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Performance characteristics and clinical utility of diagnostic criteria proposals in bereaved treatment-seeking patients

Published online by Cambridge University Press:  08 November 2016

C. Mauro ,
M. K. Shear ,
C. F. Reynolds III ,
N. M. Simon ,
S. Zisook ,
N. Skritskaya ,
Y. Wang ,
B. Lebowitz ,
N. Duan  and
M. B. First
...Show all authors
C. Mauro
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
M. K. Shear*
Affiliation:
Columbia University School of Social Work, New York, NY, USA Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
C. F. Reynolds III
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Department of Community and Behavioral Health Science, University of Pittsburgh Graduate School of Public Health, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
N. M. Simon
Affiliation:
Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
S. Zisook
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, CA, USA
N. Skritskaya
Affiliation:
Columbia University School of Social Work, New York, NY, USA
Y. Wang
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
B. Lebowitz
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
N. Duan
Affiliation:
Division of Biostatistics, Department of Psychiatry, Columbia University, New York, NY, USA
M. B. First
Affiliation:
Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York State Psychiatric Institute and New York Presbyterian Hospital, New York, NY, USA
A. Ghesquiere
Affiliation:
Brookdale Center for Healthy Aging, Hunter College, New York, NY, USA
C. Gribbin
Affiliation:
Columbia University School of Social Work, New York, NY, USA
K. Glickman
Affiliation:
Department of Social Work, York College/CUNY, Jamaica, NY, USA
*
*Address for correspondence: M. K. Shear, M.D., Columbia School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, USA. (Email: [email protected]) A previous presentation of this research was given at the American Psychiatric Association Annual Meeting, Toronto, Ontario, 17 May 2015.
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Abstract

Background

Persistent complex bereavement disorder (PCBD) is a protracted form of grief included in DSM Section 3 indicating a need for more research. Two other criteria sets [prolonged grief disorder (PGD) and complicated grief (CG) disorder] are also currently in use by researchers. This study evaluates rates of diagnosis of each proposed criteria set in a clinical sample of bereaved individuals participating in clinical research.

Method

Two groups in which persistent grief was judged to be present or absent completed an assessment instrument that included items needed to diagnose PCBD as well as PGD and CG. One group included grief treatment-seeking participants in our multicenter National Institute of Mental Health (NIMH)-sponsored study who scored ⩾30 on the Inventory of Complicated Grief (ICG) and the other comprised bereaved adults enrolled in clinical research studies who scored <20 on the ICG. Rates of diagnosis were determined for proposed PCBD, PGD and CG criteria.

Results

PCBD criteria diagnosed 70 [95% confidence interval (CI) 64.2–75.8] % of the grief treatment-seeking group, PGD criteria identified 59.6 (95% CI 53.4–65.8) % of these individuals and CG criteria identified 99.6 (95% CI 98.8–100.0) %. None of the three proposed criteria identified any cases in the bereaved comparison group.

Conclusions

Both proposed DSM-5 criteria for PCBD and criteria for PGD appear to be too restrictive as they failed to identify substantial numbers of treatment-seeking individuals with clinically significant levels of grief-related distress and impairment. Use of CG criteria or a similar algorithm appears to be warranted.

Keywords

Complicated griefDSM-5 criteriafunctional impairmentpersistent complex bereavement disorderstress
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 4 , March 2017 , pp. 608 - 615
Copyright
Copyright © Cambridge University Press 2016 

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