Treatment Development: Bereavement in Older Adults

描述（由申请人提供）： 在经历配偶死亡的老年人中，有整整三分之一的人患有“复杂的丧亲之痛”，这是一种与抑郁症和创伤后应激障碍（PTSD）共有特征的综合症。遭受复杂丧亲之痛的老年人更有可能在配偶死亡后至少三年内经历与健康有关的功能问题、心理疾病和死亡。尽管最常见的压力事件之一的这些结果，实际上没有标准化的，有效的，易于管理的，成本效益高的方案存在，无论是在医院或社区治疗和/或预防复杂的丧亲之痛及其相关的医疗和心理健康后遗症。 目前的R-21提案将通过为遭受复杂丧亲之痛的老年人开发一种新的干预措施来解决这一需求。在我们中心对老年人和创伤受害者进行的初步研究数据的指导下，并在该领域几位著名顾问和领导者的帮助下，将开发和完善治疗手册。此外，我们将使用随机对照2x 4析因设计（按时间治疗）对这种干预进行初步评估。具体而言，在治疗前、治疗后以及3个月和6个月随访评估时，将多学科行为治疗与通常提供的治疗（丧亲组）进行比较，使用标准化和经验证的心理健康、健康相关功能和与“复杂丧亲”相关领域的人际功能障碍的相关指标。“实验性治疗是基于创伤后应激障碍的心理治疗模型和重度抑郁症的行为激活治疗模型。拟议的治疗将纳入我们目前对暴力受害者的治疗结果研究的方法和结果，以及这一领域其他研究人员现有的经验性干预项目的结果。

DESCRIPTION (provided by applicant): Fully one-third of the older adults who experience the death of a spouse suffer from "complicated bereavement," a syndrome that shares features with both depression and post-traumatic stress disorder (PTSD). Older adults suffering from complicated bereavement are more likely to experience health-related functional problems, psychological illness, and mortality for at least three years following the death of a spouse. Despite these outcomes of one of the most common stressful events, virtually no standardized, effective, easily administered, and cost-effective programs exist, either in hospitals or in communities to treat and / or prevent complicated bereavement and its associated medical and mental health sequelae. The present R-21 proposal will address this need by developing a novel intervention for older adults suffering from complicated bereavement. Guided by data from preliminary studies with older adults and trauma victims conducted at our center, and with the help of several notable consultants and leaders in the field, a treatment manual will be developed and refined. Moreover, we will subject this intervention to preliminary evaluation using a randomized controlled 2x4 factorial design (treatment by time). Specifically, a multidisciplinary behavioral treatment will be compared to typically offered treatment (bereavement groups) at pre-treatment, post-treatment and at 3 and 6 month follow-up assessments using standardized and validated dependent measures of mental health, health related functioning, and interpersonal impairment in areas associated with "complicated bereavement." The experimental treatment is based on exposure-based psychological treatment models for PTSD and behavioral activation treatment models for major depression. The proposed treatment will incorporate methodology and findings from our current treatment outcome studies with victims of violence, as well as with findings from existing empirical intervention projects of other researchers in this area.