APPENDIX B

Evaluation Table

Appendix B
 Evaluation Table
Level of
Evidence Type of
/ Year / Therapy /
Reference / Title Country Aim Intervention Method Measures Sample / Setting Results & Conclusion Limitations & Bias
Abouguendia, M., III-1 Whether Interpretive or Patients were matched in Intrusion and Avoidance n = 107 patients with Patient-rated alliance Stated Limits: Alliance
Joyce, A. S., Piper, 2004 therapeutic supportive pairs according to their subscale of 15-item IES; CG (average age (quality of relationship ratings were aggregated
W. E., & Canada alliance mediates time-limited QOR, use of 7 items developed by 43yrs; 77% female; with therapist) played a into a single global
Ogrodniczuk, J. S. between patient group medications, gender and Prigerson; 54-item SAS- 90% Caucasian; 72% mediating role in the score; Single measure
(2004). Alliance as a expectancy of psychotherapy age. Matched patients SR; Alliance rated on previous psychiatric relationship between of expectancy before
mediator of improvement and randomly assigned to quality of working treatment; 49% lost a outcome expectancy and therapy; Not clear if
expectancy effects in the outcome of one of the treatment relationship between partner), Setting: group benefit results are transferable
short-term group group groups. Weekly 90-min therapist and patient (7- University-based
psychotherapy. psychotherapy sessions over 12 weeks. point Likert-type scale). psychiatric treatment
Group Dynamics: clinic
Theory, Research,
and Practice, 8(1), 3-
12.
Barry, L. C., Kasl, IV To examine the N/A Baseline interview 4 ICG-R; MDD and n= 122 (average age 13 (10.7%) CG at 4 months Stated Limits: Sample
S. V., & Prigerson, 2003 association months postloss and PTSD modules of SCID 63.7yrs, 70.5% postloss, 10 (8.2%) CG at 9 had relatively good
H. G. (2002). USA between the follow-up interview 9 axis 1 modules female, 91% months postloss. Less health, relatively low
Psychiatric disorders perception of months postloss. Caucasian, 88.4% prepared for death the more levels of CG, PTSD,
among bereaved death and widowed) likely participants were to and MDD compared to
persons: The role of preparedness for have CG. Perception of previous reports;
perceived the death and suffering, how drawn out Retrospective ratings of
circumstances of psychiatric the death was, or violent perception of death;
death and disorders death was not associated to Perception and
preparedness for CG. preparedness for death
death. American assessed at same time
Journal of Geriatric as baseline psychiatric
Psychiatry, 10(4), diagnosis; 96% death
447-457. due to natural causes;
Location of death,

Appendix B
 caregivers burden,
caregivers perception
of quality of life not
explored.
Beery, L. C., III-3 To examine the N/A Participants interviewed HAM-D; ITG preloss n= 70 Spousal Caregivers burden was Stated Limits:
Prigerson, H. G., 1997 possible factors prior to spouse's death, version; Caregivers caregivers of found to significantly Caregivers gratification
Bierhals, A. J., USA associated with then 3, 6, and 13 months burden, caregivers terminally ill patients associated to both measure had not been
Santucci, L. M., depression and post-death. HAM-D change in role function, (69% female; 86% traumatic grief and validated by any other
Newsom, J., T., traumatic grief completed during the and activities of daily Caucasian; mean depression. No significant study; Only addresses
Maciejewski, P. K., among caregivers interview and other living age of 68; 88% of association was found caregivers burden and
et al. (1997). of terminally ill measures were given to participant's spouses between the time spent not other risk factors;
Traumatic grief, spouses participants to complete being cared for at caring and duration of Terminally ill spouses
depression and at home then mail in. home). Setting = caregiving with either in the sample suffered
caregiving in elderly Participants home or depression or traumatic from a wide range of
spouses of the university setting. grief. Change in role illnesses. Limits: Not
terminally ill. function of the caregiver clear if ITG preloss
Omega: Journal of was associated with version was also used
Death & Dying, depression, but not after the death of the
35(3), 261-279. traumatic grief. No spouse.
significant association was
found for caregivers
gratification with either
depression or traumatic
grief.
Boelen, P. A., & van IV To confirm N/A Participants recruited 12 items from Dutch n= 1,321 CG, depression, and Stated Limits: Subjects
den Bout, J. (2005). 2005 previous research both by those working ITG; 16 item depression Participants (mean anxiety symptoms loaded drawn from different
Complicated grief, Nether- that complicated with bereaved and by subscale from Dutch age 43.2yrs, 82.1% on separate factors, was sources; Low response
depression, and lands grief symptoms Dutch internet site about SCL-90; 7 items from female, 43.4% lost a superior to a one-factor rate; Subgroups used
anxiety as distinct are distinct from grief. Questionnaires anxiety subscale SCL- spouse, average 32.5 model, had good fit, and for analysis relatively
postloss syndromes: bereavement were filled out that 90 months postloss, was stable across small, lowering the
A confirmatory related depression measured CG, 81.4% non-violent) subgroups even when power.
factor analysis study. and anxiety depression, and anxiety. severity of CG differed
American Journal of between subgroups.
Psychiatry, 162(11),
2175-2177.

Appendix B
Boelen, P. A., van IV To explore the N/A Questionnaires handed ITG; SCL-90 (16-item n = 329 Bereaved Each of the cognitive Stated Limits: Under
den Bout, J., & van 2003 relationship out and returned by mail depression subscale and individuals (loss of a variables were significantly representation of
den Hout, M. A. Nether- between negative once they had been filled 10-item anxiety first degree relative related to traumatic grief, individuals with little
(2003). The role of lands cognitions and in. subscale); Grief & received help) depression, and anxiety or no grief reactions;
cognitive variables in emotional Cognitions (81.2% female, mean symptoms severity Can't draw causality
psychological problems after Questionnaire (global age 49.67yrs, 66.9% (controlling for background between cognitive
functioning after the bereavement negative beliefs, deceased was and loss-related variables). variables and emotional
death of a first degree cognitions about self- partner, mean of 27.8 49% of variance in problems due to cross
relative. Behaviour, blame, negative months since death). traumatic grief severity sectional design of
Research and cognitions about other was explained by the study; Did not assess
Therapy, 41(10), people's responses after global negative beliefs other cognitive
1123-1136. the loss, and negative about life, threatening variables such as
cognitions about one's interpretations of grief positive attitude toward
own grief reactions) reactions, negative beliefs death etc.; Symptoms
about the world, and the measured by self-report
future. 10% of ITG score rather than interviewed-
variance was explained by based assessment.
demographic variable (age,
time since loss, & level of
education). Need to address
negative cognitions when
treating traumatic grief
Boelen, P. A., van IV To replicate the N/A Intake interview and ITG; SCL-90 n= 130 outpatients Three distinct symptom Stated Limits: None
den Bout, J., & de 2003 findings of questionnaires who had lost a first- clusters were replicated: stated.
Keijser, J. (2003). Nether- previous studies degree relative traumatic grief,
Traumatic grief as a lands that have found (25.2% meet DSM-IV bereavement-related
disorder distinct from traumatic grief to criteria for depression, and
bereavement-related be distinct from depressive disorder; bereavement-related
depression and bereavement- 2.9% anxiety; 9.7% anxiety. The Dutch
anxiety: A replication related depression both; 23.3% using findings are comparable to
study with bereaved and anxiety antidepressant; none studies by Prigerson and
mental health care receiving treatment; colleagues in the USA
patients. American mean age 44yrs; suggesting cross-cultural
Journal of Psychiatry, 74.8% female; generalisability.
160(7), 1339-1341. average of 41.7
months postloss)

Appendix B
Boelen, P. A., van IV
den Bout, J., & van 2003
den Hout, M. A. Nether-
(2003). The role of lands
negative
interpretations of
grief reactions in
emotional problems
after bereavement.
Journal of Behavior
Therapy and
Experimental
Psychiatry, 34(3-4),
225-238.
Boerner, K., III-3
Wortman, C. B., & 2005
Bonanno, G. A. USA
(2005). Resilient or
at risk? A 4 -year
study of older adults
who initially showed
high or low distress
following conjugal
loss. The Journals of
Gerontology, 60B(2),
67-73.
To examine the N/A Participants recruited NIGS; ITG; 16-item n = 234 who had The negative interpretation Stated Limits: The
role of negative though internet site subscale Depression lossed first-degree of grief reactions were cross sectional design
interpretations of about grief and from SCL-90 relative. Majority highly associated with the precludes any casual
grief reactions in bereavement, filled in female & on average degree to which these interpretations; Self-
emotional online digital 2yrs postloss. reactions were experienced selected sample; Grief
problems after questionnaire or mailed as distressing, the degree to frequency, distraction,
bereavement questionnaire which mourners engaged in and thought
avoidance behaviours and suppression were
the severity of the assessed with single
symptoms of traumatic items. Limits:
grief and depression. Population recruited
Behavioral and cognitive through internet; No
avoidance strategies were control.
significantly related to the
severity of traumatic grief
and depression.
Do the resilient N/A Widowed participants of CES-D; Bereavement Data obtained from Delayed grief or depression Stated Limits: Small
stay resilient and original study took part Index; Present Feelings Changing Lives of was not found in either of sample size; Reduced
depressed- in follow-up interviews About Loss scale; TRIG Older Couples study. the two groups. statistical power due to
improved remain at 6, 18, and 48 months n= 92 widow(er)s Chronically depressed were small sample size of
improved in the postloss. Original study completed all three more likely to be searching subgroups; Attrition;
long term? gathered prospective follow-up interviews. for meaning and asking Participants who did
data prior to death of 90% women, average 'why me' at 48 months not complete tended to
spouse. age 70yrs. postloss. Those with be more depressed,
initially low distress hence, % of
continued to do well 4yr participants with poor
postloss. High distress long-term adaptation
initially and over time may have been higher
suggested that this pattern
remained chronic only for
those who had reported
high distress preloss.
Appendix B
Bonanno, G.A. and III-3 To examine N/A Structured interviews TRIG, BDI, 18 item n= 39 midlife, No cases of delayed Stated Limit: Small
N.P. Field (2001) 2001 different and a questionnaire. self-report checklist on conjugally bereaved symptom elevations were sample size
Examining the USA theoretical somatic complaints adults in their fifth observed and data on the
delayed grief positions on grief year of bereavement emotional processing of the
hypothesis across 5 and bereavement loss at six months failed to
years of support the traditional
bereavement. The assumption that minimal
American Journal of emotional processing of the
Behavioral Scientist, loss would lead to delayed
44(5): 798-816. grief.
Bonanno, G. A., III-3 To examine N/A Participants were 32-item Dyadic n = 42 conjugally Negative dissociation at 6 Stated Limits:
Keltner, D., Holen, 1995 emotional randomly selected from Adjustment Scale bereaved 3-6 monthsmonths was associated Although the measure
A., & Horowitz, M. USA avoidance (via the responders who meet (DAS); BDI; SCL-90; before intake into the
with minimal grief for severe grief
J. (1995). When verbal autonomic the inclusion criteria. 18-item self-report study symptoms across 14 received convergent
avoiding unpleasant response Questionnaires were checklist for somatic months. Negative support compared to
emotions might not dissociation) and mailed to participants 3- symptoms; Structured dissociation scores were other measures, there
be such a bad thing: its effect on grief 6 months postloss. grief-specific interview also linked to initially high still may be other costs
Verbal-autonomic symptoms. Structured grief designed by the authors; levels of somatic of avoidance that are
response dissociation symptoms interview self-rating emotions; symptoms, which dropped not captured; 14 month
and midlife conjugal were carried out 6 Heart Rate to a low level by 14 follow-up measure may
bereavement. Journal months postloss, then 17 months. There was no be too short a time
of Personality and days later semi- evidence of a delayed grief period to capture the
Social Psychology, structured narrative reaction among any of the delayed effects of
69(5), 975-989. interview. 14 months participants. Emotional avoidance;
postloss grief symptom avoidance may be an Homogenous nature of
interview were adaptive function during population
conducted. bereavement.
Bonanno, G. A., III-2 To examine N/A At 4 & 18 months 13-item grief processing n = 142 (68 USA & Although differences in Stated Limits: Data
Papa, A., Lalande, 2005 whether parental postloss participants scale and 7-item grief 74 China). Setting = grief processing and obtained from self
K., Zhang, N., & USA & loss results in completed a set of avoidance scale USA participants avoidance were observed, report measures; due to
Noll, J. G. (2005). China more severe questionnaires. Age- developed by completed measures the factor structure of these only two assessment
Grief processing and grieving, more matched samples were researchers that was at home and mailed measures proved invariant points some grief
deliberate grief extensive grief used. appropriate for both responses. In China across culture. Consistent theory can not be
avoidance: A processing, or cultures; Symptoms a research assistant with the grief work as address; Grief
prospective grief avoidance. Check List; Global visited participants rumination hypothesis, experience before 4

