Prolonged grief disorder linked to psychiatric disorders, suicide ideation among veterans

Veterans with prolonged grief disorder had greater odds of also having PTSD, major depressive disorder, generalized anxiety and suicidal thoughts and behaviors, according to data published in the American Journal of Geriatric Psychiatry.

“After experiencing a loss, some individuals may develop prolonged grief disorder, which was first included as a formal diagnosis in the DSM-5-TR in 2022 and is characterized by persistent loss-related emotional pain and grief that causes clinically significant distress or functional impairment,” Peter J. Na, MD, MPH, a staff psychiatrist in the Veterans Affairs Connecticut Healthcare System in West Haven, and colleagues wrote. “Military veterans represent a population at heightened risk for prolonged grief disorder, given their exposure to excessive deaths due to advanced age, combat deployments and high prevalence of suicide. To date, however, no known population-based study has examined the prevalence and factors associated with prolonged grief disorder in U.S. veterans.”

Na and colleagues analyzed data from participants in the National Health and Resilience in Veterans Study, a nationally representative cohort. Participants responded to the five-item Brief Grief Questionnaire (BGQ) to assess prolonged grief disorder, the Patient Health Questionnaire (PHQ)-4 to assess major depressive disorder and generalized anxiety, the PTSD checklist for DSM-5 to assess PTSD and the Suicide Behaviors Questionnaire-Revised (SBQ-R) to assess ideation in the past year.

In total, 2,441 veterans (average age, 63.2 years) participated in the study, 2,339 (92.7%) of whom reported losing someone close to them. A total of 158 (7.3%) veterans were reported to have prolonged grief disorder.

Veterans were more likely to have prolonged grief disorder if they were women, were Black, had served in the Marines, had more adverse childhood experiences, had lost more people close to them, had experienced loss related to suicide or homicide, had previously had COVID-19 or knew someone who died from COVID-19, according to the study. Education and experiencing loss due to old age or natural causes were associated with lower likelihood of prolonged grief disorder.

Multivariable analyses revealed that prolonged grief disorder was associated with greater odds of PTSD (OR = 9.71; 95% CI, 6.29-14.98), major depressive disorder (OR = 5.16; 95% CI, 3.2-8.31), generalized anxiety disorder (OR = 5.42; 95% CI, 3.44-8.53), current suicidal ideation (OR = 2.03; 95% CI, 1.26-3.27) and current mental health treatment (OR = 2.21; 95% CI, 1.45-3.38).

Prolonged grief disorder was also associated with greater odds of non-suicidal self-injury (OR = 2.13; 95% CI, 1.31-3.48), suicide planning (OR = 2.02; 95% CI, 1.3-3.15) and suicide attempt (OR = 1.85; 95% CI, 1.03-3.33) at any point in life, the researchers reported.

“Further research is needed to replicate these findings; evaluate interrelationships between prolonged grief disorder and other psychiatric outcomes; and evaluate the efficacy of interventions targeting prolonged grief disorder in this population,” Na and colleagues wrote.