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Xu X, Skritskaya NA, Zhou N, Wen J, Shi G, Shear MK. A case report to understand the use of an evidence-based approach of prolonged grief therapy in Chinese culture. DEATH STUDIES 2024:1-10. [PMID: 38758643 DOI: 10.1080/07481187.2024.2355228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Prolonged grief disorder (PGD) is a new diagnosis that may cause significant functional impairment. Prolonged grief therapy (PGT) is a manualized 16-session intervention, whose efficacy has been demonstrated in studies primarily from Western cultures. The current report aimed to present a case to illustrate the use of PGT in Chinese culture. The client was a bereaved adult suffering from PGD after the death of her mother ten years ago. Additionally, she lost her father three months ago. Questionnaires were completed before and after treatment. In-depth interview was conducted at a 3-month follow-up. The client's scores for grief, functional impairment, grief-related beliefs and avoidance, depression and insomnia all decreased substantially after treatment. The follow-up feedbacks indicated that the beneficial effects of PGT persisted in the client's life. This case report provides preliminary evidence that bereaved people in China could benefit greatly from PGT, with minimal cultural adaptation.
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Affiliation(s)
- Xin Xu
- Department of Psychology, School of Education, Soochow University, Suzhou, China
| | - Natalia A Skritskaya
- Center for Prolonged Grief, Columbia School of Social Work, New York, New York, USA
| | - Ningning Zhou
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Jun Wen
- Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Guangyuan Shi
- Center for psychological development, Tsinghua University, Beijing, China
| | - M Katherine Shear
- Center for Prolonged Grief, Columbia School of Social Work, New York, New York, USA
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2
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Sawyer JS. Grief and bereavement beliefs and their associations with death anxiety and complicated grief in a U.S. college student sample. DEATH STUDIES 2024:1-12. [PMID: 38713539 DOI: 10.1080/07481187.2024.2349933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
This study examined beliefs about grief and bereavement, and how the endorsement of myths is related to death anxiety and complicated grief. Results from a sample of college students in the United States (N = 391) suggested that myths about grief and bereavement are prevalent in this group. Additionally, the endorsement of certain myths significantly explained both death anxiety and complicated grief. Findings from this study provide additional support for death education in college and university settings to promote grief literacy. Implications for education, advocacy, research, and practice are discussed.
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Affiliation(s)
- Jacob S Sawyer
- Department of Psychology, Alma College, Alma, Michigan, USA
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3
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Rueger MS, Lechner-Meichsner F, Kirschbaum L, Lubik S, Roll SC, Steil R. Prolonged grief disorder in an inpatient psychiatric sample: psychometric properties of a new clinical interview and preliminary prevalence. BMC Psychiatry 2024; 24:333. [PMID: 38693470 PMCID: PMC11064282 DOI: 10.1186/s12888-024-05784-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/22/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Prolonged Grief Disorder (PGD) was newly included in the ICD-11 and DSM-5-TR. It is not yet part of the standard assessments in many healthcare systems, including psychiatric wards. Because disordered grief is associated with suicidality, sleep problems and substance use disorders, an investigation into PGD in psychiatric inpatients is warranted. METHOD We interviewed N = 101 psychiatric inpatients who were admitted to the open psychiatric wards and the day hospital of a German psychiatric hospital and who had lost a person close to them. Assessments comprised clinical interviews and self-report instruments covering PGD and other mental disorders. We specifically developed the International Interview for Prolonged Grief Disorder according to ICD-11 (I-PGD-11) for the study and examined its psychometric properties. RESULTS The prevalence rate of PGD among bereaved patients according to ICD-11 was 16.83% and according to DSM-5-TR 10.89%. The I-PGD-11 showed good psychometric properties (Mc Donald's ω = 0.89, ICC = 0.985). Being female, having lost a child or spouse, and unnatural or surprising circumstances of the death were associated with higher PGD scores. TRIAL REGISTRATION Approval was obtained by the ethics committee of the of the Goethe University Frankfurt (2021-62, 2023-17) and the Chamber of Hessian Physicians (2021-2730-evBO). The study was preregistered ( https://doi.org/10.17605/OSF.IO/K98MF ). LIMITATIONS We only assessed inpatients of one psychiatric clinic in Germany, limiting the generalizability of our findings. CONCLUSION The present study underlines the importance of exploring loss and grief in psychiatric inpatients and including PGD in the assessments. Given that a significant minority of psychiatric inpatients has prolonged grief symptoms, more research into inpatient treatment programs is needed.
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Affiliation(s)
- Mirjam Sophie Rueger
- Department Clinical Psychology & Psychotherapy, Goethe-University Frankfurt am Main, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany.
| | | | - Lotte Kirschbaum
- Department Clinical Psychology & Psychotherapy, Goethe-University Frankfurt am Main, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany
| | - Silke Lubik
- Klinik für psychische Gesundheit, varisano Klinikum Frankfurt Höchst, Gotenstraße 6-8, 65929, Frankfurt am Main, Germany
| | - Sibylle C Roll
- Klinik für psychische Gesundheit, varisano Klinikum Frankfurt Höchst, Gotenstraße 6-8, 65929, Frankfurt am Main, Germany
| | - Regina Steil
- Department Clinical Psychology & Psychotherapy, Goethe-University Frankfurt am Main, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany
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Prigerson HG, Singer J, Killikelly C. Prolonged Grief Disorder: Addressing Misconceptions With Evidence. Am J Geriatr Psychiatry 2024; 32:527-534. [PMID: 38001019 DOI: 10.1016/j.jagp.2023.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
There are many misconceptions about Prolonged Grief Disorder (PGD). We show with data that PGD is a diagnosis that applies to a rare few of mourners who are at risk of significant distress and dysfunction. Those mourners who meet criteria for PGD have been shown to benefit from specialized, targeted treatment for it. The case against PGD is empirically unsubstantiated, and the need for scientific examination of effective treatments is warranted.
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Affiliation(s)
| | - Jonathan Singer
- Department of Psychological Science (JS), Texas Tech University, Lubbock, TX; Fred Hutchinson Cancer Center (JS), Seattle, WA
| | - Clare Killikelly
- Department of Psychology, Psychopathology and Clinical Intervention (CK), University of Zurich, Zurich, Switzerland
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5
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Eisma MC. Prolonged Grief Disorder: Conceptions and Misconceptions. Commentary on Prigerson et al. Am J Geriatr Psychiatry 2024; 32:632-633. [PMID: 38267356 DOI: 10.1016/j.jagp.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands.
