Understanding the impact of complicated grief on combat related posttraumatic stress disorder, guilt, suicide, and functional impairment in a clinical trial of post-9/11 service members and veterans.
Understanding the impact of complicated grief on combat related posttraumatic stress disorder, guilt, suicide, and functional impairment in a clinical trial of post-9/11 service members and veterans.
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在一项针对 9/11 后服役人员和退伍军人的临床试验中，了解复杂的悲伤对与战斗相关的创伤后应激障碍、内疚、自杀和功能障碍的影响。
DOI：
10.1002/da.22911
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发表时间：
2020
影响因子：
7.4
通讯作者：
Rauch,She
中科院分区：
文献类型：
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作者：
Simon,NaomiM;Hoeppner,SusanneS;Lubin,RebeccaE;Robinaugh,DonaldJ;Malgaroli,Matteo;Norman,SonyaB;Acierno,Ron;Goetter,ElizabethM;Hellberg,SamanthaN;Charney,MeredithE;Bui,Eric;Baker,AmandaW;Smith,Erin;Kim,HMyra;Rauch,She
背景复杂性悲伤（CG）是一种与创伤后应激障碍（PTSD）不同但常合并的丧亲特异性综合征。虽然丧亲之痛在军事人员中很常见（Simon等人，2018），有很少的研究CG合并症对PTSD治疗outcome.MethodsTo评估共病CG对PTSD治疗结果的影响，我们分析了来自一项随机试验的数据，该试验比较了长期暴露，舍曲林及其组合在退伍军人中的初步诊断为战斗相关的PTSD（n= 194）。在24周的试验中，在基线和第6、12和24周对PTSD、创伤相关内疚、功能障碍、自杀意念和行为进行评估。（比值比（OR）= 0.29，95%置信区间（CI）[0.12，0.69]，p= 0.005）和缓解（OR = 0.28，95% CI [0.11，0.71]，p= 0.007）。在基线和终点时，CG患者的PTSD（p= 0.005）和创伤相关内疚（<0.001）的严重程度更高。此外，CG患者在研究期间更容易出现自杀意念（对照组35%，14/40;对照组15%，20/130; OR = 3.01，95% CI [1.29，7.02]，p= 0.011）结论：共病CG与创伤后应激障碍严重程度升高相关，并与战斗相关退伍军人的终点治疗结果较差独立相关。PTSD，这表明可能需要对CG进行筛查和额外干预。
BackgroundComplicated grief (CG) is a bereavement‐specific syndrome distinct from but commonly comorbid with posttraumatic stress disorder (PTSD). While bereavement is common among military personnel (Simon et al., 2018), there is little research on the impact of CG comorbidity on PTSD treatment outcomes.MethodsTo evaluate the impact of comorbid CG on PTSD treatment outcomes we analyzed data from a randomized trial comparing prolonged exposure, sertraline, and their combination in veterans with a primary diagnosis of combat‐related PTSD (n= 194). Assessment of PTSD, trauma‐related guilt, functional impairment, and suicidal ideation and behavior occurred at baseline and weeks 6, 12, and 24 during the 24‐week trial.ResultsCG was associated with lower PTSD treatment response (odds ratio (OR) = 0.29, 95% confidence interval (CI) [0.12, 0.69],p= 0.005) and remission (OR = 0.28, 95% CI [0.11, 0.71],p= 0.007). Those with CG had greater severity of PTSD (p= 0.005) and trauma‐related guilt (<0.001) at baseline and endpoint. In addition, those with CG were more likely to experience suicidal ideation during the study (CG: 35%, 14/40 vs. no CG 15%, 20/130; OR = 3.01, 95% CI [1.29, 7.02],p= 0.011).ConclusionsComorbid CG is associated with elevated PTSD severity and independently associated with poorer endpoint treatment outcomes in veterans with combat‐related PTSD, suggesting that screening and additional intervention for CG may be needed.