Appendix B
comparison of
bereaved spouses and
parents in the United
States and the
People's Republic of
China. Journal of
Consulting and
Clinical Psychology,
73(1), 86-98.
Bonanno, G. A., III-3
Wortman, C. B., & 2004
Nesse, R. M. (2004). USA
Prospective patterns
of resilience and
maladjustment during
widowhood.
Psychology and
Aging, 19(2), 260-
271.
Then if these symptoms Index (GSI); homes. both grief processing and months postloss not
effects varied 3 self-report questions deliberate grief avoidance measured;
between the USA for perceived health predicted poor long-term Bereavement outcomes
and China. adjustment for US limited to general
participants. Furthermore, levels of adjustment
initial grief processing rather than grief-
predicted later grief specific difficulties;
processing in both cultures. Different recruitment
However, among China's rates in each country.
participants, neither grief Limits: Individuals in
processing nor deliberate each country were paid
avoidance evidenced clear the equivalent of
psychological US$60 for each data
consequences. collection
To examine the N/A Widowed participants of CES-D; Bereavement Data obtained from As well as having Stated Limits: Data was
differences in original study took part Index; Present Feelings Changing Lives of relatively healthy profiles, self-report; Postloss
how participants in follow-up interviews About Loss scale; TRIG Older Couples study. the resilient and date only collected up
in each group at 6 & 18 months n= 185 widow(er)s depressive-improved at 6 & 18 months;
identified by postloss. Original study completed both groups showed relatively Earlier than 6 months
Bonanno et al. gathered prospective follow-up interviews little grief, searching for postloss and more
(2002) reacted to data prior to death of (88% women, meaning, or processing the frequent assessment
and processed spouse. average of 72yrs) loss, and low would provide more
loss. In particular (Common grief avoidance/distraction reliable information on
differences in 10.7%; chronic grief scores. High levels of grief early experiences of
coping, meaning 15.6%; chronic in chronic grief group were bereavement;
making, context, depression 7.8%; found to be due to the Assessment beyond 2
and depression- upheaval surrounding the yrs may help
representations of improvement 10.2%; loss of a healthy spouse. differentiate the
the lost and resilience Chronic depression groups patterns of grieving
relationship were 45.9%) distress was related to more outcomes. Limits: No
examined. enduring emotional control group
difficulties that were
exacerbated by the loss.
Appendix B
Bonanno, G. A., III-3 To examine N/A Widowed participants of CES-D; Bereavement Data obtained from Common grief (10.7%), Stated Limits: Data was
Wortman, C. B., 2002 different patterns original study took part Index; Present Feelings Changing Lives of chronic grief (15.6%), self-report; Samples
Lehman, D. R., USA of bereavement in follow-up interviews About Loss scale; TRIG Older Couples study. chronic depression (7.8%), mean age was 72yrs;
Tweed, R. G., following the loss at 6 & 18 months n= 205 widow(er)s depression-improvement Only reported on 18
Haring, M., of a spouse and postloss. Original study (180 women and 25 (10.2%), and resilience months postloss.
Sonnega, J., et al. their predictors gathered prospective men) completed both (45.9%) were identified as Limits: No control
(2002). Resilience to data prior to death of follow-up interviews core bereavement patterns. group
loss and chronic spouse. (88% women, Resilient pattern was most
grief: A prospective average of 72yrs). frequent and no evidence
study from preloss to was found of a delayed
18-months postloss. grief pattern. Chronic grief
Journal of was associated with preloss
Personality and dependency. Resilience
Social Psychology, with associated to preloss
83(5), 1150-1164. acceptance of death and
belief in a just world.
Chronically depressed
individuals very similar to
CG patients. Chronically
depressed individuals
highly emotionally
unstable, had low
confidence in their ability
to cope with stressful
events and believed
strongly that negative
events were uncontrollable.

Appendix B
Bonanno, G. A., III-2
Znoj, H., Siddique, 1999
H. I., & Horowitz, USA
M. J. (1999). Verbal-
autonomic
dissociation and
adaptation to midlife
conjugal loss: A
follow-up at 25
months. Cognitive
Therapy and
Research, 23(6), 605-
624.
Brintzen-hofeSzoc, IV
K. M., Smith, E. D., 1999
& Zabora, J. R. USA
(1999). Screening to
predict complicated
grief in spouses of
cancer patients. A
Multidisciplinary
Journal of Cancer
Care, 7(5), 233-239.
Follow-up at 25 N/A Participants were 32-item Dyadic n = 42 conjugally Verbal-autonomic Stated Limits: Data is
months for randomly selected from Adjustment Scale bereaved 3-6 months dissociation was linked to in relation to a death of
Bonanno et al. the responders who meet (DAS); BDI; SCL-90; before intake into the the mildest grief course a spouse; Homogeneity
(1995) study on the inclusion criteria. 18-item self-report study (mean age with no evidence of of population; Study
that examined Questionnaires were checklist for somatic 48.2yrs, 69% female, delayed grief (even when did not use an objective
emotional mailed to participants 3- symptoms; Structured 83% Caucasian, controlling for initial level measure of health
avoidance (via 6 months postloss. grief-specific interview mean of 14.1yrs of grief). No enduring or outcome
verbal autonomic Structured grief designed by the authors; education) delayed health difficulties
response symptoms interview self-rating emotions; were found to be associated
dissociation) and were carried out 6 Heart Rate with verbal-autonomic
its effect on grief months postloss, then 17 dissociation.
symptoms days later semi-
structured narrative
interview. 14 & 25
months postloss grief
symptom interview were
conducted.
Pilot study to N/A Cross-sectional TRIG; FACE III; Brief n= 37 Spouse who 21% acute reaction Stated Limits: Small
identify descriptive, multi- Symptoms Inventory lost a spouse to (considered normal), 26% sample size; family
individuals at risk correlational study. (BSI); Global Severity cancer whilst being absence of grief, 12% functioning measure
of CG by Survey mailed to Index (GSI) an inpatient at a delayed grief reaction, 41% was retrospective;
examining the participants. cancer centre or prolonged grief reaction mode of data collection
relationship hospice (60% (21% normal and 83% was self-reported and
between family women; 92% complicated grief reaction). close-ended items;
functioning and Caucasian; 62% 52 For family functioning length of time since
psychological yrs or older married 48.6% identified as mid- death of spouse and
distress with grief more than 20yrs) range or balanced for data collection was 5 to
reactions cohesion and adaptability 19 months postloss.
dimensions. 46% reported
levels of psychological
distress identified as
clinical cases. Complicated
grief was more likely the
more distressed, depressed
and anxious the surviving
spouse was. Study supports
Appendix B
 the merits of screening
surviving spouses before
the death of their spouse.
Burnett, P., III-2 To develop a N/A Four-phase longitudinal 76-item bereavement n= 53 bereaved Seven subscales were Stated Limits: None
Middleton, W., 1997 scale that design: Participants phenomenology spouses, 52 adult produced from the factor stated.
Raphael, B., & Australia measures interviewed at 1 month, questionnaire (BQ). children, 53 analysis. Three of these
Martinek, N. (1997). bereavement and 10 weeks, 7 months, and Developed from bereaved parents tapped frequently
Measuring core to test its validity 13 months post- literature by Raphael & experienced bereavement
bereavement in different bereavement Middleton and from phenomena and were used
phenomena. bereaved clinical experience. to form a single measure
Psychological populations called the Core
Medicine, 27(1), 49- Bereavement Items (CBI).
57. Preliminary analysis
suggests that CBI is a
reliable and valid
instrument.
Chen, J. H., III-2 To examine if N/A Intake interview at time Modified version of n =150 widow(er)s Three distinct symptoms Stated Limits: Reduced
Bierhals, A. J., 1999 traumatic grief, of spouse's hospital Grief Measurement bereaved at 6 month cluster found (traumatic sample size due to
Prigerson, H. G., USA depression and admission and then Scale (only included interview (61% grief, depression, and stratification by gender;
Kasl, S. V., Mazure, anxiety symptoms intensive, face-to-face ICG items in order to female, mean age anxiety). Symptoms for all Rarity of some health
C. M., & Jacobs, S. form three distinct follow -up interviews at measure traumatic 62.1yrs female & three decreased outcomes may make
(1999). Gender symptom clusters 6 weeks, 6 months, 13 grief); CES-D; PERI 62.9yrs male, 89% significantly over 25 month the estimate of risk
differences in the and if these months, and 25 months white) / 135 interview period. No unreliable.
effects of symptoms predict after hospitalisation completed 13 month gender difference found for
bereavement-related the health assessment / 122 resolution of symptoms
psychological outcomes of completed 25 month over time. Widows
distress in health widow(er)s. assessment. (bereaved by 6 week
outcomes. interview) had higher mean
Psychological symptom levels for
Medicine, 29(2), traumatic grief, depression,
367-380. and anxiety at all four time
points postloss. High
traumatic grief symptom
levels at 6 months

Appendix B
 predicted physical health
outcomes at 25 months for
both men and women.
High traumatic grief
symptom levels in 1st yr
postloss tended to have a
stronger influence on the
physical and mental health
of widowers.
Cohen, J. A., III-3 Pilot study to Trauma- Parallel individual child Child completed: EGI n= 22 children who PTSD, CTG, anxiety, Stated Limits: Due to
Goodman, R. F., 2004 examine focused and parent therapy (measures CTG had lost a loved one depression, and no control, can't tell if
Brown, E. J., & USA effectiveness of cognitive- sessions with same symptoms); CPSS; due traumatic event behavioural problems recovery was due to
Mannarino, A. P. parallel individual behavioural therapist. Manual based MFQ; SCARED. Parent (6-17yrs old, 50% significantly improved therapy or natural
(2004). Treatment of child and parent therapy 16-week treatment (8 completed about child: female, 68% white, during treatment for recovery; RCT needed;
childhood traumatic trauma-focused trauma-focused, 8 grief- UCLA Index; CBCL. mean of 11.5 months children. CTG improved Small sample size.
grief: Contributing to cognitive- focused sessions). Parent completed about since death). All during both the trauma and
a newly emerging behavioural Sessions 60min long. self: PTSD Diagnostic children had grief focused session.
condition in the wake therapy for Scale; BDI-II significant CTG and PTSD only improved
of community childhood PTSD symptoms. during the trauma focused
trauma. Harvard traumatic grief sessions. Parents also
Review of (CTG) experienced improvement
Psychiatry, 12(4), in PTSD and depressive
213-216. symptoms.
deCinque, N., IV To determine N/A Survey of all major 19-item questionnaire n= 9 hospitals A multidisciplinary Stated Limits: Staff
Monterosso, L., 2004 current practice tertiary paediatric with open-ended and completed (10 bereavement service was education regarding
Dadd, G., Sidhu, R., Australia relating to oncology units in closed questions eligible). Setting = provided by most hospitals loss and grief, and the
& Lucas, R. (2004). hospital Australian and New Major tertiary for ~1yr after death of a provision of
Bereavement support bereavement- Zealand paediatric oncology child. Most common bereavement support
for families based support units hospital-based program was not covered in the
following the death programmes provided were counselling survey
of a child from and support groups.
cancer: Practice Significant number of
characteristics of hospitals worked from a
Australian and New limited theoretical basis
Zealand paediatric and understanding, did not

Appendix B
oncology units. formally evaluate their
Journal of Paediatrics programme, did not screen
and Child Health, for high risk of
40(3), 131-135. complicated grieving, and
areas of unmet needs were
identified.
Dyregrov, K., III-3 To explore the N/A Questionnaires GHQ-28, IES-15, ICG, n=232 parents from Self-isolation was found to Stated Limits: Small
Nordanger, D. & 2003 differences of completed and questionnaire developed 140 families (83 be the best predictor of sub-samples.
Dyregrov, A. (2003) Norway psychosocial subsample of 40 families specifically for study - families bereaved by psychosocial distress and
Predictors of impact of interviewed indepth mapped parental suicide, 37 by being female predicted
psychosocial distress survivors on experiences accident and 20 complicated grief in the
after suicide, sids and suicide, accident families lost a child suicide and SIDS samples.
accidents. Death and SIDS and to by SIDS). There was no evidence of
Studies, 27: 143-165. determine if suicide survivors having
characteristics of greater difficulties in
the survivor or the adapting to the death
deceased, time compared with survivors of
since death, or SIDS or accidents.
isolation best
explain the
variation of the
psychosocial
impact 1-1.5 years
post loss

Appendix B
Ellifritt, J., Nelson, IV To evaluate N/A Respondents asked to Bereavement Risk n = 508 (262 No significant association Stated Limits: Design
K. A., & Walsh, D. 2003 questionnaire that rate the 19 factors in the Questionnaire responded & 262 was found between may have influence
(2003). Complicated USA was developed to questionnaire using a 4- developed by authors were complete) profession and responses. responses as a list of
bereavement: A identify point scale to identify bereavement Significant risks factors possible risk factors
national survey of caregivers at risk which factors are coordinators of were rated by most to be: was provided. Limits:
potential risk factors. of CG considered by hospice programs. perceived lack of social Does not test the
American Journal of professionals to be risk support, caregivers history effectiveness of the
Hospice and factors for CG of drug/alcohol abuse, tool.
Palliative Care, caregiver poor coping
20(2), 114-120. skills, caregiver history of
mental illness, and if
patient is a child.
Field, N. P., & III-3 To examine Gestalt empty- Participants undertook BDI; IES; monologue n= 73 participants The extent of unresolved Stated Limits: Small
Horowitz, M. J. 1998 impact of chair the Gestalt empty-chair questionnaire contained (included for grief as assessed by the effect size; Empty-chair
(1998). Applying an USA unresolved technique: monologue task for 5 13 items indicative of analysis) who had on monologue questionnaire at technique may have
empty-chair feelings during empty minutes, then completed unresolved grief average lost a spouse 6 months postloss was had a therapeutic effect
monologue paradigm associated with chair questionnaires about the 6 months before the predictive of 14-months reducing symptoms
to examine the loss on later monologue task emotions they study postloss symptoms, even levels; No control
unresolved grief. adjustment in participant had experienced during the when statistically group; Self-selected,
Psychiatry, 61(4), conjugal one final task. Measures controlling for 6 months largely middle-class
279-287. bereavement opportunity to administered before the postloss symptoms in Caucasian sample.
speak to their monologue and 14 hierarchical regression
spouse months postloss (average analyses.
of 8 months after
monologue).

