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Depression: HELP
Articles by Naomi M. Simon
Based on 25 articles published since 2010
(Why 25 articles?)
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Between 2010 and 2020, Naomi Simon wrote the following 25 articles about Depression.
 
+ Citations + Abstracts
1 Review Bereavement: course, consequences, and care. 2014

Zisook, Sidney / Iglewicz, Alana / Avanzino, Julie / Maglione, Jeanne / Glorioso, Danielle / Zetumer, Samuel / Seay, Kathryn / Vahia, Ipsit / Young, Ilanit / Lebowitz, Barry / Pies, Ronald / Reynolds, Charles / Simon, Naomi / Shear, M Katherine. ·Department of Psychiatry, University of California, 3350 La Jolla Village Dr, San Diego, CA, 92161-116A, USA, szisook@ucsd.edu. ·Curr Psychiatry Rep · Pubmed #25135781.

ABSTRACT: This paper discusses each of several potential consequences of bereavement. First, we describe ordinary grief, followed by a discussion of grief gone awry, or complicated grief (CG). Then, we cover other potential adverse outcomes of bereavement, each of which may contribute to, but are not identical with, CG: general medical comorbidity, mood disorders, post-traumatic stress disorder, anxiety, and substance use.

2 Review Pharmacological approaches to the treatment of complicated grief: rationale and a brief review of the literature. 2012

Bui, Eric / Nadal-Vicens, Mireya / Simon, Naomi M. ·Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA. tebui@partners.org ·Dialogues Clin Neurosci · Pubmed #22754287.

ABSTRACT: Complicated grief (CG) is a common and often under-acknowledged cause of profound impairment experienced after the loss of a loved one. Although both clinical and basic research suggests that pharmacological agents might be of use in the treatment of CG, research on pharmacological approaches to this condition is still scarce. Three open-label trials and one randomized trial on bereavement-related depression suggest that tricyclic antidepressants may be effective, although they may be more efficacious for depressive symptoms than for grief-specific symptoms. Four open-label trials (total number of participants, 50) of selective serotonin reuptake inhibitors (SSRIs) have yielded results, providing very preliminary support that they might be effective in the treatment of CG, both as a standalone treatment and in conjunction with psychotherapeutic interventions. These more recent studies have shown an effect on both depression and grief-specific scales. Furthermore, therapeutic interventions for CG may be more effective in conjunction with SSRI administration. Given the small number of pharmacological studies to date, there is a need for randomized trials to test the potential efficacy of pharmacological agents in the treatment of CG.

3 Review The bereavement exclusion and DSM-5. 2012

Zisook, Sidney / Corruble, Emmanuelle / Duan, Naihua / Iglewicz, Alana / Karam, Elie G / Lanouette, Nicole / Lebowitz, Barry / Pies, Ronald / Reynolds, Charles / Seay, Kathryn / Katherine Shear, M / Simon, Naomi / Young, Ilanit Tal. ·Department of Psychiatry, University of California, San Diego, CA 92093, USA. szisook@ucsd.edu ·Depress Anxiety · Pubmed #22495967.

ABSTRACT: BACKGROUND: Pre-DSM-III (where DSM is Diagnostic and Statistical Manual), a series of studies demonstrated that major depressive syndromes were common after bereavement and that these syndromes often were transient, not requiring treatment. Largely on the basis of these studies, a decision was made to exclude the diagnosis of a major depressive episode (MDE) if symptoms could be "better accounted for by bereavement than by MDE" unless symptoms were severe and very impairing. Thus, since the publication of DSM-III in 1980, the official position of American Psychiatry has been that recent bereavement may be an exclusion criterion for the diagnosis of an MDE. This review article attempts to answer the question, "Does the best available research favor continuing the 'bereavement exclusion' (BE) in DSM-5?" We have previously discussed the proposal by the DSM-5 Mood Disorders Work Group to remove the BE from DSM-5. METHODS: Prior reviews have evaluated the validity of the BE based on studies published through 2006. The current review adds research studies published since 2006 and critically examines arguments for and against retaining the BE in DSM-5. RESULTS: The preponderance of data suggests that bereavement-related depression is not different from MDE that presents in any other context; it is equally genetically influenced, most likely to occur in individuals with past personal and family histories of MDE, has similar personality characteristics and patterns of comorbidity, is as likely to be chronic and/or recurrent, and responds to antidepressant medications. CONCLUSIONS: We conclude that the BE should not be retained in DSM-5.

4 Clinical Trial Complicated grief after suicide bereavement and other causes of death. 2017

Tal, Ilanit / Mauro, Christine / Reynolds, Charles F / Shear, M Katherine / Simon, Naomi / Lebowitz, Barry / Skritskaya, Natalia / Wang, Yuanjia / Qiu, Xin / Iglewicz, Alana / Glorioso, Danielle / Avanzino, Julie / Wetherell, Julie Loebach / Karp, Jordan F / Robinaugh, Don / Zisook, Sidney. ·a Veterans Affairs San Diego Healthcare System , Veterans Medical Research Foundation , San Diego , California , USA. · b Department of Biostatistics, Mailman School of Public Health , Columbia University , New York , New York , USA. · c Department of Psychiatry, Western Psychiatric Institute and Clinic , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA. · d Center for Complicated Grief , Columbia School of Social Work , New York , New York , USA. · e Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , New York , USA. · f Center for Anxiety and Traumatic Stress Disorders , Massachusetts General Hospital , Boston , Massachusetts , USA. · g Harvard Medical School , Boston , Massachusetts , USA. · h Department of Psychiatry , University of California San Diego , La Jolla , California , USA. ·Death Stud · Pubmed #27892842.

ABSTRACT: The authors compared baseline demographic characteristics, clinical features, and grief-related thoughts, feelings, and behaviors of individuals bereaved by suicide, accident/homicide and natural causes participating in a complicated grief (CG) treatment clinical trial. Severity of CG and depression and current depression diagnosis did not vary by loss type. After adjusting for baseline demographic features, time since death and relationship to the deceased, those with CG after suicide had the highest rates of lifetime depression, preloss passive suicidal ideation, self-blaming thoughts, and impaired work and social adjustment. Even among this treatment-seeking sample of research participants with CG, suicide survivors may face unique challenges.

