1
|
Aeschlimann A, Gordillo N, Ueno T, Maercker A, Killikelly C. Feasibility and Acceptability of a Mobile App for Prolonged Grief Disorder Symptoms. CLINICAL PSYCHOLOGY IN EUROPE 2024; 6:e10881. [PMID: 39119221 PMCID: PMC11303913 DOI: 10.32872/cpe.10881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/15/2024] [Indexed: 08/10/2024] Open
Abstract
Background Mobile apps provide a unique platform for mental health assessment and monitoring. They can provide real time, accessible data on symptoms of mental disorders that may yield rich data for detailed clinical assessment and help individuals gain insight into their current mental state. We developed one of the first apps for tracking symptoms of prolonged grief disorder. Method In this pilot feasibility study, we assess the feasibility and acceptability of a new mobile app mGAGE for use once a day for 3 weeks. 27 participants completed mental health assessments at t1 and t2. Results Adherence to the app protocol was very high with 100% for the first two weeks of use. A surprising finding was the improvement of grief symptoms at t2. Debriefing interviews revealed general qualitative categories including positive feedback, negative feedback and specific recommendations. Overall, the app was found to be feasible for use for the first two weeks and acceptable for bereaved individuals. Conclusions This app could provide valuable data for in depth clinical assessment, may support individuals to gain greater insight into their symptoms and may have a therapeutic effect in terms of improved grief symptoms. Implications for future studies including use in larger intervention studies are discussed.
Collapse
Affiliation(s)
| | - Nicolas Gordillo
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | | | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Clare Killikelly
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| |
Collapse
|
2
|
McConnell T, Gillespie K, Potvin N, Roulston A, Kirkwood J, Thomas D, McCullagh A, Roche L, O'Sullivan M, Binnie K, Clements-Cortés A, DiMaio L, Thompson Z, Tsiris G, Radulovic R, Graham-Wisener L. Developing a best-practice agenda for music therapy research to support informal carers of terminally ill patients pre- and post-death bereavement: a world café approach. BMC Palliat Care 2024; 23:33. [PMID: 38326820 PMCID: PMC10851575 DOI: 10.1186/s12904-024-01369-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Informal carers of terminally ill patients play a vital role in providing palliative care at home, which impacts on their pre- and post-death bereavement experience and presents an up to 50% greater risk for mental-health problems. However, developing and implementing effective bereavement support remains challenging. There is a need to build the evidence base for music therapy as a potentially promising bereavement support for this vulnerable population. This study aimed to co-design an international best practice agenda for research into music therapy for informal carers of patients pre- and post-death bereavement. METHODS Online half day workshop using a World Café approach; an innovative method for harnessing group intelligence within a group of international expert stakeholders (music therapy clinicians and academics with experience of music therapy with informal carers at end-of-life). Demographics, experience, key priorities and methodological challenges were gathered during a pre-workshop survey to inform workshop discussions. The online workshop involved four rounds of rotating, 25-minute, small group parallel discussions using Padlet. One final large group discussion involved a consensus building activity. All data were analysed thematically to identify patterns to inform priorities and recommendations. RESULTS Twenty-two consented and completed the pre-event survey (response rate 44%), from countries representing 10 different time zones. Sixteen participated in the workshop and developed the following best practice agenda. The effectiveness of music therapy in supporting informal carers across the bereavement continuum should be prioritised. This should be done using a mixed methods design to draw on the strengths of different methodological approaches to building the evidence base. It should involve service users throughout and should use a core outcome set to guide the choice of clinically important bereavement outcome measures in efficacy/effectiveness research. CONCLUSIONS Findings should inform future pre- and post-death bereavement support research for informal caregivers of terminally ill patients. This is an important step in building the evidence base for commissioners and service providers on how to incorporate more innovative approaches in palliative care bereavement services.
Collapse
Affiliation(s)
- Tracey McConnell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
| | - Kathryn Gillespie
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
| | - Noah Potvin
- Mary Pappert School of Music, Duquesne University, Pittsburgh, PA, USA
| | - Audrey Roulston
- School of Social Sciences, Education & Social Work, Queen's University Belfast, Belfast, UK
| | | | - Daniel Thomas
- CHROMA Therapies, Overross House, Ross Park, Ross on Wye, Herefordshire, UK
| | | | - Lorna Roche
- MusiCARER Project Carer Advisory Group, Belfast, UK
| | | | - Kate Binnie
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, Yorkshire, UK
| | | | - Lauren DiMaio
- Music Therapy, Texas Woman's University, Denton, USA
| | - Zara Thompson
- Creative Arts and Music Therapy Research Unit, Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Australia
| | - Giorgos Tsiris
- Division of Occupational Therapy and Arts Therapies, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Ranka Radulovic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Lisa Graham-Wisener
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
| |
Collapse
|
3
|
Stroebe MS, Schut HAW, Eisma MC. On the Classification and Reporting of Prolonged Grief: Assessment and Research Guidelines. Harv Rev Psychiatry 2024; 32:15-32. [PMID: 38181100 DOI: 10.1097/hrp.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
LEARNING OBJECTIVES AFTER PARTICIPATING IN THIS CME ACTIVITY, THE PSYCHIATRIST SHOULD BE BETTER ABLE TO • Explain the steps required for diagnosis of mental disorders in diagnostic handbooks.• Identify current procedures for classifying and reporting prolonged grief disorder. ABSTRACT Prolonged grief disorder (PGD) was added to the 11th edition of the International Classification of Diseases in 2018 and to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders in its 2022 text revision. Thus, reporting and classifying PGD according to established guidelines has become fundamental for scientific research and clinical practice. Yet, PGD assessment instruments and criteria are still being developed and debated. The purpose of this article is to examine the adequacy of current procedures for classifying and reporting PGD in research and to suggest guidelines for future investigation and dissemination of knowledge. We outline the standard steps required for diagnosis and assessment of a mental disorder (notably, the administration of clinical interviews). In order to illustrate reporting about the presence/prevalence of PGD in recent scientific articles, we conducted a search of Scopus that identified 22 relevant articles published between 2019 and 2023. Our review of the literature shows that standard classification procedures are not (yet) followed. Prevalences of PGD are based on self-reported symptomatology, with rates derived from percentages of bereaved persons reaching a certain cutoff score on a questionnaire, without clinical interviewing. This likely results in systematic overestimation of prevalences. Nevertheless, the actual establishment of PGD prevalence was often stated in titles, abstracts, and results sections of articles. Further, the need for structured clinical interviews for diagnostic classification was frequently mentioned only among limitations in discussion sections-but was not highlighted. We conclude by providing guidelines for researching and reporting self-reported prolonged grief symptoms and the presence/prevalence of PGD.
Collapse
Affiliation(s)
- Margaret S Stroebe
- From the Department of Clinical Psychology, Utrecht University (Drs. Stroebe and Schut); Department of Clinical Psychology & Experimental Psychopathology, University of Groningen (Drs. Stroebe and Eisma)
| | | | | |
Collapse
|
4
|
Elinger G, Hasson-Ohayon I, Bar-Shachar Y, Peri T. A quasi-experimental trial of narrative reconstruction for prolonged grief disorder: Symptomatic improvement and enhanced memory integration. J Clin Psychol 2023; 79:2849-2868. [PMID: 37590286 DOI: 10.1002/jclp.23583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/27/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Prolonged grief disorder (PGD) was recently approved as a formal diagnosis in the DSM-5-TR. The implementation of bereavement interventions is frequently requested, but their effectiveness has been controversial. Narrative reconstruction (NR) is a time-limited integrative therapy, originally developed for the treatment of post-traumatic stress disorder (PTSD) and adapted for the treatment of PGD. NR consists of exposure to the loss memory, a detailed written reconstruction of the loss memory narrative, and an elaboration of the personal significance of that memory for the bereaved. OBJECTIVES In this study we evaluated the efficacy of NR for PGD. METHOD In this study, 33 participants with PGD were quasi-randomized-that is, assigned to an immediate (n = 20) or delayed (n = 13) 16-session NR intervention. PGD, intrusion, avoidance and depression symptoms, as well as levels of the loss memory integration, were assessed at pretreatment, post-treatment, and at a 3-month follow-up. RESULTS Mixed linear models showed significant intervention effects for PGD and intrusive symptomatology. Results also showed an increase in integration of the loss memory, and improvements remained stable for all outcomes at follow-up. CONCLUSION In this study we established NR as an effective intervention for PGD and call for further validation in future studies. Integrating this intervention into the routine care of people with PGD seems important and beneficial.
