Verlusterleben und prolongierte Trauer bei depressiven Patienten

Zusammenfassung

Anliegen: Depressive Patienten, die eine nahestehende Person verloren haben, hinsichtlich verlustspezifischer Variablen und prolongierter Trauer (PT) zu untersuchen.

Methode und Ergebnisse: Von 127 Patienten erfüllten 14,2 % die Kriterien der PT (ICG-R). Patienten mit PT hatten eine geringere Schulbildung, waren bezogen auf den Verlust belasteter, hatten signifikant andere Beziehungen zu den Verstorbenen und der Verlust lag kürzer zurück als bei Patienten ohne PT.

Diskussion: Zur Behandlung von Depressionen ist eine adäquate differenzielle Diagnostik unabdingbar, die verlustbezogene Faktoren und Symptome der PT berücksichtigt.

Abstract

Objective: Inpatients diagnosed with major depression that had lost a loved person were asked about loss-related variables and symptoms of complicated grief (CG).

Methods and Results: CG was assessed by the Inventory of Complicated Grief (ICG-R). 14.2 % of n = 127 individuals with unipolar depression met the criteria for CG. Depressive patients with CG compared to those without CG had a lower educational level; reported a higher loss-related burden at the time of loss, during the survey and the year after the loss; had significant different closeness within the relationships to the deceased; and time of loss was more recently.

Conclusions: An adequate differential diagnostic is essential for the treatment of major depression. Therefore loss-related factors and symptoms of complicated grief must be investigated regularly.

Schlüsselwörter

prolongierte Trauer - unipolare depressive Störung - verlustspezifische Variablen