5 Article Anxiety Symptoms Questionnaire (ASQ): development and validation. 2019

Baker, Amanda / Simon, Naomi / Keshaviah, Aparna / Farabaugh, Amy / Deckersbach, Thilo / Worthington, John J / Hoge, Elizabeth / Fava, Maurizio / Pollack, Mark P. ·Massachusetts General Hospital, Boston, Massachusetts, USA. · Harvard Medical School, Boston, Massachusetts, USA. · New York University Medical Center, New York, New York, USA. · Georgetown University Medical Center, Washington, District of Columbia, USA. · Rush University Medical Center, Chicago, Illinois, USA. ·Gen Psychiatr · Pubmed #31922090.

ABSTRACT: Background: The Anxiety Symptoms Questionnaire (ASQ) is a brief self-report questionnaire which measures frequency and intensity of symptoms and was developed to improve assessment of anxiety symptoms in a clinical setting. We examined the reliability and validity of the ASQ in patients with anxiety disorders and/or depression, non-clinical control subjects and college students. Methods: 240 outpatients with generalised anxiety disorder, social anxiety disorder, panic disorder or major depressive disorder were administered the ASQ and additional questionnaires measuring depression and anxiety, as were 111 non-clinical control subjects and 487 college students. Factor analysis, Pearson's correlation coefficients and logistic regression were used to assess reliability and validity. Test-retest reliability of the ASQ was measured using a subset who were re-administered the ASQ after 4 weeks. Results: Factor analysis revealed measurement of a single dimension by the ASQ. Internal consistency and test-retest reliability were strong. The ASQ total score also significantly distinguished patients with an anxiety disorder from the clinical controls above and beyond the clinician-rated Hamilton Anxiety Scale. Conclusions: The ASQ is a valid, reliable and effective self-rated measure of anxiety and may be a useful tool for screening and assessing anxiety symptoms in psychiatric as well as college settings.

6 Article Circulating levels of oxytocin may be elevated in complicated grief: a pilot study. 2019

Bui, Eric / Hellberg, Samantha N / Hoeppner, Susanne S / Rosencrans, Peter / Young, Allison / Ross, Rachel A / Hoge, Elizabeth / Simon, Naomi M. ·Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. · Department of Psychiatry, Harvard Medical School, Boston, MA, USA. · Department of Psychiatry, New York University School of Medicine, New York, NY, USA. · Department of Psychiatry, Georgetown University Medical Center, Georgetown, DC, USA. ·Eur J Psychotraumatol · Pubmed #31489134.

ABSTRACT: Complicated grief (CG) is a debilitating syndrome characterized by persisting and intense distress and impairment after the death of a loved one. The biological mechanisms associated with this syndrome remain unclear but may involve neurobiological pathways implicated in the stress response and attachment systems. The neuropeptide oxytocin has been implicated in attachment and social behaviour, and loss of social bonds has been associated with disruptions in oxytocin signalling. Furthermore, prior research has reported associations between circulating oxytocin and other mental illnesses, including depression. The present pilot study aimed to examine plasma levels of oxytocin in bereaved adults with primary CG (

7 Article The relation of telomere length at midlife to subsequent 20-year depression trajectories among women. 2019

Gillis, Jennifer Cai / Chang, Shun-Chiao / Wang, Wei / Simon, Naomi M / Normand, Sharon-Lise / Rosner, Bernard A / Blacker, Deborah / DeVivo, Immaculata / Okereke, Olivia I. ·Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. · Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. · Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Department of Psychiatry, NYU School of Medicine, New York, New York. · Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. ·Depress Anxiety · Pubmed #30958913.

ABSTRACT: BACKGROUND: Telomeres cap and protect DNA but shorten with each somatic cell division. Aging and environmental and lifestyle factors contribute to the speed of telomere attrition. Current evidence suggests a link between relative telomere length (RTL) and depression but the directionality of the relationship remains unclear. We prospectively examined associations between RTL and subsequent depressive symptom trajectories. METHODS: Among 8,801 women of the Nurses' Health Study, depressive symptoms were measured every 4 years from 1992 to 2012; group-based trajectories of symptoms were identified using latent class growth-curve analysis. Multinomial logistic models were used to relate midlife RTLs to the probabilities of assignment to subsequent depressive symptom trajectory groups. RESULTS: We identified four depressive symptom trajectory groups: minimal depressive symptoms (62%), worsening depressive symptoms (14%), improving depressive symptoms (19%), and persistent-severe depressive symptoms (5%). Longer midlife RTLs were related to significantly lower odds of being in the worsening symptoms trajectory versus minimal trajectory but not to other trajectories. In comparison with being in the minimal symptoms group, the multivariable-adjusted odds ratio of being in the worsening depressive symptoms group was 0.78 (95% confidence interval, 0.62-0.97; p = 0.02), for every standard deviation increase in baseline RTL. CONCLUSIONS: In this large prospective study of generally healthy women, longer telomeres at midlife were associated with significantly lower risk of a subsequent trajectory of worsening mood symptoms over 20 years. The results raise the possibility of telomere shortening as a novel contributing factor to late-life depression.

8 Article Postconcussive symptoms (PCS) following combat-related traumatic brain injury (TBI) in Veterans with posttraumatic stress disorder (PTSD): Influence of TBI, PTSD, and depression on symptoms measured by the Neurobehavioral Symptom Inventory (NSI). 2018

Porter, Katherine E / Stein, Murray B / Martis, Brian / Avallone, Kimberly M / McSweeney, Lauren B / Smith, Erin R / Simon, Naomi M / Gargan, Sean / Liberzon, Israel / Hoge, Charles W / Rauch, Sheila A M. ·VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan, Ann Arbor, MI, USA. Electronic address: katherine.porter2@va.gov. · University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA. · VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan, Ann Arbor, MI, USA. · VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Emory University School of Medicine, Atlanta, GA, USA. · Massachusetts General Hospital, Boston, MA, USA; New York University School of Medicine, New York, NY, USA. · University of Michigan, Ann Arbor, MI, USA. · Walter Reed Army Institute of Research, Silver Spring, MD, USA. · Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Atlanta, GA, USA. ·J Psychiatr Res · Pubmed #29554536.