Collapse
Affiliation(s)
- Gali Elinger
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | | | - Yael Bar-Shachar
- Department of Psychology, Ben-Gurion University, Beer Sheva, Israel
| | - Tuvia Peri
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| |
Collapse
|
5
|
Pociunaite J, van Dijk I, Reitsma L, Nordström EEL, Boelen PA, Lenferink LIM. Latent trajectories of DSM-5-TR-based Prolonged Grief Disorder: findings from a data pooling project MARBLES. Eur J Psychotraumatol 2023; 14:2281183. [PMID: 38010149 PMCID: PMC10990441 DOI: 10.1080/20008066.2023.2281183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023] Open
Abstract
Background: With the release of the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5-TR), criteria for Prolonged Grief Disorder (PGD) were included. This necessitates studying grief trajectories based on these criteria.Objective: This is the first study examining latent trajectories of DSM-5-TR-based PGD symptom levels and testing whether specific risk factors (e.g. cause of death) predicted PGD trajectories.Method: We evaluated latent DSM-5-TR PGD trajectories using pooled existing data collected at 6-12, 13-24, and 25-60 months post-loss in Danish and Dutch bereaved adults (N = 398). Latent Growth Mixture Modelling (LGMM) was employed to determine the trajectories. Multinomial logistic regression analyses were used to examine which risk factors predicted class membership.Results: The four-class LGMM solution with a quadratic term was best-fitting the data. This solution represented four trajectories: High stable PGD (6%), High PGD quick recovery (10%), High PGD slow recovery (35%), and Low PGD symptoms (49%). Participants with a higher educational level were more likely to be assigned to the Low PGD symptoms trajectory compared to High stable PGD and High PGD slow recovery trajectories. Unnatural causes of death increased the likelihood of being in the High stable PGD and High PGD slow recovery trajectories compared to the Low PGD symptoms trajectory.Conclusions: Consistent with prior research, the Low PGD symptoms trajectory was the most common. A significant minority experienced high and stable levels of PGD within five years after the loss. About one-third of participants experienced high acute grief levels that decreased slowly; how slow decreasing symptoms relate to an individual's functioning requires further attention. This study demonstrates that a significant minority of bereaved people develop acute PGD symptomatology that does not diminish within five years post-loss, emphasizing the need for early screening for PGD to prevent long-lasting complaints.
Collapse
Affiliation(s)
| | - Iris van Dijk
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands
| | - Lyanne Reitsma
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands
| | - Erik Edwin Leonard Nordström
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
- Helse Fonna Local Health Authority, Haugesund, Norway
| | - Paul A. Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands
- ARQ Centrum’45, Diemen, the Netherlands
| | - Lonneke I. M. Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
- Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, the Netherlands
| |
Collapse
|
6
|
Lenferink LIM, van Dijk I, Eisma MC, Eklund R, Boelen PA, Sveen J. Psychometric evaluation of the Swedish Traumatic Grief Inventory Self-Report Plus (TGI-SR+) in bereaved parents. Clin Psychol Psychother 2023. [PMID: 37872000 DOI: 10.1002/cpp.2922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
The International Classification of Diseases Eleventh Edition (ICD-11), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), now include prolonged grief disorder (PGD). Since criteria for PGD in both classification systems differ from prior proposed grief disorders and each other, the validation of a single instrument to screen for prolonged grief (PG) symptoms of both new diagnoses is critical for bereavement research and care. Therefore, we evaluated the psychometric properties of the Swedish version of the Traumatic Grief Inventory Self-Report Plus (TGI-SR+). Two-hundred and forty-eight bereaved parents completed questions about sociodemographic and loss-related variables, the TGI-SR+, and symptom measures of post-traumatic stress (PTS), depression and an older measure of PG symptoms, the Prolonged Grief Disorder-13 (PG-13). Confirmatory factor analyses showed that a one-factor model best fit DSM-5-TR and ICD-11 PG symptoms and the analyses of the internal consistency and inter-item correlations showed that these symptoms could be reliably assessed. In support of convergent validity, DSM-5-TR and ICD-11 PG symptoms correlated with symptoms of PTS, depression and PG assessed with the PG-13. In support of known-groups validity, DSM-5-TR and ICD-11 PG symptoms were higher among lower educated (vs. higher educated) participants and related negatively to time since loss. ROC analyses showed optimal cut-off score of ≥71 and ≥72 to determine probable caseness for DSM-5-TR and ICD-11 PGD, respectively. Results support the reliability and validity of the Swedish TGI-SR+ as a screening instrument for PG in research and bereavement care.
Collapse
Affiliation(s)
- Lonneke I M Lenferink
- Department of Psychology, Health & Technology, Faculty of Behavioural Management and Social Sciences, University of Twente, Enschede, The Netherlands
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Iris van Dijk
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Rakel Eklund
- Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Josefin Sveen
- Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| |
Collapse
|
7
|
Shevlin M, Redican E, Hyland P, Murphy J, Karatzias T, McBride O, Bennett K, Butter S, Hartman TK, Vallières F, Bentall RP. Symptoms and levels of ICD-11 Prolonged Grief Disorder in a representative community sample of UK adults. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1535-1547. [PMID: 37039844 PMCID: PMC10098228 DOI: 10.1007/s00127-023-02469-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Prolonged Grief Disorder (PGD) is a new disorder included in ICD-11 (WHO, 2018). There is a growing body of literature surrounding the prevalence and correlates of ICD-11 PGD symptoms as assessed using various measures. This study was the first to assess levels of ICD-11 PGD symptoms as measured by the International Prolonged Grief Disorder Scale (IPGDS), a self-report scale directly aligned with the ICD-11 definition of PGD, among the United Kingdom adult general population, and identify correlates. METHOD Participants included 2025 adults who participated in Wave 5 of the COVID-19 Psychological Research Consortium Study (C19PRC-UK). Prevalence rates of PGD were estimated based on two commonly used algorithms defined as 'strict' and 'moderate'. Sociodemographic, loss-related, and mental health correlates (i.e., anxiety, depression, mental health treatment seeking, loneliness) of strict and moderate PGD were then examined using multinomial logistic regressions. RESULTS It was found that 2.4% (n = 43) of participants met probable caseness for PGD using the strict criteria while 7.9% (n = 140) met probable caseness for PGD using the moderate criteria. Multinomial logistic regression analysis results showed, as predicted, that income, time since bereavement, death of a child, religiosity, and depression were associated with both moderate and strict PGD. Correlates of moderate PGD included country of residence, urbanicity, younger age of bereaved, and loneliness. CONCLUSIONS This study highlights that some symptoms of PGD are commonly reported in the general population, although relatively few meet the criteria for clinical significance. The routine assessment for PGD following a bereavement is discussed and the development of appropriate interventions are recommended.
Collapse
Affiliation(s)
- Mark Shevlin
- School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA Northern Ireland
| | - Enya Redican
- School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA Northern Ireland
| | | | - Jamie Murphy
- School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA Northern Ireland
| | | | - Orla McBride
- School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA Northern Ireland
| | | | - Sarah Butter
- School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA Northern Ireland
| | | | | | | |
Collapse
|
8
|
Crawley S, Sampson EL, Moore KJ, Kupeli N, West E. Grief in family carers of people living with dementia: A systematic review. Int Psychogeriatr 2023; 35:477-508. [PMID: 35086600 DOI: 10.1017/s1041610221002787] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Grief research in family carers of people with dementia has increased. We aimed to report the prevalence of pre-death and post-death grief and to synthesize associated factors and the relationship between pre-death factors and post-death grief and services used to manage grief. DESIGN (Prospero protocol: CRD42020165071) We systematically reviewed literature from PsycINFO, MEDLINE, CINAHL, and ASSIA until April 2020. Effectiveness of intervention data and studies not written in English were excluded; qualitative studies were additionally excluded during study selection. Study quality was assessed using the Mixed Methods Appraisal Tool. Evidence was narratively summarized. PARTICIPANTS Family non-paid carers of somebody with any dementia type. MEASUREMENTS Validated measures of pre-death and/or post-death grief. RESULTS We included quantitative data from 55 studies (44 rated as high quality). Most included solely spouse or adult child carers. Forty-one studies reported pre-death grief, 12 post-death grief, and 6 service use; eight were longitudinal. 17% met the Prolonged Grief Disorder criteria pre-death (n = 1) and 6-26% (n = 4) of participants met the Complicated Grief criteria post-death. Being a spouse, less educated, caring for somebody with advanced dementia, and greater burden and depression were associated with higher pre-death grief. Lower education level and depression were predictive of higher post-death grief. Pre-death factors found to influence post-death grief were grief and depression. Limited service use evidence was reported. CONCLUSION Awareness of characteristics which increase the likelihood of higher grief can help identify those in need of support. Future research should focus on what supports or services are beneficial to grief experiences.
