Mazza Amelie, Maercker Andreas, Forstmeier Simon, Müller Mario, Killikelly Clare
Department of Psychology, Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland.
Department of Psychology, Developmental Psychology and Clinical Psychology of the Lifespan, University of Siegen, Siegen, Germany.
Psychopathology. 2025;58(2):69-79. doi: 10.1159/000541321. Epub 2024 Oct 10.
The new ICD-11 diagnosis of prolonged grief disorder (PGD) is characterized by the prominent role of yearning as hallmark symptom. A secondary analysis of eight international datasets on PGD was conducted to evaluate this assumption. Additionally, cross-cultural comparison explored whether the centrality of yearning differs across world regions.
Primary studies originated from German-speaking countries (n = 4 samples), other European countries and Israel (n = 3 samples), as well as China (n = 1 samples). Different PGD measures were used, including yearning and longing as symptoms. For the centrality assessment of yearning, PGD symptoms were ranked by their factor loadings from confirmatory factor analyses, followed by statistical testing to determine significant differences between yearning and other symptoms of PGD in their factor loading estimates. Subsequently, ranking positions of yearning in three world regions (German-speaking, other Europe-Israel, and China) were compared. Finally, proxy thresholds for individuals at high-risk states for PGD were defined for the different datasets, and sensitivity-specificity analyses of yearning were performed.
Yearning was ranked high in five out of 12 models tested. In the German-speaking region, it was predominantly ranked among the most central symptoms; in the other Europe-Israel region as well as China, it tended to fall into the middle or lower rankings of symptom centrality. Sensitivity values were consistently high, while specificity values indicated moderate levels.
In line with previous research on the general outcomes of grief, the present study showed that yearning may be subject to a culture-specific distribution. Other central symptoms such as feeling as if a part of oneself died have also been shown to potentially play a central role in PGD across world regions. On the other hand, the sensitivity-specificity analyses revealed that yearning can be considered a significant (diagnostically highly sensitive) symptom for individuals in high-risk states for PGD, although it has only moderate specificity (i.e., its absence does not necessarily indicate individuals experiencing normative grief). Nonetheless, a culture-sensitive approach to psychopathology should consider the cultural differences in the centrality of this symptom group. More research is needed to better understand the role of yearning and its determinants across world regions.
The new ICD-11 diagnosis of prolonged grief disorder (PGD) is characterized by the prominent role of yearning as hallmark symptom. A secondary analysis of eight international datasets on PGD was conducted to evaluate this assumption. Additionally, cross-cultural comparison explored whether the centrality of yearning differs across world regions.
Primary studies originated from German-speaking countries (n = 4 samples), other European countries and Israel (n = 3 samples), as well as China (n = 1 samples). Different PGD measures were used, including yearning and longing as symptoms. For the centrality assessment of yearning, PGD symptoms were ranked by their factor loadings from confirmatory factor analyses, followed by statistical testing to determine significant differences between yearning and other symptoms of PGD in their factor loading estimates. Subsequently, ranking positions of yearning in three world regions (German-speaking, other Europe-Israel, and China) were compared. Finally, proxy thresholds for individuals at high-risk states for PGD were defined for the different datasets, and sensitivity-specificity analyses of yearning were performed.
Yearning was ranked high in five out of 12 models tested. In the German-speaking region, it was predominantly ranked among the most central symptoms; in the other Europe-Israel region as well as China, it tended to fall into the middle or lower rankings of symptom centrality. Sensitivity values were consistently high, while specificity values indicated moderate levels.
In line with previous research on the general outcomes of grief, the present study showed that yearning may be subject to a culture-specific distribution. Other central symptoms such as feeling as if a part of oneself died have also been shown to potentially play a central role in PGD across world regions. On the other hand, the sensitivity-specificity analyses revealed that yearning can be considered a significant (diagnostically highly sensitive) symptom for individuals in high-risk states for PGD, although it has only moderate specificity (i.e., its absence does not necessarily indicate individuals experiencing normative grief). Nonetheless, a culture-sensitive approach to psychopathology should consider the cultural differences in the centrality of this symptom group. More research is needed to better understand the role of yearning and its determinants across world regions.
