Kim Jane, Tol Wietse A, Shrestha Abina, Kafle Hari Maya, Rayamajhi Rajin, Luitel Nagendra P, Thapa Lily, Surkan Pamela J
Psychiatry. 2017 Spring;80(1):1-16. doi: 10.1080/00332747.2016.1213560.
Persistent complex bereavement disorder (PCBD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), has not been well studied in socioculturally diverse populations. Thus, this qualitative study examined (a) how widows in Nepal understand grief, (b) whether a local construct of PCBD exists, and (c) its comparability with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), terminology.
Using an adapted Explanatory Model Interview Catalogue (EMIC) framework, semistructured interviews with 25 widows and 12 key informants, as well as three focus-group discussions (n = 20), were conducted between October 2014 and April 2015. Through an inductive grounded theory-based approach, we used the constant comparative method, iteratively coding transcripts to identify themes and patterns in the data. Also, we created two lists of grief responses, one of early reactions and another all reactions to grief, based on the frequency of mention.
No single term for grief was reported. Widows reported a local construct of PCBD, which was broadly compatible with DSM-5 terminology but with important variation reflecting societal influence. Surviving torture during conflict, economic and family stressors, and discrimination were mentioned as important determinants that prolong and complicate grief. Suicidal ideation was common, with about 31% and 62% of widows reporting past-year and lifetime suicidality, respectively. Findings may not be generalizable to all Nepali widows; participants were recruited from a non-governmental organization, from Kathmandu and its neighboring districts, and were primarily of reproductive age.
While PCBD symptoms proposed in DSM-5 were mentioned as relevant by study participants, some components may need adaptation for use in non-Western settings, such as Nepal.
《精神疾病诊断与统计手册》第五版（DSM - 5）中的持续性复杂丧亲之痛障碍（PCBD）在社会文化背景多样的人群中尚未得到充分研究。因此，本定性研究考察了：（a）尼泊尔寡妇如何理解悲痛；（b）当地是否存在PCBD的概念；（c）其与《精神疾病诊断与统计手册》第五版（DSM - 5）术语的可比性。
采用经过调整的解释性模型访谈目录（EMIC）框架，于2014年10月至2015年4月期间，对25名寡妇和12名关键信息提供者进行了半结构化访谈，并开展了三次焦点小组讨论（n = 20）。通过基于归纳性扎根理论的方法，我们运用持续比较法，对访谈记录进行反复编码，以识别数据中的主题和模式。此外，我们根据提及频率创建了两份悲痛反应清单，一份是早期反应清单，另一份是对悲痛的所有反应清单。
未报告有单一的悲痛术语。寡妇们报告了一种当地的PCBD概念，它与DSM - 5术语大致相符，但存在重要差异，反映了社会影响。在冲突期间遭受酷刑、经济和家庭压力源以及歧视被提及为延长悲痛并使其复杂化的重要决定因素。自杀意念很常见，分别有大约31%和62%的寡妇报告过去一年和一生中有过自杀行为。研究结果可能不适用于所有尼泊尔寡妇；参与者是从一个非政府组织招募的，来自加德满都及其周边地区，且主要为育龄妇女。
虽然研究参与者提到DSM - 5中提出的PCBD症状是相关的，但某些组成部分可能需要调整以用于非西方背景，如尼泊尔。
