As many as 7% of U.S. veterans were found to have a positive screen for prolonged grief disorder, reports a study in The American Journal of Geriatric Psychiatry. Veterans with prolonged grief disorder were more likely than those without the disorder to also have posttraumatic stress disorder (PTSD), major depressive disorder, and generalized anxiety disorder. They were also more likely to endorse suicidal thoughts and behaviors.

Prolonged grief disorder was approved by the APA Board of Trustees and Assembly for inclusion in DSM-5 in 2020. The disorder is characterized by a cluster of symptoms that persist more than a year after the death of a loved one and differ markedly from those that are part of the normal grieving process. The symptoms of prolonged grief disorder are also associated with poorer prognosis and greater functional impairment.

Peter J. Na, M.D., M.P.H., of VA Connecticut Healthcare System and colleagues analyzed data from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 2,441 U.S. veterans. Survey participants were asked, “Have you ever experienced a death of someone close?” Those who answered affirmatively were asked to think about the person who had been most difficult to lose and were assessed using the 5-item Brief Grief Questionnaire. Veterans were determined to have prolonged grief disorder if the loss was at least 12 months prior to taking the questionnaire and they scored 5 or greater. The participants were also evaluated for PTSD, major depression, generalized anxiety disorder, and suicidal thoughts or behaviors in the previous year.

Of the 2,441 study participants (average age 63 years, predominantly White and non-Hispanic), 2,339 (92.7%) reported the loss of someone close and 158 (7.3%) screened positive for prolonged grief disorder. Factors associated with an increased risk for the disorder were being female; Black; having served in the Marine Corps; having more adverse childhood experiences; losing someone to suicide, homicide, or COVID-19; and/or having a personal history of COVID-19 infection.

After the researchers adjusted for sociodemographic, military, and trauma variables, veterans with prolonged grief disorder were five to nine times more likely to screen positive for PTSD, major depressive disorder, and generalized anxiety disorder. After additional adjustment for current psychiatric and substance use disorders, veterans were two to three times more likely to endorse suicidal thoughts and behaviors.

“Further research is needed to replicate these findings, evaluate interrelationships between [prolonged grief disorder] and other psychiatric outcomes, and evaluate the efficacy of interventions targeting [prolonged grief disorder] in this population,” the authors wrote.

For related information, see the Psychiatric News article “Pandemic Takes Toll on Those Who Grieve.”