Appendix B
Finlay, I. G., & IV
Jones, N. K. (2000). 2000
Unresolved grief in UK
young offenders in
prison. British
Journal of General
Practice, 50(456),
569-570.
Germain, A., IV
Caroff, K., Buysse, 2005
D. J., & Shear, K. USA
(2005). Sleep quality
in complicated grief.
Journal of Traumatic
Stress, 18(4), 343-
346.
Pilots study Grief Structured interviews Screening questionnaire Male young Young offenders who Limits: Screening
looking at a grief awareness asking about to identify CG offenders with CGattended the program questionnaire to
awareness program bereavement (30-45 developed by medical reported more depression
(17-21yrs old): n= 8 identify young
programme for mins) staff and anxiety symptoms, as
attendees (mean age offenders with CG is
young offenders well as poorer coping with
18yrs, experienced not described;
with CG more bereavement death. More attendees had Structured interviews
overall than non-witness a violent death not described; No
attendees, 6 compared to non-attendees randomised control;
experienced a (n=3 & n=1 respectively). Small sample size; Rate
Attendees were older when
traumatic death), n= of CG identified by
7 non-attendees bereaved. Death of a father presented; Assumption
(mean age 19yrs).figure was three times as that those who attended
Setting = Prison common among attendees. program have higher
Use of illicit drugs to cope levels of trauma.
with grief was reported and
suicidal thoughts were
reported by those wanting
help with coping.
To examine the N/A Structured clinical HAM-D; PSQI; ICG; n= 105 Individuals Participants meet the Stated Limits: Small
severity of sleep interviews Structured Clinical with complicated criteria: 35.2% CG only; sample size to generate
disturbance due to Interview for DSM-IV grief (mean of 12.4% CG + PTSD; 28.6% group differences;
complicated grief, to assess MDD & PTSD 3.95yrs postloss, ICG CG + MDD; 23.8% CG + Need control with out
depression and/or score greater or PTSD + MDD. 12 (11.4%) CG, MDD and PTSD;
PTSD equal to 30, 76.2% participants had minimal Assessment occurred
white, 22.1% African sleep disturbances (PSQI on average ~4yrs
American, 84.8% scores <5). 9.44 mean postloss.
female; 43% violent global PSQI score for total
death; 43.8% on sample. Both ICG and
antidepressants) HAM-D scores predicted
poor sleep quality.
Depression worsened sleep
quality of individuals with
complicated grief, where as
PTSD did not.
Appendix B
Ginzburg, K., IV
Geron, Y., & 2002
Solomon, Z. (2002). Israel
Patterns of
complicated grief
among bereaved
parents. Omega:
Journal of Death &
Dying, 45(2), 119-
132.
Goodenough, B., IV
Drew, D., Higgins, 2004 term bereavement
S., & Trethewie, S. Australia and psychological
(2004). Bereavement
outcomes for parents
who lose a child to
cancer: Are place of
death and sex of
parent associated
with differences in
psychological
functioning? Psycho-
oncology, 13, 779-
791.
To assess patterns N/A Battery of questionnaires TIG; SCL-90; n= 85 bereaved Absent and delayed grief Stated Limits: All
of grief reaction 2.5 yrs after loss questionnaire based on parents lost child reactions most prevalent participants were
and their PAIS; during military variants (31 and 28 participating in a
adaptiveness in service. Setting = participants respectively). support group and data
bereaved parents Administered at the These were associated with collection occurred
who have lost a regular group lower levels of during the intervention,
child during sessions run by psychosocial adjustment leading to a
military service Rehabilitation compared to delayed grief confounding effect of
Department for the reactions. Circumstances of the intervention;
Israeli Ministry of the loss, level of education, Special characteristics
Defence and religious attitudes were of sample and unique
associated to the type of social context.
grief reaction.
Address the long- N/A Questionnaires were DASS 2; ICG; FAD; n= 25 father-mother Fathers reported Stated Limits: Self-
mailed to participants. dyads who had lost a significantly higher levels selected participants;
child within 5yrs of depression, anxiety and Confronting & highly
outcomes of (mean time since stress when a child died in personal retrospective
parents who have death 4.4yrs, 15 hospital rather than home. nature of study; May
lost a child to dyads child died at Mothers tended to show not capture more
cancer in relation home, mean age of smaller differences in distressed families; Did
to of parents child at diagnosis psychological outcomes as not address other
gender and place 5.7yrs, mean age of a function of place of factors such as
of child's death child at death death. Shorter time since preference for place of
8.3yrs). Setting = child's death, higher death, only explored in
Children's hospital depression scores and dichotomous fashion
centre for children's higher level of family (home vs. hospital).
cancer and blood friction associated to
disorders higher ratings of traumatic
distress, separation distress,
and core grief. Female
parent associated to higher
ratings of traumatic
distress, and core grief.
Death in hospital
associated to higher core
Appendix B
 grief scores.
Goodkin, K., II To examine the Homogenous Participants were TIG, ad hoc n = 166 homosexual The bereavement support Stated Limits: Not
Blaney, N. T., 1999 impact of a semi- HIV-1 randomly assigned to a complicated grief index, men with HIV, group significantly reduced generalisable to
Feaster, D. J., USA structured seropositive & group and assessed at Profile of Mood States, Setting: Not stated bereavement-related populations with more
Baldewicz, T., bereavement HIV-1 entry and at 10weeks. TMD, grief-overall distress. However, grief severe distress and/or
Burkhalter, J. E., & support group seronegative distress composite also significant decreased psychopathology;
Leeds, B. (1999). A among HIV men randomly score, SIGH-AD, HAM- in control group. Small number of HIV-
randomized homosexual males assigned to A 1seropositive subjects
controlled clinical either with advanced disease.
trial of a bereavement bereavement Limits: Unclear about
support group inter- support group support group.
vention in human or control
immunodeficiency group
virus type 1-
seropositive and
sero negative
homosexual men.
Archives of General
Psychiatry, 56(1), 52-
59.
Hardison, H. G., III-2 To examine the N/A Data used from ICG; 14-item sleep n = 508 Bereaved 22% of bereaved group and Stated Limits: Data was
Neimeyer, R. A., & 2005 relationship Prigerson & Jacobs questionnaire consistent undergraduate 17% of nonbereaved group self-reported;
Lichstein, K. L. USA between (2001) study. with DSM criteria for psychology students reported insomnia. For the Population reflected
(2005). Insomnia and insomnia, CG, Questionnaires insomnia (bereaved in last 2 insomniacs middle college men and
complicated grief and type of death distributed to bereaved yrs, 76% female, insomnia was higher in women, Caucasians
symptoms in and non-bereaved mean age 20.57yrs, bereaved than nonbereaved and African Americans,
bereaved college participants. 58% white & 37% (67% vs. 50%). Bereaved but not other ethnic
students. Behavioral African American) & insomniacs had groups; Does insomnia
Sleep Medicine, 3(2), n= 307 Nonbereaved significantly higher CG effect CG or CG effect
99-111. students (73% scores than bereaved non- insomnia? 73% of
female, mean age insomniacs. Bereavement- participants were
20.55yrs, 65% white, related sleep variables female.
28% African (dreaming of deceased and
American). Setting = ruminating about the
Questionnaires deceased) were

Appendix B

Hogan, NS., III-2
Greenfield, DB., 2001
Schmidt, LA. (2001) USA
Development and
validation of the
hogan grief reaction
checklist. Death
Studies, 25, 1-32.
distributed in significantly related to CG
undergraduate symptomology. CG was
psychology classes more frequent in
traumatically bereaved
young adults, and the
closeness to the deceased
was associated to more
complications.
To provide data N/A Interviews and anecdotal Hogan Grief Reaction n=209 parents from Six catergories identified: Stated Limits: the use
on a recently data were obtained and Checklist (HGRC) mutual bereavement despair, panic behaviour, of cross-sectional data.
developed content analysed to support groups blame and anger,
instrument to obtain 6 theoretical disorganisation,
measure the categorial. Items were detachment, and personal
multidimensional generated to represent growth.
nature of the the properties of the The HGRC subscales were
bereavement caterhories. An initial set compared to subscale
process of 100 items was scores on the Texas
developed and then Revised Inventory of Grief
analysed using focus (TRIG), Grief Experience
groups. A panel of Inventory (GEI), and
experts reviewed the Impact of Event Scale
items. The scale was (IES) to determine
then given to several convergent and divergent
different samples and validity. Statistically
revised. significant correlations
were reported and were
clinically interpretable.
The instrument was also
able to detect changes in
bereavement responses
Appendix B
 over time.

Hogan, NS., III-3 To empirically N/A Questionnaires CGD, HGRC, BDI-II n= 166 bereaved The pattern of correlations Stated limits: None
Worden, JW., 2003-4 test the distributed parents recruited between the CG factors of stated.
Schmidt, LA. (2003- USA complicate grief from National Donor separation distress and
4) An empirical study disorder criteria Family Council of traumatic distress, and the
of the proposed the National Kidney normal grief factors of the
complicated grief Foundation HGRC were significant
disorder criteria, and large. Hogan and
Omega, 48(3) 263- colleagues argue that these
277. findings challenge the
notion that CG and normal
grief are conceptually
distinct.

Appendix B
Horowitz, M. J., III-3 To investigate a N/A Structured clinical Structured Clinical n= 70 participants 7 out of 30 grief symptoms Stated Limits: None
Siegel, B., Holen, A., 1997 new diagnosis interviews and self- Interview for DSM-III- whose long-term assessed 6 and 14 months stated
Bonanno, G. A., USA that would report rating scales 6 & R-Non-Patient Edition spouse/partner had postloss were identified as
Milbrath, C., & include the 14 months postloss (SCID-NP); TRIG; died (21-55yrs of potential diagnostic criteria
Stinson, C. H. symptoms that Reaction to Loss age; lived together for CG. 3 or more of the
(1997). Diagnostic differ from the Inventory for minimum of 3yrs) possible 7 symptoms was
criteria for DSM major classified as CG. 41%
complicated grief depressive (n=29) of subjects meet
disorder. American disorder this criteria for CG. 29%
Journal of Psychiatry, (n=6) of these 29
154(7), 904-910. participants had a
concurrent diagnosis of
major depressive disorder.
Participants with a history
of depressive disorders
were significantly
associated with current CG.
Supports a new DSM
category for CG.
Johnson, J., First, IV To investigate N/A Interviews conducted ICG-R, Stigma n=135 recently 16 participants (12%) had a Stated Limits: small
M., Block, S., USA attitudes about with participants Receptivity Scale bereaved individuals psychiatric disorder and 16 sample size in the sub-
Vanderweker, L., In press grief symptoms, (SRS). who had completed had had CG at some point group analyses and lack
Bambauer, K., receptivity to assessments of CG during study. 6 of 16 had of a comparison group
Zhang, B. & treatment for and attitudes about both CG and a psychiatric of non-bereaved.
Prigerson, H. (In mental illness, grief during their disorder, 10 had only a
Press) Stigmatization and stigmatization participation in the psychiatric disorder, and
and receptivity to arttributable to Yale Bereavement another 10 had CG only.
mental health grieving among Study (YBS). Both a psychiatric
services among bereaved persons diagnosis and CG were
recently bereaved in the community independent predictors of
adults. recent mental health
services use. Receptivity to
a bereavement support
group sig. increased the
odds that they had used any
mental health services in

Appendix B
 past 60 days compared
with those who were not
receptive to the support
group. Individuals who
were concerned about
meeting criteria for a
mental illness were sig.
less likely to have received
any mental health
treatment than those who
were not concerned about
meeting criteria.
Jones, D., Harvey, IV To examine the N/A Data used from study Grief severity measured Interview data used 33 (22% of 148 ) reported Stated Limits: None
J., Giza, D., 2003 prevalence of into assertive community by changes in global from a subsample of death of significant other stated. Limits: Self-
Rodican, C., USA significant loss treatment programs and self-rating from death original study: 148 with majority (21 of 33) reported; Poor
Barreira, P., & and CG in certified clubhouse event; PANSS Participants with a involving the loss of one or measures of grief;
Macias, C. (2003). psychiatric programs. 3-5 years after serious mental illness more parent. Parental death Frequency of
Parental death in the outpatients. In entering the study (52% schizophrenia, was less likely to be complicated situational
lives of people with particular the participants were asked 30% major accompanied by factors was looked at
serious mental affects of parental to review a chart of life depression, 18% complication factors. Death rather than measuring
illness. Journal of bereavement. events and report how bipolar) (average of parent were less sudden. CG; Small sample.
Loss & Trauma, 8(4), they were doing at each age 38yrs, 10% 52% (11) of parental deaths
307-322. life event. Data was used Hispanic, 10% had complicating factors
for those who self- African American, and resulted in more severe
reported losing a 55% male). Setting and prolonged grief, most
significant other. = Psychiatric also had not had any
outpatient service preparation for parental
loss.

Appendix B
Jordan, J. R., III-3 To assess the N/A GEM and several other GEM; ICG; ITG; IES- Validity testing - n = GEM's internal consistency Stated Limits: Sample
Baker, J., Matteis, 2005 psychometric measures were filled out R; Treatment Outcome 92 bereaved adults and test-retest reliability not representative of
M., Rosenthal, S., & USA properties of the and mailed back by the Package; SF-36 for initial sample, n were high. Results in the entire bereavement
Ware, E. S. (2005). grief evaluation validity testing sample at = 53 bereaved adults two weeks test-retest population; May have
The Grief Evaluation measure (GEM). intake and one year for 1 year follow up reliability was very high been a selection bias;
Measure (GEM): An This article follow up. The reliability (bereaved in last two for both the Experience Majority of sample
initial validation focuses on the group received two sets yrs at intake of section and the Problems female and uneven
study. Death Studies, most central parts of GEM, one to study). Test-retest section of GEM (r= 0.97 & distribution of age;
29(4), 301-332. of GEM, the complete immediately reliability testing - n 0.88 respectively). GEM Reliability and validity
sections and one to complete two = 23. Majority of Experience correlated may not be as high with
'Experience' and weeks later. participants, for both highly with other grief more representative
'Problems' which samples, were female measures. GEM sample; Self-reported
directly assess and Caucasian. Experiences successfully measure may be
current grief and predicted psychological influenced by
symptom levels. adjustment 1yr after initial personality, defensive
evaluation. For GEM styles, and current
Problems a strong mood; Length of
correlation was found measure. Limits:
between initial measure Majority of sample
and 1yr later. GEM Caucasian
Experience and Problems
sections appear to be a
valuable screening
instrument.
Kempson, D. A. III-2 To investigate the Touch therapy Six to eight 1-hour GEI; MSPSS n = 64 bereaved Touch therapy was found Stated Limits: No
(2000-2001). Effects 2000- effect of touch group and intervention sessions mothers (Majority to significantly improve specific instrument to
of intentional touch 2001 therapy on control group within 14-weeks white and middle- despair, depersonalization, measure experience of
on complicated grief USA grieving mothers class) and somatization. touch; Possible sample
of bereaved mothers. bias of participants who
Omega: Journal of were seeking
Death & Dying, assistance; Participants
42(4), 341-353. primarily white &
middle-class. Limits:
Does not measure or
report on CG.