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Bryant RA, Azevedo S, Yadav S, Cahill C, Kenny L, Maccallum F, Tran J, Choi-Christou J, Rawson N, Tockar J, Garber B, Keyan D, Dawson KS. Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2024:2818040. [PMID: 38656428 PMCID: PMC11044011 DOI: 10.1001/jamapsychiatry.2024.0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/09/2024] [Indexed: 04/26/2024]
Abstract
Importance Although grief-focused cognitive behavior therapies are the most empirically supported treatment for prolonged grief disorder, many people find this treatment difficult. A viable alternative for treatment is mindfulness-based cognitive therapy. Objective To examine the relative efficacies of grief-focused cognitive behavior therapy and mindfulness-based cognitive therapy to reduce prolonged grief disorder severity. Design, Setting, and Participants A single-blind, parallel, randomized clinical trial was conducted among adults aged 18 to 70 years with prolonged grief disorder, as defined in the International Classification of Diseases, 11th Revision, and assessed by clinical interview based on the Prolonged Grief-13 (PG-13) scale. Those with severe suicidal risk, presence of psychosis, or substance dependence were excluded. Between November 2012 and November 2022, eligible participants were randomized 1:1 to eleven 90-minute sessions of grief-focused cognitive behavior therapy or mindfulness-based cognitive therapy at a traumatic stress clinic in Sydney, Australia, with follow-up through 6 months. Interventions Both groups received once-weekly 90-minute individual sessions for 11 weeks. Grief-focused cognitive behavior therapy comprised 5 sessions of recalling memories of the deceased, plus cognitive restructuring and planning future social and positive activities. Mindfulness-based cognitive therapy comprised mindfulness exercises adapted to tolerate grief-related distress. Main Outcomes and Measures The primary outcome was change in prolonged grief disorder severity measured by the PG-13 scale assessed at baseline, 1 week posttreatment, and 6 months after treatment (primary outcome time point), as well as secondary outcome measures of depression, anxiety, grief-related cognition, and quality of life. Results The trial included 100 participants (mean [SD] age, 47.3 [13.4] years; 87 [87.0%] female), 50 in the grief-focused cognitive behavior therapy condition and 50 in the mindfulness-based cognitive therapy condition. Linear mixed models indicated that at the 6-month assessment, participants in the grief-focused cognitive behavior therapy group showed greater reduction in PG-13 scale score relative to those in the mindfulness-based cognitive therapy group (mean difference, 7.1; 95% CI, 1.6-12.5; P = .01), with a large between-group effect size (0.8; 95% CI, 0.2-1.3). Participants in the grief-focused cognitive behavior therapy group also demonstrated greater reductions in depression as measured on the Beck Depression Inventory than those in the mindfulness-based cognitive therapy group (mean difference, 6.6; 95% CI, 0.5-12.9; P = .04) and grief-related cognition (mean difference, 14.4; 95% CI, 2.8-25.9; P = .02). There were no other significant differences between treatment groups and no reported adverse events. Conclusions and Relevance In this study, grief-focused cognitive behavior therapy conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy. Although both treatments may be considered for prolonged grief disorder, grief-focused cognitive behavior therapy might be the more effective choice, taking all factors into consideration. Trial Registration anzctr.org.au Identifier: ACTRN12612000307808.
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Affiliation(s)
- Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Suzanna Azevedo
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Srishti Yadav
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Cahill
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Lucy Kenny
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Maccallum
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Tran
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasmine Choi-Christou
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Rawson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Julia Tockar
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Benjamin Garber
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Dharani Keyan
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Katie S. Dawson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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7
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Lechner-Meichsner F, Comtesse H, Olk M. Prevalence, comorbidities, and factors associated with prolonged grief disorder, posttraumatic stress disorder and complex posttraumatic stress disorder in refugees: a systematic review. Confl Health 2024; 18:32. [PMID: 38627778 PMCID: PMC11020800 DOI: 10.1186/s13031-024-00586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The number of refugees worldwide is at an all-time high with many being exposed to potentially traumatic events and the loss of loved ones. The 11th revision of the International Statistical Classification of Diseases and Related Health Problems now includes prolonged grief disorder and complex posttraumatic stress disorder and revised criteria for posttraumatic stress disorder. An overview of these stress-related disorders among people who have become refugees is therefore needed. Consequently, we conducted a systematic review to determine prevalence rates, comorbidities, and associated factors for each of the disorders. METHOD We systematically searched PubMed, Web of Science, and PsycArticles to identify studies that reported prevalence rates, predictors or associated factors, and/or comorbid mental disorders for either (1) prolonged grief disorder, (2) posttraumatic stress disorder, or (3) complex posttraumatic stress disorder among refugees. The selection process followed the PRISMA guidelines. RESULTS A total of 36 studies met the inclusion criteria. Most of the studies were of high quality. There was substantial variation in prevalence rates by disorder, with prolonged grief ranging from 6 to 54%, posttraumatic stress disorder ranging from 0.4 to 80%, and complex posttraumatic stress disorder ranging from 3 to 74.6%. Pooled prevalence for posttraumatic stress disorder was estimated at 29.8% in treatment seeking samples and 9.92% in population samples. For complex posttraumatic stress disorder, it was estimated at 57.4% in treatment seeking samples and 7.8% in population samples. Posttraumatic stress disorder was among the most frequent comorbidities for prolonged grief disorder while depressive symptoms were the most frequently occurring co-morbidity across all three disorders. Sociodemographic variables, trauma exposure, and loss characteristics were associated with higher symptom severity. Postmigration living difficulties played an important role in prolonged grief and complex posttraumatic stress disorder. CONCLUSION The review revealed substantial differences in prevalence rates between the three studied disorders but underscored a very high prevalence of ICD-11 stress-related disorders among refugees. The identified associated factors point to subgroups that may be particularly at risk and establishes a foundational basis for targeted interventions and potential policy changes. Future research should incorporate longitudinal investigations and emphasize culturally sensitive assessments.
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Affiliation(s)
- Franziska Lechner-Meichsner
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany.
- Clinical Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS, Netherlands.
| | - Hannah Comtesse
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Ostenstraße 26, 85072, Eichstätt, Germany
| | - Marie Olk
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany
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8
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Schmidt V, Treml J, Brähler E, Kersting A. Psychometric properties of the German version of the Pre-loss Grief Questionnaire (PG-12-R). DEATH STUDIES 2024:1-9. [PMID: 38626113 DOI: 10.1080/07481187.2024.2337201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
This study aimed to develop a German version of the revised Pre-loss Grief Questionnaire (PG-12-R) and examine its factor structure, reliability and validity. The PG-12-R was assessed in a representative German sample (N = 2,515). Of these, 362 (14.4%) reported to have a loved one suffering from an incurable disease and 352 provided full data sets. Principal component factor analysis, scree-plot and parallel analysis were conducted. Results supported a one-factor model of PG-12-R with high internal consistency. Convergent validity was confirmed by negative correlations with psychological well-being and time since diagnosis and positive correlations with a more difficult perception of circumstances surrounding the illness and unpreparedness. The German version of the PG-12-R represents a reliable and valid measurement tool of pre-loss grief. It may be used as a screening measure for high levels of pre-loss grief to identify individuals who may need additional support.
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Affiliation(s)
- Viktoria Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
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9
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Comtesse H, Smid GE, Rummel AM, Spreeuwenberg P, Lundorff M, Dückers MLA. Cross-national analysis of the prevalence of prolonged grief disorder. J Affect Disord 2024; 350:359-365. [PMID: 38220101 DOI: 10.1016/j.jad.2024.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Prolonged grief disorder (PGD) is now included as a diagnosis in international classification systems. Most research on PGD is based on Western populations, but first data from non-Western countries have recently become available. Little is still known about country-related effects on PGD's prevalence. OBJECTIVE Determining possible causes of variations in the prevalence of PGD as defined by DSM-5-TR and ICD-11 within and between countries. METHODS We retrieved data from 24 prevalence studies, the World Bank and the 2022 World Risk Report. Negative binomial regressions were used to explore methodological, loss-related and country context characteristics as predictors of PGD. The average rate of PGD was calculated using random effects models. RESULTS The included studies comprised 34 samples from 16 countries (20,347 participants). Non-probability sampling and older mean age of the sample as well as lower country vulnerability were associated with higher PGD rates. The average PGD prevalence was 13 % (95 % CI [11, 22]), varying from 5 % (95 % CI [3, 11]) in probability to 16 % (95 % CI [13, 25]) in non-probability samples. LIMITATIONS Samples from Europe and North America were overrepresented. For about half of the countries, data were available from only one sample. CONCLUSIONS While confirming the importance of studies' methodological quality, the results show that PGD is of public health relevance around the world, but especially common in less vulnerabled countries with better access to daily necessities and healthcare services, highlighting sociocultural impacts on grief processing. Further investigations of cross-national differences are needed.
