Unit for Bereavement Research, Department of Psychology, Aarhus University, Aarhus, Denmark; The Danish National Center for Grief, Copenhagen, Denmark.
DEFACTUM, Central Denmark Region, Aarhus, Denmark.
J Affect Disord. 2019 May 15;251:52-59. doi: 10.1016/j.jad.2019.01.056. Epub 2019 Mar 18.
A distinct grief-specific disorder is included in the ICD-11. Lack of clarity remains regarding whether different proposed diagnostic criteria capture similar or different diagnostic entities. Our aim was to examine the specificity of four proposed diagnostic criteria-sets for pathological grief in a population-based sample.
Participants were 206 conjugally bereaved elderly Danes (59% female; mean age = 72.5 years, SD = 4.2; range 65-81) who completed self-report questionnaires six months post-loss. The main measure was the Danish version of Inventory of Complicated Grief-Revised.
Results indicate substantial agreement between Prolonged Grief Disorder (PGD), Persistent Complex Bereavement Disorder (PCBD) and ICD-11-PGD (kappa's = 0.69-0.84), which found 6-9% of cases tested positive for pathological grief. Complicated Grief (CG) was partly in agreement with the three other symptom-diagnostic tests (kappa's = 0.13-0.20), and the prevalence-rate of pathological grief was 48%.
The low response-rate of 39%. The selective inclusion of data ≥6 months post-loss prevents a comparison of acute and prolonged grief reactions. Using self-reported data, not diagnostic interviews, challenges the validity of our findings. Using a sample of elderly people may limit the generalizability of our results to other age groups.
We suggest that PGD, PCBD and ICD-11-PGD may be more discriminative in identifying a specific grief-related psychopathology, while CG may identify a broader set of grief reactions.
ICD-11 中包含一种独特的 grief-specific 障碍。目前仍不清楚不同的提议诊断标准是否捕捉到相似或不同的诊断实体。我们的目的是在基于人群的样本中检查四种病理性悲伤的提议诊断标准集的特异性。
参与者是 206 名配偶丧亲的丹麦老年人（59%为女性；平均年龄为 72.5 岁，标准差为 4.2；范围为 65-81），他们在丧失后六个月完成了自我报告问卷。主要测量工具是丹麦版的修订后的复杂悲伤清单。
结果表明，延长性悲伤障碍（PGD）、持续性复杂丧亲障碍（PCBD）和 ICD-11-PGD 之间存在实质性的一致性（kappa's=0.69-0.84），这三种诊断标准发现有 6-9%的病例被检测为病理性悲伤。复杂悲伤（CG）与其他三种症状诊断测试部分一致（kappa's=0.13-0.20），病理性悲伤的患病率为 48%。
39%的低回应率。选择性纳入数据≥6 个月后丧失，阻止了对急性和延长性悲伤反应的比较。使用自我报告的数据，而不是诊断访谈，对我们研究结果的有效性提出了挑战。使用老年人样本可能会限制我们的研究结果在其他年龄组中的普遍性。
我们建议，PGD、PCBD 和 ICD-11-PGD 可能更具鉴别力，可用于识别特定的与悲伤相关的精神病理学，而 CG 可能识别更广泛的悲伤反应。
