Eric Bui1, Arielle Horenstein2, Riva Shah2, Natalia A Skritskaya3, Christine Mauro4, Yuanjia Wang4, Naihua Duan5, Charles F Reynolds6, Sidney Zisook7, M Katherine Shear8, Naomi M Simon9. 1. Department of Psychiatry, Massachusetts General Hospital, One Bowdoin square, Boston, MA 02114, United States; Harvard Medical School, Boston, MA, United States. Electronic address: tebui@mgh.harvard.edu. 2. Department of Psychiatry, Massachusetts General Hospital, One Bowdoin square, Boston, MA 02114, United States. 3. Columbia School of Social Work, New York, NY, United States. 4. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States. 5. Division of Biostatistics, Department of Psychiatry, Columbia University, New York, NY, United States. 6. University of Pittsburgh Medical Center, Pittsburgh, PA, United States. 7. University of California, San Diego, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States. 8. Columbia School of Social Work, New York, NY, United States; Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, United States. 9. Department of Psychiatry, Massachusetts General Hospital, One Bowdoin square, Boston, MA 02114, United States; Harvard Medical School, Boston, MA, United States.
Abstract
BACKGROUND: Although Complicated Grief (CG) has been associated with comorbid Panic Disorder (PD), little is known about panic attacks in CG, and whether panic symptoms may be grief-related. The present study examines the presence and impact of grief-related panic symptoms in CG. METHODS: Individuals with CG (n=146, 78% women, mean (SD) age=52.4(15.0)) were assessed for CG, DSM-IV diagnoses, work and social impairment, and with the Panic Disorder Severity Scale modified to assess symptoms "related to or triggered by reminders of your loss" and anticipatory worry. RESULTS: Overall, 39.7% reported at least one full or limited-symptom grief-related panic attack over the past week, and 32.2% reported some level of anticipatory worry about grief-related panic. Of interest, 17% met DSM criteria for PD. Among those without PD, 34.7% reported at least one full or limited-symptom grief-related panic attack over the past week, and this was associated with higher CG symptom severity (t=-2.23, p<0.05), and functional impairment (t=-3.31, p<0.01). Among the full sample, controlling for CG symptom severity and current PD, the presence of at least one full or limited-symptom grief-related panic attack was independently associated with increased functional impairment (B(SE)=4.86(1.7), p<0.01). LIMITATIONS: Limitations include a lack of assessment of non-grief-related panic symptoms and examination of a sample of individuals seeking treatment for CG. CONCLUSIONS: Grief-related panic symptoms may be prevalent among individuals with CG and independently contribute to distress and functional impairment.
BACKGROUND: Although Complicated Grief (CG) has been associated with comorbid Panic Disorder (PD), little is known about panic attacks in CG, and whether panic symptoms may be grief-related. The present study examines the presence and impact of grief-related panic symptoms in CG. METHODS: Individuals with CG (n=146, 78% women, mean (SD) age=52.4(15.0)) were assessed for CG, DSM-IV diagnoses, work and social impairment, and with the Panic Disorder Severity Scale modified to assess symptoms "related to or triggered by reminders of your loss" and anticipatory worry. RESULTS: Overall, 39.7% reported at least one full or limited-symptom grief-related panic attack over the past week, and 32.2% reported some level of anticipatory worry about grief-related panic. Of interest, 17% met DSM criteria for PD. Among those without PD, 34.7% reported at least one full or limited-symptom grief-related panic attack over the past week, and this was associated with higher CG symptom severity (t=-2.23, p<0.05), and functional impairment (t=-3.31, p<0.01). Among the full sample, controlling for CG symptom severity and current PD, the presence of at least one full or limited-symptom grief-related panic attack was independently associated with increased functional impairment (B(SE)=4.86(1.7), p<0.01). LIMITATIONS: Limitations include a lack of assessment of non-grief-related panic symptoms and examination of a sample of individuals seeking treatment for CG. CONCLUSIONS: Grief-related panic symptoms may be prevalent among individuals with CG and independently contribute to distress and functional impairment.
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