ABSTRACT: Mild traumatic brain injury (mTBI) is commonly reported in recent combat Veterans. While the majority resolve, some Veterans develop postconcussive symptoms (PCS). Previous research suggests these symptoms are not specific to head injury and are often associated with psychiatric symptoms. The current study examines the relative contributions of posttraumatic stress, depressive symptoms, and TBI on postconcussive symptoms, and explores whether the relationship remains after controlling for symptom overlap. Two hundred eighteen combat Veterans from Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) provided the data for this study as part of a baseline evaluation for inclusion into larger treatment study for posttraumatic stress disorder (PTSD). Participants completed the Brief Traumatic Brain Injury Screen (BTBIS), Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Stressor Version (PCL-S), Beck Depression Inventory-II (BDI-II). Significant differences in NSI total score between individuals with and without history of TBI were not found. A series of regression analyses demonstrated that Depression and PTSD were significant predictors of NSI score even after removal of NSI symptoms that overlap with PTSD or depression. TBI status was also a significant predictor of PCS in most models, but its relative contribution was much smaller than that of depression and PTSD. Within PTSD symptoms, hyperarousal cluster was a significant predictor of NSI scores. Findings demonstrate that depression and PTSD are related to PCS beyond similarities in construct. Further, within a primarily PTSD treatment-seeking population, these psychiatric symptoms appear to be a stronger contributor than TBI.

9 Article Prospective association between major depressive disorder and leukocyte telomere length over two years. 2018

Vance, Mary C / Bui, Eric / Hoeppner, Susanne S / Kovachy, Benjamin / Prescott, Jennifer / Mischoulon, David / Walton, Zandra E / Dong, Melissa / Nadal, Mireya F / Worthington, John J / Hoge, Elizabeth A / Cassano, Paolo / Orr, Esther H / Fava, Maurizio / de Vivo, Immaculata / Wong, Kwok-Kin / Simon, Naomi M. ·University of Michigan, United States; VA Ann Arbor Healthcare System, United States. Electronic address: marycv@med.umich.edu. · Massachusetts General Hospital, United States; Harvard School of Public Health, United States. · Harvard School of Public Health, United States. · Dana Farber Cancer Institute, United States; University of Pennsylvania, United States. · Massachusetts General Hospital, United States. · Georgetown University Medical Center, United States. · Brigham and Women's Hospital, United States. · Harvard School of Public Health, United States; Dana Farber Cancer Institute, United States; New York University Medical School, United States. · Massachusetts General Hospital, United States; Harvard School of Public Health, United States; New York University Medical School, United States. ·Psychoneuroendocrinology · Pubmed #29499556.

ABSTRACT: BACKGROUND: Reduced leukocyte telomere length (LTL) has been found to be associated with multiple common age-related diseases, including heart disease, diabetes, and cancer. A link has also been suggested between shortened LTL and major depressive disorder (MDD), suggesting that MDD may be a disease of accelerated aging. This prospective, longitudinal study examined the association between depression diagnosis at baseline and change in LTL over two years in a well-characterized sample of N = 117 adults with or without MDD at baseline, using rigorous entry criteria. METHODS: Participants aged 18-70 were assessed with validated instruments by trained, doctoral-level clinician raters at baseline and at two-year follow-up, and blood samples were obtained at both visits. LTL was assayed under identical methods using quantitative polymerase chain reaction (qPCR). The effect of an MDD diagnosis at baseline on change in LTL over two years was examined via hierarchical mixed models, which included potential confounders. RESULTS: Individuals with MDD at baseline had greater LTL shortening over two years than individuals without MDD (p = 0.03), even after controlling for differences in age, sex, and body mass index (BMI). In the sub-sample of individuals with MDD diagnoses at baseline, no significant associations between LTL change and symptom severity or duration were found. CONCLUSION: A baseline diagnosis of MDD prospectively predicted LTL shortening over two years. Our results provide further support for MDD as a disease associated with accelerated aging in a well-characterized sample using validated, clinician-rated measures.

10 Article Prospective association of depression and phobic anxiety with changes in telomere lengths over 11 years. 2018

Chang, Shun-Chiao / Crous-Bou, Marta / Prescott, Jennifer / Rosner, Bernard / Simon, Naomi M / Wang, Wei / De Vivo, Immaculata / Okereke, Olivia I. ·Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. · Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. · Clinical Research Program, Barcelona Beta Brain Research Center, Barcelona, Spain. · Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA. · Anxiety and Complicated Grief Program, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA. · Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA. · Department of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA. · Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, MA, USA. · Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. ·Depress Anxiety · Pubmed #29486096.

ABSTRACT: BACKGROUND: Although depression and anxiety have been associated with shorter telomeres in cross-sectional studies, the data regarding the prospective relations of depression and anxiety to accelerated telomere length shortening are limited and findings are mixed. We prospectively examined relations of baseline depression and phobic anxiety to subsequent 11-year change in relative leukocyte telomere lengths (LTLs). METHODS: We selected 1,250 women from a subcohort of the Nurses' Health Study who provided blood specimens at both blood collections (1989-1990 and 2000-2001). Depression was defined by self-reported regular antidepressant use or presence of severe depressive symptoms; anxiety symptoms were assessed using the Crown-Crisp Experiential Index. Using quantitative real-time polymerase chain reaction assay, LTLs were measured as the copy number ratio of telomere repeat to a single control gene. Changes in LTLs were defined in three ways: absolute change, symmetrized percent change, and decile shift. RESULTS: Overall, there were no statistically significant associations of depression or phobic anxiety to subsequent 11-year LTL shortening, despite a point estimates in the direction of greater telomere shortening among participants with versus without depression, across all three metrics of telomere change. The strongest predictor of LTL change was baseline telomere length, and regression-to-the-mean was observed. CONCLUSION: Baseline depression and phobic anxiety were not significantly associated with 11-year attrition in LTLs among 1,250 mid-life and older women. However, a suggestion of depression and greater subsequent LTL attrition, while not statistically significant, may warrant further inquiry, particularly in prospective studies with larger sample sizes and broader windows of the lifespan.

11 Article Relation of long-term patterns in caregiving activity and depressive symptoms to telomere length in older women. 2018

Chang, Shun-Chiao / Crous-Bou, Marta / Prescott, Jennifer / Rosner, Bernard / Simon, Naomi M / Wang, Wei / De Vivo, Immaculata / Okereke, Olivia I. ·Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. · Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Clinical Research Program, Barcelona Beta Brain Research Center, 08005 Barcelona, Spain. · Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Biostatistics, Boston, MA 02115, USA. · Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA. · Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA; Department of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA. · Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, MA 02115, USA. · Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. Electronic address: ookereke@partners.org. ·Psychoneuroendocrinology · Pubmed #29414028.