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Affiliation(s)
- Hannah Comtesse
- Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.
| | - Geert E Smid
- ARQ National Psychotrauma Centre, Diemen, Netherlands; University of Humanistic Studies, Utrecht, Netherlands
| | | | - Peter Spreeuwenberg
- Nivel-Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | | | - Michel L A Dückers
- ARQ National Psychotrauma Centre, Diemen, Netherlands; Nivel-Netherlands Institute for Health Services Research, Utrecht, Netherlands; Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
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10
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Bağcaz A, Kılıç C. Differential correlates of prolonged grief and depression after bereavement in a population-based sample. J Trauma Stress 2024; 37:231-242. [PMID: 38129914 DOI: 10.1002/jts.22998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 12/23/2023]
Abstract
Bereavement can lead to prolonged grief disorder (PGD) as well as episodes of major depression. Studies on the prevalence of PGD and its differences from postbereavement depression have not been conclusive. This study compared the correlates of depression and prolonged grief (PG) symptoms in a population-based random sample (N = 535) using the Beck Depression Inventory, Inventory of Complicated Grief-Revised, Anxiety Sensitivity Index (ASI), and Adult Separation Anxiety Questionnaire (ASAQ). Correlates of PG and depressive symptoms were examined using linear regression in 328 bereaved respondents. The prevalence of probable PGD based on PGD-2009 criteria was 3.0% among bereaved respondents and 1.9% in the total sample. PG was related to bereavement-related features including sex of the deceased, β = - .110, p = .026; time since loss, β = - .179, p = .001; the number of lifetime losses experienced, β = .157, p = .016; and perceived closeness with the deceased, β = .214, p < .001. Only lower income of the bereaved predicted depression, β = - .139, p = .018. In women, but not in men, the loss of a male family member (i.e., brother or son) was a significant predictor of PG symptoms, β = - .180, p = .006. The results confirm the qualitative distinction between depression and PG in a nonclinical sample and show that PG is mainly related to the intrinsic and extrinsic characteristics of the deceased or of death, whereas depression relates only to the characteristics of the bereaved person.
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Affiliation(s)
- Arda Bağcaz
- Department of Psychiatry, Başkent University Faculty of Medicine, Ankara, Turkey
- Stress Assessment and Research Center, Hacettepe University, Ankara, Turkey
| | - Cengiz Kılıç
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
- Stress Assessment and Research Center, Hacettepe University, Ankara, Turkey
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11
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Aguiar A, Pinto M, Duarte R. Urgent Attention Needed for Mental Health Challenges Arising from Prolonged Grief During and in the Aftermath of COVID-19. ACTA MEDICA PORT 2024; 37:305-307. [PMID: 38484777 DOI: 10.20344/amp.20993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/24/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Ana Aguiar
- EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR). Porto; Estudo das Populações. Instituto de Ciências Biomédicas Abel Salazar (ICBAS). Universidade do Porto. Porto. Portugal
| | - Marta Pinto
- Faculdade de Psicologia e Ciências da Educação. Universidade do Porto. Porto. Portugal
| | - Raquel Duarte
- EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR). Porto; Estudo das Populações. Instituto de Ciências Biomédicas Abel Salazar (ICBAS). Universidade do Porto. Porto. Portugal
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Aliyaki H, Momeni F, Dolatshahi B, Hosseinzadeh S, Yousefi S, Abdoli F. Mourning in the time of coronavirus: Examining how grief differs in those who lost loved ones to COVID-19 vs. natural causes in Iran. Palliat Support Care 2024:1-10. [PMID: 38533611 DOI: 10.1017/s1478951524000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVES Our study aimed to analyze and compare the grief experiences of individuals in Iran who lost family members to COVID-19 and those who lost loved ones to other natural causes. METHODS In this study, telephone interviews were conducted with 640 first-degree relatives, and finally, a total of 395 people remained in the research. Participants answered the Prolonged Grief Questionnaire (PG-13-R) and Grief Experience Questionnaire. RESULTS The results showed that the most common symptoms and features of grief were feeling guilt, searching for an explanation, somatic reactions, and rejection, with no significant difference observed between the 2 death groups. However, the average scores for these symptoms were higher in the COVID-19 death group. Moreover, the majority of bereaved reported signs and symptoms of prolonged grief, with a higher percentage in the COVID-19 death group, although there was no significant difference between the 2 death groups in terms of the distribution of symptoms and signs of prolonged grief. These findings suggest that the bereavement process can be challenging, and losing a loved one to COVID-19 may lead to more intense experiences of grief. SIGNIFICANCE OF RESULTS The study reveals high levels of guilt, searching for meaning, somatic reactions, and rejection among COVID-19 grievers. Losing loved ones to the pandemic appears linked to more intense, prolonged grief symptoms.
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Affiliation(s)
- Hajar Aliyaki
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Fereshteh Momeni
- Department of Psychology, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Behrouz Dolatshahi
- Department of Psychology, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Samaneh Hosseinzadeh
- Department of Biostatistics, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Shahab Yousefi
- Department of Clinical Psychology, School of Behavioral Science and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Science, Tehran, Iran
| | - Fatemeh Abdoli
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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13
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Werner K, Wick JY. Bereavement and Loss: Understanding Grief in Older People. Sr Care Pharm 2024; 39:98-104. [PMID: 38379138 DOI: 10.4140/tcp.n.2024.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Everyone experiences grief from time to time, but older people are more likely to experience grief simply because they live longer. Grief, bereavement, and mourning are different elements associated with death of a loved one. For most people, grief follows a fairly predictable trajectory, and over time resolves. One of the most used descriptions of grief was developed by Elizabeth Kubler-Ross and it is reviewed herein. However, for some people, grief becomes unbearable and chronic leading to prolonged grief disorder. For clinicians, it's essential to differentiate between prolonged grief disorder and major depressive disorder. Older people who experience unbearable grief often need medication to deal with some of its symptoms, which include depression, anxiety, hypertension, and lack of sleep. Older people also need considerable support as they deal with grief so that they do not become isolated, experience comorbidities, or spiral into physical and mental decline. Little specific research has examined pharmacists' opportunities to help older people who have prolonged grief, but some data suggest that these patients are more likely to visit the pharmacy and need medication more than others.