Keywords

complicated grief - major depression - loss-related factors

• Literatur

• 1 Rosner R, Wagner B. Komplizierte Trauer. In: Seidler GH, Freyberger HJ, Maercker A, Hrsg. Handbuch der Psychotraumatologie. Stuttgart: Klett-Cotta; 2011: 220-231
• 2 Silverman GK, Jacobs SC, Kasl SV et al. Quality of life impairments associated with diagnostic criteria for traumatic grief. Psychol Med 2000; 30: 857-862
• 3 Stroebe M, Schut H, Stroebe W. Health outcomes of bereavement. Lancet 2007; 370: 1960-1973
• 4 Znoj H. Trauer. Psychiatr Psychother Up2date 2009; 3: 317-332
• 5 Shear MK, Simon N, Wall M et al. Complicated grief and related bereavement issues for DSM-5. Depress Anxiety 2011; 28: 103-117
• 6 Freud S. Trauer und Melancholie. Int Z ärztl Psychoanal 1917; 4: 288-301
• 7 Boelen PA, vd Schoot R, vd Hout MA et al. Prolonged Grief Disorder, depression, and posttraumatic stress disorder are distinguishable syndromes. J Affect Disord 2010; 125: 374-378
• 8 Boelen PA, vd Bout J. Complicated grief, depression, and anxiety as distinct postloss syndromes: A confirmatory factor analysis study. Am J Psychiatry 2005; 162: 2175-2177
• 9 Boelen PA, vd Bout J, de Keijser J. Traumatic grief as a disorder distinct from bereavement-related depression and anxiety: A replication study with bereaved mental health care patients. Am J Psychiatry 2003; 160: 1339-1341
• 10 Bonanno GA, Neria Y, Mancini A et al. Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity. J Abnorm Psychol 2007; 116: 342-351
• 11 Melhem NM, Rosales C, Karageorge J et al. Comorbidity of axis I disorders in patients with traumatic grief. J Clin Psychiatry 2001; 62: 884-887
• 12 Simon NM, Shear KM, Thompson EH et al. The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief. Compr Psychiatry 2007; 48: 395-399
• 13 Neria Y, Gross R, Litz B et al. Prevalence and psychological correlates of complicated grief among bereaved adults 2.5-3.5 years after September 11th attacks. J Trauma Stress 2007; 20: 251-262
• 14 Jacobs SC, Nelson JC, Zisook S. Treating depressions of bereavement with antidepressants. A pilot study. Psychiatr Clin North Am 1987; 10: 501-510
• 15 O'Connor MF, Wellisch DK, Stanton AL et al. Craving love? Enduring grief activates brain's reward center. Neuroimage 2008; 42: 969-972
• 16 Prigerson HG, Frank E, Kasl SV et al. Complicated grief and bereavement-related depression as distinct disorders: Preliminary empirical validation in elderly bereaved spouses. Am J Psychiatry 1995; 152: 22-30
• 17 McDermott OD, Prigerson HG, Reynolds CF et al. Sleep in the wake of complicated grief symptoms: an exploratory study. Biol Psychiatry 1997; 41: 710-716
• 18 Lichtenthal WG, Cruess DG, Prigerson HG. A case for establishing complicated grief as a distinct mental disorder in DSM-V. Clin Psychol Rev 2004; 24: 637-662
• 19 Prigerson HG, Horowitz MJ, Jacobs SC et al. Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Med 2009; 6: e1000121
• 20 Fujisawa D, Miyashita M, Nakajima S et al. Prevalence and determinants of complicated grief in general population. J Affect Disord 2010; 127: 352-358
• 21 Kersting A, Brähler E, Glaesmer H et al. Prevalence of complicated grief in a representative population-based sample. J Affect Disord 2011; 131: 339-343
• 22 Shear K, Frank E, Houck PR et al. Treatment of complicated grief: A randomized controlled trial. JAMA 2005; 293: 2601-2608
• 23 Kersting A, Kroker K, Horstmann J et al. Complicated grief in patients with unipolar depression. J Affect Disord 2009; 118: 201-204
• 24 Sung SC, Dryman MT, Marks E et al. Complicated grief among individuals with major depression: prevalence, comorbidity, and associated features. J Affect Disord 2011; 134: 453-458
• 25 Simon NM, Pollack MH, Fischmann D et al. Complicated grief and its correlates in patients with bipolar disorder. J Clin Psychiatry 2005; 66: 1105-1110
• 26 Kersting A. [Peripartum depression and grief after pregnancy loss: special problem areas in obstetrics]. Nervenarzt 2012; 83: 1434-1441
• 27 Barry LC, Kasl SV, Prigerson HV. Psychiatric disorders among bereaved persons: The role of perceived circumstances of death and preparedness for death. Am J Geriatr Psychiatry 2002; 10: 447-457
• 28 Baune BT, Hohoff C, Berger K et al. Association of the COMT val158met variant with antidepressant treatment response in major depression. Neuropsychopharmacology 2007; 33: 924-932
• 29 Wittchen H-U, Zaudig M, Fydrich T. Strukturiertes Klinisches Interview für DSM-IV. Göttingen: Hogrefe 1997
• 30 Prigerson HG, Maciejewski PK, Reynolds CF et al. Inventory of Complicated Grief: A scale to measure maladaptive symptoms of loss. Psychiatry Res 1995; 59: 65-79
• 31 Rosner R. Deutsche Version des Fragebogens zur komplizierten Trauer (nach der Kurzversion von Prigerson und Jacobs). Unveröffentlichtes Manuskript. München: LMU; 2002
• 32 O’Connor M, Lasgaard M, Shevlin M et al. A confirmatory factor analysis of combined models of the Harvard Trauma Questionnaire and the Inventory of Complicated Grief-Revised: are we measuring complicated grief or posttraumatic stress?. J Anxiety Disord 2010; 24: 672-679
• 33 Prigerson HG, Jacobs SC. Perspectives on care at the close of life. Caring for bereaved patients: “all the doctors just suddenly go”. JAMA 2001; 286: 1369-1376
• 34 Zisook S, Downs NS. Diagnosis and treatment of depression in late life. J Clin Psychiatry 1998; 59 (Suppl. 04) 80-91
• 35 Berking M. Ursachen psychischer Störungen. In: Berking M, Rief W, Hrsg. Klinische Psychologie und Psychotherapie für Bachelor. Berlin, Heidelberg: Springer; 2012: 19-28
• 36 Piper WE, Ogrodniczuk JS, Weideman R. Screening for complicated grief: When less may provide more. Can J Psychiatry 2005; 50: 680-683
• 37 Shear MK, Frank E, Foa E et al. Traumatic grief treatment: A pilot study. Am J Psychiatry 2001; 158: 1506-1508
• 38 Boelen PA. Cognitive-behavioral therapy for complicated Grief: Theoretical underpinnings and case descriptions. J Loss Trauma 2006; 11: 1-30
• 39 Maercker A. Psychotherapie der Posttraumatischen Belastungsstörung und Komplizierten Trauer. Psychomed 1999; 11: 45-50
• 40 Wagner B, Knaevelsrud C, Maercker A. Internet-based cognitive-behavioral therapy for complicated grief: A randomized controlled trial. Death Stud 2006; 30: 429-453
• 41 Kersting A, Kroker K, Schlicht S et al. Efficacy of cognitive behavioral internet-based therapy in parents after the loss of a child during pregnancy: pilot data from a randomized controlled trial. Arch Womens Ment Health 2011; 14: 465-477
• 42 Reynolds 3rd CF, Miller MD, Pasternak RE et al. Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy. Am J Psychiatry 1999; 156: 202-208
• 43 Boelen PA, de Keijser J, vd Hout MA et al. Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling. J Consult Clin Psychol 2007; 75: 277-284
• 44 Ott CH. The impact of complicated grief on mental and physical health at various points in the bereavement process. Death Stud 2003; 27: 249-272
• 45 Melhem NM, Rosales C, Karageorge J et al. Comorbidity of axis I disorders in patients with traumatic grief. J Clin Psychiatry 2001; 62: 884-887
• 46 Jacobs S, Hansen F, Berkman L et al. Depressions of bereavement. Compr Psychiatry 1989; 30: 218-224
• 47 Zisook S, Paulus M, Shuchter SR et al. The many faces of depression following spousal bereavement. J Affect Disord 1997; 45: 85-94