functioning. CGT shows efficacy for PTSS, while the antidepressant citalopram does not.

Trial Registration: ClinicalTrials.gov identifier: NCT01179568

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