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14
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Falala A, Lannes A, Bui E, Revet A. Prevalence of prolonged grief disorder in bereaved children and adolescents: A systematic review. L'ENCEPHALE 2024:S0013-7006(24)00006-X. [PMID: 38413249 DOI: 10.1016/j.encep.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 02/29/2024]
Abstract
PURPOSE Prolonged Grief Disorder (PGD) is a condition recently introduced in international classifications of mental disorders. Although PGD is associated with significant distress and impairment that may have developmental consequences, to date, little is known about its prevalence and associated factors in children and adolescents. The present systematic review registered in PROSPERO (CRD42021236026) aimed to: (i) review existing data on the prevalence of PGD in bereaved children and adolescents; and (ii) identify factors associated with PGD in this population. METHODS Six electronic databases, grey literature and a manually searched journal identified 1,716 articles with no backward limit to September 2021. Epidemiological studies were included if they reported the prevalence of PGD in bereaved children and adolescents. Study characteristics, diagnostic and assessment tools, population, loss-related characteristics and prevalence of PGD were reviewed. RESULTS Five studies met our inclusion criteria. The reported prevalences of PGD ranged from 10.4% to 32%. Female gender, cognitive avoidance, chronic stressors such as economic hardship, exposure to trauma or other losses appear to be associated with more severe symptoms or even a higher risk of PGD. Conversely, data suggest social support may be protective. CONCLUSION This first systematic review found a relatively high prevalence of PGD in bereaved children and adolescents. While further large epidemiological studies are needed, this review highlights the importance of evaluating PGD in current clinical practice and suggests that further research into diagnostic and therapeutic approaches targeting this disorder is warranted.
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Affiliation(s)
- Aude Falala
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpital Purpan, CHU de Toulouse, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
| | - Alice Lannes
- Unité d'hospitalisation pour adolescents, pôle de pédopsychiatrie, hôpitaux de Lannemezan, Lannemezan, France; Inserm, UPS, CERPOP, université de Toulouse, Toulouse, France
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Department of Psychiatry, University of Caen-Normandy & Caen University Hospital, Caen, France
| | - Alexis Revet
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpital Purpan, CHU de Toulouse, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France; Inserm, UPS, CERPOP, université de Toulouse, Toulouse, France
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15
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Treml J, Linde K, Brähler E, Kersting A. Prolonged grief disorder in ICD-11 and DSM-5-TR: differences in prevalence and diagnostic criteria. Front Psychiatry 2024; 15:1266132. [PMID: 38389981 PMCID: PMC10881750 DOI: 10.3389/fpsyt.2024.1266132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Background Prolonged grief disorder (PGD) was recently included as a disorder in the ICD-11 and DSM-5-TR. Although both classification systems use the same name, the criteria content, and diagnostic approach vary. This study aimed to estimate the respective prevalence of PGDICD-11 and PGDDSM-5-TR and examine the diagnostic agreement while varying the diagnostic algorithm of PGDICD-11 (bereavement vs. symptom period; varying number of accessory symptoms). Methods A representative sample of the German general population (N = 2,509) was investigated, of which n=1,071 reported the loss of a close person. PGD symptoms were assessed with the Traumatic Grief Inventory - Self Report Plus (TGI-SR+). Results The point prevalence of PGD among the bereaved varied between 4.7%-6.8%, depending on the criteria and diagnostic algorithm. The prevalence of PGDDSM-5-TR was significantly lower than the prevalence of PGDICD-11. The diagnostic agreement between both criteria sets was substantial and increased after the number of accessory symptoms for PGDICD-11 was increased from one to three. The most common symptoms were intrusive thoughts/images related to the deceased person, longing for the deceased person, and difficulty accepting the loss. Conclusion The results demonstrate that the prevalence of PGD significantly varies depending on the application of the diagnostic algorithm and criteria. PGD affects a substantial proportion of the general population and should be addressed by healthcare providers. However, applying the minimum ICD-11 criteria could lead overestimating the prevalence. Therefore, further harmonizing the ICD-11 and DSM-5-TR criteria and diagnostic algorithm for PGD seems appropriate.
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Affiliation(s)
- Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Katja Linde
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
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16
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Hyland P, Redican E, Karatzias T, Shevlin M. The International Grief Questionnaire (IGQ): A new measure of ICD-11 prolonged grief disorder. J Trauma Stress 2024; 37:141-153. [PMID: 37919835 DOI: 10.1002/jts.22986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
Prolonged grief disorder (PGD) is included in the 11th version of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). This study sought to test the validity and reliability of a new brief measure to screen for ICD-11 PGD-the International Grief Questionnaire (IGQ). The psychometric properties of the IGQ were tested using data collected from two bereaved samples of adults from the United Kingdom (n = 1,012) and Ireland (n = 1,011). Confirmatory factor analysis demonstrated that a correlated two-factor model best captured the latent dimensionality of the IGQ in both samples. Estimates of internal reliability were high, whereas the convergent and concurrent validity of the scale were supported through strong associations with external measures. Measurement invariance and differential item functioning testing showed no statistically significant difference in the latent structure of the IGQ nor the functioning of the IGQ items by age, sex, and nationality. For participants who were bereaved for more than 6 months, the rates of probable PGD derived from the IGQ were 10.9% and 15.3% for the Irish and U.K. samples, respectively. The IGQ is a brief, easy-to-use, self-report screening measure that captures all diagnostic criteria of PGD set forth in the ICD-11. Findings from this study provide initial support for the validity, measurement invariance, and reliability of the IGQ among two national samples.
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Affiliation(s)
- Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Enya Redican
- School of Psychology, Ulster University, Coleraine, Northern Ireland, UK
| | - Thanos Karatzias
- School of Health and Social Care, Napier University, Edinburgh, Scotland, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland, UK
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17
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Stroebe MS, Schut HAW, Eisma MC. On the Classification and Reporting of Prolonged Grief: Assessment and Research Guidelines. Harv Rev Psychiatry 2024; 32:15-32. [PMID: 38181100 DOI: 10.1097/hrp.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
LEARNING OBJECTIVES AFTER PARTICIPATING IN THIS CME ACTIVITY, THE PSYCHIATRIST SHOULD BE BETTER ABLE TO • Explain the steps required for diagnosis of mental disorders in diagnostic handbooks.• Identify current procedures for classifying and reporting prolonged grief disorder. ABSTRACT Prolonged grief disorder (PGD) was added to the 11th edition of the International Classification of Diseases in 2018 and to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders in its 2022 text revision. Thus, reporting and classifying PGD according to established guidelines has become fundamental for scientific research and clinical practice. Yet, PGD assessment instruments and criteria are still being developed and debated. The purpose of this article is to examine the adequacy of current procedures for classifying and reporting PGD in research and to suggest guidelines for future investigation and dissemination of knowledge. We outline the standard steps required for diagnosis and assessment of a mental disorder (notably, the administration of clinical interviews). In order to illustrate reporting about the presence/prevalence of PGD in recent scientific articles, we conducted a search of Scopus that identified 22 relevant articles published between 2019 and 2023. Our review of the literature shows that standard classification procedures are not (yet) followed. Prevalences of PGD are based on self-reported symptomatology, with rates derived from percentages of bereaved persons reaching a certain cutoff score on a questionnaire, without clinical interviewing. This likely results in systematic overestimation of prevalences. Nevertheless, the actual establishment of PGD prevalence was often stated in titles, abstracts, and results sections of articles. Further, the need for structured clinical interviews for diagnostic classification was frequently mentioned only among limitations in discussion sections-but was not highlighted. We conclude by providing guidelines for researching and reporting self-reported prolonged grief symptoms and the presence/prevalence of PGD.