ABSTRACT: BACKGROUND: Research links psychological stress to accelerated cellular aging. Here we examined whether long-term patterns of depression and caregiving burden, forms of chronic psychological stress, were associated with shorter telomere length, a biomarker of cellular aging. METHODS: The study included 1250 healthy older women (mean: 68.0; range: 60-81 years) in the Nurses' Health Study. Long-term patterns in depressive symptoms and caregiving activity (separated into care of children/grandchildren vs. ill or disabled family members/others) incorporated questionnaire data between 1992 and 2000; relative leukocyte telomere lengths (LTLs) were measured in 2000-2001. Least-squares means LTL z-scores were calculated across categories of depression patterns and caregiving intensity. RESULTS: Six empirically-derived latent classes of depressive symptom trajectories were identified: minimal-stable (63.7%), mild-worsening (3.9%), subthreshold-improving (22.8%), subthreshold-worsening (2.7%), clinical range depressive-improving (6.2%), and clinical range depressive-persistent (0.6%). After collapsing trajectory patterns into 4 groups (combining those with minimal and mild symptoms into one group and those with clinical range depressive symptoms into one group) due to very small sample sizes in some groups, we observed marginal associations (p = 0.07): e.g., the least-squares means LTL z-scores were lowest (-0.08; 95% CI: -0.22 to 0.06) for the clinical range depressive symptoms group and highest (0.12; 0.04-0.20) for the subthreshold-improving group (Tukey's post-hoc pairwise p = 0.07). With six depressive symptom trajectories, no significant associations were observed with regard to telomere lengths. There were no significant associations between caregiving intensity and LTLs. CONCLUSIONS: There were no associations between long-term patterns of caregiving burden and telomere lengths among older women. Possible differences in telomere lengths by types of long-term depressive symptom trajectories may warrant further investigation.

12 Article Complicated Grief Among Military Service Members and Veterans Who Served After September 11, 2001. 2018

Charney, Meredith E / Bui, Eric / Sager, Julia C / Ohye, Bonnie Y / Goetter, Elizabeth M / Simon, Naomi M. ·The Home Base Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA. · Harvard Medical School, Boston, Massachusetts, USA. · Department of Psychiatry, New York University School of Medicine, New York, New York, USA. ·J Trauma Stress · Pubmed #29384232.

ABSTRACT: Minimal research is available on the prevalence and impact of complicated grief (CG) in military service members and veterans, despite high reported rates of loss in this population. The present study aimed to examine prevalence rates of CG in a sample of treatment-seeking military service and members and veterans who served after September 11, 2001. Additionally, the study aimed to examine characteristics associated with CG as well as the association between CG and quality of life. In a sample of 622 military service members and veterans who served after September 11, 2001, 502 reported a significant loss (80.7%). Usable data were available for a total of 468 participants. Of these 468 participants, 30.3% (n = 142) met diagnostic criteria for CG, as defined by a score of 30 or more on the Inventory of Complicated Grief (ICG; Prigerson et al., 1995). We conducted a series of t tests and chi-square tests to examine the differences between individuals who met criteria for CG and those who did not. The presence of CG was associated with worse PTSD, d = 0.68, p < .001; depression, d = -1.10, p < .001; anxiety, d = -1.02, p < .001; stress, d = 0.99, p < .001; and quality of life, d = 0.76, p < .001. Multiple regression analyses examined the independent impact of CG on quality of life. Complicated grief was associated with poorer quality of life above and beyond PTSD, β = -.12, p = .017. In addition, in a separate regression, CG was associated with poorer quality of life above and beyond depression, β = -.13, p < .001. Overall, our findings highlight the impact of CG on this population, and have implications for assessment and treatment.

13 Article Medical comorbidity in complicated grief: Results from the HEAL collaborative trial. 2018

Robbins-Welty, Gregg / Stahl, Sarah / Zhang, Jun / Anderson, Stewart / Schenker, Yael / Shear, M Katherine / Simon, Naomi M / Zisook, Sidney / Skritskaya, Natalia / Mauro, Christina / Lebowitz, Barry D / Reynolds, Charles F. ·University of Pittsburgh School of Medicine, United States. · University of Pittsburgh Graduate School of Public Health, United States. · Columbia University School of Social Work and College of Physicians and Surgeons, United States. · Massachusetts General Hospital, Harvard Medical School, United States. · University of California, San Diego, United States. · University of Pittsburgh School of Medicine, United States. Electronic address: ReynoldsCF@upmc.edu. ·J Psychiatr Res · Pubmed #28987981.

ABSTRACT: OBJECTIVE: To describe medical comorbidity in persons with Complicated Grief (CG) and to test whether medical comorbidity in individuals with CG is associated with the severity and duration of CG, after adjusting for age, sex, race, and current depressive symptoms. METHODS: In exploratory analyses, we compared data from participants in an NIMH-sponsored multisite clinical trial of CG ("HEAL": "Healing Emotions After Loss") to archival data from participants matched on age, gender, and race/ethnicity, stratified by the presence or absence of current major depression. We used the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) as a measure of medical polymorbidity. We investigated the association between CG and medical comorbidity via multiple linear regression, adjusting for sociodemographic and clinical variables, including severity of depressive symptoms. RESULTS: Chronological age and severity of co-occurring symptoms of major depression correlated with cumulative medical polymorbidity in persons with Complicated Grief. The severity of CG and the time since loss did not correlate with global medical polymorbidity (CIRS-G score). Nor was there an interaction between severity of depressive symptoms and severity of CG symptoms in predicting global CIRS-G score. Cumulative medical comorbidity, as measured by CIRS-G scores, was greater in subjects with current major depression ("DEPRESSED") than in CG subjects, and both DEPRESSED and CG subjects had greater medical morbidity than CONTROLS. CONCLUSION: Medical comorbidity is prevalent in Complicated Grief, associated with increasing age and co-occurring depressive symptoms but apparently not with chronicity and severity of Complicated Grief per se. This observation suggests that treating depression in the context of CG may be important to managing medical conditions in individuals with Complicated Grief to attenuate or prevent the long-term medical sequelae of CG.

