Indirect self-destructive behavior and overt suicidality in patients with complicated grief

J Clin Psychiatry. 2006 Feb;67(2):233-9. doi: 10.4088/jcp.v67n0209.


Background: Complicated grief is associated with increased suicidal ideation in samples of bereaved individuals; however, suicidal behavior has not been assessed in these patients. Additionally, there are no reports of suicidality among help-seeking individuals with complicated grief. Therefore, we examined suicidal behavior and its correlates in 149 patients who signed informed consent statements to participate in a National Institute of Mental Health-funded treatment study of complicated grief.

Method: All patients met criteria for complicated grief (Inventory of Complicated Grief score>or=25). Suicidality was assessed using a structured clinical interview administered prior to beginning treatment. Participants also completed self-report questionnaires and interview assessment measures rating the presence or absence of DSM-IV Axis I diagnosis and symptom severity. Data were gathered between April 2001 and April 2004.

Results: Thoughts of wanting to die following the death of a loved one were reported by 65% of participants. More than half of this group (38% of the study sample) engaged in self-destructive behavior, including 9% who made a suicide attempt and 29% who engaged in indirect suicidal behavior. In a multiple logistic regression model, only the severity of complicated grief symptoms (p<.0001) and history of a suicide attempt (p<.02) were significantly associated with postloss suicidal behavior.

Discussion: Consistent with reports of non-help-seeking bereaved people, a high rate of individuals seeking treatment for complicated grief endorsed a wish to die. Notably, 13% of this group made at least 1 suicide attempt, and 44% engaged in indirect self-destructive behavior. Given its frequency, this behavior should be included in assessment of bereaved people.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude to Death
  • Bereavement
  • Depressive Disorder, Major / diagnosis
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / psychology
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Grief*
  • Humans
  • Logistic Models
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology*
  • Mental Disorders / psychology
  • Middle Aged
  • Patient Acceptance of Health Care / psychology
  • Personality Inventory / statistics & numerical data
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Self-Injurious Behavior / diagnosis
  • Self-Injurious Behavior / epidemiology*
  • Self-Injurious Behavior / psychology
  • Severity of Illness Index
  • Sex Factors
  • Suicide / psychology*
  • Suicide / statistics & numerical data
  • Suicide, Attempted / psychology
  • Suicide, Attempted / statistics & numerical data
  • Surveys and Questionnaires