Appendix B
Kim, K. and Jacobs, IV To examine the Telephone interviews SCID, CES-D; PERI; n=25 widows and 64% of participants met Pilot study - a larger
S. (1991). 1991 relationship which consisted of measures of separtion widowers (bereaved
criteria for patholgocial sample size required to
Pathological grief USA between several self-report distress and numbness/ for over 6 months)
grief. The group with gain stronger test
and its relationship to pathological gried measures of emotional disbelief; TIG and a (average age 51yrs;
pathological grief was results.
other psychiatric and two disorders: distress self-rating of the 92% widows, 68% significantly more likely to
disorders. Journal of major depression severity of grief (scale completed be diagnosed with major
Affective Disorders, and anxiety of 0-4). highschool, 56% depression than those
21: 257-263. disorders employed. without pathologic grief.
They were also more likely
to be diagnosed with
anxiety disorders (not
significant). Risk factors
were compared between
the groups, however no
signficant differences were
found expect for acute
cardiac cause of spouse's
death, which was observed
significantly more often in
the group with pathologic
grief.
Kissane, DW., III-3 To identify N/A Questionnaires Family Environment n= 115 families who Five types of families Stated limits: response
Bloch, S., Dowe, 1996 patterns of family adminstered 6 weeks, 6 Scale, Family had lost a parent emerged from dimensions rate of 68%
Dl., Snyder, RD., Australia functioning in months, 13 months after Adaptability and of cohesiveness, conflict
Onghena, P., adult families the death of a parent Cohesion Evaluation and expressiveness on the
McKenzie, DP., after the death of Scales (FACES II), BDI Family Environment Scale.
Wallace, CS., a parent and BSI 36% of families were
(1996) The considered supportive and
Melbourne family another 23% resolved
grief study, I: conflict effectively. Two
Perceptions of family types were dysfunctional:
function ing in hostile families and sullen
Bereavement, The families.
American Journal of
Psychiatry, 153(5),
650-658

Appendix B
Kissane, DW., III-3 To describe the
Bloch, S., Onghena, 1996 intensity of grief,
P., McKenzie, BA., Australia the psychosocial
Snyder, RD., Dowe, morbidity, and the
DL., (1996) The coping patterns in
Melbourne family members of
grief study, II: families classified
Psychosocial according to a
morbidity and grief typology of
in bereaved families, family
The American functioning
Journal of Psychiatry, comprising
153(5), 659-666 support, conflict-
resolving,
intermediate,
sullen, and hostile
classes
Kristjanson, LJ., III-2 To test the
Cousins, K., Smith, 2005 validity,
J., and Lewin, G. Australia reliability and
(2005) Evaluation of feasibility of
the Bereavement using a modified
Risk Index (BRI): A verson of Parkes'
community hospice (1993)
care protocol for Bereavement Risk
bereavement support, Index (BRI) and
International Journal bereavement
of Palliative Nursing, support protocol
11(12), 610-618. in an Australia
home hospice
care setting
N/A Questionnaires Bereavement n= 115 families who Sullen families displayed Study limits: study
adminstered 6 weeks, 6 Phenomenology had lost a parent the most intense grief and group biased by
months, 13 months after Questionnaire, the most severe nonresponders,
the death of a parent Cognitive items of the psychological morbidity. dropouts and the
Beck Depression Well-functioning families study's requirement for
Inventory and the Brief (supportive and conflict- spoken English,
Symptom inventory, resolving) resolved their exclusion of patients
grief and adjusted more older than 65 years
adaptively than their
dysfunctional counterparts
(intermediate, sullen and
hostile).
Participants Outcome measures were BRI, CBI, SF-36, FAD n= 150 bereaved Results indicated that a Stated Limits: None
received 1 of 3 completed at three and family members. 72 shorter 4-item version of stated.
types of six month post-death by of the participants the BRI was more
bereavement the family member were the patient's internally consistent than
support: wife, 32 were the the longer 8-item version
follow-up patient's husband, 28 and demonstrated good
based on BRI were the patient's predictive validity when
assessment daughter and the correlated with outcome
from nurses remaining 18 measures at 3 and 6 months
who had described their following the patients
received a relationship to the death. 7% oif the
bereavement patient as other. individuals were classifed
education in the 'high risk'
program, category.All bereaved
follow-up from family members in the
nurses who had study reported poorer
received a health scores as measured
bereavement by the SF36 at three and
education six months following the
Appendix B
 program only, patients death, compared
or standard with normative data for the
care. same aged groups.
Latham, A. E., & III-3 To examine the N/A On average baseline and YES; ICG-R; Structured n= 281 widowed Cross-sectionally, CG was Stated Limits: Only
Prigerson, H. G. 2004 influence of CG follow-up interviews Clinical Interview for persons who had associated with a greater examined risk factors
(2004). Suicidality USA on suicidality were completed at 6.2 the DSM-IV; ISEL completed data forlikelihood of high for suicidality not
and bereavement: among bereaved and 10.8 months postloss suicidality and CGsuicidality (6.58 times suicide per se; majority
Complicated grief as adults measures (20-91yrsgreater at 6.2 months Caucasian and female
psychiatric disorder old, mean 64yrs, postloss and an 11.30 times sample; Data collected
presenting greatest 92.2% Caucasian, greater at 10.8 months at only two time points.
risk for suicidality. 73.5% female, postloss) after controlling
Suicide and Life- average 14yrs for confounders (gender,
Threatening education). race, major depressive
Behavior, 34(4), 350- disorder, PTSD, and social
362. support). Concluded that
CG substantially heightens
the risk of suicidality.
Layne, C., Pynoos, IV To investigate trauma/grief pre-group and post- Reaction-Index Revised, n= 55 war- 50% of the students Stated Limits: groups
R., Saltzman, R., 2001 whether focused group group self-report GSS, Depression, Self- traumatized showed reliable started at different
Arslanagic, B., USA & participation in psychotherapy questionnaires of Rating Scale, Child-Self secondary school improvements in the points during year, less
Savjak, N., Popovic, Bosnia trauma/grief- posttraumatic stress, Rating Scale, Self- students in Bosnia primary outcome measures than half the school
T., Durakovic, E., focused group depression and grief Satisfaction Survey (73% girls and 27% of posttraumatic stress and completed the full
Music, M., et al. psychotherapy symptoms. boys ranging 15-20 grief symptoms and 35% treatment protocol, the
(2001) Trauma/grief- was associated years). showed reliable study did not involve a
focused group with reduced improvements in control group or
psychotherapy: posttraumatic depressive symptoms. random assignment to
School-based stress, treatment providers and
postwar intervention complicated grief relied only on self-
with traumatized and depressive reported instruments,
Bosnian adolescents. symptoms the comparison group
Group Dynamics: participated in
Theory, Research, treatment of a shorter
and Practice, 5(4): p. duration than the full-
277-290. program participant.

Appendix B
Lev, E., Monro, B. IV To revise the GEI N/A Questionnaires were Revised Grief n = 418 Bereaved Taking medication for Stated Limits:
H., & McCorkie, R. 1993 according to mailed to participants. Experience Inventory primary care givers anxiety was associated to Response rate of 41%;
(1993). A shortened USA, UK, Parkes (1972) Included a cover letter (RGEI) of a significant other increased RGEI scores. majority of participants
version of an Australia framework which and first class return (78% female; 88% Subjects relationship to were middle-aged
instrument outlined grief as postage. Caucasian; 343 deceased predicts grief Caucasian women in
measuring stages that blend deceased due to reaction, with spouses middle to upper
bereavement. into and replace cancer; 201 spouse having a greater reaction socioeconomic strata;
International one another. Then to deceased) than those who lost a Did not address support
Journal of Nursing test the validity of parent. RGEI had an or stressors. Limits:
Studies, 30(3), 213- the measure. internal consistency Majority of participants
226. reliability of 0.93. Shown were the spouse of the
to be a concise, valid, anddeceased; Majority of
reliable grief measure. deceased had died due
to cancer.
Macias, C., Jones, IV To explore the N/A Data used from study Grief severity measured Interview data used 33 (22% of 148) reported Stated Limits: Small
D., Harvey, J., 2004 prevalence of into assertive community by changes in global from a subsample of death of significant other sample size; Self-
Barreira, P., USA severe grief and treatment programs and self-rating from death original study: 148 with majority in 6 months reports by participants.
Harding, C., & the situational certified clubhouse event; PANSS Participants with a preceding enrolment or Limits: Measures of
Rodican, C. (2004). factors that programs. 3-5 years after serious mental illness after enrolment. Of these grief not described
Bereavement in the contribute to it entering the study (90% on psychiatric 15 had relatively acute and sufficiently; No
context of serious among adults with participants were asked medication, 51% brief grief & 18 had severe control; Psychiatric
mental illness. a serious mental to review a chart of life male, 22% ethnic and prolonged grief. If any patients not compared
Psychiatric Services, illness. And events and report how minority, 53% of the situational factors to general population.
55(4), 421-426. whether these they were doing at each schizophrenia, mean (sudden death, residing
situational factors life event. Data was used age 38yrs). Setting = with deceased at time of
are the same as for those who self- Psychiatric death, co-occurring
the general reported losing a outpatient service stressors, & low social
population. significant other. support) accompanied
death of a significant other
the participants were
significantly more likely to
experience prolonged or
severe grief, irrespective of
psychiatric
symptomatology.

Appendix B
 Maercker, A., et al., 1998 N/A Narrative Interviews The Diagnostic n= 44 (27 widows 8 positive and 8 negative Stated Limits: sample
(1998) Prediction of conducted and a number Interview Model for and 17 men) who had themes were identified. size and homogenous
complicated grief by of assessments taken Grief, TRIG, impact of been bereaved Findings revealed no sample given the
positive and negative Event Scale (IES), BDI between 3 and 6 systematic relationship potential effect of cross
themes in narratives. and BAI. months prior to the between corresponding cultural factors.
Journal of Clinical study. negative and positive
Psychology, 54(8): themes. Only small inter-
p. 1117-1136. correlations among and
within the positive and
negative themes were
found.
McCallum, M., III-1 To investigate Interpretive or Patients were matched in 7 items developed by n = 139 outpatients Immediate dropouts after Stated Limits: The
Piper, W. E., 2002 early group supportive pairs according to their Prigerson; PGI; IES; with CG began the first therapy session experience of positive
Ogrodniczuk, J. S., Canada process variables short-term QOR, PM, use of SAS-SR; Affect; treatment (74% had reported significantly less feelings reported may
& Joyce, A. S. as predictors of group therapy medications, gender and Cohesion Questionnaire; Axis I diagnosis; positive affect (pleasure, not reflect a reaction to
(2002). Early process CG participants age. Matched patients Therapeutic alliance; 52% Axis II warmth, acceptance, or group therapy as the
and dropping out dropping out of randomly assigned to Group Climate diagnosis; average optimism) than those who participants where not
from short-term group one of the treatment Questionnaire age 41.7yrs; 77% remained. The therapists' restricted to rating
group therapy for psychotherapy groups. Weekly 90-min female; 90% also reported significantly events within the group
complicated grief. sessions over 12 weeks. Caucasian). Setting: lower cohesion ratings for
Group Dynamics: Process measures Outpatient dropouts than those who
Theory, Research, administrated at psychiatric clinic remained. Hence,
and Practice, 6(3), commencement of encouragement of positive
243-254. therapy and after each affect and the facilitation of
session. bonds among group
members by the therapist is
important early in therapy.

Appendix B
McCallum, M., III-1 Whether two Data from two Patients were matched in PMAP; TAS-20 Setting: University- Comparing patient Stated Limits: Predictor
Piper, W. E., 2003 patient trials: Each pairs according to their based psychiatric characteristics and therapy variables were
Ogrodniczuk, J. S., Canada characteristics, trial compared QOR, PM, use of treatment clinic; a) n types failed to show any relatively small
& Joyce, A. S. PM and interpretive or medications, gender and = 107 outpatients strong evidence of effect percentages of the
(2003). Relationships alexithymia, are supportive age. Then assigned with CG (average on treatment outcome. outcome variables;
among psychological predictors of therapies; a) randomly to a therapy age 43yrs; 77% Higher levels of PM and Different methods of
mindedness, psychotherapy short-term and therapist. female; 90% lower levels of alexithymia assessment were used
alexithymia and outcomes group therapy Caucasian; average were associated with for alexithymia and PM
outcome in four for CG of 9yrs since loss; benefit from all types of which may have
forms of short-term patients; b) 72% previous therapy. Hence, these two contributed to these
psychotherapy. short-term psychiatric patient characteristics are factors being found to
Psychology and individual treatment); b) n = thought to be important to be independent of one
Psychotherapy, 76, therapy for a 144 outpatients of the success of therapy. another
133-144. heterogenous mixed diagnosis
sample of (average age
psychiatric 34.3yrs; 61% female;
outpatients 94% Caucasian;
73% previous
psychiatric
treatment).
McDermott, O. D., III-3 To explore if CG N/A Participants were part of SADS-L; TRIG; GMS; n= 65 elderly CG and depression Stated Limits: Proxy
Prigerson, H. G., 1997 symptoms are a a longitudinal EEG sleep HDRS; BSI; PSQI; bereaved spouses symtomology was found to measure of CG was
Reynolds, C. F., USA form of PTS study by Reynolds Proxy measure of ICG (>60yrs, 57% both co-occur and occur in used rather than precise
Houck, P. R., Dew, rather than (1992). Subjects kept a consisting of 13 of the female) isolation in subjects. Whilst criteria
M. A., Hall, M., et depression, and if sleep-wake diary 19 items mild subjective sleep
al. (1997). Sleep in they have a impairment was associated
the wake of different effect on with CG no effect was
complicated grief sleep detected using the
symptoms: An electroencephalographic
exploratory study. (EEG) sleep measures. CG
Biological interacted with depression
Psychiatry, 41(6), to increase REM sleep
710-716. percentage. CG does not
appear to have the same
effect on sleep as
depression.

