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，足足有三分之一的人患有“复杂的丧亲之痛”，这是一种与抑郁症和创伤后应激障碍(PTSD)共同特征的综合症。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相关的功能问题、心理疾病和死亡。尽管这是最常见的应激性事件之一的结果，但无论是在医院还是在社区，几乎没有标准化、有效、易于管理和成本效益高的计划来治疗和/或预防复杂的丧亲及其相关的医疗和心理健康后遗症。 目前的R-21提案将通过为患有复杂丧亲之痛的老年人开发一种新的干预措施来满足这一需求。根据我们中心对老年人和创伤受害者进行的初步研究的数据，并在该领域几位著名顾问和领导者的帮助下，将制定和完善一份治疗手册。此外，我们将使用随机对照2x4析因设计(按时间处理)对该干预措施进行初步评估。具体地说，多学科行为治疗将在治疗前、治疗后以及在3个月和6个月的随访评估中进行比较，使用标准化和有效的心理健康、健康相关功能和人际关系损害的标准和验证的相关测量，在与“复杂的丧亲”相关的领域提供治疗(丧亲组)。实验性治疗是基于创伤后应激障碍的暴露心理治疗模式和严重抑郁症的行为激活治疗模式。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经验干预项目的结果。

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.