14 Article Examining the Relationship Between Parent and Child Psychopathology in Treatment-Seeking Veterans. 2018

Zalta, Alyson K / Bui, Eric / Karnik, Niranjan S / Held, Philip / Laifer, Lauren M / Sager, Julia C / Zou, Denise / Rauch, Paula K / Simon, Naomi M / Pollack, Mark H / Ohye, Bonnie. ·Road Home Program, Department of Psychiatry, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 602, Chicago, IL, 60612, USA. Alyson_Zalta@rush.edu. · Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA. Alyson_Zalta@rush.edu. · Home Base, a Red Sox Foundation and Massachusetts General Hospital program, Boston, MA, USA. · Department of Psychiatry, Harvard Medical School, Boston, MA, USA. · Road Home Program, Department of Psychiatry, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 602, Chicago, IL, 60612, USA. ·Child Psychiatry Hum Dev · Pubmed #28660407.

ABSTRACT: This study aimed to examine: (1) the relationship between parental psychopathology and child psychopathology in military families and (2) parenting sense of competence as a mediator of the relationship between veteran psychopathology and child psychopathology. As part of their standard clinical evaluations, 215 treatment-seeking veterans who reported having a child between the ages of 4 and 17 were assessed for psychopathology (posttraumatic stress disorder, depression, anxiety, and stress), their sense of competence as a parent, and their child's psychopathology (internalizing, externalizing, and attentional symptoms). A path analysis model examining parenting sense of competence as a mediator of the relationship between veteran psychopathology and child psychopathology showed significant indirect effects of veteran depression on all child psychopathology outcomes via parenting sense of competence. Parental sense of competence may be a critical mechanism linking veteran depression and child psychopathology, and may therefore be an important target for intervention.

15 Article Depression, inflammation, and epidermal growth factor receptor (EGFR) status in metastatic non-small cell lung cancer: A pilot study. 2017

Jacobs, Jamie M / Traeger, Lara / Eusebio, Justin / Simon, Naomi M / Sequist, Lecia V / Greer, Joseph A / Temel, Jennifer S / Pirl, William F. ·Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States. Electronic address: jjacobs@mgh.harvard.edu. · Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States. · Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 6th floor, Boston, MA 02114, United States. · Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 7B, Boston, MA 02114, United States. ·J Psychosom Res · Pubmed #28712427.

ABSTRACT: OBJECTIVE: Patients with stage IV non-small cell lung cancer (NSCLC) have high risk for depressive symptoms and major depressive disorder (MDD); however, those with epidermal growth factor receptor (EGFR) mutations may have decreased risk. The biological underpinning of this relationship is unknown. We examined differences in depression severity and MDD in patients with newly diagnosed stage IV NSCLC based on EGFR mutation status, and examined proinflammatory cytokines and growth factors known to play a role in cancer progression and depression. METHODS: Fifty-five patients with newly diagnosed stage IV NSCLC completed self-report and clinician-administered depression assessments prior to receiving results of tumor genotyping. We measured serum levels of circulating biological markers of inflammation: IL-1β, IL-6, TGF-α, and TNF-α. We examined differences in depression severity, MDD, and inflammatory biomarkers in patients with and without EGFR mutations. RESULTS: Patients with EGFR mutations (n=10) had lower depression severity (t[43]=2.38, p=0.03) than those without EGFR mutations (n=38) and fewer patients with EGFR mutations had concurrent MDD (2.08%) relative to those without mutations (27.08%). Patients with MDD had higher levels of TNF-α than those without MDD (t[40]=2.95, p=0.005). Those with EGFR mutations exhibited higher levels of TNF-α relative to those without EGFR mutations (t[35]=2.17, p=0.04). CONCLUSIONS: Patients with stage IV NSCLC harboring an EGFR mutation exhibited elevated proinflammatory marker TNF-α, yet had lower depression severity than patients without EGFR mutations. More work is warranted to examine the interaction between tumor genotyping and inflammatory cytokines in the context of depression.

16 Article Contribution of Perceived Cognitive Functioning to Quality of Life in Service Members and Veterans With Posttraumatic Stress Disorder. 2017

Silverberg, Noah D / Wojtowicz, Magdalena / Bui, Eric / Wershba, Rebecca / Zafonte, Ross / Laifer, Lauren M / Simon, Naomi M / Iverson, Grant L. ·Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada. · Harvard Medical School: Department of Physical Medicine & Rehabilitation, Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts, USA. · Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA. ·J Trauma Stress · Pubmed #28544024.

ABSTRACT: Perceived cognitive impairment is a core clinical feature of posttraumatic stress disorder (PTSD) and may be an important determinant of quality of life (QOL) in those who suffer from this disorder. Using a clinical data repository, we evaluated this hypothesis in a cross-sectional sample of U.S. military service members and veterans who served after September 11, 2001, and were seeking mental health treatment at a tertiary outpatient clinic. A consecutive series of 117 patients with a clinical diagnosis of PTSD completed a battery of questionnaires at intake, including the PTSD Checklist (Weathers, Litz, Herman, Huska, & Keane, 1993), a 4-item Cognitive Symptom subscale of the Neurobehavioral Symptom Inventory (Cicerone & Kalmar, 1995), the Depression Anxiety Stress Scale-21 (Lovibond & Lovibond, 1995), and the Quality of Life Enjoyment and Satisfaction Questionnaire (Endicott, Nee, Harrison, & Blumenthal, 1993). Cognitive symptom reporting was very high, even in the subgroup without a history of traumatic brain injury. In a regression analysis, cognitive symptom severity was independently associated with QOL (β = -.204). This relationship was not explained by comorbid traumatic brain injury, but was restricted to patients with comorbid depression (β = -.278 in the subgroup with an elevated Depression Anxiety Stress Scale-21 Depression subscale; n = 91). In conclusion, perceived cognitive impairment was common in this PTSD sample and helped to explain impairments in QOL, especially in patients with comorbid depression.

17 Article Inflammatory cytokines in major depressive disorder: A case-control study. 2017

Cassano, Paolo / Bui, Eric / Rogers, Andrew H / Walton, Zandra E / Ross, Rachel / Zeng, Mary / Nadal-Vicens, Mireya / Mischoulon, David / Baker, Amanda W / Keshaviah, Aparna / Worthington, John / Hoge, Elizabeth A / Alpert, Jonathan / Fava, Maurizio / Wong, Kwok K / Simon, Naomi M. ·1 Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. · 2 Dana-Farber Cancer Institute, Boston, MA, USA. ·Aust N Z J Psychiatry · Pubmed #27313138.

