The Role of Avoidance in Complicated Grief: A Detailed Examination of the Grief-Related Avoidance Questionnaire (GRAQ) in a Large Sample of Individuals with Complicated Grief

ABSTRACT

Grief-related avoidance is a significant component of complicated grief, yet has rarely been formally measured in a validated fashion. Further, more work is needed to understand the impact of grief-related avoidance on symptom severity and functional impairment among individuals with complicated grief (CG). The Grief-Related Avoidance Questionnaire (GRAQ; Shear, Monk et al. 2007) was created to assess grief-related avoidance and the present analysis aimed to further develop this measure and construct by confirming the GRAQ’s psychometric properties and examining loss-related predictors of avoidance. In a sample of 393 adults with CG, we found the GRAQ had high internal consistency, with a Cronbach’s alpha of 0.89 and good convergent validity. While the EFA results suggest that the GRAQ may be unidimensional, a 3-factor model generally corresponded with the findings by (Shear, Monk et al. 2007), which suggested the presence of 3 subscales. Loss-related variables age, relationship to the deceased, and cause of death were all significant predictors of GRAQ scores. Our findings support that among individuals with complicated grief, avoidance is common, measurable and an important contributor to impairment.

KEYWORDS:

• Anxiety
• avoidance
• grief
• loss
• questionnaire

Notes on contributors

Amanda W. Baker is a clinical psychologist at the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital and an Instructor in Psychiatry at Harvard Medical School. Her research interests involve mediators and moderators of the etiology of and cognitive behavioral treatments for emotional disorders.

Aparna Keshaviah is a statistician at Mathmatica Policy Research and a former statistician at the Massachusetts General Hospital, Department of Psychiatry.

Arielle Horenstein is a graduate student at Temple University and a former clinical research coordinator at the Massachusetts General Hospital, Department of Psychiatry.

Elizabeth M. Goetter is a clinical psychologist at the Center for Anxiety and Traumatic Stress Disorders and the Home Base Program at Massachusetts General Hospital and an Instructor in Psychiatry at Harvard Medical School. She is interested in research on the utilization of and access to empirically supported treatments for anxiety and traumatic stress disorders.

Christine Mauro is an Associate Research Scientist in the Department of Biostatistics at Columbia University. Her expertise is in the analysis of clinical trials, psychometrics, and longitudinal data analysis.

Charles F. Reynolds III is an Endowed Professor in Geriatric Psychiatry at the University of Pittsburgh Medical Center and Director of the Aging Institute at the University of Pittsburgh. His primary research interests focus on mood, grief, and sleep disorders of later life.

Sidney Zisook is a distinguished professor of psychiatry at the University of California San Diego. His research interests include bereavement, suicide prevention, and the treatment of major depressive disorders.

M. Katherine Shear is the Director of the Center for Complicated Grief at Columbia School of Social Work and is the Marion E. Kenworthy Professor of Psychiatry at the Columbia School of Social Work and Columbia University College of Physicians and Surgeons. Dr. Shear is a leading expert in complicated grief and is the developer of Complicated Grief Therapy.

Naomi M. Simon is the Director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital and Associate Professor of Psychiatry at Harvard Medical School. Dr. Simon’s major clinical and research interests include initial and next step treatments for anxiety disorders, anxiety comorbid with mood disorders, complicated grief, and the biological impact of chronic stress due to these disorders.