Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao-Yuan, Taiwan.
Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan.
Psychooncology. 2018 Mar;27(3):1027-1034. doi: 10.1002/pon.4629. Epub 2018 Jan 24.
Prolonged grief disorder (PGD) and depression are recognized as distinct emotional-distress disorders for bereaved family caregivers. However, this distinction has been mostly validated in cross-sectional studies, neglecting the dynamic characteristics of bereaved caregivers' emotional distress.
To validate the distinction between symptoms of PGD and depression across the first bereavement year for family caregivers of terminally ill cancer patients.
In this descriptive, longitudinal study of 394 bereaved Taiwanese family caregivers, we measured symptoms of PGD and depression by the Prolonged Grief-13 and Center for Epidemiologic Studies Depression (CES-D) scales at 6 and 13 months postloss, respectively. Agreement between cases of PGD and severe depressive symptoms (CES-D score ≥ 16) was analyzed by Cohen's kappa. Structural distinctiveness was longitudinally examined using confirmatory bifactor modeling.
Agreement was poor between cases of PGD and severe depressive symptoms at 6 and 13 months postloss (kappa = .16 [confidence interval = .09, .22] and .12 [confidence interval = .03, .19], respectively). Symptoms of PGD and depression shared a general factor, but were distinct as shown by their significant specific factor loadings at 6 and 13 months postloss. Confirmatory bifactor models showed structural invariance (confirmatory fit index difference < .01 and χ difference P > .05) between 6 and 13 months postloss.
Symptoms of PGD and depression were confirmed as distinct across the first year of bereavement. Health care professionals should recognize early in bereavement that symptoms of PGD and depression are distinct, identify high-risk groups, and provide care tailored to caregivers' unique needs to facilitate recovery from bereavement-related emotional-distress disorders.
延长哀伤障碍（PGD）和抑郁症被认为是丧亲家庭照顾者的两种不同的情绪障碍。然而，这种区分主要是在横断面研究中得到验证，而忽略了丧亲照顾者情绪困扰的动态特征。
在绝症癌症患者丧亲的第一年，验证 PGD 症状与抑郁症症状之间的区别。
在这项对 394 名丧亲的台湾家庭照顾者的描述性、纵向研究中，我们分别在丧亲后 6 个月和 13 个月使用延长哀伤 13 项量表（PG-13）和流行病学研究中心抑郁量表（CES-D）测量 PGD 和抑郁症状。使用 Cohen's kappa 分析 PGD 病例与严重抑郁症状（CES-D 评分≥16）之间的一致性。使用验证性双因素模型纵向检查结构独特性。
PGD 病例与严重抑郁症状在丧亲后 6 个月和 13 个月时的一致性较差（kappa 值分别为.16 [置信区间：.09，.22]和.12 [置信区间：.03，.19]）。PGD 症状和抑郁症状共享一个一般因素，但在丧亲后 6 个月和 13 个月时，它们具有显著的特定因素负荷，表明它们是不同的。验证性双因素模型显示，丧亲后 6 个月和 13 个月之间结构具有不变性（验证性拟合指数差异<.01 且 χ 差异 P>.05）。
PGD 症状和抑郁症状在丧亲后的第一年被证实是不同的。医疗保健专业人员应在丧亲早期认识到，PGD 症状和抑郁症状是不同的，识别高风险群体，并根据照顾者的独特需求提供护理，以促进从丧亲相关情绪障碍中康复。