ABSTRACT: INTRODUCTION: There is mixed evidence in the literature on the role of inflammation in major depressive disorder. Contradictory findings are attributed to lack of rigorous characterization of study subjects, to the presence of concomitant medical illnesses, to the small sample sizes, and to the limited number of cytokines tested. METHODS: Subjects aged 18-70 years, diagnosed with major depressive disorder and presenting with chronic course of illness, as well as matched controls ( n = 236), were evaluated by trained raters and provided blood for cytokine measurements. Cytokine levels in EDTA plasma were measured with the MILLIPLEX Multi-Analyte Profiling Human Cytokine/Chemokine Assay employing Luminex technology. The Wilcoxon rank-sum test was used to compare cytokine levels between major depressive disorder subjects and healthy volunteers, before (interleukin [IL]-1β, IL-6, and tumor necrosis factor-α) and after Bonferroni correction for multiple comparisons (IL-1α, IL-2, IL-3, IL-4, IL-5, IL-7, IL-8, IL-10, IL-12(p40), IL-12(p70), IL-13, IL-15, IFN-γ-inducible protein 10, Eotaxin, interferon-γ, monotype chemoattractant protein-1, macrophage inflammatory protein-1α, granulocyte-macrophage colony-stimulating factor and vascular endothelial growth factor). RESULTS: There were no significant differences in cytokine levels between major depressive disorder subjects and controls, both prior to and after correction for multiple analyses (significance set at p ⩽ 0.05 and p ⩽ 0.002, respectively). CONCLUSION: Our well-characterized examination of cytokine plasma levels did not support the association of major depressive disorder with systemic inflammation. The heterogeneity of major depressive disorder, as well as a potential sampling bias selecting for non-inflammatory depression, might have determined our findings discordant with the literature.

18 Article Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial. 2016

Shear, M Katherine / Reynolds, Charles F / Simon, Naomi M / Zisook, Sidney / Wang, Yuanjia / Mauro, Christine / Duan, Naihua / Lebowitz, Barry / Skritskaya, Natalia. ·Columbia School of Social Work, Columbia University College of Physicians and Surgeons, New York, New York2Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York. · Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. · Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston5Harvard Medical School, Boston, Massachusetts. · Department of Psychiatry, University of California, San Diego7Veterans Affairs San Diego Healthcare System, La Jolla, California8Veterans Medical and Research Foundation, La Jolla, California. · Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York. · Division of Biostatistics, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York. · Department of Psychiatry, University of California, San Diego. · Columbia School of Social Work, Columbia University College of Physicians and Surgeons, New York, New York. ·JAMA Psychiatry · Pubmed #27276373.

ABSTRACT: IMPORTANCE: To our knowledge, this is the first placebo-controlled randomized clinical trial to evaluate the efficacy of antidepressant pharmacotherapy, with and without complicated grief psychotherapy, in the treatment of complicated grief. OBJECTIVE: To confirm the efficacy of a targeted complicated grief treatment (CGT), determine whether citalopram (CIT) enhances CGT outcome, and examine CIT efficacy without CGT. DESIGN, SETTING, AND PARTICIPANTS: Included in the study were 395 bereaved adults who met criteria for CG recruited from March 2010 to September 2014 from academic medical centers in Boston, Massachusetts; New York, New York; Pittsburgh, Pennsylvania; and San Diego, California. Co-occurring substance abuse, psychosis, mania, and cognitive impairment were exclusionary. Study participants were randomized using site-specific permuted blocks stratified by major depression into groups prescribed CIT (n = 101), placebo (PLA; n = 99), CGT with CIT (n = 99), and CGT with PLA (n = 96). Independent evaluators conducted monthly assessments for 20 weeks. Response rates were compared under the intention-to-treat principle, including all randomized participants in a logistic regression with inverse probability weighting. INTERVENTIONS: All participants received protocolized pharmacotherapy optimized by flexible dosing, psychoeducation, grief monitoring, and encouragement to engage in activities. Half were also randomized to receive manualized CGT in 16 concurrent weekly sessions. MAIN OUTCOMES AND MEASURES: Complicated grief-anchored Clinical Global Impression scale measurments every 4 weeks. Response was measured as a rating of "much improved" or "very much improved." RESULTS: Of the 395 study participants, 308 (78.0%) were female and 325 (82.3%) were white. Participants' response to CGT with PLA vs PLA (82.5% vs 54.8%; relative risk [RR], 1.51; 95% CI, 1.16-1.95; P = .002; number needed to treat [NNT], 3.6) suggested the efficacy of CGT, and the addition of CIT did not significantly improve CGT outcome (CGT with CIT vs CGT with PLA: 83.7% vs 82.5%; RR, 1.01; 95% CI, 0.88-1.17; P = .84; NNT, 84). However, depressive symptoms decreased significantly more when CIT was added to treatment (CGT with CIT vs CGT with PLA: model-based adjusted mean [standard error] difference, -2.06 [1.00]; 95% CI, -4.02 to -0.11; P = .04). By contrast, adding CGT improved CIT outcome (CIT vs CGT with CIT: 69.3% vs 83.7%; RR, 1.21; 95% CI, 1.00-1.46; P = .05; NNT, 6.9). Last, participant response to CIT was not significantly different from PLA at week 12 (45.9% vs 37.9%; RR, 1.21; 95% CI, 0.82-1.81; P = .35; NNT, 12.4) or at week 20 (69.3% vs 54.8%; RR, 1.26; 95% CI, 0.95-1.68; P = .11; NNT, 6.9). Rates of suicidal ideation diminished to a substantially greater extent among participants receiving CGT than among those who did not. CONCLUSIONS AND RELEVANCE: Complicated grief treatment is the treatment of choice for CG, and the addition of CIT optimizes the treatment of co-occurring depressive symptoms. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01179568.

19 Article THE STRUCTURED CLINICAL INTERVIEW FOR COMPLICATED GRIEF: RELIABILITY, VALIDITY, AND EXPLORATORY FACTOR ANALYSIS. 2015

Bui, Eric / Mauro, Christine / Robinaugh, Donald J / Skritskaya, Natalia A / Wang, Yuanjia / Gribbin, Colleen / Ghesquiere, Angela / Horenstein, Arielle / Duan, Naihua / Reynolds, Charles / Zisook, Sidney / Simon, Naomi M / Shear, M Katherine. ·Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts. · Harvard Medical School, Boston, Massachusetts. · Center for Complicated Grief, Columbia School of Social Work, New York, New York. · University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. · University of California, San Diego, California. · VA San Diego Healthcare System, San Diego, California. ·Depress Anxiety · Pubmed #26061724.

