Sarah, a 32-year-old woman, was referred to the outpatient psychiatric clinic by her primary care physician due to persistent depressive symptoms and difficulty functioning in daily life.

Background

Fifteen months ago, Sarah's mother died suddenly from a heart attack at age 58. Sarah and her mother had been extremely close, speaking daily and seeing each other multiple times per week. Sarah described her mother as her "best friend" and primary source of emotional support.

Since her mother's death, Sarah has experienced:

These symptoms have persisted without significant improvement for over a year since the loss. Sarah reports that the intensity of her grief feels just as strong now as it did immediately after her mother's death.

Sarah's work performance has declined significantly. She has been reprimanded for excessive absences and missed deadlines. Her social relationships have deteriorated as she isolates herself and avoids social gatherings. Sarah has also neglected her physical health, skipping meals and doctor's appointments.

Sarah attended three grief counseling sessions shortly after her mother's death but found them unhelpful and discontinued. She has been taking an SSRI antidepressant prescribed by her primary care doctor for the past six months with minimal effect on her symptoms.

Based on the persistent and impairing nature of Sarah's grief symptoms more than 12 months after her loss, she meets the criteria for prolonged grief disorder. Her symptoms go beyond customary cultural and religious norms for grief and are causing significant functional impairment.

A comprehensive treatment approach is recommended, including:

The goals are to help Sarah process her grief, find ways to maintain a healthy connection to her mother's memory, and gradually re-engage in life. Regular monitoring of suicidal ideation is also warranted, given the elevated suicide risk associated with prolonged grief.