Publication year
2018
Citation Title
The loss of a fellow service member: Complicated grief in post-9/11 service members and veterans with combat-related posttraumatic stress disorder.
Journal Name
Journal of Neuroscience Research
Journal Volume
9
Page Numbers
5-15
DOI
10.1002/jnr.24094
Summary
Many Service members and Veterans experience complicated grief due to the loss of an important person. The goal of this study was to examine the prevalence, severity, and impact that complicated grief has on Veterans with combat-related PTSD. Finding suggest that complicated grief was prevalent among combat-related PTSD Veterans and Service members led to adverse effects.
Key Findings
The prevalence of complicated grief was significantly higher among individuals who reported losing a fellow Service member than those who did not.
Participants with complicated grief reported higher PTSD severity than those without complicated grief.
Bereaved Veterans with complicated grief were more likely to report one or more lifetime suicide attempts compared to those without.
Individuals with complicated grief experienced higher levels of trauma-related guilt and distress.
Implications for Program Leaders
Disseminate information regarding possible symptoms related to complicated grief
Enhance education and curriculum focused on coping mechanisms related to loss
Provide workshops to help Service members and Veterans apply various coping mechanisms
Implications for Policy Makers
Continue to support programs to provide resources for combat-related PTSD
Encourage the training of professionals to better identify Service members who are dealing with complicated grief following the loss of an important person
Promote reintegration programs that include attention to assisting Service members in coping following the loss of a fellow Service member
Methods
Active Duty Service members or Veterans who were enrolled in and met the criteria for a Department of Defense funded, randomized controlled treatment trial were selected.
Participants were considered eligible if they served during OIF/OEF and/or OND and experienced combat-related PTSD.
Following informed consent, Service members and Veterans participated in a structured clinical interview, a clinician-administrated PTSD scale assessment, and a 19-item inventory of complicated grief assessment.
Results were analyzed by dividing the sample into those with complicated grief and those without.
Participants
Participants included 160 Service members or Veterans who reported losing at least one important person and completed the inventory of complicated grief.
The mean age was 36 years old for Service members and Veterans, and the majority of participants were male (88.75%) and White (55.97%) or Black (32.08%).
Ninety-five (59.4%) participants reported the loss of a fellow Service member and almost two-thirds of these participants (N=58) identified this as their most distressing loss.
Most of the Veteran participants had been deployed more than once (68.79%).
Limitations
The study was largely men, so the results may not generalize to other populations, such as female Veterans and Service members who may also experience complicated grief.
Because the sample focused on combat-related PTSD, the data did not address the prevalence of complicated grief in Veterans and Service members in general.
The final components of the complicated grief diagnosis are still being finalized which may affect the reliability of findings over time.
Avenues for Future Research
Replicate the study and include a selection of female participants to ensure an accurate representation of their experiences
Incorporate a measure addressing complicated grief in a larger sample of Veterans and Service members
Utilize finalized complicated grief diagnostic criteria for more reliable results
Focus
Multiple Branches
Target Population
Population Focus
Military Component
Abstract
Bereavement is a potent and highly prevalent stressor among service members and veterans.
However, the psychological consequences of bereavement, including complicated grief (CG), have
been minimally examined. Loss was assessed in 204 post-9/11, when service members and veterans
with combat-related posttraumatic stress disorder (PTSD) took part in a multicenter treatment
study. Those who reported the loss of an important person completed the inventory of complicated
grief (ICG; n5160). Over three quarters (79.41%) of the sample reported an important
lifetime loss, with close to half (47.06%) reporting the loss of a fellow service member (FSM). The
prevalence of CG was 24.75% overall, and nearly one third (31.25%) among the bereaved. CG was
more prevalent among veterans who lost a fellow service member (FSM) (41.05%, n539) compared
to those bereaved who did not (16.92%, n511; OR53.41, 95% CI: 1.59, 7.36). CG was
associated with significantly greater PTSD severity, functional impairment, trauma-related guilt,
and lifetime suicide attempts. Complicated grief was prevalent and associated with adverse psychosocial
outcomes in veterans and service members with combat-related PTSD. Clinicians
working with this population should inquire about bereavement, including loss of a FSM, and
screen for CG. Additional research examining CG in this population is needed.
However, the psychological consequences of bereavement, including complicated grief (CG), have
been minimally examined. Loss was assessed in 204 post-9/11, when service members and veterans
with combat-related posttraumatic stress disorder (PTSD) took part in a multicenter treatment
study. Those who reported the loss of an important person completed the inventory of complicated
grief (ICG; n5160). Over three quarters (79.41%) of the sample reported an important
lifetime loss, with close to half (47.06%) reporting the loss of a fellow service member (FSM). The
prevalence of CG was 24.75% overall, and nearly one third (31.25%) among the bereaved. CG was
more prevalent among veterans who lost a fellow service member (FSM) (41.05%, n539) compared
to those bereaved who did not (16.92%, n511; OR53.41, 95% CI: 1.59, 7.36). CG was
associated with significantly greater PTSD severity, functional impairment, trauma-related guilt,
and lifetime suicide attempts. Complicated grief was prevalent and associated with adverse psychosocial
outcomes in veterans and service members with combat-related PTSD. Clinicians
working with this population should inquire about bereavement, including loss of a FSM, and
screen for CG. Additional research examining CG in this population is needed.
Abstract Document
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