Treating Complicated Grief in Suicide Survivors

Grief is a natural human response to loss, but for some people, especially those grieving a sudden or traumatic death, such as the loss of a loved one to suicide, the pain can remain so intense and long-lasting that it develops into Prolonged Grief Disorder (PGD). This condition is marked by persistent yearning, emotional numbness, and difficulty returning to daily life, with accompanied by significant distress and functional impairment. Evidence-based treatments like Prolonged Grief Disorder Therapy (PGDT) have been shown to help many people adapt to loss and rebuild meaning, yet some individuals do not experience meaningful relief. Understanding why certain people respond to treatment while others continue to struggle is key to improving care for all bereaved individuals, including suicide loss survivors. Because depression frequently co-occurs with prolonged grief, it may interfere with recovery. Using tools like machine learning, researchers are now able to analyze complex patterns in clinical trial data to identify which factors (e.g., depression severity or functional impairment) predict different treatment outcomes, paving the way toward more personalized and responsive grief care.

With their Linked Standard Research Grant, a team of AFSP-funded researchers analyzed data from 333 adults with PGD who took part in a 20-week randomized clinical trial testing four treatment conditions for Prolonged Grief Disorder: PGDT with citalopram (an antidepressant), PGDT with placebo, citalopram with clinical management, or placebo with clinical management. Using machine learning, the team identified three distinct treatment trajectories: two groups that showed substantial improvement (one with lower initial symptom severity, one with higher) and a third group with severe symptoms that did not respond to treatment. Differences between people who responded to treatment and those who didn’t became apparent by week eight. The strongest predictors of minimal response were higher baseline depression and greater grief-related functional impairment, while receiving PGDT and having a longer time since the loss were linked with better outcomes. These findings suggest that clinicians should pay particular attention to grieving patients who begin treatment with significant depressive symptoms or major disruptions in daily functioning. For those not showing early progress, especially suicide loss survivors and others experiencing complex grief, adjusting or intensifying care by the second month of treatment may be essential for supporting recovery.

Citation: Calderon, A., Irwin, M., Simon, N. M., Shear, M. K., Mauro, C., Zisook, S., Reynolds, C. F., 3rd, & Malgaroli, M. (2024). Depression is Associated with Treatment Response Trajectories in Adults with Prolonged Grief Disorder: A Machine Learning Analysis. medRxiv : the preprint server for health sciences, 2024.12.11.24318861. https://doi.org/10.1101/2024.12.11.24318861