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A Randomized Controlled Trial

Katherine Shear, MD; Ellen Frank, PhD; Patricia R. Houck, MSH; Charles F. Reynolds III, MD

JAMA. 2005;293:2601-2608.

Context  Complicated grief is a debilitating disorder associated with important negative health consequences, but the results of existing treatments for it have been disappointing.

Objective  To compare the efficacy of a novel approach, complicated grief treatment, with a standard psychotherapy (interpersonal psychotherapy).

Design  Two-cell, prospective, randomized controlled clinical trial, stratified by manner of death of loved one and treatment site.

Setting  A university-based psychiatric research clinic as well as a satellite clinic in a low-income African American community between April 2001 and April 2004.

Participants  A total of 83 women and 12 men aged 18 to 85 years recruited through professional referral, self-referral, and media announcements who met criteria for complicated grief.

Interventions  Participants were randomly assigned to receive interpersonal psychotherapy (n = 46) or complicated grief treatment (n = 49); both were administered in 16 sessions during an average interval of 19 weeks per participant.

Main Outcome Measure  Treatment response, defined either as independent evaluator-rated Clinical Global Improvement score of 1 or 2 or as time to a 20-point or better improvement in the self-reported Inventory of Complicated Grief.

Results  Both treatments produced improvement in complicated grief symptoms. The response rate was greater for complicated grief treatment (51%) than for interpersonal psychotherapy (28%; P = .02) and time to response was faster for complicated grief treatment (P = .02). The number needed to treat was 4.3.

Conclusion  Complicated grief treatment is an improved treatment over interpersonal psychotherapy, showing higher response rates and faster time to response.

Author Affiliations: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pa.

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