Appendix B
Melhem, N. M., III-3
Day, N., Shear, M. 2004
K., Day, R., USA
Reynolds, C. F., &
Brent, D. A. (2004).
Predictors of
complicated grief
among adolescents
exposed to a peer's
suicide. Journal of
Loss & Trauma,
2004. 9(1): p. 21-34.
Melhem, N. M., III-3
Day, N., Shear, M. 2004
K., Day, R., USA
Reynolds, C. F., &
Brent, D. A. (2004).
Traumatic grief
among adolescents
exposed to a peer's
suicide. American
Journal of Psychiatry,
161(8), 1411-1416.
To examine the N/A Interviewed at 6, 12-18, TIG, DSM-III-R, n= 146 friends & Multivariate analyses Stated Limits: Sample
predictors of & 36 months after peer's PTSD-Reaction Index acquaintances of 26 showed that complicated consisted of friends and
complicated grief, suicide. suicide victims (18- grief at 6 months was acquaintances of
depression and 21 yrs, 45% female, significantly associated suicide victims with
post traumatic 95.5% white, 54.8% with gender (female), high rates of previous
stress disorder previous psychiatric participants feeling that psychiatric problems,
among disorder). Setting = they could have done the 6 month assessment
adolescents Not stated something to prevent the may have been affected
exposed to the death and a previous by recall bias leading to
suicide of a peer history of depression. under-reporting, and
PTSD at 6 months was their current mental
significantly associated status leading to over-
with a previous history of reporting.
anxiety disorders (p=.003,
CI 2.2-38.7); that they
could have done something
to prevent the death;
financial problems and a
previous history of
depression.
To describe N/A Interviewed at 6, 12-18, TRIG; ICG n= 146 friends & 29 participants had Stated Limits: 54.8%
traumatic grief & 36 months after peer's acquaintances of 26 traumatic grief at 6 months. participants had
among suicide. Subgroup suicide victims (18- Occurrence of traumatic previous psychiatric
adolescents interviewed 6 years 21 yrs, 45% female, grief was found to be history; assessment of
exposed to peer afterwards. 95.5% white, 54.8% independent to depression grief reactions needed
suicide. Examine previous psychiatric and PTSD. Traumatic grief directly after suicide;
relationship disorder). Setting = at 6 months predicted Length of time
between traumatic Not stated depression and PTSD at variation in second
grief, depression, subsequent assessments. assessment (12-18
and PTSD. months); Ethnic
homogeneity of group
(95.5% white)
Appendix B
Melhem, N. M., IV To examine the N/A Data used from a pilot ICG; Structured Clinical n= 23 with ICG 44% had only 1 concurrent Stated Limits: As the
Rosales, C., 2001 rate of DSM-IV study of an exposure- Interview for DSM-IV; scores of 25 or above diagnosis, 48% had 2 or participants were
Karageorge, J., USA Axis I disorders in based psychotherapy for BAI; BDI; PDS; WSAS (21 participants more additional psychiatric referred and help-
Reynolds, C. F., a sample of traumatic grief. All referred from disorders, 8% had a seeking the level of
Frank, E., & Shear, traumatic grief participants had psychiatric clinic, 2 lifetime diagnosis. 52% psychiatric comorbidity
K. (2001). symptomology traumatic grief (assessed self-referred) (17 major depressive disorder, is likely to be higher
Comorbidity of axis participants by ICG). A Structured female, mean age of 30% PTSD. 52% had a than community
1 disorders in Clinical Interview for 52.6yrs, 21 prior psychiatric history. sample; Small sample
patients with DSM-IV was Caucasian, mean of ICG scores and functional size; No comparative
traumatic grief. The administered at intake to 4.4yrs since loss). impairment were higher group
Journal of Clinical assess lifetime and among patients with more
Psychiatry, 62(11), current psychiatric than one concurrent Axis I
884-887. disorders. diagnosis. Hence, prior
psychiatric illness may be a
risk factor for traumatic
grief.
Mitchell, A., Kim, III-3 To assess suicide N/A Within 1 month postloss ICG n = 60 Caucasian 43.3% (26 of 60) scored Stated Limits: Level of
Y., Prigerson, H., & 2004 survivors for CG participants completed survivors of suicide above 25 on the ICG & emotional attachment
Mortimer-Stephens, USA baseline measures as part (72% female) classified as having CG. to the suicide victim
M. (2004). of a large crisis Closely related suicide was not taken into
Complicated grief in intervention study survivors experienced account. Limits: Pilot
survivors of suicide. nearly twice the level of study; Small sample
Crisis, 25(1), 12-18. CG than distantly related size in subgroups;
survivors (37.44 compared Participants were
to 17.27). Caucasian and majority
female.

Appendix B
Mitchell, A. M., III-3 To examine the N/A Within 1 month postloss ICG; BDI; Suicide n= 60 Suicide 43.3% scored above 25 on Stated Limits: Small
Yookyung, K., 2005 association of participants completed ideation determined by survivors (lost family the ICG & classified as and homogenous
Prigerson, H. G., & USA suicide ideation baseline measures as part BDI member or having CG. Syndromal sample; Possible
Mortimer, M. and CG in of a large crisis significant other, levels of CG 9.68 times selection bias as
(2005). Complicated survivors of intervention study 72% female, 100% more likely to report participants were taking
grief and suicidal suicide Caucasian, 67% suicidal ideation, after part in crisis
ideation in adult Catholic, 23% controlling for depression. intervention study;
survivors of suicide. Protestant, mean age CG was highly predictive Family network effect
Suicide & Life- 43.3yrs) of suicide ideation in not examined fully.
Threatening suicide survivors with a
Behavior, 35(5), 498- 83.3% predictive success.
506.
Momartin, S., III-3 To examine grief N/A Structured clinical trauma invetory;CBI; n= 126 Bosnian 31% scored above CG Stated Limits: Modest
Silove, D., 2004 and its interviews were used to Clinician-Administered Muslim refugees threshold. Only sample size; non-
Manicavasagar, V., Australia relationship to obtain information about PTSD scale; SCID (61% female, mean widowhood due to war was random selection of
& Steel, Z. (2004). PTSD and participants experiences age 47yrs, 5yrs associated to higher CBI participants; Snowball
Complicated grief in depression in during war (interpreter average since scores. Traumatic loss was sampling yielded high
Bosnian refugees: Bosnian refugees used). exposure to most a significant predictor of levels of
Associations with severe trauma, 74% CG (odd ratios of 2.1-6). psychopathology;
posttraumatic stress spoke little or no No association between Retrospective nature of
disorder and English). Setting = PTSD and grief, except results & average of
depression. Participants own low-order association with 5yrs since trauma;
Comprehensive home PTSD intrusion dimension.
Psychiatry, 45(6), Strong association found
475-482. between of grief/depression
subgroup and traumatic
loss.

Appendix B
Monk, T.H., Houck, III-3 To determine Patients matched with Diary asked questions n= 64 patients. CG patients were Stated limits: historical
P.R., Shear, M.K. 2006 which elements of control according to age, about sleep and dream Control group (64) significantly more likely control group obtained
(2006), The daily life USA a patient's daily gender ratio, and and events that the obtained from than controls to miss from a different study.
of complicated grief routine were minority representation. patients had been existing data in priorpersonal contact, breakfast, The study does not
patients-what gets likely to be Baseline data acquired involved in on that day studies. lunch, dinner, work, have a 'simple' grief
missed, what gets missed or added. during the first 2 weeks exercise, and going control group
added? of participation in larger outside, and significantly
treatment study. Each more likely than controls to
patient completed a add an afternoon nap and
supplemental diary for an evening snack or drink.
14 consecutive days at Activity scores were lower
baseline. for CG than controls.
Nakao, M., III-2 To examine the Questionnaires TIG, TAS-20, POMS, n=54 bereaved TIG scores were Stated limits: patient
Kashiwagi, M., 2005 relationship adminstered to women (33 significantly associated and no-patient samples
Yano, E. (2005). Japan between grief participants outpatients attending with the first TAS-20 were grouped together
Alexithymia and reactions and the Psychosomatic factor of Difficulty in for an analysis of wide-
grief reactions in alexithymia. Clinic and 21 healthy Identifying Feelings and range date relating to
bereaved Japenese volunteers) POMS. The scores on the the TIG and TAS-20
women. Death first TAS-20 factor were scores. Results cannot
Studies, 29: 423-433. higher in the be generalised to non-
psychosomatic group than Japenese people. The
in the normal group. Japenese version of the
POMS scores significantly TIG has not been
associated with TIG scores validated. Small sample
and also higher in the size.
psychosomatic group.

Appendix B
Ogrodniczuk, J. S., III-1 Role of patients Interpretive or Patients were matched in 7 pathological grief n = 47 outpatients Women where found to Stated Limits: Small
Piper, W. E., & 2004 gender on group supportive pairs according to their items ; 7-item Intrusion with CG and major generally have better sample size; Small
Joyce, A. S. (2004). Canada therapy process group therapy QOR, PM, use of subscale and 8-item depression (average outcomes compared to men number of men; Only
Differences in men's and outcome medications, gender and Avoidance subscale of age 42.9yrs; 77% across both treatment gender-mixed groups
and women's age. Matched patients IES; 13-item Present female). Setting: groups. In comparison to were studied; The
responses to short- randomly assigned to Feelings subscale of the Outpatient women, men were less effect of patient
term group one of the treatment TRIG; DSM-III-R; BDI; psychiatric clinic committed and perceived preference for a
psychotherapy. groups. Weekly 90-min STATE; Global other group members as particular treatment
Psychotherapy sessions over 12 weeks. Severity Index of the less compatible. Hence, was not investigated
Research, 14(2), 231- Brief Symptom, men may benefit less from
243. Checklist group psychotherapy than
women.
Ogrodniczuk, J. S., III-1 Association Interpretive or Patients were matched in PGI; IES; SAS-SR; n = 107 outpatients Engagement was Stated Limits: Results
& Piper, W. E. 2003 between supportive pairs according to their GCQ-S with CG completed significantly associated to are correlation, not
(2003). The effect of Canada perceived group short-term QOR, PM, use of (73.8% had Axis I favourable treatment possible to determine
group climate on climate group therapy medications, gender and diagnosis; 55.1% outcome. Neither causal effect; Findings
outcome in two (engagement, age. Matched patients Axis II diagnosis; avoidance or conflict was limited to significant
forms of short-term avoidance, and randomly assigned to average age 43yrs; significantly related to loss and CG; Did not
group therapy. Group conflict) and one of the treatment 77% female; 90% outcome. The two therapies examine relationship
Dynamics: Theory, treatment groups. Weekly 90-min Caucasian). Setting: did not differ significantly between type of loss
Research, and outcomes in sessions over 12 weeks. Outpatient in the relationship between and perception of group
Practice, 7(1), 64-76. group therapy psychiatric clinic group climate dimensions climate; Analysis of
and outcome. study did not account
for nested nature of the
data; Only three
repeated assessments of
group climate over time

Appendix B
Ogrodniczuk, J. S., III-1 Changes in Interpretive or Perceived social support PGI, IES, SAS-SR n = 61 psychiatric Perceived social supportStated Limits: Did not
Joyce, A. S., & 2003 perceived social supportive was measured pre- outpatients with CG assess different types of
changed significantly for
Piper, W. E. (2003). Canada support after group therapy treatment, post- (from parent study by all three sources, for social support, whether
Changes in perceived group therapy for treatment, and 6 months Piper et al. 2001) participants in both social support needs
social support after participants with follow up. Patients were (77% had Axis I were met, or whether
therapies, during the follow
group therapy for CG matched in pairs diagnosis; 49.2% the support was
up period after treatment.
complicated grief. according to PM, use of Axis II diagnosis; Little change occurred perceived as helpful;
The Journal of medications, gender and average age 44.2yrs; during the intervention.Did not specify who the
Nervous and Mental age. Matched patients 79% female; 95% Changes in depressive person providing
Disease, 191(8), 524- randomly assigned to Caucasian). Setting: symptoms were directly support was; Limited to
530. one of the treatment Outpatient related to changes in only three points in
groups. Weekly 90-min psychiatric clinic perceived social supporttime; Modest sample
sessions over 12 weeks. size; Lack of control
from friends and a special
person. group; Uncertain of
how representative of
CG pop their sample is.
Ogrodniczuk, J. S., III-1 To examine Interpretive or Patients were matched in 20-item self-administer n = 107 outpatients Less favourable treatment Stated Limits: Findings
Piper, W. E., & 2005 therapist reactions supportive pairs according to their Toronto Alexithymia with CG completed outcomes were associated apply to group
Joyce, A. S. (2005). Canada to a patient as a group therapy QOR, PM, use of Scale-20; PGI, IES, (average age 43yrs; to high levels of psychotherapy, unclear
The negative effect possible mediator medications, gender and SAS-SR 77% female; 90% alexithymia. Negative if these can be
of alexithymia on the of the relationship age. Matched patients Caucasian; 72% therapist reactions to a generalised to other
outcome of group between randomly assigned to previous psychiatric patient also was associated formats of
therapy for alexithymia and one of the treatment treatment; 49% lost to less favourable psychotherapy;
complicated grief: outcome in group groups. Weekly 90-min partner; average of outcomes. When the effect Alexithymia is only
What role might the psychotherapy for sessions over 12 weeks. 8.9yrs since loss), on outcome from a one variable in the
therapist play? CG Setting: Outpatient therapists reaction was psychotherapy change
Comprehensive psychiatric clinic taken into account, process
Psychiatry, 46(3), alexithymia no longer had
206-213. a significant effect on
outcome. Hence, the effect
of alexithymia on treatment
outcome was mediated by
the therapists reaction to a
patient.

