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Digital archive of theses discussed at the University of Pisa


Thesis etd-04182011-180819

Thesis type
Tesi di dottorato di ricerca
Thesis title
Frequency and correlates of adult Separation Anxiety Disorder among individuals with Complicated Grief: an exploratory study
Academic discipline
Course of study
tutor Prof. Pini, Stefano
  • Complicated Grief
  • Separation Anxiety
Graduation session start date
Introduction: Recent epidemiological data indicate that adult Separation Anxiety (SEPAD) has a lifetime prevalence of 6.6% in the general population. Moreover, adult SEPAD is highly co-morbid with other psychiatric disorders and associated with substantial impairment in role functioning. A growing body of data suggests that 10% to 20% of bereaved persons develop complicated grief (CG). Attachment theory might offer insight into both SEPAD and CG and childhood SEPAD was found to be linked to a higher risk of developing CG in adulthood. Even though adult SEPAD might be expected to be highly prevalent among CG patients and to impact functioning and treatment response, no studies have so far investigated adult SEPAD among people with CG. The proposed research attempts to explore the prevalence of adult SEPAD among CG patients, its possible association with specific dimensions of loss and its pattern of co-morbidity with PTSD, depression and PD. Moreover, we aim to investigate whether adult SEPAD might affect functioning of people with CG.
Methods: 151 bereaved individuals were evaluated with the Inventory of Complicated Grief (ICG), the Structured Clinical Interview for the DSM-IV (SCID-I),the Hamilton Rating Scale for Depression (HAM-D), the Separation Anxiety Symptoms Questionnaire (ASA-27), the Grief Related Avoidance Questionnaire (GRAQ), the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), the Impact of Events Scale (IES), the Work and Social Adjustment Scale (WSAS).
Results: People with and without SEPAD did not differ significantly for gender distribution, age, education and marital status. A significant difference was found with respect to race (P=0.002). With respect to grief measures, no differences were found in terms of total number of losses, type of loss and relationship to the deceased. People with adult SEPAD showed higher scores on the ICG (P<0.001), the PDEQ(P=0.004), the GRAQ(P<0.001), the IES intrusion (P<0.001) and IES avoidance (P<0.001). People with adult SEPAD showed a greater grief related impairment as evaluated with the WSAS (P=0.006). People with adult SEPAD, compared to those without, had a significantly higher co-morbidity with PTSD lifetime (P=0.04) and PD (current: P=0.001; lifetime: P=0.001). Adult SEPAD was not significantly associated with MDD, either current or lifetime. Nevertheless, HAM-D total score was significantly higher among people with adult SEPAD than those without P<0.001). As to ASA-27 total score, people with PTSD (either current or lifetime) showed significantly higher scores than people without PTSD (current: P=0.02; lifetime: P=0.002), as did people with PD (current: P<0.001; lifetime: P<0.001) whereas people with MDD, either current or lifetime, did not.
Conclusions: Adult SEPAD is highly frequent among patients with CG. As to other anxiety disorders, adult SEPAD is strongly associated with PTSD and PD. Even though there is a correlation between SEPAD symptoms and the severity of depressive symptoms, adult SEPAD is not significantly co-morbid with unipolar depression. Further studies will be necessary in order to confirm and generalize our results and to elucidate whether adult SEPAD might affect the course of CG and treatment response.