ABSTRACT: BACKGROUND: Complicated grief (CG) has been recently included in the DSM-5, under the term "persistent complex bereavement disorder," as a condition requiring further study. To our knowledge, no psychometric data on any structured clinical interview for CG (SCI-CG) is available to date. In this manuscript, we introduce the SCI-CG, a 31-item "SCID-like" clinician-administered instrument to assess the presence of CG symptoms. METHODS: Participants were 281 treatment-seeking adults with CG (77.9% [n = 219] women, mean age = 52.4, standard deviation [SD] = 17.8) who were assessed with the SCI-CG and measures of depression, posttraumatic stress, anxiety, functional impairment. RESULTS: The SCI-CG exhibited satisfactory internal consistency (α = .78), good test-retest reliability (interclass correlation [ICC] 0.68, 95% CI [0.60-0.75]), and excellent interrater reliability (ICC = 0.95, 95% CI [0.89-0.98]). Exploratory factor analyses revealed that a five-factor structure, explaining 50.3% of the total variance, was the best fit for the data. CONCLUSIONS: The clinician-rated SCI-CG demonstrates good internal consistency, reliability, and convergent validity in treatment-seeking individuals with CG and therefore can be a useful tool to assess CG. Although diagnostic criteria for CG have yet to be adequately validated, the SCI-CG may facilitate this process. The SCI-CG can now be used as a validated instrument in research and clinical practice.

20 Article Increasing support for the treatment of complicated grief in adults of all ages. 2015

Simon, Naomi M. ·Complicated Grief Program and Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston. ·JAMA · Pubmed #26034957.

ABSTRACT: -- No abstract --

21 Article Telomere length and telomerase in a well-characterized sample of individuals with major depressive disorder compared to controls. 2015

Simon, Naomi M / Walton, Zandra E / Bui, Eric / Prescott, Jennifer / Hoge, Elizabeth / Keshaviah, Aparna / Schwarz, Noah / Dryman, Taylor / Ojserkis, Rebecca A / Kovachy, Benjamin / Mischoulon, David / Worthington, John / De Vivo, Immaculata / Fava, Maurizio / Wong, Kwok-Kin. ·Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States. Electronic address: nsimon@mgh.harvard.edu. · Dana-Farber Cancer Institute, Boston, MA, United States. · Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States. · Dana-Farber Cancer Institute, Boston, MA, United States; Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States. · Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States. · Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States. · Harvard Medical School, Boston, MA, United States; Dana-Farber Cancer Institute, Boston, MA, United States. ·Psychoneuroendocrinology · Pubmed #25932992.

ABSTRACT: BACKGROUND: Leukocyte telomere length (LTL) is a marker of cellular turnover and oxidative stress. Studies suggest major depressive disorder (MDD) is associated with oxidative stress, but examinations of MDD and LTL have yielded mixed results, likely because of differences in measurement methods and unmeasured confounding. This study examined LTL and telomerase activity in 166 individuals with MDD compared to 166 age- and gender-matched matched controls free of any psychiatric disorder, using well-validated assays and clinical assessment methods, and controlling for a range of potential confounders. METHODS: Subjects aged 18 to 70 were evaluated by trained raters and provided blood for LTL and telomerase activity measurement. LTL was assayed using Southern blot and replicated with qPCR, and telomerase activity was assayed with a repeat amplification protocol using a commercial kit. RESULTS: There was no significant difference in telomere length for individuals with MDD [mean (SD)=9.1 (3.0)kbp] compared to controls [mean(SD)=8.9(2.5)kbp] measured by Southern blot (p=0.65) or by confirmatory qPCR (p=0.91) assays. Controlling for potential confounders did not alter the results. Telomerase activity did not differ by MDD diagnosis overall (p=0.40), but the effect of MDD was significantly modified by gender (t(299)=2.67, p=0.0079) even after controlling for potential confounders, with telomerase activity significantly greater only in males with MDD versus controls. CONCLUSION: Our well-characterized, well-powered examination of concurrently assessed telomere length and telomerase activity in individuals with clinically significant, chronic MDD and matched controls failed to provide strong evidence of an association of MDD with shorter LTL, while telomerase activity was higher in men with MDD [corrected].

22 Article The impact of losing a child on the clinical presentation of complicated grief. 2015

Zetumer, Samuel / Young, Ilanit / Shear, M Katherine / Skritskaya, Natalia / Lebowitz, Barry / Simon, Naomi / Reynolds, Charles / Mauro, Christine / Zisook, Sidney. ·Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, CA, USA. · Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, CA, USA; Department of Psychiatry, University of California, 3350 La Jolla Village Dr, La Jolla, CA 92161-116A, USA. · Complicated Grief Treatment Research Program, Columbia University School of Social Work and Department of Psychiatry, DC, USA; University College of Physicians and Surgeons, New York, NY, USA. · Department of Biostatistics and Psychiatry, Columbia University, New York, NY, USA. · Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, CA, USA; Complicated Grief Treatment Research Program, Columbia University School of Social Work and Department of Psychiatry, DC, USA. · Center for Anxiety and Traumatic Stress Disorders and Complicated Grief Program, Massachusetts General Hospital, Boston, MA, USA. · Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Community and Behavioral Health Science, University of Pittsburgh Graduate School of Public Health, Western Psychiatry Institute and Clinic, Pittsburgh, PA, USA. · Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, CA, USA; Department of Psychiatry, University of California, 3350 La Jolla Village Dr, La Jolla, CA 92161-116A, USA. Electronic address: szisook@ucsd.edu. ·J Affect Disord · Pubmed #25217759.