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Affiliation(s)
- Margaret S Stroebe
- From the Department of Clinical Psychology, Utrecht University (Drs. Stroebe and Schut); Department of Clinical Psychology & Experimental Psychopathology, University of Groningen (Drs. Stroebe and Eisma)
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18
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Redican E, Vang ML, Komischke-Konnerup K, Elklit A, Shevlin M, O'Connor M. Operationalization, implications and correlates of the cultural deviance criterion for ICD-11 and DSM-5 prolonged grief disorder. DEATH STUDIES 2023:1-12. [PMID: 38147040 DOI: 10.1080/07481187.2023.2297061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Prolonged Grief Disorder (PGD) is included in ICD-11 and DSM-5-TR and includes a requirement of cultural deviance. This study examined endorsement rates and factors associated with endorsement of this criterion among Danish bereaved spouses (n = 425) and their adult children (n = 159) four years post-loss. In total, 7.5% (n = 44) participants endorsed this criterion. Both including and excluding the criterion, the prevalence rates for probable DSM-5-TR PGD were 1.4% (n = 8) and 1.7% (n = 10), respectively and for probable ICD-11 PGD were 1.4% (n = 8) and 2.2% (n = 13), respectively. Age and gender of the deceased, age of the bereaved, greater grief severity, and comorbid psychopathology were positively associated with endorsement of the criterion. Findings demonstrate low endorsement of the cultural deviation criterion, that its inclusion excludes several potential PGD cases, and unanticipated associations with several factors raise questions about the criterion's validity.
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Affiliation(s)
- E Redican
- Department of Psychology, Ulster University, Coleraine, UK
| | - M L Vang
- National Centre for Psychotraumatology, Department of Psychology, University of Southern, Odense, Denmark
- Unit for Bereavement Research, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - K Komischke-Konnerup
- Unit for Bereavement Research, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - A Elklit
- National Centre for Psychotraumatology, Department of Psychology, University of Southern, Odense, Denmark
| | - M Shevlin
- Department of Psychology, Ulster University, Coleraine, UK
| | - M O'Connor
- Unit for Bereavement Research, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
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19
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Müller H, Zwingmann C, Hanewald B, Hauch H, Sibelius U, Berthold D. [When the diagnosis came in … Bereavement care in Germany in 2020/2021: Where do we stand?]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 182-183:63-70. [PMID: 37827947 DOI: 10.1016/j.zefq.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/20/2023] [Accepted: 09/16/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND In Germany, numerous health care providers work in the field of bereavement care. An epidemiological study of the field immediately after the introduction of the ICD-11 diagnosis "Prolonged Grief Disorder" (PGD) is pending. METHODS The second survey of the trend study, which is designed over a total of three measurement points at intervals of one decade each, explores whether and to what extent the field of bereavement care has evolved after the introduction of the grief-specific diagnosis PGD. For this purpose, providers of bereavement care at various organizational levels were asked to participate in an online survey. The survey was conducted from October 2020 to January 2021. RESULTS 456 questionnaires were included in the study. Data analysis was descriptive. 80.5% of the participants have an additional grief-specific qualification, 59.4% base their work on a grief-specific concept. In view of the PGD diagnosis, only a few respondents have participated in a PGD-related advanced training. Most are afraid that the topic of grief will increasingly be subsumed in the medical-psychological-therapeutic field. An increase in bereavement research and the number and quality of continuing education is also expected. DISCUSSION Some positive trends in German bereavement care can be identified. However, there is a need for further development in the areas "designation of the activity", "diagnostics", and "intervention". Also, there is a need for training with regard to PGD. CONCLUSION After the introduction of PGD, the field of bereavement care in Germany turns out to be slightly different. The diagnosis is viewed skeptically.
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Affiliation(s)
- Heidi Müller
- Internistische Onkologie, Hämatologie und Palliativmedizin, Medizinische Klinik IV, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | | | - Bernd Hanewald
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - Holger Hauch
- Universität Witten/Herdecke, Vestische Kinder- und Jugendklinik Datteln, Kinderpalliativzentrum und Deutsches Kinderschmerzzentrum Datteln, Dateln, Deutschland
| | - Ulf Sibelius
- Internistische Onkologie, Hämatologie und Palliativmedizin, Medizinische Klinik IV, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - Daniel Berthold
- Internistische Onkologie, Hämatologie und Palliativmedizin, Medizinische Klinik IV, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland.
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20
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Pociunaite J, van Dijk I, Reitsma L, Nordström EEL, Boelen PA, Lenferink LIM. Latent trajectories of DSM-5-TR-based Prolonged Grief Disorder: findings from a data pooling project MARBLES. Eur J Psychotraumatol 2023; 14:2281183. [PMID: 38010149 PMCID: PMC10990441 DOI: 10.1080/20008066.2023.2281183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023] Open
Abstract
Background: With the release of the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5-TR), criteria for Prolonged Grief Disorder (PGD) were included. This necessitates studying grief trajectories based on these criteria.Objective: This is the first study examining latent trajectories of DSM-5-TR-based PGD symptom levels and testing whether specific risk factors (e.g. cause of death) predicted PGD trajectories.Method: We evaluated latent DSM-5-TR PGD trajectories using pooled existing data collected at 6-12, 13-24, and 25-60 months post-loss in Danish and Dutch bereaved adults (N = 398). Latent Growth Mixture Modelling (LGMM) was employed to determine the trajectories. Multinomial logistic regression analyses were used to examine which risk factors predicted class membership.Results: The four-class LGMM solution with a quadratic term was best-fitting the data. This solution represented four trajectories: High stable PGD (6%), High PGD quick recovery (10%), High PGD slow recovery (35%), and Low PGD symptoms (49%). Participants with a higher educational level were more likely to be assigned to the Low PGD symptoms trajectory compared to High stable PGD and High PGD slow recovery trajectories. Unnatural causes of death increased the likelihood of being in the High stable PGD and High PGD slow recovery trajectories compared to the Low PGD symptoms trajectory.Conclusions: Consistent with prior research, the Low PGD symptoms trajectory was the most common. A significant minority experienced high and stable levels of PGD within five years after the loss. About one-third of participants experienced high acute grief levels that decreased slowly; how slow decreasing symptoms relate to an individual's functioning requires further attention. This study demonstrates that a significant minority of bereaved people develop acute PGD symptomatology that does not diminish within five years post-loss, emphasizing the need for early screening for PGD to prevent long-lasting complaints.
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Affiliation(s)
| | - Iris van Dijk
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands
| | - Lyanne Reitsma
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands
| | - Erik Edwin Leonard Nordström
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
- Helse Fonna Local Health Authority, Haugesund, Norway
| | - Paul A. Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands
- ARQ Centrum’45, Diemen, the Netherlands
| | - Lonneke I. M. Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
- Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, the Netherlands
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21
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Thieleman K, Cacciatore J, Frances A. Rates of Prolonged Grief Disorder: Considering relationship to the person who died and cause of death. J Affect Disord 2023; 339:832-837. [PMID: 37474009 DOI: 10.1016/j.jad.2023.07.094] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/26/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Prolonged Grief Disorder (PGD) was recently included in DSM-5-TR. The rate of PGD is known to vary according to a number of factors and little is known about how bereaved individuals view the diagnosis. METHODS This cross-sectional study assessed PGD rates using the Prolonged Grief-13-Revised (PG-13-R) among a large sample (n = 1137) of bereaved individuals, considering the relationship to the deceased and cause of death. It also investigated bereaved individuals' attitudes toward the diagnosis. RESULTS Overall, 34.3 % of the sample met PGD criteria. Bereaved parents had the highest rate (41.6 %), followed by bereaved spouses/partners (33.7 %) and siblings (29.4 %). According to cause of death, those bereaved by substance overdose had the highest rate (59.1 %), followed by homicide/suicide (46 %) and accidental (36 %). The majority of respondents (65-95.6 %) viewed their responses, as measured by the PG-13-R items, as normal, and 98.1 % agreed that their responses in general were normal. Fewer than 12 % reported that a PGD diagnosis would be helpful to them. LIMITATIONS This study used a self-selecting, non-representative sample that was predominantly female and white. Findings may or may not apply to more diverse groups and cannot be generalized. This study also used a self-report measure rather than a clinical interview. CONCLUSIONS In line with prior research, this study found higher rates of PGD in specific subgroups, including bereaved parents, spouses, and those who lost loved ones to substance overdose, homicide/suicide, or accidents. Bereaved individuals in this sample generally did not view receiving a diagnosis of PGD as helpful.
