Table 2.
Effects of Treatment, Family Type, and Treatment by Family-Type Interaction on Complicated Grief and Depression in Bereaved Family Members
| Family Type and Treatment for Complicated Grief and Depression | Mean (SD) of Participants | Mean (95% CI) | Analyzed Effecta | ||||
|---|---|---|---|---|---|---|---|
| Baseline | 6-Month Bereavement | 13-Month Bereavement | Post-Bereavement Model-Estimated Average 6-13 Months | Treatment | Family Type | Treatment by Family-Type at Average of 6-13 Months | |
| CGIb | Wald χ2 = 6.88; df = 2; P = .032 | Wald χ2 = 4.01; df = 2; P = .135 | Wald χ2 = 20.64; df = 4; P < .001c | ||||
| Low communicating | |||||||
| SC | NAd | 23.6 (7.8) | 22.5 (7.9) | 23.16 (20.06 to 26.25) | |||
| Six sessions | 20.2 (9.5) | 22.6 (6.6) | 22.54 (20.18 to 24.90) | ||||
| 10 sessions | 17.6 (6.9)e | 17.0 (6.9)fg | 17.58 (15.25 to 19.91)h | ||||
| Low involvement | |||||||
| SC | NAd | 19.2 (7.0) | 16.8 (6.4) | 18.08 (15.60 to 20.56) | |||
| Six sessions | 19.9 (6.3) | 19.0 (6.9) | 19.59 (17.54 to 21.65) | ||||
| 10 sessions | 21.1 (7.9) | 19.7 (6.9) | 20.70 (18.37 to 23.03) | ||||
| High conflict | |||||||
| SC | NAd | 20.9 (8.1) | 20.4 (9.8) | 21.63 (17.40 to 25.87) | |||
| Six sessions | 20.7 (6.0) | 18.1 (6.8) | 20.19 (17.41 to 22.97) | ||||
| 10 sessions | 19.3 (8.3)i | 17.1 (6.9)j | 17.63 (14.40 to 20.85)k | ||||
| BDIl | Wald χ2 = 1.00; df = 2; P = .608 | Wald χ2 = 8.47; df = 2; P = .0145 | Wald χ2 = 4.25; df = 4; P = .374 | ||||
| Low communicating | |||||||
| SC | 13.3 (7.7) | 12.1 (10.6) | 10.9 (11.2) | 10.08 (6.77 to 13.39) | |||
| Six sessions | 13.6 (6.6) | 11.6 (7.1) | 12.8 (9.0) | 11.24 (8.44 to 14.05) | |||
| 10 sessions | 7.7 (7.1) | 7.0 (6.8) | 6.6 (6.5) | 9.49 (6.89 to 12.10) | |||
| Low involvement | |||||||
| SC | 12.2 (8.9) | 11.5 (10.6) | 8.8 (8.6) | 10.26 (7.39 to 13.14) | |||
| Six sessions | 12.0 (8.6) | 10.1 (7.7) | 9.7 (9.1) | 9.83 (7.27 to 12.39) | |||
| 10 sessions | 14.3 (9.6) | 13.6 (9.5) | 11.0 (9.3) | 11.02 (8.47 to 13.58) | |||
| High conflict | |||||||
| SC | 16.8 (11.5) | 12.4 (8.6) | 11.9 (7.8) | 8.82 (5.92 to 11.73) | |||
| Six sessions | 14.2 (9.6) | 11.0 (7.1) | 10.2 (9.8) | 8.60 (5.78 to 11.43) | |||
| 10 sessions | 10.3 (7.0) | 6.0 (6.9) | 5.7 (6.8) | 7.01 (4.73 to 9.28) | |||
NOTE. Unless noted in the footnotes, all other post hoc pairwise comparisons were nonsignificant.
Abbreviations: BDI, Beck Depression Inventory II; CGI, Complicated Grief Inventory, Abbreviated; NA, not available; SC, standard care.
Analyzed treatments were SC and six sessions or 10 sessions of family intervention. Treatment by family-type interaction on complicated grief was assessed with the CGI; BDI was used to assess depression
CGI analysis used data from 416 family members nested within 151 families.
To better understand the treatment by family-type interaction, we contrasted the treatment effect (10 sessions v SC, aggregating as per generalized estimated equations default over 6 and 13 months) between the following family types: low-communicating versus low-involvement families (−8.20; 95% adjusted CI, −12.32 to −4.08; adjusted P < .001); high-conflict versus low-involvement families (−6.63; 95% adjusted CI, −12.46 to −0.79; adjusted P = .039); high-conflict versus low-communicating families (1.57; 95% CI, −4.61 to 7.76; adjusted P =.618). A lower CGI score indicated a better outcome; thus, a negative score was the expected direction of contrast. In high-conflict families, the model-estimated treatment effect was −4 (17.63 minus 21.63), which, when contrasted against that of low-involvement families, yielded an overall estimate of −6.63 (−4 plus −2.62, after rounding). These post hoc analyses suggest that the treatment by family-type interaction resulted from greater benefits gained by low-communicating and high-conflict families than by low-involvement families in a comparison of 10-session interventions with SC. High-conflict families did not gain greater benefits than low-communicating families; their respective gains were similar.
CGI not assessed prior to death of patient.
Post hoc analyses, for CGI, within low-communicating families: at 6 months of bereavement, post hoc 10-session intervention compared with SC: mean estimated difference = −6.14 (95% adjusted CI, −11.32 to −0.97); adjusted P = .0104.
Post hoc analyses, for CGI, within low-communicating families: at 13 months of bereavement, post hoc 10 sessions compared with six sessions: mean estimated difference = −4.96 (95% adjusted CI, −9.21 to −071); adjusted P = .009.
Post hoc analyses, for CGI, within low-communicating families: at 13 months of bereavement, post hoc 10-session intervention compared with SC: mean estimated difference = −5.58 (95% adjusted CI, −10.60 to −0.56); adjusted P = .017.
Post hoc analyses, for CGI, within low-communicating families at an average of 6 to 13 months of bereavement, post hoc 10-session intervention compared with SC: mean estimated difference = −5.70 (95% adjusted CI, −10.01 to −1.40); adjusted P = .004.
Post hoc analyses, for CGI within conflictual families: at 6 months of bereavement, post hoc 10-session intervention compared with SC: mean estimated difference = −4.43 (95% adjusted CI, −10.27 to 1.41); adjusted P = .228.
Post hoc analyses, for CGI within conflictual families: at 13 months of bereavement, post hoc 10-session intervention compared with SC: mean estimated difference = −4.194 (95% adjusted CI, −11.690 to 3.302); adjusted P = .503.
Post hoc analyses, for CGI within conflictual families: at an average of 6 to 13 months of bereavement, post hoc 10-session intervention compared with SC: mean estimated difference = −3.961 (95% adjusted CI, −10.60 to 2.68); adjusted P = .378.
BDI analysis used data from 417 family members nested within 151 families; also, baseline BDI score was included as a covariate.