ABSTRACT: BACKGROUND: It is unclear whether bereaved parents with Complicated Grief (CG) struggle with their grief differently than others with CG. This study addressed this question by comparing CG severity, CG-related symptoms, thoughts and behaviors, and comorbid psychiatric diagnoses of bereaved parents with CG to the diagnoses and symptoms of others with CG. METHODS: Baseline data from 345 participants enrolled in the Healing Emotions After Loss (HEAL) study, a multi-site CG treatment study, were used to compare parents with CG (n=75) to others with CG (n=275). Data from the parent group was then used to compare parents with CG who had lost a younger child (n=24) to parents with CG who had lost an older child (n=34). Demographic and loss-related data were also gathered and used to control for confounders between groups. RESULTS: Parents with CG demonstrated slightly higher levels of CG (p=0.025), caregiver self-blame (p=0.007), and suicidality (p=0.025) than non-parents with CG. Parents who had lost younger children were more likely to have had a wish to be dead since the loss than parents who had lost older children (p=0.041). LIMITATIONS: All data were gathered from a treatment research study, limiting the generalizability of these results. No corrections were made for multiple comparisons. The comparison of parents who lost younger children to parents who lost older children was limited by a small sample size. CONCLUSIONS: Even in the context of CG, the relationship to the deceased may have a bearing on the degree and severity of grief symptoms and associated features. Bereaved parents with CG reported more intense CG, self-blame, and suicidality than other bereaved groups with CG, though this finding requires confirmation. The heightened levels of suicidal ideation experienced by parents with CG, especially after losing a younger child, suggest the value of routinely screening for suicidal thoughts and behaviors in this group.

23 Article Cognitive functioning in complicated grief. 2014

Hall, Charles A / Reynolds, Charles F / Butters, Meryl / Zisook, Sidney / Simon, Naomi / Corey-Bloom, Jody / Lebowitz, Barry D / Begley, Amy / Mauro, Christine / Shear, M Katherine. ·Department of Psychiatry, University of Pittsburgh, School of Medicine, USA; SUNY Downstate College of Medicine, USA. · Department of Psychiatry, University of Pittsburgh, School of Medicine, USA. Electronic address: reynoldscf@upmc.edu. · Department of Psychiatry, University of Pittsburgh, School of Medicine, USA. · Department of Psychiatry, University of California San Diego, USA; Veterans Affairs San Diego Healthcare System, USA; Veterans Medical and Research Foundation, USA. · Center for Anxiety and Traumatic Stress Disorders (NMS), Massachusetts General Hospital, USA. · Department of Neuroscience, University of California San Diego, USA. · Department of Psychiatry, University of California San Diego, USA. · Department of Biostatistics, Mailman School of Public Health, Columbia University, USA. · Columbia University School of Social Work, USA; Columbia University College of Physicians and Surgeons, USA. ·J Psychiatr Res · Pubmed #25088285.

ABSTRACT: Complicated grief (CG) is increasingly recognized as a debilitating outcome of bereavement. Given the intensity of the stressor, its chronicity, and its association with depression, it is important to know the impact CG may have on cognitive functioning. This exploratory and descriptive study examined global and domain-specific cognitive functioning in a help-seeking sample of individuals with CG (n = 335) compared to a separately ascertained control sample (n = 250). Cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA). Controlling for age, sex and education effects, CG participants had lower total MoCA, visuospatial and attention scores relative to control participants. The two groups did not differ significantly in the domains of executive function, language, memory or orientation. Age, sex, and education accounted for much of the variance in MoCA scores, while CG severity and chronicity accounted for a very small percentage of MoCA score variance. Major depression was not a significant predictor of MoCA scores. This study is consistent with previous work demonstrating lower attention and global cognitive performance in individuals with CG compared to control participants. This study newly identifies the visuospatial domain as a target for future studies investigating cognitive functioning in CG.

24 Article De novo fear conditioning across diagnostic groups in the affective disorders: evidence for learning impairments. 2014

Otto, Michael W / Moshier, Samantha J / Kinner, Dina G / Simon, Naomi M / Pollack, Mark H / Orr, Scott P. ·Boston University. Electronic address: mwotto@bu.edu. · Boston University. · Massachusetts General Hospital and Harvard Medical School. ·Behav Ther · Pubmed #25022773.

ABSTRACT: De novo fear conditioning paradigms have served as a model for how clinical anxiety may be acquired and maintained. To further examine variable findings in the acquisition and extinction of fear responses between clinical and nonclinical samples, we assessed de novo fear conditioning outcomes in outpatients with either anxiety disorders or depression and healthy subjects recruited from the community. Overall, we found evidence for attenuated fear conditioning, as measured by skin conductance, among the patient sample, with significantly lower fear acquisition among patients with depression and posttraumatic stress disorder. These acquisition deficits were evident in both the simple (considering the CS+only) and differential (evaluating the CS+in relation to the CS-) paradigms. Examination of extinction outcomes were hampered by the low numbers of patients who achieved adequate conditioning, but the available data indicated slower extinction among the patient, primarily panic disorder, sample. Results are interpreted in the context of the cognitive deficits that are common to the anxiety and mood disorders, with attention to a range of potential factors, including mood comorbidity, higher-and lower-order cognitive processes and deficits, and medication use, that may modulate outcomes in fear conditioning studies, and, potentially, in exposure-based cognitive behavioral therapy.

25 Article Periloss dissociation, symptom severity, and treatment response in complicated grief. 2013

Bui, Eric / Simon, Naomi M / Robinaugh, Donald J / Leblanc, Nicole J / Wang, Yuanjia / Skritskaya, Natalia A / Mauro, Christine / Shear, M Katherine. ·Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. tebui@partners.org ·Depress Anxiety · Pubmed #23212730.

ABSTRACT: BACKGROUND: Complicated grief (CG) is a bereavement-specific syndrome characterized by traumatic and separation distress lasting over 6 months. Little is known about the role of dissociation experienced during or immediately after the loss of a loved one (i.e., periloss dissociation [PLD]) in CG. The present study aimed to examine the psychometric properties of the PLD-adapted Peritraumatic Dissociative Experiences Questionnaire and its association with symptom severity, treatment response, and drop-out rate. METHODS: PLD data collected as part of a randomized controlled trial of two loss-focused psychotherapy approaches for CG were examined. Treatment-seeking individuals with primary CG (n = 193) were assessed for PLD at the initial visit, 95 of whom were randomized and completed at least one treatment session. RESULTS: The PLD-adapted Peritraumatic Dissociative Experiences Questionnaire was found to be internally consistent (α = 0.91) with good convergent and divergent validity. After controlling for age, gender, time since loss, and current comorbid psychiatric diagnosis, self-reported PLD was associated with greater CG symptom severity (P < .01). However, contrary to our hypotheses, after controlling for age, baseline symptoms severity, psychiatric comorbidity, and treatment arm, PLD was predictive of better treatment response (P < .05) and lower study discontinuation (P < .01). CONCLUSIONS: PLD may be useful in identifying individuals at risk for CG and those who might respond to psychotherapy. Additional research should investigate the relationship of PLD with treatment outcome for different treatment approaches, and whether PLD prospectively predicts the development of CG.