Collapse
Affiliation(s)
- Sophie Crawley
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, LondonW1T 7NF, United Kingdom
| | | | - Kirsten J Moore
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Melbourne, Australia
| | - Nuriye Kupeli
- Division of Psychiatry, UCL, LondonW1T 7NF, United Kingdom
| | - Emily West
- Division of Psychiatry, UCL, LondonW1T 7NF, United Kingdom
| |
Collapse
|
9
|
Abstract
Prolonged grief disorder has recently been added to the International Classification of Diseases, 11th edition and the Diagnostic and Statistical Manual of Mental Disorders 5, Text Revision. This historical development is often presented as a linear process culminating in the inclusion of valid, clinically relevant prolonged grief disorder criteria in diagnostic handbooks. The present contribution provides an overview of work contradicting this dominant narrative. First, I show that the developmental history of prolonged grief disorder has been nonlinear and that this yields questions on generalizability and problems with measurement of the newest criteria sets. Second, I highlight an important gap in the validity evidence: the distinction of prolonged grief disorder from normal grief. Third, I discuss concerns relating to the societal effects of the inclusion of prolonged grief disorder in diagnostic handbooks, including the medicalization of grief, development and adverse effects of pharmacotherapy and stigmatization. A more realistic, balanced view on the history, validity and societal impact of prolonged grief disorder appears appropriate. I recommend stringent validation of assessment instruments for prolonged grief disorder, convergence of criteria-sets, closing gaps in validity evidence and developing strategies to mitigate the negative effects of grief diagnoses.
Collapse
Affiliation(s)
- Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
10
|
Lenferink LIM, Franzen M, Ten Klooster PM, Knaevelsrud C, Boelen PA, Heeke C. The Traumatic Grief Inventory-Clinician Administered: A psychometric evaluation of a new interview for ICD-11 and DSM-5-TR prolonged grief disorder severity and probable caseness. J Affect Disord 2023; 330:188-197. [PMID: 36907465 DOI: 10.1016/j.jad.2023.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/06/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND There is a need for an interview-based measure to assess Prolonged Grief Disorder (PGD) included in the text revision of the fifth Diagnostic and Statistical Manual for Mental Disorder (DSM-5-TR) and 11th edition of the International Classification of Disease (ICD-11). We evaluated the psychometric properties of the Traumatic Grief Inventory-Clinician Administered (TGI-CA); a new interview measuring DSM-5-TR and ICD-11 PGD severity and probable caseness. METHODS In 211 Dutch and 222 German bereaved adults, the: (i) factor structure, (ii) internal consistency, (iii) test-retest reliability, (iv) measurement invariance across subgroups (e.g., differing in language), (v) prevalence of probable caseness, (vi) convergent validity, and (vii) known-groups validity were examined. RESULTS Confirmatory factor analyses (CFAs) showed acceptable fit for the unidimensional model for DSM-5-TR and ICD-11 PGD. Omega values indicated good internal consistency. Test-retest reliability was high. Multi-group CFAs demonstrated configural and metric invariance for DSM-5-TR and ICD-11 PGD criteria for all group-comparisons; for some we found support for scalar invariance. Rates of probable caseness for DSM-5-TR PGD were lower than ICD-11 PGD. Optimal agreement in probable caseness was reached when increasing the number of accessory symptoms for ICD-11 PGD from 1+ to 3+. Convergent and known-groups validity was demonstrated for both criteria-sets. LIMITATIONS The TGI-CA was developed to assess PGD severity and probable caseness. Clinical diagnostic interviews for PGD are needed. CONCLUSIONS The TGI-CA seems a reliable and valid interview for DSM-5-TR and ICD-11 PGD symptomatology. More research in larger and more diverse samples is needed to further test its psychometric properties.
Collapse
Affiliation(s)
- Lonneke I M Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, the Netherlands; Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands.
| | - Minita Franzen
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, the Netherlands
| | - Peter M Ten Klooster
- Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands
| | - Christine Knaevelsrud
- Freie University Berlin, Department of Clinical-Psychological Intervention, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; ARQ National Psychotrauma Center, Diemen, the Netherlands
| | - Carina Heeke
- Freie University Berlin, Department of Clinical-Psychological Intervention, Habelschwerdter Allee 45, 14195 Berlin, Germany
| |
Collapse
|
11
|
Larsen LH, Guldberg A, Kring V. A Group Therapy Program for Parentally Bereaved Young Adults With Grief Complications: Rationale, Method and Case Examples. OMEGA-JOURNAL OF DEATH AND DYING 2023; 86:1212-1234. [PMID: 33818158 DOI: 10.1177/0030222821997705] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Considerable effort has gone into studying bereavement in children, adults and the elderly, but few studies have investigated the effects of bereavement or grief interventions in young adults. Even fewer studies have reported on the effect of interventions for young adults with grief complications. The present study seeks to help fill this gap by describing a Danish treatment program specially developed for young adults with complicated grief reactions. The dual process model of coping with bereavement, psychodynamic theory, and a narrative approach provide the foundation for the treatment. In addition, it utilizes an eclectic use of techniques and a group treatment modality that involves providing individual therapy within a group context. The core elements of the treatment are discussed and then exemplified in two case studies.
Collapse
Affiliation(s)
| | | | - Villy Kring
- Danish National Center for Grief, Copenhagen K, Denmark
| |
Collapse
|
12
|
Boelen PA, Lenferink LIM. Prolonged grief disorder in DSM-5-TR: Early predictors and
longitudinal measurement invariance. Aust N Z J Psychiatry 2022; 56:667-674. [PMID: 34233500 PMCID: PMC9131400 DOI: 10.1177/00048674211025728] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision includes prolonged grief disorder as a novel disorder. Prolonged grief disorder can be diagnosed when acute grief stays distressing and disabling, beyond 12 months following bereavement. Evidence indicates that elevated prolonged grief disorder symptoms in the first year of bereavement predict pervasive grief later in time; targeting early elevated grief may potentially prevent symptoms getting chronic. There is limited knowledge about the characteristics of people in the first year of bereavement who have an elevated chance of developing full prolonged grief disorder beyond the 12-month time point. This study examined these characteristics. METHODS We used self-reported data from 306 adults who all completed questions on socio-demographic and loss-related characteristics plus a measure of prolonged grief disorder within the first year of bereavement (Wave 1; time since loss: M = 4.97, SD = 3.13 months) and again 1 year later (Wave 2; time since loss: M = 17.84, SD = 3.38 months). We examined the prevalence rates of probable prolonged grief disorder (Wave 2), measurement invariance of prolonged grief disorder symptoms between waves, and associations of socio-demographic and loss-related variables, and Wave 1 prolonged grief disorder with probable prolonged grief disorder at Wave 2. RESULTS Regarding prevalence, 10.1% (n = 31) met criteria for probable prolonged grief disorder (Wave 2). Multigroup confirmatory factor analysis supported longitudinal measurement invariance of prolonged grief disorder symptoms. People meeting criteria at Wave 1 (except the time criterion) had a significantly increased risk of meeting criteria at Wave 2. Variables best predicting probable prolonged grief disorder at Wave 2 were prolonged grief disorder at Wave 1, lower education, loss of a child and loss to unnatural/violent causes (sensitivity = 56.67%, specificity = 98.12%, 93.92% correct classifications). CONCLUSION People meeting criteria for prolonged grief disorder (except the time criterion) before the first anniversary of the death are at risk of full-blown prolonged grief disorder beyond this time point, particularly those who have lower education, confronted the death of a child and confronted unnatural/violent loss. Findings may inform advances in preventive bereavement care.
Collapse
Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology,
Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands,ARQ National Psychotrauma Centre,
Diemen, The Netherlands,Paul A Boelen, Department of Clinical
Psychology, Faculty of Social Sciences, Utrecht University, PO Box 80140, 3508
TC Utrecht, The Netherlands.
| | - Lonneke IM Lenferink
- Department of Clinical Psychology,
Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands,Department of Clinical Psychology and
Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University
of Groningen, Groningen, The Netherlands
| |
Collapse
|
13
|
Doering BK, Barke A, Vogel A, Comtesse H, Rosner R. Predictors of Prolonged Grief Disorder in a German Representative Population Sample: Unexpectedness of Bereavement Contributes to Grief Severity and Prolonged Grief Disorder. Front Psychiatry 2022; 13:853698. [PMID: 35558417 PMCID: PMC9090313 DOI: 10.3389/fpsyt.2022.853698] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/01/2022] [Indexed: 12/13/2022] Open
Abstract
Most people adapt to bereavement over time. For a minority, the grief persists and may lead to a prolonged grief disorder (PGD). Identifying grievers at risk of PGD may enable specific prevention measures. The present study examined the extent to which the subjective unexpectedness of the death predicted grief outcomes above and beyond known sociodemographic and objective loss-related variables in a sample drawn from a population-representative investigation. In our sample (n = 2,531), 811 participants (M age 55.1 ± 17.8 years, 59.2% women) had experienced the loss of a significant person six or more months ago. Participants provided demographic and loss-related information, perceptions of the unexpectedness of the death and completed the Prolonged Grief Disorder-13 + 9 (PG-13 + 9). The PG-13 + 9 was used to determine PGD caseness. A binary logistic regression investigated predictors of PGD caseness, and a linear regression predictors of grief severity. ANCOVAs compared PGD symptoms between the groups who had experienced an "expected" vs. "unexpected" loss, while controlling for the relationship to the deceased and time since loss. The loss of a child (OR = 23.66; 95%CI, 6.03-68.28), or a partner (OR = 5.32; 95%CI, 1.79-15.83), the time since loss (OR = 0.99; 95%CI, 0.99-1.00) and the unexpectedness of the death (OR = 3.58; 95%CI, 1.70-7.69) were significant predictors of PGD caseness (Nagelkerke's R2 = 0.25) and grief severity. Participants who had experienced the loss as unexpected (vs. expected) reported higher scores on all PGD symptoms. Unexpectedness of the death emerged as significant risk factor for PGD, even after controlling for demographic and other loss-related variables. While our findings replicate previous research on the importance of the relationship to the deceased as a risk factor for PGD, they also highlight the importance of assessing the subjective unexpectedness of a death and may help to identify risk groups who can profit from preventive interventions.