Appendix B
Ogrodniczuk, J. S., III-1 The effect of Interpretive or Patients were matched in PGI; IES; SAS-SR; n = 107 outpatients Perceived social support Stated Limits: Majority
Piper, W. E., Joyce, 2002 perceived social supportive pairs according to their MSPSS with CG (73.8% had from friends was directly of participants were
A. S., McCallum, Canada support on the short-term QOR, PM, use of Axis I diagnosis; associated to favourable parental losses; Did not
M., & Rosie, J. S. outcome of group group therapy medications, gender and 55.1% Axis II outcomes for both types of assess different types of
(2002). Social therapy for CG age. Matched patients diagnosis; average therapy. The outcome of social support, whether
support as a predictor randomly assigned to age 43yrs; 77% participants in both social support needs
of response to group one of the treatment female; 90% therapies was inversely were met, or whether
therapy for groups. Weekly 90-min Caucasian). Setting:related to perceived social the support has
complicated grief. sessions over 12 weeks. Outpatient support from family. An perceived as helpful;
Psychiatry, 65(4), Perceived social support psychiatric clinic improvement in grief Did not specific who
346-357. from family, friends, and symptomology for the person providing
a special person was participants in interpretive support was.
rated prior to therapy. therapy was directly related
to perceived social support
from a special person,
however, unrelated for
supportive therapy. Hence,
its important to assess
perceived social support
and the source of the
support.
Ogrodniczuk, J. S., III-1 To investigate Interpretive or Patients were matched in Intrusion and Avoidance n = 107 outpatients In both forms of therapy Stated Limits: Did not
Piper, W. E., Joyce, 2003 personality supportive pairs according to their subscale of IES; set of with CG (73.8% had extroversion, examine different types
A. S., McCallum, Canada variables short-term QOR, PM, use of pathological grief items Axis I diagnosis; conscientiousness, and of loss and its
M., & Rosie, J. S. relationship with group therapy medications, gender and by Prigerson et al.; 55.1% Axis II openness were directly association with NEO
(2003). NEO-five group therapy age. Matched patients SAS-SR; NEO-FFI diagnosis; average associated with favourable dimensions; Only
factor personality outcome randomly assigned to age 4.yrs; 77% treatment outcomes for CG modest outcome
traits as predictors of one of the treatment female; 90% participants. Neuroticism variance; The
response to two groups. Personality Caucasian). Setting: was inversely related to experiment wise error
forms of group variables here measured Outpatient favourable outcomes for rate was inflated,
psychotherapy. prior to treatment. psychiatric clinic both therapies. In increasing the
International Journal interpretive therapy, and likelihood of finding
of Group not supportive therapy, significant effects due
Psychotherapy, agreeableness was directly to chance
53(4), 417-442. related to favourable
treatment outcomes.

Appendix B
Ogrodniczuk, J. S., III-1 Patients' Interpretive or Patients were matched in PGI; IES; SAS-SR; n = 107 outpatients In both forms of therapy a Stated Limits: Did not
Piper, W. E., 2002 interpersonal supportive pairs according to Reciprocal Attachment with CG (73.8% had more secure attachment to examine interpersonal
McCallum, M., Canada functioning short-term personality variables, use Questionnaire Axis I diagnosis; the lost person and better functioning and
Joyce, A. S., & (attachment to group therapy of medications, gender 55.1% Axis II social role functioning was outcomes for different
Rosie, J. S. (2002). lost person, and age. Matched diagnosis; average associated to more types of death loss;
Interpersonal quality of object patients were then age 43yrs; 77% favourable outcome. Participants primarily
predictors of group relations, level of randomly assigned to female; 90% Participants with higher Caucasian and well
therapy outcome for recent social role one of the treatment Caucasian). Setting: QOR in interpretive educated; Did not
complicated grief. functioning) as groups. Weekly 90-min Outpatient therapy and lower QOR in include process data
International Journal predictors of sessions over 12 weeks. psychiatric clinic supportive therapy reported
of Group outcomes for more favourable outcomes.
Psychotherapy, group therapy
52(4), 511-535.
Ogrodniczuk, J., III-1 (1) To examine N/A Data from the prevalence TRIG, a set of Total n= 398. For A principal component Stated Limits: The
Piper, W., Joyce, A., 2003 whether investigation described Pathological Grief items Study (1) n= 235. analysis found that among cross sectional design
Weideman, R., Canada dimensions of by Piper et al. (2001) adapted from the work All participants had a sample of psychiatric out- does not allow the
McCallum, M., complicate grief was used to conduct part of Prigerson, the Impact at least 1 significant patients, CG symptoms determination of the
Azim, H. and Rosie, (CG) could be (1) of this study. Data of Events Scale and the death loss. emerged as a distinct set of stability of the factor
J. (2003). distinguished from the intervention Social Adjustment dimensions that were over time, Possible that
Differentiating from dimensions study by Piper et al. Scale, BDI-II. relatively independent of some aspects of
Symptoms of of depression. (2) (2001) was used to depressive symptoms. The complicated grief were
Complicated Grief To determine conduct part (2) of this PCA identified five not assessed, Only one
and Depression whether these study. dimensions accounting for measure of depression
Among Psychiatric dimensions were 53% of the variance. The used, only preliminary
Outpatients, 48(2), differentially first dimension (grief results, although sig.
87-93. affected by group symptoms) accounted for difference in outcome
psychotherapy for 15%, the second 13% between the 2 forms of
CG. (grief experience), the third group therapy, it was
11% (depression-cognitive) for only 1 of the 5
the 4th 8.3% (grief outcomes.
avoidance) and the fifth
accounted for 7% of the
variance (depressive-
somatic). Improvement in
grief symptom was

Appendix B
 significantly greater in
interpretive therapy than in
supportive therapy.
Ott, C. H. (2003). III-2 Is CG associated N/A Cohort sequential ICG; MHI; Social n = 120 participants 29 participants identified as Stated Limits: May not
The impact of 2003 with an increase design. Participants Support Scale; Illness (96 widows & 24 having CG. Mental health represent 'typical'
complicated grief on USA in mental and grouped into time frame by self-report widowers) 3-18 scores were significantly griever due to volunteer
mental and physical health problems closes to the death (3, 6, months postloss. 118 lower for CG group 6 nature of recruitment
health at various in the spousal 9, 12, 15, or 18 months). completed 6 months months postloss and process; Participation
points in the bereavement Data collected at time of & 112 completed continued through out the rate was low (29%) but
bereavement process. process? entry into the study, 3 whole study. 97% study. CG group completion rates were
Death Studies, 27(3), months, 6 months, and 1 Caucasian, well experienced more high (93%); Over
249-272. year later. educated, relatively additional life stressors, representation of
high socioeconomic perceived less social women; Cohort
status. Setting = support, and achieved less sequential design
Questionnaires clinically significant means that data is not
administered at changes in the mental from one time frame
participants home health scores. weakening findings;
and by mail participants not asked
when health problems
developed, not able to
link CG to the
development of new
health problems

Appendix B
Piper, W. E., III-1 Interaction of Interpretive or Patients were matched in PGI, IES, SAS-SR n = 107 outpatients Patients in both therapiesStated Limits: Most
McCallum, M., 2001 patient personality supportive pairs according to their with CG completed improved. Grief symptoms patients initially did not
Joyce, A. S., Rosie, Canada characteristics group therapy QOR, PM, use of (73.8% had Axis I in high-QOR patients include grief as a
J. S., & (QOR and PM) medications, gender and diagnosis; 55.1% improved more in complaint when
Ogrodniczuk, J. S. and treatment age. Matched patients Axis II diagnosis; interpretive therapy and attending the clinic; No
(2001). Patient outcome of group randomly assigned to average age 44yrs; low-QOR patients control condition;
personality and time- therapy for CG one of the treatment 77% female; 90% improved more in Medication effect not
limited group groups. Weekly 90-min Caucasian) (139 supportive therapy. Grief determined; No time
psychotherapy for sessions over 12 weeks. started therapy). symptoms in high-PM delay assessed after
complicated grief. Setting: Outpatient patients improved more in intervention; Only a
International Journal psychiatric clinic both therapies. Interpretive
small amount of
of Group therapy patients had a variance accounted for;
Psychotherapy, significant improvement inPatients primarily
51(4), 525-552. their general symptoms. Caucasian and well-
educated
Piper, W. E., IV To examine the N/A Pre-intake questionnaires BDI; Trait Anxiety n = 235 Participants Completers of Stated Limits: Not all
Ogrodniczuk, J. S., 2001 prevalence of asked about variables not Scale; Brief Symptom who had lost a questionnaire (235): 73 participants were asked
Azim, H. F., & Canada significant loss specific to loss. During Inventory; IES; TRIG; significant other (31%) of these met criteria about loss and only
Weideman, R. and CG in interviews participants SAS-SR; Pathological (98% had axis I for moderate CG & 69 58.3% of those who
(2001). Prevalence of psychiatric were either asked about grief assessed by 7 diagnosis, 50% (29%) for severe CG. Time experienced a
loss and complicated outpatients losses or not asked. items by Prigerson and major depression; since loss indicates long- significant loss took
grief among Those who reported colleagues 49% at least one axis term CG. Severe CG part in the
psychiatric losses completed post-in- II diagnoses; average group: significantly higher questionnaire;
outpatients. take questionnaires about age 42.2yrs; 57% levels of social Participants were
Psychiatric Services, the loss and grief. female; Racial data dysfunctioning and seeking help; Majority
52(8), 1069-1074. not available; depression disturbance Caucasian; No control
average 2.9 variables. Depression, group
significant losses & anxiety, and grief
10yrs since loss). symptomatic distress were
Setting = Two significantly higher for
psychiatric severe CG group compared
outpatient service to moderate CG and those
who had not experienced
loss. For entire outpatient
population it is estimated
that 33.3% (312 patients)

Appendix B
 met criteria for CG (17.1%
moderate CG & 16.2%
severe CG).

Piper, W. E., III-1 Relationship Interpretive or Patients were matched in PGI, IES, SAS-SR n = 107 outpatients Direct relationship between Stated Limits:
Ogrodniczuk, J. S., 2002 among patients supportive pairs according to their with CG completed the experience and Generalisations may be
Joyce, A. S., Canada affect group therapy QOR, PM, use of (73.8% had Axis I expression of positive difficult due to the
McCallum, M., & (experienced and medications, gender and diagnosis; 55.1% affect during therapy specific nature of the
Rosie, J. S. (2002). expressed), work, age. Matched patients Axis II diagnosis; sessions and favourable therapies, patients, and
Relationships among and outcome in randomly assigned to average age 43yrs; treatment outcome. To a measures
affect, work, and group therapy for one of the treatment 76.6% female; 89.7% lesser extent an inverse
outcome in group CG groups. Weekly 90-min Caucasian). Setting: relationship between the
therapy for patients sessions over 12 weeks. Outpatient experience or expression of
with complicated psychiatric clinic negative affect and
grief. American favourable outcome was
Journal of found.
Psychotherapy,
56(3), 347-361.

Appendix B
Piper, W. E., III-1 Affect variables Interpretive or Patients matched in pairs PGI; Intrusion Subscale n = 107 outpatients A significant mediating Stated Limits: Unable
Ogrodniczuk, J. S., 2003 were investigated supportive bases on their QOR, PM, of the IES, SAS-SR; with CG completed variable was found to be to tell if affects were
McCallum, M., Canada as potential group therapy use of medication, QOR score; (average age the balance of positive and focused on the death
Joyce, A. S., & mediating gender, and age. One Psychological 41.2yrs; 85% female; negative affect expressed loss of the patient; May
Rosie, J. S. (2003). variables using patient from each pair Mindedness 85% Caucasian; in therapy (rated by both not be able to
Expression of affect the multistep was randomly assigned 70% previous patients and therapists). generalise findings to
as a mediator of the procedure of to each intervention. 12 psychiatric Higher QOR, for two affect broader population
relationship between Baron & Kenney weekly time-limited treatment; 51% lost a variables, was associated to
quality of object (1986) interventions parent; average of more positive scores and
relations and group 7.5yrs since death), better health outcomes. A
therapy outcome for Setting: Teaching greater balance between
patients with hospital outpatient the expression of positive
complicated grief. psychiatric clinic and negative feelings was
Journal of Consulting associated to more positive
and Clinical scores.
Psychology, 71(4),
664-671.
Pivar, I. L., & Field, IV To determine the N/A On admission to the TRIG; CBI; Mississippi n = 114 male High levels of grief- Stated Limits: The
N. P. (2004). 2004 prominence and PTSD program those Scale of Combat- Vietnam veterans specific symptoms reported retrospective nature of
Unresolved grief in USA distinct status of who agreed to participate Related PTSD; BDI; with PTSD (mean of in veterans compared to assessment; Only
combat veterans with grief-symptoms were administered a set Combat experiences 50.85yrs at interview widow(er)s from another veterans who are
PTSD. Journal of from trauma and of instruments that & 20.17yrs at study. Grief severity currently diagnosed
Anxiety Disorders, depressive measured PTSD, combat loss). Setting associated with losses of with PTSD were
18(6), 745-755. symptoms in depression, grief-specific = PTSD inpatient comrades during combat, included
Vietnam veterans symptoms, attachment to rehabilitation unit at no relationship was shown
with PTSD and losses of comrades a veteran health care for trauma or depressive
service symptoms.