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Affiliation(s)
- Kara Thieleman
- REACH Institute, Department of Psychology, Arizona State University, United States of America.
| | - Joanne Cacciatore
- School of Social Work, Arizona State University, United States of America
| | - Allen Frances
- Department of Psychiatry, Duke University, United States of America; DSM-IV Task Force, United States of America
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22
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Hennemann S, Killikelly C, Hyland P, Maercker A, Witthöft M. Somatic symptom distress and ICD-11 prolonged grief in a large intercultural sample. Eur J Psychotraumatol 2023; 14:2254584. [PMID: 37767693 PMCID: PMC10540649 DOI: 10.1080/20008066.2023.2254584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/12/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Grief is a multi-faceted experience including emotional, social, and physical reactions. Research in ICD-11 prolonged grief disorder (PGD) in different cultural contexts has revealed different or potentially missing grief symptoms that may be relevant.Objective: This study thus aimed to explore the prevalence of somatic symptom distress and its associations with grief and negative affect in a culturally diverse sample of bereaved individuals with symptoms of PGD.Methods: Based on cross-sectional survey data from the Measurement and Assessment of Grief (MAGIC) project, this study included 1337 participants (mean age 23.79 yrs, 76.1% female) from three regions (USA: 62.3%, Turkey/Iran: 24.2%, Cyprus/Greece: 13.5%), who experienced a loss of a significant other. Associations between somatic symptom distress (Somatic Symptom Scale, SSS-8), symptoms of PGD (International Prolonged Grief Disorder Scale, IPGDS-33), anxiety (Generalized Anxiety Disorder Questionnaire, GAD-7), depression (Patient Health Questionnaire, PHQ-9) as well as demographic and loss related characteristics were investigated. Three hundred and thirteen participants (23.4%) scored above the proposed cut-off for clinically severe PGD.Results: 'High' or 'very high' levels of somatic symptom distress were more frequent in a possible PGD group (58.2%), than in a non-PGD group (22.4%), p < .001, as divided per cut-off in the IPGDS. In a multiple regression analysis, PGD symptoms were significantly but weakly associated with somatic symptom distress (β = 0.08, p < .001) beyond demographics, loss-related variables, and negative affect. Negative affect (anxiety and depression) mediated the relationship of PGD symptoms with somatic symptom distress and the indirect effect explained 58% of the variance.Conclusions: High levels of somatic symptom distress can be observed in a substantial proportion of bereaved across cultures. Our findings suggest that PGD is related to somatic symptom distress partly and indirectly through facets of negative affect.
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Affiliation(s)
- Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Clare Killikelly
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
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23
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First MB, Clarke DE, Yousif L, Eng AM, Gogtay N, Appelbaum PS. DSM-5-TR: Rationale, Process, and Overview of Changes. Psychiatr Serv 2023; 74:869-875. [PMID: 36510761 DOI: 10.1176/appi.ps.20220334] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The DSM-5 text revision (DSM-5-TR) is the first published revision of the DSM-5 since its publication in 2013. Like the previous text revision (DSM-IV-TR), the main goal of the DSM-5-TR is to comprehensively update the descriptive text accompanying each DSM disorder on the basis of reviews of the literature over the past 10 years. In contrast to the DSM-IV-TR, in which updates were confined almost exclusively to the text, the DSM-5-TR includes many other changes and enhancements of interest to practicing clinicians, such as the addition of diagnostic categories (prolonged grief disorder, stimulant-induced mild neurocognitive disorder, unspecified mood disorder, and a category to indicate the absence of a diagnosis); the provision of ICD-10-CM symptom codes for reporting suicidal and nonsuicidal self-injurious behavior; modifications, mostly for clarity, of the diagnostic criteria for more than 70 disorders; and updates in terminology (e.g., replacing "neuroleptic medications" with "antipsychotic medications or other dopamine receptor blocking agents" throughout the text and replacing "desired gender" with "experienced gender" in the text for gender dysphoria). Finally, the entire text was reviewed by an Ethnoracial Equity and Inclusion Work Group to ensure appropriate attention to risk factors such as the experience of racism and discrimination, as well as the use of nonstigmatizing language.
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Affiliation(s)
- Michael B First
- Division of Behavioral Health and Policy Research (First) and Center for Law, Ethics and Psychiatry (Appelbaum), Department of Psychiatry, Columbia University Irving Medical Center, New York City; Division of Research (Clarke, Yousif, Gogtay) and American Psychiatric Association Publishing (Eng), American Psychiatric Association, Washington, D.C.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke); New York State Psychiatric Institute, New York City (Appelbaum)
| | - Diana E Clarke
- Division of Behavioral Health and Policy Research (First) and Center for Law, Ethics and Psychiatry (Appelbaum), Department of Psychiatry, Columbia University Irving Medical Center, New York City; Division of Research (Clarke, Yousif, Gogtay) and American Psychiatric Association Publishing (Eng), American Psychiatric Association, Washington, D.C.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke); New York State Psychiatric Institute, New York City (Appelbaum)
| | - Lamyaa Yousif
- Division of Behavioral Health and Policy Research (First) and Center for Law, Ethics and Psychiatry (Appelbaum), Department of Psychiatry, Columbia University Irving Medical Center, New York City; Division of Research (Clarke, Yousif, Gogtay) and American Psychiatric Association Publishing (Eng), American Psychiatric Association, Washington, D.C.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke); New York State Psychiatric Institute, New York City (Appelbaum)
| | - Ann M Eng
- Division of Behavioral Health and Policy Research (First) and Center for Law, Ethics and Psychiatry (Appelbaum), Department of Psychiatry, Columbia University Irving Medical Center, New York City; Division of Research (Clarke, Yousif, Gogtay) and American Psychiatric Association Publishing (Eng), American Psychiatric Association, Washington, D.C.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke); New York State Psychiatric Institute, New York City (Appelbaum)
| | - Nitin Gogtay
- Division of Behavioral Health and Policy Research (First) and Center for Law, Ethics and Psychiatry (Appelbaum), Department of Psychiatry, Columbia University Irving Medical Center, New York City; Division of Research (Clarke, Yousif, Gogtay) and American Psychiatric Association Publishing (Eng), American Psychiatric Association, Washington, D.C.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke); New York State Psychiatric Institute, New York City (Appelbaum)
| | - Paul S Appelbaum
- Division of Behavioral Health and Policy Research (First) and Center for Law, Ethics and Psychiatry (Appelbaum), Department of Psychiatry, Columbia University Irving Medical Center, New York City; Division of Research (Clarke, Yousif, Gogtay) and American Psychiatric Association Publishing (Eng), American Psychiatric Association, Washington, D.C.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke); New York State Psychiatric Institute, New York City (Appelbaum)
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Yıldırım YE. Prevalence of Prolonged Grief Disorder and Related Clinical Factors Among Turkish Psychiatric Outpatients During the COVID-19 Pandemic. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231187296. [PMID: 37386898 PMCID: PMC10315512 DOI: 10.1177/00302228231187296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Prolonged grief disorder (PGD), a new diagnosis in some classification systems, has gained prominence due to the high mortality rates observed during the Covid-19 pandemic. Herein, the prevalence of PGD (diagnosed with structured clinical interviews), death-related features, and associated clinical factors were investigated among outpatient psychiatric patients who lost a first-degree relative within the past 12-24 months. PGD was diagnosed in 30/68 patients (44.1%). PGD development did not differ based on cause of death (Covid-19-related vs. other causes) but was associated with higher age of the bereaved, younger age of the deceased, and degree of kinship. Higher rates of depression, insomnia, and anxious attachment were also observed in PGD patients. Finally, the unexpectedness of death predicted the development of PGD. Due to the high prevalence of PGD among psychiatric patients, clinicians should be aware of the disorder, monitor grief processes in high-risk patients, and consider PGD in treatment planning.
