Practice Guidelines

The Iraq War Clinician Guide 2nd Edition
This is an excellent resource for health care professionals who provide services to casualties from Operation Iraqi Freedom. It covers issues related to the psychiatric treatment of military personnel, assessment and treatment related to service members returning from the Iraq War, and the impact of deployment on military families. Information about Traumatic Grief is featured in chapter 11 of the manual.

Clinical Assessment Tools

Normal vs. Prolonged/Complicated Grief

There are no research-based, widely supported criteria to distinguish normal from problematic grief. Bereaving individuals typically struggle with moderate levels of symptoms and have difficulty managing responsibilities, but they somehow struggle through these tasks and gradually return to their normal level of functioning. However, chronic grievers experience more intense symptoms and their daily life functioning is more severely impaired for at least a year after the loss.

Chronic Grief vs. Chronic Depression

It is important to distinguish between chronic grief and chronic depression, particularly because treatments for each of these conditions differ (source) [Mancini, A. D., & Bonanno, G. A. (in press). In J. E. Fisher & W. O'Donohue (Eds). Practitioner's guide to evidence-based psychotherapy. New York: Kluwer Academic]. People with chronic depression believe that they are less able to cope, have more difficulty managing troubling feelings, and have less positive affect. Also, people suffering from chronic depression have higher levels distress prior to the loss. Chronic grievers tend to make more active efforts to understand the loss through processing and searching for meaning during the first 6-months of bereavement (source) [Bonanno, G. A., Wortman, C. B., & Nesse, R. M. (2004b). Prospective patterns of resilience and maladjustment in widowhood. Psychology & Aging, 19, 260-271].

Clinician Administered Assessment Tools

Mancini and Bonanno (source) [Mancini, A. D., & Bonanno, G. A. (in press). In J. E. Fisher & W. O'Donohue (Eds). Practitioner's guide to evidence-based psychotherapy. New York: Kluwer Academic] recommend that the following variables be assessed:

• Characteristics of the loss, including circumstances surrounding loss and the nature of relationship to deceased if applicable
• Clinical history, including past psychiatric history and premorbid level of functioning
• Current level of functioning
• Personality characteristics that may impact the reaction or ability to cope with loss

Self-Report Assessment Tools

Iraq War Clinician Guide, 2nd Edition

Screens for Complicated Grief are located on page 117. The following assessment instruments are recommended:

• TexasRevised Inventory of Grief