Collapse
Affiliation(s)
- Bettina K Doering
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.,Clinical Psychology and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Antonia Barke
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Anna Vogel
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Hannah Comtesse
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rita Rosner
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| |
Collapse
|
14
|
Eisma MC, Janshen A, Lenferink LIM. Content overlap analyses of ICD-11 and DSM-5 prolonged grief disorder and prior criteria-sets. Eur J Psychotraumatol 2022; 13:2011691. [PMID: 35096286 PMCID: PMC8794064 DOI: 10.1080/20008198.2021.2011691] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The International Classification of Diseases eleventh edition (ICD-11) has recently included prolonged grief disorder (PGD), a diagnosis characterized by severe, persistent, and disabling grief. The text revision of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5-TR) is scheduled to include a similar but distinct diagnosis, also termed PGD. Concerns have been raised that these new diagnoses are qualitatively different from both prior proposed diagnoses for pathological grief and each other, which may affect the generalizability of findings obtained with different criteria sets. OBJECTIVE We conducted a content overlap analysis of PGDICD-11, PGDDSM-5-TR, and previous proposals for pathological grief diagnoses (i.e. PGD 2009; complicated grief (CG), PGD ICD-11 beta draft, persistent complex bereavement disorder (PCBD) per DSM-5). METHODS Using the Jaccard's Index, we established the degree of content overlap between core and accessory symptoms of PGDICD-11, PGDDSM-5-TR, and prior proposals for pathological grief diagnoses. RESULTS Main findings are that PGDICD-11 and PGDDSM-5-TR showed moderate content overlap with each other and with most prior proposed diagnoses for pathological grief. PGDICD-11 and PGDDSM-5-TR showed the strongest content overlap with their direct predecessors, PGDICD-11 beta draft and PCBD, respectively. CONCLUSIONS Limited content overlap between PGDICD-11 and PGDDSM-5-TR and preceding criteria sets may threaten generalizability of past research on phenomenological characteristics of pathological grief to current criteria sets. Similarly, findings obtained with instruments to assess PGDICD-11 may not generalize to PGDDSM-5-TR and vice versa. Researchers should aim to determine under which circumstances criteria sets for PGD yield similar or distinct characteristics. Convergence of criteria sets for PGD remains an important goal for the future.
Collapse
Affiliation(s)
- Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Antje Janshen
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Lonneke I M Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.,Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, The Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
15
|
Harrison O, Windmann S, Rosner R, Steil R. Inclusion of the other in the self as a potential risk factor for prolonged grief disorder: A comparison of patients with matched bereaved healthy controls. Clin Psychol Psychother 2021; 29:1101-1112. [PMID: 34822735 DOI: 10.1002/cpp.2697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022]
Abstract
Pathological grief has received increasing attention in recent years, as about 10% of the bereaved suffer from one kind of it. Pathological grief in the form of prolonged grief disorder (PGD) is a relatively new diagnostic category which will be included into the upcoming ICD-11. To date, various risk and protective factors, as well as treatment options for pathological grief, have been proposed. Nevertheless, empirical evidence in that area is still scarce. Our aim was to identify the association of interpersonal closeness with the deceased and bereavement outcome. Interpersonal closeness with the deceased in 54 participants (27 patients suffering from PGD and 27 bereaved healthy controls) was assessed as the overlap of pictured identities via the inclusion of the other in the self scale (IOS scale). In addition to that, data on PGD symptomatology, general mental distress and depression were collected. Patients suffering from PGD reported higher inclusion of the deceased in the self. By contrast, they reported feeling less close towards another living close person. Results of the IOS scale were associated with PGD severity, general mental distress and depression. Inclusion of the deceased in the self is a significant statistical predictor for PGD caseness.
Collapse
Affiliation(s)
- Octavia Harrison
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Sabine Windmann
- Department of Cognitive Psychology II, Goethe University Frankfurt, Frankfurt, Germany
| | - Rita Rosner
- Department of Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany.,Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany
| |
Collapse
|
16
|
Vedder A, Stroebe MS, Schut HAW, Boerner K, Stokes JE, Boelen PA. Loneliness in Bereavement: Measurement Matters. Front Psychol 2021; 12:741762. [PMID: 34589033 PMCID: PMC8473627 DOI: 10.3389/fpsyg.2021.741762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
The role of loneliness in the bereavement experience has been reported as substantial, with the death of a close person leaving a considerable void in the life of the bereaved. Yet, there is lack of agreement about its precise role and, notably, whether loneliness should be included as a core symptom for diagnosis of grief complications. The ongoing threat of heightened social isolation due to the COVID-19 pandemic underlines the need to understand the impact of loneliness, and to accurately chart its prevalence, intensity, duration, and associated difficulties in the context of bereavement. Assessment issues are central to this endeavor. In this article, we review the scientific literature to examine how loneliness after bereavement has been operationalized and measured. Sixty-three articles analyzing 51 independent datasets were reviewed. Results show major disparities: approximately half of the projects assessed loneliness by means of one of two validated scales (spanning different versions); the remainder included only single- or few-item measures. Diverse instructions, content and answer categories were used. While one size does not fit all, awareness of assessment options and dis/advantages may aid selection of the most appropriate measure, to suit the goals of a particular study and the specific groups under investigation. Our conclusion is that, in selecting a loneliness measure, health care professionals should come to their own well-informed decision, aided by the information provided in our review.
Collapse
Affiliation(s)
- Anneke Vedder
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | - Margeret S Stroebe
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands.,Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Henk A W Schut
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | - Kathrin Boerner
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, United States
| | - Jeffrey E Stokes
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, United States
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands
| |
Collapse
|
17
|
Lee SA, Neimeyer RA, Breen LJ. The Utility of the Pandemic Grief Scale in Identifying Functional Impairment from COVID-19 Bereavement. J Palliat Med 2021; 24:1783-1788. [PMID: 33926228 DOI: 10.1089/jpm.2021.0103] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Meeting the needs of people bereaved by COVID-19 poses a substantial challenge to palliative care. The Pandemic Grief Scale (PGS) is a 5-item mental health screener to identify probable cases of dysfunctional grief during the pandemic. Objective: The PGS has strong psychometric and diagnostic features. The objective was to examine the incremental validity of the PGS in identifying mourners at risk of harmful outcomes. Design: A cross-sectional survey design involving sociodemographic questions and self-report measures of pandemic grief, generalized anxiety, depression, post-traumatic stress, separation distress, functional impairment, meaning-making difficulties, and substance use coping. Setting/Subjects: A sample of people bereaved through COVID-19 (N = 1065) in the United States. Results: Fully 56.6% of participants scored above the cut score of ≥7 on the PGS for clinically dysfunctional pandemic grief and 69.7% coped with their loss using drugs or alcohol for at least several days in past two weeks. PGS scores were not associated with time since loss. Hierarchical multiple regression models demonstrated that the PGS uniquely explained variance in functional impairment, meaning-making difficulties, and substance use coping, over relevant background factors, bereavement-related psychopathology, and separation distress. In the final model, the standardized regression coefficients for the PGS were 2-15 times larger than for the other competing measures in explaining each of the three outcomes. Conclusions: The findings underscore the clinical utility of this short and easy-to-use measure in identifying risk of deleterious outcomes across a range of functional and behavioral domains.