Appendix B
Prigerson, H. G., IV
Bierhals, A. J., Kasl, 1996
S. V., Reynolds, C. USA
F., Shear, K.,
Newsom, J., T., et
al. (1996).
Complicated grief as
a disorder distinct
from bereavement-
related depression
and anxiety: A
replication study.
American Journal of
Psychiatry, 153(11),
1484-1486.
Prigerson, H. G., III-3
Frank, E., Kasl, S. 1995
V., Reynolds, C. F., USA
Anderson, B.,
Zubenko, G. S., et
al. (1995).
Complicated grief
and bereavement-
related depression as
distinct disorders:
Preliminary empirical
validation in elderly
bereaved spouses.
American Journal of
Psychiatry, 152(1),
22-30.
To confirm N/A Face-to-face interviews GMS (items from this n= 150 Subjects Three distinct symptom Limits: This study was
previous research of subjects 6 months used to measure CG); spouse admitted to dimensions were found - conducted to address
that complicated post-hospitalisation CES-D Scale; hospital with a life- complicated grief, the following limits
grief symptoms Psychiatric threatening illness & bereavement related which were identified
are distinct from Epidemiology Research had died by the 6 depression, and in a previously
bereavement Interview anxiety scale months follow-up bereavement related conducted study by the
related depression (61% female, mean anxiety. With symptoms of authors: small study
and anxiety age of 62.4 yrs) CG loading quite highly on group, potential
the CG factor and very selection bias and the
poorly on the anxiety and use of antidepressant
depression factors. This treatment in the earlier
confirms previous findings studies.
that CG symptoms are
distinct.
If symptoms N/A Participants diagnosed as HAM-D; SADS-L; n= 56 widow(er)s Using data from 82 Stated Limits: Study
interpreted as CG depressed were treated Brief Symptoms who completed 18 subjects at baseline two group selection bias
can be identified with nortriptyline. They Inventory; Grief months follow-up distinct symptom clusters may have resulted in
and distinguished were seen weekly by a Measurement Scale; (68% female, 93% were identified, one underestimation of CG
from psychiatrist for GAS; Pittsburgh Sleep white). Setting = reflecting the symptoms of reactions; Results only
bereavement- adjustment of Quality Index; Geriatric centre complicated grief and the valid for treated
related nortriptyline dose, Cumulative Illness other depression. CG populations due to the
depression. If the measurements of blood Rating Scale- Geriatric scores were significantly use of nortriptyline;
presence of CG levels, clinical Version; Interpersonal associated with Inclusion of
predicts enduring assessment, social Support Evaluation List impairments in global participants who
functional support, and functioning, mood, sleep, entered study less than
impairments. psychoeducation. and self-esteem at 18 6 months after losing
Baseline data collected months. their spouse provided a
for 3-6 months & at 18 conservative test for
months. hypothesis as their grief
improved more rapidly
to start with.
Appendix B
Prigerson, H. G., III-3 To distinguish the 14 subjects Data used from a sleep SADS-L; TRIG; GMS; n= 56 elderly Anxiety, depression, and Stated Limits: Did not
Shear, M. K., 1996 unique symptoms were diagnosed physiology study by HDRS; BSI; Subset of widowers (38 grief all declined have data to determine
Newsom, J. T., USA of anxiety, as depressed Reynolds (1992). complicated grief females; 60-85yrs; significantly over time (6 levels of anxiety or
Frank, E., depression, and and treated Assessed on entry to symptoms from ICG 52 White) to 18 months postloss) for complicated grief
Reynolds, C. F., grief in recently with study at 6 months both the treated and
Maciejewski, P. K., bereaved elderly nortriptyline. 9 postloss (baseline), then untreated subjects, except
et al. (1996). Anxiety spouses of these also 12- & 18-months for the "stunned by the
among widowed received postloss follow-ups. death" measure. This may
elders: Is it distinct Interpersonal be important for
from depression and Psychotherapy diagnosing complicated
grief? Anxiety, 2(1), grief. Whilst anxiety,
1-12. depression, and grief were
significantly associated to
one another this was not
high enough to suggest
they were measuring the
same thing and therefore
are distinct emotional
dysfunctions. Nortriptyline
did not effect grief
symptoms, and when left
untreated grief symptoms
persist and predict
depression at 12 months
postloss.

Appendix B
Prigerson, H., III-3 To what extent N/A Intake interview at time Modified version of n =150 widow(er)s High levels of traumatic Stated Limits: Rarity of
Bierhals, A. J., Kasl, 1997 symptoms of of spouse's hospital Grief Measurement bereaved at 6 month grief declined sharply: 57% outcomes being
S. V., Reynolds, C. USA traumatic grief are admission and then Scale (only included interview (61% at 2 months postloss, 6% at measured; no case-
F., Shear, M. K., predictors of intensive, face-to-face ICG items in order to female, mean age 13 months, 7% at 25 control
Day, N., et al. future physical follow -up interviews at measure traumatic 62.4yrs, 61.3% months. Traumatic grief
(1997). Traumatic and mental health 6 weeks, 6 months, 13 grief); CES-D; PERI white, mean yrs symptoms present 6
grief as a risk factor outcomes months, and 25 months married 34.5yrs) / months postloss predicted
for mental and after hospitalisation 135 completed 13 negative health outcomes
physical morbidity. month assessment / 13- and 25-months follow-
American Journal of 122 completed 25 up, these included: cancer,
Psychiatry, 154(5), month assessment. heart disease, high blood
616-623. pressure, suicidal ideation,
and changes in eating
habits.
Prigerson, H., III-3 To examine the N/A Intake, 3-year follow-up Beck-Kovacs Scale for n = 76 young adult 15 (20%) participants were Stated Limits: None.
Bridge, J., 1999 influence of interviews, and 6.3-year Suicidal Ideation; ICG; friends of suicide classified as having CG. A Limits: Small number
Maciejewski, P., USA traumatic grief on follow-up questionnaire BDI victims (92% 5.08 time higher likelihood of participants with CG
Beery, L. C., suicidal ideation Caucasian, 58% of suicidal ideation was
Rosenheck, R., women) associated to traumatic
Jacobs, S., et al. grief. After controlling for
(1999). Influence of depression, gender, and
traumatic grief on time since loss traumatic
suicidal ideation grief still has a significant
among young adults. effect on suicide ideation.
American Journal of Comorbid traumatic grief
Psychiatry, 156(12), and depression did not
1994-1995. have a significant
association with suicidal
ideation.

Appendix B
Prigerson, H. G., IV
Ahmed, I., 2002 rates and risk
Silverman, G. K., Pakistan factors of CG in
Saxena, A. K.,
Maciejewski, P. K.,
Jacobs, S., et al.
(2002). Rates and
risks of complicated
grief among
psychiatric clinic
patients in Karachi,
Pakistan. Death
Studies, 26(10), 781-
792.
Prigerson, H., IV
Maciejewski, P., 1995
Reynolds, C. F., USA
Bierhals, A. J.,
Newsom, J., T.,
Fasiczka, A., et al.
(1995). Inventory of
complicated grief: A
scale to measure
maladaptive
symptoms of loss.
Psychiatry Research,
59(1-2), 65-79.
To examine the N/A A Karachi psychologist ITG n= 151 bereaved 34% of sample meet CG Stated Limits:
approached all his relatives or close criteria. Cause of death did Assessment conducted
private clinic patients to friends of 25 not significantly increase by single psychiatrist;
recently bereaved take part in study. deceased people risk of CG. Separation thorough psychiatric
psychiatric clinic Patients were (53% female, mean distress (eg. yearning) was history and evaluation
patients in interviewed to determine age 34.9yrs, mean if significantly higher for was not conducted;
Pakistan whether the had CG. 5.3 months postloss; those bereaved by violent Lack of detailed
48% violent death) death than accidental death. information on
Anger/bitterness and lost circumstances of death;
sense of high number of
security/trust/control participants from same
(traumatic distress family (6 bereaved
symptoms) more elevated participants per 1
in those bereaved by deceased patients);
violent death than other
forms of death. Spouses
had highest frequency of
meeting CG criteria.
To develop a N/A ICG developed from ICG; BDI; TRIG n= 97 widowed Participants with ICG Stated Limits: Need
scale that can previous work by the elders (70 women, scores of >25 had further evaluation of
identify authors (Prigerson et al. mean age of 81.63 significantly worse general, the validity of the
uncomplicated 1995) and their clinical yrs) mental, and physical proposed threshold for
and complicated experience. Participants health, social functioning, CG; No healthy
grievers were recruited from a and bodily pain scores. comparison group;
sleep physiology study. Scores >25 were set as the Limited by sample's
They completed a series criteria for CG. 20% of the age and type of death
of measures. For ICG studies participants scored
they reported the >25. ICG scores associated
frequency they to severity of depression
experienced each and general measures of
emotional, cognitive, and grief suggests a valid and
behavioural state. distinct grief assessment.
High levels of internal
consistency and
consistency over time.
Close association between
Appendix B
 ICG and TRIG scores
evidence that ICG is
measuring complicated
grief. ICG was well
tolerated and 85%
preferred it to TRIG.
Saltzman, W. R., IV Assess prevalence Trauma- 5 groups meet once a Community Violence n = 26 students 11- High levels of community Stated Limits: Small
Pynoos, R. S., 2001 of trauma focused group week for ~20 Exposure Survey 14yrs old (61% male, violence exposure was sample size and non-
Layne, C. M., USA exposure in psychotherapy consecutive weeks (CVES); UCLA PTSD mean age 12.58yrs, found in the students representative; Not
Steinberg, A. M., & children and Reaction Index- 68% Hispanic, 28% screened. 14 of 26 have randomised with a
Aisenberg, E. evaluate the Adolescent Version; African American, severe to very-severe levels control group; Limited
(2001). Trauma and effectiveness of a Reynolds Adolescent 4% white) (812 of PTSD. Participation in battery of measures
grief-focused school-based, Depression Scale students screened, 58 group psychotherapy was used. Limits: Not all
intervention for trauma- and grief- (RADS); GSS; UCLA meet inclusion found to significantly the participants had
adolescents exposed focused group Trauma-Grief Screening criteria). Setting: decrease PTSD and CG experienced a traumatic
to community psychotherapy Interview; Grade point School grounds symptoms, as well as death
violence: Results of a average improve academic
school-based performance.
screening and group
treatment protocol.
Group Dynamics:
Theory, Research,
and Practice, 5(4),
291-303.

Appendix B
Shear, K., Frank, IV
E., Foa, E., Cherry, 2001
C., Reynolds, C. F., USA
Vander Bilt, J., et
al. (2001). Traumatic
grief treatment: A
pilot study. American
Journal of Psychiatry,
158(9), 1506-1508.
Shear, K., Frank, II
E., Houck, P. R., & 2005
Reynolds, C. F. USA
(2005). Treatment of
complicated grief: A
randomized
controlled trial.
JAMA, 293(21),
2601-2608.
To investigate the Traumatic grief 16 sessions of traumatic ICG; Beck Anxiety n = 13 participants Significant improvement in Stated Limits: None
effects of a treatment grief treatment over 4 Inventory; BDI with traumatic grief completed group and stated, Limits: Pilot
treatment program protocol: months completed (mean age intent-to-treat group for study; Small sample
targeting imaginal re- 58.8yrs, 2.9yrs since grief symptoms and size; Does not state
debilitating grief living of the death,). Setting: Not associated anxiety and where sample was
symptoms in a death, in vivo stated depression. Pilot study has recruited from; Intent-
pilot study exposure to produced promising to-treat group is not
avoided results. Call for RCT. defined or described.
activities and
situations, and
interpersonal
therapy
To compare Complicated Participants randomly Self-reported ICG; CGI; n = 83 women & 12 Complicated grief Stated Limits: 45% of
complicated grief grief treatment assigned to a therapy BDI; HAM-D; HAM-A men with CG treatment is an improved study were taking
treatment (which (using loss- (stratified by treatment (majority white), treatment over psychotropic
is based on focused site and within sites by Setting: University- interpersonal medications;
Stroebe & Schut's cognitive- violent vs nonviolent based psychiatric psychotherapy, with Heterogeneity of the
1999 dual-process behavioural death). 16 sessions over research clinic & a response rates 51% and sample; 36% of
model) to a therapy an average of 19 weeks satellite clinic in low- 28% respectively. participants either
standard techniques and income African Participants in the dropped out or did not
psychotherapy restoration- American community complicated grief treatment complete
focused group showed a faster time
interpersonal to responded to treatment.
psychotherapy
strategies)
compared to
Interpersonal
Psychotherapy
Appendix B
Simon, N. M., IV To explore the N/A Participants from a ICG; MSPSS; First 2 n= 120 Participants 24.3% (25/103) met ICG Stated Limits: Self-
Pollack, M. H., 2005 frequency and larger study on items of Panic Disorder (62% bipolar I criteria for CG. 60% selected participants;
Fischmann, D., USA impact of predictors of suicidality Severity Scale; Marks diagnosis; mean of (15/25) of CG sample Self-assessment for loss
Perlman, C. A., complicated grief were mailed Fear Questionnaire 26.9yrs of illness; reported more than one did not have clinical
Muriel, A. C., on bipolar questionnaire packs and (phobic avoidance); 59% female; mean loss. 58.3% of CG sample validation & losses not
Moore, C. W., et al. disorder compensated $30 on Panic-Agoraphobic age of 44.1yrs; 95% reported lifetime history of corroborated; Don't
(2005). Complicated return of the pack. Spectrum Self-Report white) (86% or a suicide attempt (33.8% know which loss the
grief and its Scale; Range of 103/120 completed non-CG sample). CG participant had in mind
correlates in patients Impaired Functioning ICG and reported associated to higher rates when completing ICG;
with bipolar disorder. Tool significant loss) of current alcohol abuse, Can't confirm direction
Journal of Clinical current panic disorder of effect for variables
Psychiatry, 66(9), (with or without (CG causing panic
1105-1110. agrophobia), phobic attacks and avoidance
avoidance, & lifetime or vice versa).
obsessive-compulsive
disorder. CG was
associated to poorer
functioning and poorer
levels of social support.
Silverman, G. K., IV To examine the N/A Over the phone or face- TRGR2L; Medical n=67 widow(er)s 18% met Traumatic Grief Limits: Cross-sectional
Jacobs, S., Kasl, S. 2000 association to-face interviews Outcomes Survey SF- (mean age 64.3yrs, (TG) diagnosis at 4 months design and small
V., Shear, M. K., USA between quality 36; MDD & PTSD 57% female, mean of postloss. TG was sample size.
Maciejewski, P., of life and modules of SCID 4 months postloss) significantly associated to
Noaghiul, F. S., et traumatic grief lower social functioning
al. (2000). Quality of scores, lower mental
life impairments health, & lower energy
associated with levels.
diagnostic criteria for
traumatic grief.
Psychological
Medicine, 30(4),
857-862.

