This resubmission application is for competitive renewals of our prior grant (MH060783) in which we established the efficacy of a targeted complicated grief treatment (CGT). The current application is to conduct a multicenter study to take the next steps needed to optimize treatment for individuals suffering from complicated grief, and responds to PA-07-092 inviting grant applications for collaborative studies of mental disorders in adults. Complicated grief (CG) is a debilitating condition that is estimated to affect millions of people in the United States alone. Our prior study was the first RCT to address this condition. Participants in our study continued stable antidepressant medication while receiving CGT or Interpersonal Psychotherapy (IPT). Individuals taking antidepressants had better outcome in both treatments, though CGT was superior to IPT when administered with (60% responders v. 40%) or without (42% v. 19%) antidepressants. Studies of antidepressant medication alone have shown mixed results with SSRIs appearing to be promising. However, there has been no randomized controlled study of SSRIs for CG. Determining the efficacy of SSRI treatment for CG, when administered with and without CGT, is of great public health importance. We have assembled 4 groups of investigators with strong track records in bereavement research and extensive experience with intervention studies and multicenter projects, to conduct a study of escitalopram (ESC) efficacy. We plan to enroll 440 people with a primary diagnosis of Complicated Grief over 4.5 years, and to randomly assign them to receive 16 weeks of treatment with ESC, PBO, ESC + CGT or PBO + CGT.
Specific aims are to compare 1) ESC v PBO, 2) ESC + CGT v PBO + CGT and 3) CGT + ESC v ESC on measures of responder status and on improvement in CG symptoms, depression, anxiety, functional impairment, sleep and suicidality. We will explore mediator and moderator hypotheses to answer questions about how these treatments work and who might benefit most from each approach. Answers to these questions have important public health significance.

Public Health Relevance

Complicated grief (CG), estimated to occur in approximately 10% of bereaved people, causes significant distress and impairment and also puts people at risk for serious negative health consequences, including cancer and cardiovascular disease. Very little is known about how to treat this condition. Results of this study will provide critical new information for patients and clinicians regarding medication efficacy, and will provide data to inform clinicians about how best to treat individuals suffering from complicated grief.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZMH1-ERB-F (02))
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Rudorfer, Matthew V
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Columbia University (N.Y.)
Schools of Medicine
New York
United States
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Keyes, Katherine M; Pratt, Charissa; Galea, Sandro et al. (2014) The burden of loss: unexpected death of a loved one and psychiatric disorders across the life course in a national study. Am J Psychiatry 171:864-71
Hall, Charles A; Reynolds 3rd, Charles F; Butters, Meryl et al. (2014) Cognitive functioning in complicated grief. J Psychiatr Res 58:20-5
Mash, Holly B Herberman; Fullerton, Carol S; Shear, M Katherine et al. (2014) Complicated grief and depression in young adults: personality and relationship quality. J Nerv Ment Dis 202:539-43
Shear, M Katherine; Ghesquiere, Angela; Glickman, Kim (2013) Bereavement and complicated grief. Curr Psychiatry Rep 15:406
Ghesquiere, Angela; Shear, M Katherine; Gesi, Camilla et al. (2012) Prevalence and correlates of complicated grief in adults who have undergone a coronary artery bypass graft. J Affect Disord 136:381-5
Shear, M Katherine; Skritskaya, Natalia A (2012) Bereavement and anxiety. Curr Psychiatry Rep 14:169-75
Sung, Sharon C; Dryman, M Taylor; Marks, Elizabeth et al. (2011) Complicated grief among individuals with major depression: prevalence, comorbidity, and associated features. J Affect Disord 134:453-8
Simon, Naomi M; Wall, Melanie M; Keshaviah, Aparna et al. (2011) Informing the symptom profile of complicated grief. Depress Anxiety 28:118-26
Shear, M Katherine; McLaughlin, Katie A; Ghesquiere, Angela et al. (2011) Complicated grief associated with hurricane Katrina. Depress Anxiety 28:648-57
Shear, M Katherine; Simon, Naomi; Wall, Melanie et al. (2011) Complicated grief and related bereavement issues for DSM-5. Depress Anxiety 28:103-17

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