Prevalence and Correlates of Complicated Grief in Adults Who Have Undergone a Coronary Artery Bypass Graft

Background and Purpose: Complicated Grief (CG) is a prolonged, intense grief response characterized by difficulty accepting the death of a loved one, preoccupation with thoughts or images of the deceased, avoidance of reminders of the loss, and a sense of social disconnection. CG causes significant distress and impairment and has been associated with negative long-term physical and mental health consequences. Adults who have undergone a coronary artery bypass graft (CABG) are at risk for depression and may also experience CG. When present, CG may possibly impede recovery from CABG and/or associated depression. In a secondary analyses using data from the Bypassing the Blues trial, a NIH-funded RCT of the impact of telephone-delivered collaborative care for post-CABG depression, we examined CG symptom prevalence and its demographic and clinical correlates. We hypothesized that: based on previous findings, female gender, younger age, and experiencing grief over a child's death would increase the likelihood of endorsing CG symptoms, and higher CG symptoms would be associated with elevated depression and poor mental and physical health.

Methods: Patients who had undergone a CABG were recruited prior to discharge from seven Pittsburgh-area hospitals between 3/04 and 9/07 and screened for depression. Those who who scored >9 on the Patient Health Questionnaire-9 two weeks post-discharge were randomized to either "usual care" (n=152) or to an 8-month telephone-delivered collaborative care depression intervention (n=150). A non-depressed post-CABG cohort group was also enrolled (n=151). Sociodemographic and clinical data was collected at baseline and at blinded telephone assessments at 2 week and 2-, 4-, and 8-month follow-up. CG was assessed with the five-item Brief Grief (BG) measure at 2-months.

Results: The majority of the sample (97.1%), whether depressed or not, had experienced the death of someone close to them. Participants were considered to have CG symptoms if they scored 4 or greater on the BG (range: 0-10). 40(10.0%) had a BG ≥4. The depressed study group had higher BG scores than the non-depressed control group (p=0.0001). Compared to those with lower scores, those with BG scores ≥4 were significantly younger (65.1 vs. 61.1), more likely to be female (38.2% vs. 65.0%), and to be experiencing the most grief over a partner/spouse (7.8% vs. 25.0%). Moreover, higher BG scores were associated with higher mean depression scores (Depression Interview and Structured Hamilton: 11.3 vs. 18.3), and lower mean general health (46.5 vs. 38.9), physical health (30.1 vs. 25.2), mental health (47.7 vs. 35.3), social functioning (40.4 vs. 30.7), bodily pain (43.1 vs. 37.2), and role performance (27.7 vs. 31.6) 36-item Short Form subscale scores (all p<0.05). There were no differences between the two BG symptom groups on other sociodemographic and clinical measures.

Conclusions/Implications: These findings are the first to provide information about CG symptoms in adults who have undergone CABG. CG occurred in 10% of these individuals and was associated with poorer mental and physical health. These findings may assist social workers in hospital, primary care, and mental health settings working with individuals with a CABG to target CG for screening and intervention.