Abstract
Although the concept of pathological grief dates back at least as far as Freud’s “Mourning and Melancholia”, there has been opposition to its recognition as a distinct mental disorder. Resistance has been overcome by evidence demonstrating that distinctive symptoms of prolonged grief disorder (PGD) – an attachment disturbance featuring yearning for the deceased, loss of meaning and identity disruption – can endure, prove distressing and disabling, and require targeted treatment. In acknowledgement of this evidence, the American Psychiatric Association Assembly has recently voted to include PGD as a new mental disorder in the DSM-5-TR. We tested the validity of the new DSM criteria for PGD and of an adapted version of our PG-13 scale, the PG-13-Revised (PG-13-R), designed to map onto these criteria, using data from investigations conducted at Yale University (N=270), Utrecht University (N=163) and Oxford University (N=239). Baseline assessments were performed at 12-24 months post-loss; follow-up assessments took place 5.3-12.0 months later. Results indicated that the PG-13-R grief symptoms represent a unidimensional construct, with high degrees of internal consistency (Cronbach's alpha = 0.83, 0.90 and 0.93, for Yale, Utrecht and Oxford, respectively). The DSM PGD diagnosis was distinct from post-traumatic stress disorder (phi=0.12), major depressive disorder (phi=0.25) and generalized anxiety disorder (phi=0.26) at baseline. Temporal stability was remarkable for this diagnosis (r=0.86, p<0.001). Kappa agreement between a PG-13-R threshold symptom summary score of 30 and the DSM symptom criterion for PGD was 0.70-0.89 across the datasets. Both the DSM PGD diagnosis and the PG-13-R symptom summary score at baseline were significantly associated (p<0.05) with symptoms and diagnoses of major depressive disorder, post-traumatic stress disorder and/or generalized anxiety disorder, suicidal ideation, worse quality of life and functional impairments at baseline and at follow-up, in the Yale, Utrecht and Oxford datasets. Overall, the DSM-5-TR criteria for PGD and the PG-13-R both proved reliable and valid measures for the classification of bereaved individuals with maladaptive grief responses.
| Original language | English |
|---|---|
| Pages (from-to) | 96-106 |
| Number of pages | 11 |
| Journal | World Psychiatry |
| Volume | 20 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Feb 2021 |
Bibliographical note
Funding Information:This work was supported by grants from the US National Cancer Institute (nos. CA197730 and CA218313), the US National Institute of Minority Health and Health Disparities (no. MD007652), the US National Institute of Nursing Research (no. NR018693), the US National Institute on Aging (no. AG049666), the US National Institute of Mental Health (no. MH121886), the US National Center for Advancing Translational Science (no. TR002384), the Wellcome Trust (no. 200796), the National Institute for Health Research (NIHR) Biomedical Research Centre, based at Oxford University Hospitals National Health System (NHS) Trust (no. NIHR‐INF‐0085), and the Oxford Health NIHR Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the supporting institutions. The authors are grateful to A. Ehlers for her support and supervision of the Oxford Grief Study. A smart pdf version of the PG‐13‐R is available at https://endoflife.weill.cornell.edu/sites/default/files/file_uploads/pg‐13‐r.pdf .
Publisher Copyright:
© 2021 World Psychiatric Association
Keywords
- Prolonged grief disorder
- DSM-5-TR
- PG-13-R
- ICD-11
- pathological grief
- bereavement
- post-traumatic stress disorder