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Lenzo V, Quattropani MC. Psychological factors and prosociality as determinants in grief reactions: Proposals for an integrative perspective in palliative care. Front Psychol 2023; 14:1136301. [PMID: 37057170 PMCID: PMC10086117 DOI: 10.3389/fpsyg.2023.1136301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
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Lenferink LIM, Franzen M, Ten Klooster PM, Knaevelsrud C, Boelen PA, Heeke C. The Traumatic Grief Inventory-Clinician Administered: A psychometric evaluation of a new interview for ICD-11 and DSM-5-TR prolonged grief disorder severity and probable caseness. J Affect Disord 2023; 330:188-197. [PMID: 36907465 DOI: 10.1016/j.jad.2023.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/06/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND There is a need for an interview-based measure to assess Prolonged Grief Disorder (PGD) included in the text revision of the fifth Diagnostic and Statistical Manual for Mental Disorder (DSM-5-TR) and 11th edition of the International Classification of Disease (ICD-11). We evaluated the psychometric properties of the Traumatic Grief Inventory-Clinician Administered (TGI-CA); a new interview measuring DSM-5-TR and ICD-11 PGD severity and probable caseness. METHODS In 211 Dutch and 222 German bereaved adults, the: (i) factor structure, (ii) internal consistency, (iii) test-retest reliability, (iv) measurement invariance across subgroups (e.g., differing in language), (v) prevalence of probable caseness, (vi) convergent validity, and (vii) known-groups validity were examined. RESULTS Confirmatory factor analyses (CFAs) showed acceptable fit for the unidimensional model for DSM-5-TR and ICD-11 PGD. Omega values indicated good internal consistency. Test-retest reliability was high. Multi-group CFAs demonstrated configural and metric invariance for DSM-5-TR and ICD-11 PGD criteria for all group-comparisons; for some we found support for scalar invariance. Rates of probable caseness for DSM-5-TR PGD were lower than ICD-11 PGD. Optimal agreement in probable caseness was reached when increasing the number of accessory symptoms for ICD-11 PGD from 1+ to 3+. Convergent and known-groups validity was demonstrated for both criteria-sets. LIMITATIONS The TGI-CA was developed to assess PGD severity and probable caseness. Clinical diagnostic interviews for PGD are needed. CONCLUSIONS The TGI-CA seems a reliable and valid interview for DSM-5-TR and ICD-11 PGD symptomatology. More research in larger and more diverse samples is needed to further test its psychometric properties.
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Affiliation(s)
- Lonneke I M Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, the Netherlands; Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands.
| | - Minita Franzen
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, the Netherlands
| | - Peter M Ten Klooster
- Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands
| | - Christine Knaevelsrud
- Freie University Berlin, Department of Clinical-Psychological Intervention, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; ARQ National Psychotrauma Center, Diemen, the Netherlands
| | - Carina Heeke
- Freie University Berlin, Department of Clinical-Psychological Intervention, Habelschwerdter Allee 45, 14195 Berlin, Germany
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Do we all grieve the same? A multigroup test of the dimensional structure of prolonged grief disorder among Danish bereaved partners and children. Psychiatry Res 2022; 318:114937. [PMID: 36335791 DOI: 10.1016/j.psychres.2022.114937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
Prolonged Grief Disorder (PGD) is a newly recognized mental disorder in ICD-11 and DSM-5-TR. Several studies using exploratory factor analysis have found a unidimensional structure of the Prolonged Grief-13 (PG-13) measure of PGD. The recently published ICD-11 proposal proposes a distinction between two clusters of symptoms: Separation distress symptoms and associated cognitive, emotional and behavioral symptoms. The aim of the current study is to test competing factor structures of PGD in Danish samples of bereaved. Confirmatory factor analysis was used to test competing models of PGD among two samples of in total 1093 adults that completed the questionnaires 6 months post loss of either a parent or a partner. Convergent and divergent validity was tested via the relationship to depression, anxiety, post-traumatic stress disorder (PTSD) and general wellbeing using regression analysis. The Danish version of the PG 13 appeared to be both valid and reliable. A two-factor model reflecting the division of core- and associated symptoms of prolonged grief disorder provided the best description of the PG-13 among Danish bereaved adults and there was evidence of partial structural invariance of the latent structure of PGD across bereavement types. Convergent and divergent validity analysis supported the validity of the two-factor model of PGD. SIGNIFICANT OUTCOMES: : A latent variable model differing between core- and associated symptomatology of grief is supported. The Danish translation of PG-13 is a valid measure of prolonged grief symptomatology.
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Brodbeck J, Jacinto S, Gouveia A, Mendonça N, Madörin S, Brandl L, Schokking L, Rodrigues AM, Gonçalves J, Mooser B, Marques MM, Isaac J, Nogueira V, Matos Pires A, van Velsen L. A Web-Based Self-help Intervention for Coping With the Loss of a Partner: Protocol for Randomized Controlled Trials in 3 Countries. JMIR Res Protoc 2022; 11:e37827. [DOI: 10.2196/37827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background
The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content.
Objective
This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis will complement the study.
Methods
The study includes 3 different randomized control trials. The trial in Switzerland comprises a waitlist control group and 2 active arms consisting of 2 delivery formats, standardized and self-tailored. In the Netherlands and in Portugal, the trials follow a 2-arm design that will be, respectively, complemented with focus groups on technology acceptance and cost-effectiveness analysis. The main target group will consist of adults aged >60 years from the general population in Switzerland (n≥85), the Netherlands (n≥40), and Portugal (n≥80) who lost their partner and seek help for coping with grief symptoms, psychological distress, and adaptation problems in daily life. The trials will test the intervention’s clinical efficacy for reducing grief (primary outcome) and depression symptoms and loneliness (secondary outcomes) after the intervention. Measurements will take place at baseline (week 0), after the intervention (week 10), and at follow-up (week 20).
Results
The trials started in March 2022 and are expected to end in December 2022 or when the needed sample size is achieved. The first results are expected by January 2023.
Conclusions
The trials will provide insights into the efficacy and acceptance of a web-based self-help intervention among older adults who have recently lost a partner. Results will extend the knowledge on the role of self-tailoring, working alliance, and satisfaction in the effects of the intervention. Finally, the study will suggest adaptations to improve the acceptance of web-based self-help interventions for older mourners and explore the cost-effectiveness of this intervention. Limitations include a self-selective sample and the lack of cross-cultural comparisons.
