Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11

Holly G. Prigerson, Mardi J. Horowitz, Selby C. Jacobs, Colin M. Parkes, Mihaela Aslan, Karl Goodkin, Beverley Raphael, Samuel J. Marwit, Camille Wortman, Robert A. Neimeyer, George Bonanno, Susan D. Block, David Kissane, Paul Boelen, Andreas Maercker, Brett T. Litz, Jeffrey G. Johnson, Michael B. First, Paul K. Maciejewski

Research output: Contribution to journalArticleResearchpeer-review

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Abstract

Background: Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction. Methods and Findings: A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment. Conclusions:The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11.

Original languageEnglish
Article numbere1000121
JournalPLoS Medicine
Volume6
Issue number8
DOIs
Publication statusPublished - 1 Aug 2009

Cite this

Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., ... Maciejewski, P. K. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine, 6(8), [e1000121]. https://doi.org/10.1371/journal.pmed.1000121
Prigerson, Holly G. ; Horowitz, Mardi J. ; Jacobs, Selby C. ; Parkes, Colin M. ; Aslan, Mihaela ; Goodkin, Karl ; Raphael, Beverley ; Marwit, Samuel J. ; Wortman, Camille ; Neimeyer, Robert A. ; Bonanno, George ; Block, Susan D. ; Kissane, David ; Boelen, Paul ; Maercker, Andreas ; Litz, Brett T. ; Johnson, Jeffrey G. ; First, Michael B. ; Maciejewski, Paul K. / Prolonged grief disorder : Psychometric validation of criteria proposed for DSM-V and ICD-11. In: PLoS Medicine. 2009 ; Vol. 6, No. 8.
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title = "Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11",
abstract = "Background: Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction. Methods and Findings: A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment. Conclusions:The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11.",
author = "Prigerson, {Holly G.} and Horowitz, {Mardi J.} and Jacobs, {Selby C.} and Parkes, {Colin M.} and Mihaela Aslan and Karl Goodkin and Beverley Raphael and Marwit, {Samuel J.} and Camille Wortman and Neimeyer, {Robert A.} and George Bonanno and Block, {Susan D.} and David Kissane and Paul Boelen and Andreas Maercker and Litz, {Brett T.} and Johnson, {Jeffrey G.} and First, {Michael B.} and Maciejewski, {Paul K.}",
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Prigerson, HG, Horowitz, MJ, Jacobs, SC, Parkes, CM, Aslan, M, Goodkin, K, Raphael, B, Marwit, SJ, Wortman, C, Neimeyer, RA, Bonanno, G, Block, SD, Kissane, D, Boelen, P, Maercker, A, Litz, BT, Johnson, JG, First, MB & Maciejewski, PK 2009, 'Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11', PLoS Medicine, vol. 6, no. 8, e1000121. https://doi.org/10.1371/journal.pmed.1000121

Prolonged grief disorder : Psychometric validation of criteria proposed for DSM-V and ICD-11. / Prigerson, Holly G.; Horowitz, Mardi J.; Jacobs, Selby C.; Parkes, Colin M.; Aslan, Mihaela; Goodkin, Karl; Raphael, Beverley; Marwit, Samuel J.; Wortman, Camille; Neimeyer, Robert A.; Bonanno, George; Block, Susan D.; Kissane, David; Boelen, Paul; Maercker, Andreas; Litz, Brett T.; Johnson, Jeffrey G.; First, Michael B.; Maciejewski, Paul K.

In: PLoS Medicine, Vol. 6, No. 8, e1000121, 01.08.2009.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Prolonged grief disorder

T2 - Psychometric validation of criteria proposed for DSM-V and ICD-11

AU - Prigerson, Holly G.

AU - Horowitz, Mardi J.

AU - Jacobs, Selby C.

AU - Parkes, Colin M.

AU - Aslan, Mihaela

AU - Goodkin, Karl

AU - Raphael, Beverley

AU - Marwit, Samuel J.

AU - Wortman, Camille

AU - Neimeyer, Robert A.

AU - Bonanno, George

AU - Block, Susan D.

AU - Kissane, David

AU - Boelen, Paul

AU - Maercker, Andreas

AU - Litz, Brett T.

AU - Johnson, Jeffrey G.

AU - First, Michael B.

AU - Maciejewski, Paul K.

PY - 2009/8/1

Y1 - 2009/8/1

N2 - Background: Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction. Methods and Findings: A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment. Conclusions:The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11.

AB - Background: Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction. Methods and Findings: A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment. Conclusions:The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11.

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Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, Goodkin K et al. Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine. 2009 Aug 1;6(8). e1000121. https://doi.org/10.1371/journal.pmed.1000121