Collapse
Affiliation(s)
- Sherman A Lee
- Department of Psychology, Christopher Newport University, Newport News, Virginia, USA
| | - Robert A Neimeyer
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA.,Portland Institute for Loss and Transition, Portland, Oregon, USA
| | - Lauren J Breen
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
18
|
Co-occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: A systematic review and meta-analysis. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100140] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
19
|
Tang S, Xiang Z. Who suffered most after deaths due to COVID-19? Prevalence and correlates of prolonged grief disorder in COVID-19 related bereaved adults. Global Health 2021; 17:19. [PMID: 33573673 PMCID: PMC7877329 DOI: 10.1186/s12992-021-00669-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Deaths by COVID-19 have left behind nearly 12 million recent bereaved individuals worldwide and researchers have raised concerns that the circumstances of COVID-19 related deaths will lead to a rise prevalence of prolonged grief disorder (PGD) cases. However, to date, no studies have examined the prevalence of PGD among people bereaved due to COVID-19. This study aimed to estimate the prevalence of PGD and investigated demographic and loss-related factors associated with prolonged grief symptoms among Chinese individuals bereaved due to COVID-19. METHODS This was a cross-sectional online survey conducted between September 1 and October 3, 2020. A total of 422 Chinese participants (55.5% males; 32.73 [9.31] years old) who lost a close person due to COVID-19 participated in the study. Demographic and loss-related information was collected, and self-reported prolonged grief symptoms were measured by a 13-item International Prolonged Grief Disorder Scale (IPGDS: 1-65) and a 17-item Traumatic Grief Inventory Self Report (TGI-SR: 1-85). Multiple linear regression analysis was used to determine the associated factors of levels of grief symptoms. RESULTS Prevalence of PGD was 37.8% screened by IPGDS and 29.3% by TGI-SR. No difference was found in levels of grief symptoms between participants whose close one died more than 6 months ago and those who experienced the loss less than 6 months ago. More severe prolonged grief symptoms assessed by IPGDS was associated with losing a close person by COVID-19 rather than complications (B: 5.35; 95% CI: 0.54-10.05), losing a partner (B: 7.80; 95% CI: 3.24-12.37), child (B: 8.15; 95% CI: 1.03-15.26), and parent (B: 5.49; 95% CI: 1.49-9.48) rather than losing a relative or a person with other relationship, feeling more traumatic about the loss (B: 1.71; 95% CI: 0.52-2.90), being closer with the deceased (B: 1.60; 95% CI: 0.34-2.86). Moreover, Losing a grandparent (B: 6.62; 95% CI: 0.53-12.71) and having more conflicts with the deceased (B: 1.05; 95% CI: - 0.008-2.11) were related to higher levels of grief symptoms assessed by TGI-SR. CONCLUSIONS Echoing researchers' concerns, the prevalence of PGD is high among people bereaved due to COVID-19. Individuals with a higher risk of developing PGD should be identified and bereavement support should be offered as early as possible.
Collapse
Affiliation(s)
- Suqin Tang
- Department of Sociology, Law School, Shenzhen University, L3-1217, Zhili Building, Canghai Campus, Shenzhen, 618010, China.
| | - Zhendong Xiang
- Shenzhen Yishi Huolala Technology Limited Company, Futian District, Shenzhen, 518049, China
| |
Collapse
|
20
|
Killikelly C, Smid GE, Wagner B, Boelen PA. Responding to the new International Classification of Diseases-11 prolonged grief disorder during the COVID-19 pandemic: a new bereavement network and three-tiered model of care. Public Health 2021; 191:85-90. [PMID: 33556639 DOI: 10.1016/j.puhe.2020.10.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
The field of bereavement research and care is at a tipping point. The introduction of prolonged grief disorder (PGD) in the International Classification of Diseases (ICD-11) has ignited clinical interest in this new disorder, along with debate over challenges in validating and implementing these new criteria. At the same time, the global COVID-19 pandemic has launched several local and international efforts to provide urgent support and comfort for individuals and communities suffering from grief. Recently, grief experts have called for a collective response to these complicated bereavements and possible increase in PGD due to COVID-19. Here we outline a new European network that aims to unite a community of grief researchers and clinicians to provide accessible, evidence-based support particularly during times of unprecedent crisis. The Bereavement Network Europe (BNE) has been developed with two main aims. Firstly, to develop expert agreed, internationally acceptable guidelines for bereavement care through a three-tiered approach. Secondly, to provide a platform for researchers and clinicians to share knowledge, collaborate, and develop consensus protocols to facilitate the introduction of PGD to diverse stakeholders. This article outlines the current status and aims of the BNE along with the plans for upcoming network initiatives and the three-tiered bereavement care guidelines in response to the COVID-19 pandemic.
Collapse
Affiliation(s)
- C Killikelly
- Department of Psychology, University of Zurich, Switzerland.
| | - G E Smid
- University of Humanistic Studies, the Netherlands; ARQ National Psychotrauma Centre, Diemen, the Netherlands
| | - B Wagner
- MSB Medical School Berlin, Germany
| | - P A Boelen
- ARQ National Psychotrauma Centre, Diemen, the Netherlands; Department of Clinical Psychology, Utrecht University, Netherlands
| |
Collapse
|
21
|
Lundorff M, Johannsen M, O'Connor M. Time elapsed since loss or grief persistency? Prevalence and predictors of ICD-11 prolonged grief disorder using different applications of the duration criterion. J Affect Disord 2021; 279:89-97. [PMID: 33039779 DOI: 10.1016/j.jad.2020.09.116] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 08/06/2020] [Accepted: 09/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prolonged grief disorder (PGD), included in the ICD-11, encompasses a six-month duration criterion, but whether this covers 'time since loss' or 'grief persistency' is unclear. The study estimated prevalence and predictors of probable ICD-11 PGD using different applications of the duration criterion. METHODS A register-sampled cohort of bereaved spouses completed self-report questionnaires at two (T1, N=847), six (T2, N=777), and eleven months (T3, N=753) post-loss. The duration criterion was operationalized as single-point PGD (meeting criteria minimally six months post-loss; T2 or T3) and dual-point PGD (meeting criteria at two assessments separated by months; T1+T2 or T2+T3). RESULTS Single-point PGD prevalence rates (~15-20%) were significantly higher than dual-point prevalence rates (~10%). While single assessments of PGD varied between T2 and T3, the dual-point prevalence rates did not significantly differ. Early probable grief caseness emerged as the strongest predictor for later PGD. LIMITATIONS Without a structured clinical interview, only probable cases of PGD were identified. Caseness relied on a diagnostic algorithm, created by mapping items from different self-report questionnaires. Time frames between assessments did not cover an entire six-month period. CONCLUSIONS Momentarily assessed, six-month PGD symptomatology may represent a fluctuating, but remitting grief process for some individuals. Further research could test whether multiple diagnostic indicators during the first year of bereavement improve the identification of genuinely prolonged grief reactions.
Collapse
Affiliation(s)
- Marie Lundorff
- Unit for Bereavement Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark; Unit for Psycho-Oncology and Health Psychology, Department of Oncology, Aarhus University Hospital and Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.
| | - Maja Johannsen
- Unit for Bereavement Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark; Unit for Psycho-Oncology and Health Psychology, Department of Oncology, Aarhus University Hospital and Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Maja O'Connor
- Unit for Bereavement Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark; Unit for Psycho-Oncology and Health Psychology, Department of Oncology, Aarhus University Hospital and Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark; The Danish National Centre for Grief, Copenhagen, Denmark
| |
Collapse
|
22
|
Revet A, Suc A, Auriol F, Djelantik AAAMJ, Raynaud JP, Bui E. Peritraumatic distress predicts prolonged grief disorder symptom severity after the death of a parent in children and adolescents. Eur J Psychotraumatol 2021; 12:1936916. [PMID: 34249245 PMCID: PMC8245082 DOI: 10.1080/20008198.2021.1936916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: In 2015 nearly 140 million children and adolescents under 18 had experienced the death of one or both parents. Parental death is often considered the most traumatic event that a child can experience in their lifetime. While parental loss may lead to the development of prolonged grief disorder (PGD), little is known about risk factors for such negative mental health outcome in children. Objective: The present study aims to examine peritraumatic reactions as predictors of PGD in children who lost a parent. Method: Thirty-four children (M age = 10.9, SD = 3.2, 67.6% females) who lost a parent (time since death = 4.6 months, SD = 2.3) were assessed for peritraumatic distress and peritraumatic dissociation experienced at the time of the loss, and for PGD symptom severity at three timepoints post-loss (<6 months; 6-12 months; >12 months). Results: PGD score was correlated with peritraumatic distress (.61; p < .01) but not with peritraumatic dissociation (.24; p = .3). Results from the mixed-model regression analysis identified peritraumatic distress as the only significant predictor of PGD symptom severity (B = 1.58, SE = .31; p < .0001), with no statistically significant effect of peritraumatic dissociation (B = - .43, SE = .36; p = .2), or time (B = - 3.84, SE = 2.99; p = .2). Conclusion: Our results suggest that peritraumatic distress might be useful to identify children at risk for developing PGD, and in need of further support. The development of early preventive strategies to prevent PGD in parentally bereaved children who experienced high peritraumatic distress is warranted.