国际疾病分类第11版（ICD - 11）中新增的持续性悲伤障碍（PGD）诊断的特点是，渴望作为标志性症状发挥着突出作用。对八个关于PGD的国际数据集进行了二次分析，以评估这一假设。此外，跨文化比较探讨了渴望的核心地位在不同世界区域是否存在差异。
原始研究来自德语国家（n = 4个样本）、其他欧洲国家和以色列（n = 3个样本）以及中国（n = 1个样本）。使用了不同的PGD测量方法，包括将渴望和思念作为症状。为了评估渴望的核心地位，通过验证性因素分析得出的因素负荷对PGD症状进行排序，随后进行统计检验，以确定渴望与PGD其他症状在因素负荷估计值上的显著差异。随后，比较了渴望在三个世界区域（德语区、其他欧洲 - 以色列地区和中国）的排名位置。最后，为不同数据集定义了PGD高风险状态个体的替代阈值，并对渴望进行了敏感性 - 特异性分析。
在测试的12个模型中，有5个模型中渴望的排名较高。在德语区，它主要排在最核心的症状之中；在其他欧洲 - 以色列地区以及中国，它往往处于症状核心地位的中低排名。敏感性值一直很高，而特异性值表明处于中等水平。
与先前关于悲伤一般结果的研究一致，本研究表明渴望可能存在文化特异性分布。其他核心症状，如感觉自己的一部分好像死了，也已被证明在全球不同区域的PGD中可能发挥核心作用。另一方面，敏感性 - 特异性分析表明，尽管渴望的特异性仅为中等水平（即其不存在不一定表明个体经历的是正常悲伤），但对于处于PGD高风险状态的个体而言，渴望可被视为一种重要的（诊断上高度敏感的）症状。尽管如此，一种对文化敏感的精神病理学方法应考虑该症状组核心地位的文化差异。需要更多研究来更好地理解渴望在全球不同区域的作用及其决定因素。
国际疾病分类第11版（ICD - 11）中新增的持续性悲伤障碍（PGD）诊断的特点是，渴望作为标志性症状发挥着突出作用。对八个关于PGD的国际数据集进行了二次分析，以评估这一假设。此外，跨文化比较探讨了渴望的核心地位在不同世界区域是否存在差异。
原始研究来自德语国家（n = 4个样本）、其他欧洲国家和以色列（n = 3个样本）以及中国（n = 1个样本）。使用了不同的PGD测量方法，包括将渴望和思念作为症状。为了评估渴望的核心地位，通过验证性因素分析得出的因素负荷对PGD症状进行排序，随后进行统计检验，以确定渴望与PGD其他症状在因素负荷估计值上的显著差异。随后，比较了渴望在三个世界区域（德语区、其他欧洲 - 以色列地区和中国）的排名位置。最后，为不同数据集定义了PGD高风险状态个体的替代阈值，并对渴望进行了敏感性 - 特异性分析。
在测试的12个模型中，有5个模型中渴望的排名较高。在德语区，它主要排在最核心的症状之中；在其他欧洲 - 以色列地区以及中国，它往往处于症状核心地位的中低排名。敏感性值一直很高，而特异性值表明处于中等水平。
与先前关于悲伤一般结果的研究一致，本研究表明渴望可能存在文化特异性分布。其他核心症状，如感觉自己的一部分好像死了，也已被证明在全球不同区域的PGD中可能发挥核心作用。另一方面，敏感性 - 特异性分析表明，尽管渴望的特异性仅为中等水平（即其不存在不一定表明个体经历的是正常悲伤），但对于处于PGD高风险状态的个体而言，渴望可被视为一种重要的（诊断上高度敏感的）症状。尽管如此，一种对文化敏感的精神病理学方法应考虑该症状组核心地位的文化差异。需要更多研究来更好地理解渴望在全球不同区域的作用及其决定因素。
