Symptoms of Traumatic Grief (TG) (e.g., yearning, searching, detachment, emptiness, futility) have been found to form a unified syndrome distinct from symptoms of depression and anxiety, to have risk factors, clinical correlates, and a response to pharmacotherapy distinct from depressive symptoms, to predict substantial morbidity (e.g., high blood pressure, suicidality), and to persist for years. While these findings suggest the need for separate diagnostic criteria for TG, no standardized criteria exist. The PI convened a panel of experts to formulate a criteria set for TG. The primary aim of this proposal is to test the performance of the consensus criteria and to define parameters the panel left unspecified (e.g., determine the timing/duration criterion, number and severity of symptoms required for diagnosis). A sample of 360 widowed subjects aged 65 years and older will be recruited into the study at 2 months post-loss. The self-administered Inventory of Traumatic Grief (ITG) and the rater-administered Traumatic Grief Evaluation of Response to Loss (TRGR2L) structured interview will assess subjects on the proposed TG symptoms. Receiver Operator Characteristic (ROC) and Item Response Theory (IRT) analyses will be used to develop optimally efficient diagnostic algorithms for TG. Follow-up interviews at 6 and 15 months post-loss will provide information on symptom resolution over time, allow for a comparison of the morbidity associated with different temporal trajectories (e.g., chronic and delayed subtypes), and the determination of prevalence rates and temporal stability of a TG diagnosis over time. Logistic regression models will estimate the effects of insecure and/or anxious romantic attachment styles, security-increasing marriages, and lack of social integration on the likelihood of meeting criteria for TG. Random regression analyses will be used to estimate the effects of meeting criteria for TG on suicidality, and degree of impaired health and functioning. Results will provide a validated diagnostic algorithm for TG derived from proposed consensus criteria, and psychometrically sound and clinically useful assessment tools for this disorder. At-risk individuals and potentially important foci for lay (social integration) and psychotherapeutic (e.g., treatment of attachment disturbances) intervention will be identified, as will the mental and physical health impairments associated with meeting diagnostic criteria for TG.
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