Collapse
Affiliation(s)
- Alexis Revet
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France.,CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France.,CIC 1436, Team PEPSS « Pharmacologie En Population cohorteS et biobanqueS », Toulouse University Hospital, France
| | - Agnès Suc
- Centre de Ressource Douleur Soins Palliatifs Pédiatriques, CHU de Toulouse, Toulouse, France
| | - Françoise Auriol
- Unité de recherche clinique pédiatrique module plurithématique pédiatrique CIC Toulouse 1436, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - A A A Manik J Djelantik
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department Youth - KOOS, Altrecht GGZ, Utrecht, The Netherlands
| | - Jean-Philippe Raynaud
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France.,CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, University of Caen Normandy & Caen University Hospital, Caen, France
| |
Collapse
|
23
|
Lenferink LIM, van den Munckhof MJA, de Keijser J, Boelen PA. DSM-5-TR prolonged grief disorder and DSM-5 posttraumatic stress disorder are related, yet distinct: confirmatory factor analyses in traumatically bereaved people. Eur J Psychotraumatol 2021; 12:1-14. [PMID: 34912501 PMCID: PMC8667936 DOI: 10.1080/20008198.2021.2000131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Prolonged grief disorder (PGD) is newly included in the text revision of the DSM-5 (DSM-5-TR). So far, it is unknown if DSM-5-TR PGD is distinguishable from bereavement-related posttraumatic stress disorder (PTSD). Prior research examining the distinctiveness of PTSD and pathological grief focused on non-traumatic loss samples, used outdated conceptualizations of grief disorders, and has provided mixed results. OBJECTIVE In a large sample of traumatically bereaved people, we first evaluated the factor structure of PTSD and PGD separately and then evaluated the factor structure when combining PTSD and PGD symptoms to examine the distinctiveness between the two syndromes. METHODS Self-reported data were used from 468 people bereaved due to the MH17 plane disaster (N = 200) or a traffic accident (N = 268). The 10 DSM-5-TR PGD symptoms were assessed with the Traumatic Grief Inventory-Self Report Plus (TGI-SR+). The 20-item Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) was used to tap PTSD symptoms. Confirmatory factor analyses were conducted. RESULTS For PTSD, a seven factor, so-called 'Hybrid' model yielded the best fit. For PGD, a univariate factor model fits the data well. A combined model with PGD items loading on one factor and PTSD items on seven factors (associations between PGD and PTSD subscales r ≥ .50 and ≤.71), plus a higher-order factor (i.e. PTSD factors on a higher-order PTSD factor) (association between higher-order PTSD factor and PGD factor r = .82) exhibited a better fit than a model with all PGD and PTSD symptom loading on a single factor or two factors (i.e. one for PGD and one for PTSD). CONCLUSIONS This is the first study examining the factor structure of DSM-5-TR PGD and DSM-5 PTSD in people confronted with a traumatic loss. The findings provide support that PGD constitutes a syndrome distinguishable from, yet related with, PTSD.
Collapse
Affiliation(s)
- L I M Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.,Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, The Netherlands
| | - M J A van den Munckhof
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,Foundation Centrum '45, Diemen, the Netherlands.,ARQ National Psychotrauma Centre, Diemen, the Netherlands
| |
Collapse
|
24
|
Lenferink LIM, de Keijser J, Eisma MC, Smid GE, Boelen PA. Treatment gap in bereavement care: (Online) bereavement support needs and use after traumatic loss. Clin Psychol Psychother 2020; 28:907-916. [PMID: 33377266 PMCID: PMC8451936 DOI: 10.1002/cpp.2544] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/09/2020] [Accepted: 11/27/2020] [Indexed: 12/26/2022]
Abstract
People bereaved through road traffic accidents (RTAs) are at risk for severe and disabling grief (i.e., pathological grief). Knowledge about needs and use of bereavement care, including psychotherapy, pharmacotherapy, and support groups, is limited. This study charted (correlates of) the needs and use of bereavement care in RTA bereaved people. Furthermore, although online grief treatment seems effective, it is unknown whether it is perceived as acceptable. Accordingly, we examined the acceptability of online treatment. Dutch RTA bereaved adults (N = 273) completed self‐report measures about needs and use of bereavement care, acceptability of online grief treatment, and pathological grief. Regression analyses were used to identify correlates of care needs and use and acceptability of online treatment. The majority (63%) had received help from psychotherapy, pharmacotherapy, and/or support groups. One in five participants had not used bereavement care services, despite reporting elevated pathological grief levels and/or expressing a need for care, pointing to a treatment gap. Use of psychological support before the loss was the strongest predictor of bereavement care needs and use following the loss. A minority (35%) reported being inclined to use online grief treatment if in need of support. More openness towards online services was related to greater acceptability of online treatment. In conclusion, 20% of RTA bereaved people with pathological grief or care needs had not received care. This treatment gap may be reduced by improving accessibility of online treatments. However, as only 35% was open to using online treatments, increasing the acceptability of (online) treatments appears important.
Collapse
Affiliation(s)
- Lonneke I M Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jos de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Geert E Smid
- ARQ National Psychotrauma Centre, Diemen, The Netherlands.,University of Humanistic Studies, Utrecht, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| |
Collapse
|
25
|
Killikelly C, Zhou N, Merzhvynska M, Stelzer EM, Dotschung T, Rohner S, Sun LH, Maercker A. Development of the international prolonged grief disorder scale for the ICD-11: Measurement of core symptoms and culture items adapted for chinese and german-speaking samples. J Affect Disord 2020; 277:568-576. [PMID: 32896722 DOI: 10.1016/j.jad.2020.08.057] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/03/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Prolonged grief disorder (PGD) is a new mental health disorder included in the WHO ICD-11 however, the operationalization of the guidelines still needs to be empirically validated, particularly in different cultural contexts. Here we provide a preliminary validation study of the new International Prolonged Grief Disorder Scale (IPGDS) that serves to be the first self-report questionnaire directly based on the ICD-11 PGD and contains culturally adapted items. METHODS In addition to core symptom items new culturally specific items were developed in two phases. Phase 1: key informant interviews with 10 German-speaking and 14 Chinese experts in grief and mental health, followed by a focus group with four bereaved German-speaking participants. Phase 2: 214 German-speaking and 325 Chinese bereaved participants completed self-report questionnaires. RESULTS Phase 1 resulted in 19 potential culturally relevant items (e.g. feeling stuck in grief). Phase 2 exploratory factor analysis confirmed the one-dimensional nature of the IPGDS, additionally the 32-item scale revealed two factors (core grief and culturally specific symptoms). Psychometric analysis revealed strong internal consistency, concurrent validity and criterion validity. LIMITATIONS The German-speaking and Chinese samples significantly differed in terms of several demographic variables including age, gender and type of loss. CONCLUSIONS This preliminary validity study confirms that the IPGDS is a valid and reliable measure of the new ICD-11 PGD guidelines. This is the first scale of disordered grief to contain both core items and culturally specific supplementary items and aims to improve the clinical utility of the ICD-11 narrative approach.
Collapse
Affiliation(s)
| | - Ningning Zhou
- Department of Psychology, University of Zurich, Switzerland; Beijing Normal University, Faculty of Psychology, China
| | | | - Eva-Maria Stelzer
- Department of Psychology, University of Zurich, Switzerland; University of Arizona, Department of Psychology, United States
| | | | - Stefan Rohner
- Department of Psychology, University of Zurich, Switzerland
| | - Lea Han Sun
- Department of Psychology, University of Zurich, Switzerland
| | | |
Collapse
|
26
|
Smith KV, Rankin H, Ehlers A. A qualitative analysis of loss-related memories after cancer loss: a comparison of bereaved people with and without prolonged grief disorder. Eur J Psychotraumatol 2020; 11:1789325. [PMID: 33062204 PMCID: PMC7534291 DOI: 10.1080/20008198.2020.1789325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: The study aimed to explore the content and features of loss-related memories in a sample of individuals bereaved by cancer with and without a probable diagnosis of prolonged grief disorder/persistent complex bereavement disorder (PGD/PCBD). Methods: Semi-structured interviews with 28 bereaved adults (PGD/PCBD = 12, NoPGD/PCBD = 16) were analysed using thematic analysis. Results: Three superordinate themes were identified: (1) intrusive imagery, (2) qualities of memory, and (3) triggers. Results showed that individuals suffering from probable PGD/PCBD reported a predominance of negative and upsetting memories, happy memories triggering pain and more negative intrusive imagery than those without PGD/PCBD. Conclusions: Bereavement by cancer can result in troubling intrusive memories that overshadow positive memories. Sufferers of PGD/PCBD are more likely to experience loss-related memories as negative and upsetting. Clinical approaches that utilise memory processing may be of particular relevance in this group.