Appendix B
Sprang, G. (2001). III-2 To compare the Eye movement Clients self-selected TRIG; IES; STATE; n = 50 participants No marked difference Stated Limits: An
The use of Eye 2001 effects of EMDR desensitization either treatment, 2yr ISE; Treatment fidelity; traumatic loss (23 between treatment groups exploratory pilot study;
Movement USA and guided and treatment period Behavioural measures EMDR & 27 GM). for intensity of grief. not randomised; no
Desensitization and mourning on reprocessing Setting: Outpatient Significant differences nontreatment control
Reprocessing psychological and (EMDR) or mental health clinics where found for state group; use of self-
(EMDR) in the behavioural Guided in three states anxiety, Impact of Event report measures
treatment of symptoms of loss mourning Scale, Index of Self-
traumatic stress and (including grief, (GM) treatment Esteem, and PTSD.
complicated PTSD, anxiety,
mourning: and self esteem)
Psychological and
behavioral outcomes.
Research on Social
Work Practice, 11(3),
300-320.
Summers, J., III-2 To determine the N/A Participants were taking TRIG; GRI; SCID-I; n= 171 HIV 31 (18%) met criteria for Stated Limits:
Zisook, S., 1995 prevalence of part in a longitudinal HAM-D; HAM-A homosexual men who unresolved grief. No Predominantly white,
Atkinson, J. H., USA unresolved grief research program. Those had experienced a difference was found middle-class, well
Sciolla, A., and study the who reported a loss in loss in the last 12 between the resolved and educated gay males;
Whitehall, W., effects of multiple the last 12 months were months (HIV+ = unresolved groups in Higher rates of distress
Brown, S., et al. loss on grief classified as resolved 222; HIV- = 64). relation to multiple losses, may be evident in less
(1995). Psychiatric resolution. Also to grievers and unresolved Predominately white, weeks since death, supported populations
morbidity associated examine pre- grievers. They were well educated and intimacy of relationship to as the participants were
with acquired existing assessed for grief, middle-class. Setting deceased, or lifetime taking part in a
immune deficiency psychiatric anxiety, depression, and = HIV research psychiatric disorders. Men longitudinal study.
syndrome-related disorders psychiatric disorders. centre with unresolved grief were Limits: Unresolved
grief resolution. The relationship to significantly more likely to grief groups small
Journal of Nervous grief resolution have major depression and sample size
and Mental Disease, and prevalence of panic disorders.
183(6), 384-389. current
psychiatric
disorders.

Appendix B
Swarte, N. B., van III-2 How euthanasia N/A Questionnaire posted to ITG; TRIG; IES; SCL- Family members and Less traumatic grief, less Stated Limits: Possible
der Lee, M. L., van 2003 affects the grief family members and 90; DACL; SES; EPQ- close friends of current feelings of grief, underestimation &
der Bom, J. G., van Nether- response of friends of deceased RRS terminally ill cancer and less PTS reactions selection bias (those
der Bout, J., & lands bereaved family patients patients who died in found in family and friendswith greater grief & not
Heintz, P. M. and friends hospital: n= 189 of those who died from coping well prone to
(2003). Effects of bereaved due to euthanasia in comparison non-response & may
euthanasia on the euthanasia to natural death, even after
not have been invited to
bereaved family and (immediate family or adjustment for other risk participate); Possibly
friends: A cross friends, 18-85yrs) & factors. not representative
sectional study. n= 316 bereaved due (majority of oncology
British Medical to natural death. patients die at home);
Journal, 327, 1-5. Setting = Tertiary Personality factors of
referral centre for euthanasia patients not
oncology patients controlled for except
neuroticism; Prognosis
denial may have
influenced bereavement
outcome. Limits: Lack
of demographic
information.
Szanto, K., III-2 Does CG predict N/A Data used from a sleep ICG; SSI; BDI; HAM- n= 130 Widow(er)s 39% men active/passive Stated Limits: Did not
Prigerson, H. G., 1997 suicidal ideations physiology study by D; BSI; ISEL in last 2 yrs (mean ideators vs. 26% women. do multivariate
Houck, P. R., USA in the bereaved Reynolds (1992). 47% age 68yrs, 68% Active ideators had analyses; Could not
Ehrenpreis, L., & elderly? Are they sample treated for female, 58% major significantly higher CG look at effectiveness of
Reynolds, C. F. any additional bereavement-related depression, 62% first scores than passive- or different interventions
(1997). Suicidal characteristics of depression episode of non-ideators. on suicidal ideation due
ideation in elderly the bereavement (nortriptyline/placebo/int depression) Active/passive ideators had to small sample size in
bereaved: The role of process or any erpersonal significantly higher levels each treatment cell.
complicated grief. previous psychotherapy). of depression,
Suicide & Life- psychothatology Measures were hopelessness, CG, anxiety,
Threatening that increase the administered at various & social support. 57% high
Behavior, 27(2), 194- risk ? points over 17-18months CG were ideators vs. 24%
207. for both treatment and low CG were ideators. 15
nontreatment group. of 39 ideators had recurrent
depression vs. 5 of 91 non-
ideators. Increased

Appendix B
 likelihood of ideation
postloss if history of
suicide attempts. High
levels of CG and
Depression appear to
increase vulnerability to
suicidal ideation.
van den Boom, F. IV To examine the N/A Face-to-face interviews Not stated n= 60 relatives of 52 20% of survivors suffered Stated Limits: None
(1995). AIDS, 1995 relationship lasting 2-6hrs deceased AIDS episode of clinical stated. Limits: No
euthanasia and grief. Nether- between AIDS, patients (24 partners, depression, however, not description of how
AIDS Care, 7(2 lands euthanasia, and 24 family members, associated to way of death. grief was measured or
Suppl), 5175-5185. grief. Is there an 80% AIDS patients When euthanasia process the methods used; CG
association were homo/bio- was complicated, grief not defined and
between sexual men) became complicated. possibly linked to
euthanasia and depression; Small
CG? sample;
van Doorn, C. III-3 To examine the N/A Study participants SESS; Relationship n= 59 Participants Security-enhancing, Stated Limits: Marital
(1998). The influence 1998 relationship (n=59) were interviewed Styles Questionnaire; caring for terminally supportive marriage quality, attachment, and
of marital quality and USA between marital before the spouses death HAM-D; ITG ill spouse before (preloss) was positively depression assessment
attachment styles on quality and while they were caring death (71.2% female; associated to severity of preloss.
traumatic grief and adjustment to the for their terminally ill mean age 66.2yrs). traumatic grief symptoms.
depressive impeding loss of a spouse and after the Setting = Attachment styles were
symptoms. Journal of terminally ill spouses death at 3, 6 Participants home or significantly associated to
Nervous & Mental spouse residing at and 13 months post-loss, university borderline levels of
Disease, 186(9), 566- home or in using semi-structured traumatic grief. Attachment
573. nursing facilities interviews style and marital quality
did not interact and were
not associated to
depression.

Appendix B
Wiles, R., Jarrett, Qual To explore the N/A Qualitative design: N/A n= 50 GP's (from 25 Referrals of bereaved Stated Limits: size of
N., Payne, S., & 2002 factors GP's take Semi-structured practices). Setting: people by GP's to study; Mixed methods
Field, D. (2002). UK into consideration interviews (~30mins) Primary care setting counsellors are rare and of data collection.
Referrals for when making and grounded theory in both urban and counselling is not offered
bereavement referrals for approach. Interviews rural with varying to all bereaved people.
counselling in bereaved people explored views on levels of affluence. Factors that indicate a
primary care: A and the strategies bereavement and risk possible problem to the
qualitative study. used when factors; bereavement GP's were nature of the
Patient Education & counselling them care approaches; eg.'s of death, available support,
Counseling, 48(1), patient's bereavement and reaction to death. No
79-85. issues; criteria for formal assessment
referral and referral procedures appeared to be
process; effectiveness of used. Lack of awareness of
counselling. 'delayed' or 'absent' grief.
GP's conceptualised
bereavement as a linear
process with little
awareness of newer models
of grief.
Zygmont, M., III-3 To compare Paroxetine 16 week open-trial pilot ICG; HAM-D n = 15 participants Traumatic grief symptoms Stated Limits: Open
Prigerson, H. G., 1998 paroxetine's effect compared to an study of paroxetine for with traumatic grief (ICG) decreased by 53% label/archival contrast;
Houck, P. R., USA for symptoms of archival the treatment of (73% female, mean and depression ratings post hoc comparison;
Miller, M. D., traumatic grief to nortiptypline traumatic grief age, 56.9yrs, (HAM-D) decreased by psychotherapy
Shear, M. K., an archival group educated for a mean 54% in paroxetine-treated confound; paroxetine-
Jacobs, S., et al. nortriptyline 14.4yrs), Setting: Not group. Nortiptyline showed treated group more
(1998). A post hoc group stated comparable clinical affects heterogenous;
comparison of to paroxetine. However, significantly different
paroxeline and author favours paroxetine median time since lost
nortriptyline for as it is safer in overdose, between the two
symptoms of had a higher rate of groups.
traumatic grief. The diagnostic comorbidity,
Journal of Clinical and a greater chronicity of
Psychiatry, 59(5), symptoms.
241-245.

Appendix B
Appendix B
Abbreviations use in Evidence Table
Abbreviations
Name Abbreviation Developed by
20-item Toronto Alexithymia Scale TAS-20
Adult Attitude to Grief scale AAG Machin 2001
Adolescent Relationship Invetory ARI Brent and Moritx, unpublished instrument
Beck Anxiety Inventory BAI
Beck Depression Inventory BDI Beck, Maciejewski, et al. 1995
Beck Depression Inventory-II BDI-II
Zabora, Blanchard, Smith, Roberts et al.
Brief Symptoms Inventory BSI 1997
Characteristics and Exposure to Death CED Brent and Moritx, unpublished instrument
Centre for Epidemiologic Studies
Depression scale CES-D Radloff 1977
Child Behavior Checklist CBCL Achenbach 1991
Childhood Traumatic Grief CTG N/A
Children's PTSD Symptom Scale CPSS Foa et al. 2001
Clinical Global Improvement CGI
Complicated Grief CG N/A
Depression Adjective Checklist DACL
Depression, Stress and Anxity Scale -
Short form DASS-21
Dissociative Experience Scale DES
Expanded Grief Inventory EGI Layne et al. 2001
Eysenck Personality Inventory EPI Eysenck & Eysenck 1964
Eysenck Personality Questionnaire EPQ-RRS
Family Adaptability and Cohesion
Evaluation Scale FACE III Stroebe & Strobe 1993
Family Assessment Device - General
Functioning Scale FAD
General Health Questionnaire GHQ Goldberg & Hillier 1979
Global Assessment Scale GAS
Global Severity Index GSI
Grief Experience Questionnaire GEQ Barrett & Scorr 1989
Grief Experience Questionnaire GEM Jacobs et al. 2005
Grief Resolution Index GEI from TRIG
Grief Screening Scale GSS Layne, Steinberg, Savjak & Pynoos 1998
Group Climate Questionnaire-Short
Form GCQ-S MacKenzie 1983
Group Cohesiveness Scale GCS
Group/Member/Leader Cohesion
Scale GMLCS
Hamilton Rating Depression Scale HDRS Hamilton 1960
Hamilton Rating Scale for Anxiety HAM-A Hamilton 1959
Hamilton Rating Scale for Depression HAM-D Williams 1988
Hopkins Symptoms Checklist HSCL-90 Degrogatis et al. 1974
Impact of Events Scale IES Horowitz, Wilner & Alvarez 1979
Impact of Events Scale-Revised IES-R Weis & Marmar 1997
Cohen, Mermelstein, Kamarck, &
Interpersonal Support Evaluation List ISEL Hoberman 1985

Appendix B
 Prigerson, Maciejewski, Newsom,
Inventory of Complicated Grief ICG Reynolds, & Frank 1995
Inventory of Complicated Grief-
Revised ICG-R Prigerson & Jacobs 2001
Inventory of Trumatic Grief ITG Prigerson & Jacobs 2001
School-Age Schedule for Affective
Disorders and Schizoprenia, Present K-SADS-
and Epidemological Version P/E
Major Depressive Disorder MDD
Howard, Brill, Lueger, O'Mahoney &
Mental Health Inventory MHI Grissom 1993
Mood and Feelings Questionnaire MFQ Angold et al. 1995
Multidimesional Scale of Percieved
Social Support MSPSS
Based on Intrusions cognitions
Questionnaire developed by Steil &
Negative Interpretation of Grief Scale NIGS Ethlers (2000)
NEO-Five Factor Inventory NEO-FFI
Pathological Grief Items PGI Adapted from Prigerson et al. 1995
Pittsburgh Sleep Quality Inventory PSQI Buysse et al. 1989
Positive and Negative Syndrome Scale PANSS Kay, Fiszbein & Opler 1987
Post-Traumatic Stress Disorder PTSD N/A
Posttrumatic Diagnostic Scale PDS
Psychiatric Epidemiology Research
Interview PERI
Psychological Adjustment to Illness
Scale PAIS Derogatis & Lopez 1983
Psychological Mindedness PM N/A
Psychological Mindedness
Assessment Procedure PMAP
Quality of Object Relation QOR N/A
Research Diagnosis Criteria RDC
Revised Grief Experience Inventory RGEI Lev, Munro & McCorkle 1993
Revised Impact of Events Scale RIES
Scale of Suicidal Ideation SSI Beck, Kovacs & Weissman 1979
Schedule for Affective Disorders and
Schizophrenia-Lifetime Version SADS-L
Screen for Children's Anxiety Related
Emotional Disorders SCARED Birmaher et al. 1997
Self-Efficacy Scale SES
SF-36 Physical and Mental Helath
Summary Scale SF-36 Ware 1994
Social Adjustment Scale-Self Report SAS-SR Weissman & Bothwell 1976
State-Trait Anxiety Inventory STATE
Stressful Caregiving Adult Reactions to
Experiences of Dying scale SCARE Prigerson et al. 2003
Structured Clinical Interview for DSM SCID
Suicidal Circumstances Schedule SCS Brent et al. 1988
Symptoms Checklist 90 SCL-90 Derogatis 1983
Texas Inventory of Grief TIG
Texas Revised Inventory of Grief TRIG Fauschingbauer 1981
Total Mood Disturbance score TMD
Tridimensional Personality TPQ Cloninger 1987

Appendix B
Questionnaire
Traumatic Grief Evaluation of
Response to Loss TRGR2L Prigerson et al. 1998
UCLA PTSD Index for DSM-IV Parent
Report Version UCLA Index Pynoss et al. 1998
Weinberger Adjustment Inventory WAI
Work and Social Adjustment Scale WSAS
Yale Evaluation of Suicidality YES

SIGH-AD
Reaction to Loss Inventory Horowitz & Field
State-Trait Inventory Spielberger et al. 1970
Social Support Scale Fleming, Baum, Gisriel, & Gatchel 1982
Self-Rating Depression Scale Zung 1965

Appendix B