Collapse
Affiliation(s)
- Kirsten V Smith
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK.,The Loss Foundation, [Registered Charity 1147362], London, UK
| | - Harriet Rankin
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| |
Collapse
|
27
|
Lenferink L, de Keijser J, Eisma M, Smid G, Boelen P. Online cognitive-behavioural therapy for traumatically bereaved people: study protocol for a randomised waitlist-controlled trial. BMJ Open 2020; 10:e035050. [PMID: 32883723 PMCID: PMC7473627 DOI: 10.1136/bmjopen-2019-035050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The traumatic death of a loved one, such as death due to a traffic accident, can precipitate persistent complex bereavement disorder (PCBD) and comorbid post-traumatic stress disorder (PTSD) and depression. Waitlist-controlled trials have shown that grief-specific cognitive-behavioural therapy (CBT) is an effective treatment for such mental health problems. This is the first study that will examine the effectiveness of online CBT (vs waitlist controls) in a sample exclusively comprised of people bereaved by a traumatic death. Our primary hypothesis is that people allocated to the online CBT condition will show larger reductions in PCBD, PTSD and depression symptom levels at post-treatment than people allocated to a waitlist. We further expect that reductions in symptom levels during treatment are associated with reductions of negative cognitions and avoidance behaviours and the experience of fewer accident-related stressors. Moreover, the effect of the quality of the therapeutic alliance on treatment effects and drop-out rates will be explored. METHODS AND ANALYSIS A two-arm (online CBT vs waiting list) open-label parallel randomised controlled trial will be conducted. Participants will complete questionnaires at pretreatment and 12 and 20 weeks after study enrolment. Eligible for participation are Dutch adults who lost a loved one at least 1 year earlier due to a traffic accident and report clinically relevant levels of PCBD, PTSD and/or depression. Multilevel modelling will be used. ETHICS AND DISSEMINATION Ethics approval has been received by the Medical Ethics Review Board of the University Medical Center Groningen (METc UMCG: M20.252121). This study will provide new insights in the effectiveness of online CBT for traumatically bereaved people. If the treatment is demonstrated to be effective, it will be made publicly accessible. Findings will be disseminated among lay people (eg, through newsletters and media performances), our collaborators (eg, through presentations at support organisations), and clinicians and researchers (eg, through conference presentations and scientific journal articles). TRIAL REGISTRATION NUMBER NL7497.
Collapse
Affiliation(s)
- Lonneke Lenferink
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Jos de Keijser
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Maarten Eisma
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Geert Smid
- ARQ Nationaal Psychotrauma Centre, Diemen, The Netherlands
- Foundation Centrum '45, Diemen, The Netherlands
- University of Humanistic Studies, Utrecht, The Netherlands
| | - Paul Boelen
- Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- ARQ Nationaal Psychotrauma Centre, Diemen, The Netherlands
- Foundation Centrum '45, Diemen, The Netherlands
| |
Collapse
|
28
|
KOKOU-KPOLOU CK, CENAT JM, PEREZ-MARFIL MN, FERNANDEZ-ALCANTARA M. How Can Psychologists and Psychiatrists Help COVID-19 Bereaved Persons:
Five propositions to Understanding Contextual Challenges. JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2020. [DOI: 10.24193/jebp.2020.2.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The COVID-19 pandemic is causing unprecedented cumulative deaths and leaving behind millions of bereaved families and individuals. Moreover, the pandemic is disrupting social fabrics in the conventional way we mourn our deads. In this context therefore, how can psychologists, psychiatrists and other health care professionals help bereaved families and individuals more effectively? This opinion paper proposed five recommendations that cover mental health care needs and challenges which may emerge from the management of these traumatic deaths. In all, efforts to comply with either DSM-5 or ICD-11 PGD guidelines could help COVID-19 bereaved persons with overwhelming distress, as they ensure therapists' use of appropriate terminologies in therapeutic alliances. However, clinicians need to have a global perspective of COVID-19 bereavement courses, political and public health measures due to the pandemic, and flexible attitudes about the ICD-11 and of DSM-5 time-criterion for diagnosis. This paper emphasizes the importance of social and collective recognition of COVID-19 deaths through various symbolic and materialized forms to free up collective and individual capacities for resilience. The necessity of individual and group interventions through online platforms is underscored, however these modes of therapies may not reinforce social inequalities by excluding bereaved individuals who really need them.
Collapse
|
29
|
Treml J, Kaiser J, Plexnies A, Kersting A. Assessing prolonged grief disorder: A systematic review of assessment instruments. J Affect Disord 2020; 274:420-434. [PMID: 32663972 DOI: 10.1016/j.jad.2020.05.049] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/10/2020] [Accepted: 05/10/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Grief reactions that become abnormally persistent and cause significant impairment in functioning have been introduced as new diagnostic entities within the classification systems DSM-5 and ICD-11 termed persistent complex bereavement disorder (PCBDDSM-5) and prolonged grief disorder (PGDICD-11), respectively. In order to assess these conditions, reliable and valid assessment instruments are indispensable. This systematic review examines available assessment tools for disordered grief, reviews their psychometric properties and assesses the extent to which they reflect the diagnostic entities. METHODS A systematic search of PubMed, PsycINFO and Web of Science databases was conducted. English language articles describing either the development of a measure for assessing PGD in adults or the validation of such a measure were included. RESULTS Overall 2215 publications were screened, 29 of which met the eligibility criteria. Three of the eleven described assessment tools are structured clinical interviews, one tool is a carer-based assessment and the remaining tools are self-report questionnaires. Most instruments demonstrate excellent or good reliability and validity. No tool assesses the current diagnostic criteria for PGDICD-11 fully. While three tools cover all diagnostic criteria for PCBDDSM-5, only one (TGI-SR) provides an adequate, empirically tested diagnostic algorithm. LIMITATIONS The inclusion of only English-language publications may have led to omission of relevant measurement tools and/or validation studies in different languages. CONCLUSIONS The newly released ICD-11 criteria for PGD could serve as a gold standard for diagnosis and build a foundation for the development of more precise assessment tools. Recommendations for clinical practice and future research are provided.
Collapse
Affiliation(s)
- Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany.
| | - Julia Kaiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany
| | - Anna Plexnies
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany
| |
Collapse
|
30
|
Eisma MC, Rosner R, Comtesse H. ICD-11 Prolonged Grief Disorder Criteria: Turning Challenges Into Opportunities With Multiverse Analyses. Front Psychiatry 2020; 11:752. [PMID: 32848929 PMCID: PMC7427562 DOI: 10.3389/fpsyt.2020.00752] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/16/2020] [Indexed: 01/05/2023] Open
Affiliation(s)
- Maarten C. Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Ingolstadt, Germany
| | - Hannah Comtesse
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Ingolstadt, Germany
| |
Collapse
|
31
|
Boelen PA, Lenferink LIM. Associations of depressive rumination and positive affect regulation with emotional distress after the death of a loved one. Clin Psychol Psychother 2020; 27:955-964. [PMID: 32474986 PMCID: PMC7754322 DOI: 10.1002/cpp.2482] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 11/24/2022]
Abstract
The death of a loved one may precipitate symptoms of prolonged grief disorder (PGD), post‐traumatic stress disorder (PTSD) and depression. Brooding about the causes and consequences of one's negative affect (NA), also termed depressive rumination, has been linked to distress after loss. The role of dysregulation of positive affect (PA) has received less attention. We examined (1) the factor structure of depressive rumination and PA dysregulation and (2) to what extent these factors were related to PGD, PTSD and depression symptom levels. Self‐report data were included from 235 Dutch bereaved people who completed measures tapping symptoms of PGD, PTSD and depression. Depressive rumination and PA regulation strategies were assessed with the Ruminative Response Scale (RRS) Brooding Scale and the Response to Positive Affect (RPA) Questionnaire (including three subscales: emotion‐focused and self‐focused rumination and dampening), respectively. Confirmatory factor analyses and structural equation modelling were used for data analyses. The four‐factor model (i.e., depressive rumination and the three RPA subscales) showed the best fit. An increase in depressive rumination was related to higher distress levels (across all outcomes in univariate and multivariate analyses). An increase in emotion‐focused rumination about PA was associated with less depression. More dampening of PA was related to higher PTSD levels. Findings suggest that, alongside the regulation of NA, the regulation of PA plays a role in how people respond to the death of a loved one. This points to the need for more research on NA and PA regulation in grief.
Collapse
Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,ARQ Nationaal Psychotrauma Centre, Diemen, The Netherlands
| | - Lonneke I M Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
32
|
O'Connor M, Larsen L, Joensen BV, Boelen PA, Maccallum F, Komischke-Konnerup K, Bryant RA. Valid ICD-11 PGD Scales and Structured Clinical Interviews Needed. Front Psychol 2020; 11:1120. [PMID: 32547463 PMCID: PMC7270432 DOI: 10.3389/fpsyg.2020.01120] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/30/2020] [Indexed: 02/01/2023] Open
Affiliation(s)
- Maja O'Connor
- Unit for Bereavement Research, Department of Psychology, Aarhus University, Aarhus, Denmark.,The Danish National Center for Grief, Copenhagen, Denmark
| | - Lene Larsen
- The Danish National Center for Grief, Copenhagen, Denmark
| | | | - Paul A Boelen
- Department of Psychology, Utrecht University, Utrecht, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - Fiona Maccallum
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | | | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
33
|
Two Cases of Persistent Complex Bereavement Disorder Diagnosed in the Acute Inpatient Unit. Case Rep Psychiatry 2020; 2020:3632060. [PMID: 32309001 PMCID: PMC7154980 DOI: 10.1155/2020/3632060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/23/2020] [Indexed: 11/17/2022] Open
Abstract
Pathological grief has been noted to have considerable adverse effects on affected individuals. In the DSM-5, the diagnosis of complicated grief is included under conditions for further study as Persistent Complex Bereavement Disorder (PCBD). PCBD can be easily missed because it is a relatively new and developing diagnosis. It can also be overlooked when it is comorbid with more common psychiatric disorders. We present 2 patients with PCBD diagnosed in the inpatient unit, while the patients were admitted for comorbid disorders. PCBD contributed immensely to both patients' suffering and decline in functioning. This report highlights the presentation, diagnoses, and management of these patients. We theorize that paying attention to separation distress, reactive distress to loss, and identity disruption in individuals who have been bereaved for over 12 months will enhance treatment specificity and lead to better patient outcomes.
Collapse
|
34
|
Boelen PA, Lenferink LIM. Comparison of six proposed diagnostic criteria sets for disturbed grief. Psychiatry Res 2020; 285:112786. [PMID: 32000105 DOI: 10.1016/j.psychres.2020.112786] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 01/25/2023]
Abstract
Increased recognition that grief may turn into a disorder led to the inclusion of Persistent Complex Bereavement Disorder (PCBD) in DSM-5 and Prolonged Grief Disorder (PGD) in ICD-11. Four additional criteria sets for disturbed grief have been proposed in recent years: Prigerson et al. proposed criteria for PGD ("PGD-2009″), Maercker et al. presented an ICD-11 beta draft version of PGD ("PGD-BD"), Shear et al. put forth criteria for complicated grief ("CG"), and, recently, criteria for PGD in DSM-5-TR have been proposed. This study sought to evaluate these six sets in one sample, which has not been done before. Using self-reported data from 855 bereaved individuals, we examined the (i) dimensionality, (ii) number of possible symptom combinations to meet criteria for caseness, (iii) prevalence rates and diagnostic agreement, (iv) concurrent validity, and (v) socio-demographic and loss-related correlates for each set. Criteria for PCBD were best represented by a three-factor structure and CG by a two-factor structure. Symptoms of ICD-11 PGD, PGD-2009, PGD-BD, and PGD-DSM-5-TR formed a single dimension. Prevalence rates varied between ~10% and ~20%. Diagnostic agreement between sets was substantial. Sets differed in terms of possible symptom combinations and had comparable concurrent validity and socio-demographic and loss-related correlates.
Collapse
Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University. PO Box 80140 3508 TC Utrecht The Netherlands; ARQ National Psychotrauma Centre, Nienoord 5 NL-1112 XE Diemen, The Netherlands; ARQ Centrum'45, Nienoord 5, NL-1112 XE Diemen, The Netherlands.
| | - Lonneke I M Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University. PO Box 80140 3508 TC Utrecht The Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1 9712 TS Groningen, The Netherlands
| |
Collapse
|
35
|
Stammel N, Heinzl L, Heeke C, Böttche M, Knaevelsrud C. Association Between Prolonged Grief and Attitudes Toward Reconciliation in Bereaved Survivors of the Khmer Rouge Regime in Cambodia. Front Psychiatry 2020; 11:644. [PMID: 32754059 PMCID: PMC7366248 DOI: 10.3389/fpsyt.2020.00644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/19/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND During the Khmer Rouge regime in Cambodia, about a quarter of the population died, resulting in many individuals losing close relatives. Still today, many individuals are suffering from the psychological consequences of these losses, which might also affect the process of reconciliation within the Cambodian society. The aim of this paper is therefore to investigate the association between symptoms of prolonged grief and attitudes toward reconciliation. METHODS A sample of 775 survivors of the Khmer Rouge regime who lost relatives during the conflict were interviewed about their losses and traumatic events, prolonged grief (PG; Complicated Grief Assessment Self-Report, CGA-SR), posttraumatic stress disorder (PTSD Checklist - Civilian Version) and attitudes toward reconciliation (Readiness to Reconcile Inventory, RRI). RESULTS A higher symptom severity of PG was significantly associated with readiness to reconcile even when controlling for other relevant variables (β = -0.22; p <.001). Persons who met caseness criteria for PG were significantly less ready to reconcile, t(773) = 5.47, p <.001, than persons who did not meet caseness for PG. CONCLUSION PG seems to be a relevant mental health correlate of attitudes toward reconciliation. The results of the current study underline the importance of also considering PG with regard to the reconciliation process in Cambodia and possibly also in other post-conflict regions.
Collapse
Affiliation(s)
- Nadine Stammel
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany.,Research Department, CENTER ÜEBERLEBEN, Berlin, Germany
| | - Louisa Heinzl
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Carina Heeke
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Maria Böttche
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany.,Research Department, CENTER ÜEBERLEBEN, Berlin, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| |
Collapse
|
36
|
Kristensen P, Dyregrov K, Gjestad R. Different Trajectories of Prolonged Grief in Bereaved Family Members After Terror. Front Psychiatry 2020; 11:545368. [PMID: 33192660 PMCID: PMC7591785 DOI: 10.3389/fpsyt.2020.545368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/14/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: The loss of a loved one in a terror incident is associated with elevated risk for mental health disorders such as prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD), but the long- term adaptation after such losses are not well understood. This study aims to explore the trajectories of PGD among parents and siblings (n = 129) after the 2011 terror attack on Utøya Island, Norway. Methods: The 19-item Inventory of Complicated grief (ICG) was used to measure PGD at 18, 28, and 40 months post-loss. Latent class growth analysis (LCGA) was used to identify trajectories of grief and a multinomial regression analysis was conducted to examine predictors of class membership. Results: The analysis identified three grief trajectories; moderate/decreasing class (23%), high/slow decreasing class (64%), and a high/chronic class (13%). Predictors of high/slow recovery or chronic grief was female gender, previous depressive symptoms, and intrusion and avoidance symptoms. Conclusion: The findings highlights the difficult grief process and slow recovery that characterizes the majority of close family members bereaved by a terror-incident. Community mental health programs should strive for both early outreach and long-term follow-up after such incidents.
Collapse
Affiliation(s)
- Pål Kristensen
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Kari Dyregrov
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Rolf Gjestad
- Center for Crisis Psychology, University of Bergen, Bergen, Norway.,Research Department, Division of Mental Health, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
37
|
Nielsen MK, Christensen KS, Neergaard MA, Bidstrup PE, Guldin MB. Exploring Functional Impairment in Light of Prolonged Grief Disorder: A Prospective, Population-Based Cohort Study. Front Psychiatry 2020; 11:537674. [PMID: 33362592 PMCID: PMC7755858 DOI: 10.3389/fpsyt.2020.537674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/18/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Functional impairment is essential in the diagnostic criteria for prolonged grief disorder (PGD) in the ICD-11. It refers to the negative impact on everyday life, including inability to maintain the usual level of functioning. We aimed to assess the extent of functional impairment, emotion-related role limitation, and impaired social functioning before and after bereavement, and to explore associations with PGD, as measured by the 13-item Prolonged Grief Scale (PGDPG13). Method: Relatives of terminally ill patients (n = 1,622) completed a questionnaire before and after bereavement. The questionnaire assessed "overall functional impairment" (PG-13 item) and "aspects of functional impairment" measured by mean scores of the 36-item Short Form Survey (SF-36) subscales emotional role and social functioning (0: worst; 100: best). We analyzed associations between PGDPG13 and functional impairment prior to bereavement using logistic regression models adjusted for age, gender, personal relation, education, time interval to patient's death, and pre-loss grief. Results: In total, 51% reported overall functional impairment before bereavement, 27% reported functional impairment at 6 months after bereavement, and 19% reported functional impairment at 3 years after bereavement. The mean emotional role score was 47.5 (95%CI: 45.4-49.7) before bereavement, increasing to 77.4 (95%CI: 75.7-79.0) at 3 years after bereavement, compared to 85.1 (95%CI: 77.6-92.6) in a reference sample. Mean social functioning score increased gradually reaching the mean of the reference sample at 3 years after bereavement. PGDPG13 was present in 26% of those with overall functional impairment at 6 months after bereavement, decreasing to 11% at 3 years after bereavement. Pre-bereavement measures of emotional role and social functioning were associated with PGDPG13at 6 months and 3 years after bereavement. Discussion: Overall functional impairment was prevalent as reflected in low scores on daily activities and social functioning compared to a reference sample. Functioning may be an important factor during caregiving and bereavement and pre-bereavement functional impairment was associated with PGDPG13. Future studies should investigate if maintaining daily activities and social functioning before bereavement could be key in early supportive care. Moreover, the role of functional impairment in bereavement interventions should be explored.
Collapse
Affiliation(s)
- Mette Kjaergaard Nielsen
- Research Unit for General Practice, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kaj Sparle Christensen
- Research Unit for General Practice, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Aarhus, Denmark.,Palliative Care Unit, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|