Trial Registration
Switzerland: ClinicalTrials.gov NCT05280041; https://clinicaltrials.gov/ct2/show/NCT05280041; Portugal: ClinicalTrials.gov NCT05156346; https://clinicaltrials.gov/ct2/show/NCT05156346
International Registered Report Identifier (IRRID)
PRR1-10.2196/37827
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Prigerson HG, Maciejewski PK. Prolonged grief disorder. Lancet Psychiatry 2022; 9:696. [PMID: 35964579 DOI: 10.1016/s2215-0366(22)00263-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Holly G Prigerson
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA.
| | - Paul K Maciejewski
- Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
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Kameg B. Prolonged Grief Disorder: Identification and Management. Issues Ment Health Nurs 2022; 44:223-224. [PMID: 35708980 DOI: 10.1080/01612840.2022.2085349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Brayden Kameg
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Titlestad KB, Dyregrov K. Does 'Time Heal all Wounds?' The Prevalence and Predictors of Prolonged Grief Among Drug-Death Bereaved Family Members: A Cross-Sectional Study. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221098584. [PMID: 35482973 DOI: 10.1177/00302228221098584] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite rising rates of drug-related deaths (DRDs), the consequences of DRDs for bereaved family members are scarcely investigated. This study aimed to estimate the prevalence of prolonged grief (PG) symptoms in bereaved family members after DRDs, identify predictors of PG and examine whether symptom levels decrease with time. A cross-sectional design based on survey data from parents (n = 93), siblings (n = 78), children (n = 24) and other family members (n = 39) was conducted (n = 234). Descriptive analyses, a multivariate linear regression, and ANOVA were performed. 60 family members (26%) suffered from high levels of PG symptoms after DRDs (parents 31.2%, siblings 21.8%, children 20.9%). The strongest associations were found between a high level of symptoms and 'months since the loss', 'suicidal thoughts' and 'withdrawal from others'. The ANOVA analyses showed that time does not always 'heal all wounds', and the bereaved who lost one to 2 years ago had the highest level of PG symptoms.
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Affiliation(s)
- Kristine B Titlestad
- Faculty of Health and Social Sciences, 1657Western Norway University of Applied Sciences, Bergen, Norway
| | - Kari Dyregrov
- Faculty of Health and Social Sciences, 1657Western Norway University of Applied Sciences, Bergen, Norway
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Lechner-Meichsner F, Comtesse H. Beliefs About Causes and Cures of Prolonged Grief Disorder Among Arab and Sub-Saharan African Refugees. Front Psychiatry 2022; 13:852714. [PMID: 35479495 PMCID: PMC9037322 DOI: 10.3389/fpsyt.2022.852714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many refugees have experienced the death of a loved one under traumatic circumstances. Accordingly, the prevalence of Prolonged Grief Disorder (PGD) among refugees is high. Culture-specific symptoms of PGD have been described previously, but beliefs about causes and cures of PGD among refugees remain unknown. We therefore aimed at identifying illness beliefs and treatment expectations regarding PGD among refugees. Method We focused on refugees from Arab countries (n = 14) and from Sub-Sahara Africa (n = 9) and applied qualitative and quantitative methods. In a semi-structured interview, participants first answered questions about assumed causes and potential cures for prototypical PGD symptoms according to ICD-11 that were presented in a vignette as representatives of their own culture. In the quantitative part, they completed the Cause Subscale of the Illness Perception Questionnaire (IPQ-R) that included additional culture-specific items. Interviews were analyzed with Qualitative Content Analysis. Results In both groups of refugees, PGD symptoms were predominantly attributed to a close relationship to the deceased, lack of social support, personal vulnerabilities, and circumstances of the death. Participants also named a number of flight-related causes (e.g., inability to perform or participate in rituals, feeling isolated in the host country). None of the participants attributed PGD symptoms to supernatural causes. Descriptive analyses of responses on the IPQ-R indicated that participants predominantly attributed PGD symptoms to psychological causes. Participants believed that PGD can be cured and predominantly mentioned social and religious support. Psychological help was only mentioned by a minority of participants. In both groups, participants emphasized that a therapist must be familiar with the patient's culture and rituals. Participants also mentioned stigma associated with seeking psychological help. Conclusion Results suggest specific beliefs of refugees regarding causes and cures of PGD as well as similarities with Western conceptualizations. A culture-sensitive approach to the treatment of PGD in refugees that can include knowledge of culture-specific rituals and incorporating religious beliefs as well as decreasing stigma and increasing mental health literacy seem important. The study is limited by its focus on only two groups of refugees and its small sample size.
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Affiliation(s)
- Franziska Lechner-Meichsner
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Hannah Comtesse
- Clinical and Biological Psychology, Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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Harrison O, Windmann S, Rosner R, Steil R. Interpersonal problems and cooperative behavior in patients suffering from prolonged grief disorder as compared to bereaved healthy controls. J Clin Psychol 2022; 78:1912-1924. [PMID: 35247273 DOI: 10.1002/jclp.23340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/07/2021] [Accepted: 02/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Interpersonal factors, such as impairments in social interaction or lack of social support, have an important share when it comes to the development, maintenance, and progression of various mental disorders. METHODS Individuals suffering from prolonged grief disorder (PGD) and matched bereaved healthy controls (n = 54) underwent a thorough diagnostic procedure, further completed the Inventory of Interpersonal Problems (IIP-D-32), and participated in a finitely iterated prisoner's dilemma (FIPD). RESULTS Individuals suffering from PGD reported significantly more interpersonal problems. Both groups behaved differently in the FIPD with healthy controls being more carefully, adapting their behavior more flexible, whereas PGD patients displayed a lower responsiveness, which may indicate an inability to adapt to changes in relationships. CONCLUSION We conclude that interpersonal problems appear to be a relevant feature of PGD. Future studies need to clarify the causal relation behind this link, and should also include measures of attachment, social support, and disconnectedness.
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Affiliation(s)
- Octavia Harrison
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Sabine Windmann
- Department of Cognitive Psychology II, Goethe University Frankfurt, Frankfurt, Germany
| | - Rita Rosner
- Department of Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Bavaria, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany.,Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Gießen, Germany
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Doering BK, Barke A, Vogel A, Comtesse H, Rosner R. Predictors of Prolonged Grief Disorder in a German Representative Population Sample: Unexpectedness of Bereavement Contributes to Grief Severity and Prolonged Grief Disorder. Front Psychiatry 2022; 13:853698. [PMID: 35558417 PMCID: PMC9090313 DOI: 10.3389/fpsyt.2022.853698] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/01/2022] [Indexed: 12/13/2022] Open
Abstract
Most people adapt to bereavement over time. For a minority, the grief persists and may lead to a prolonged grief disorder (PGD). Identifying grievers at risk of PGD may enable specific prevention measures. The present study examined the extent to which the subjective unexpectedness of the death predicted grief outcomes above and beyond known sociodemographic and objective loss-related variables in a sample drawn from a population-representative investigation. In our sample (n = 2,531), 811 participants (M age 55.1 ± 17.8 years, 59.2% women) had experienced the loss of a significant person six or more months ago. Participants provided demographic and loss-related information, perceptions of the unexpectedness of the death and completed the Prolonged Grief Disorder-13 + 9 (PG-13 + 9). The PG-13 + 9 was used to determine PGD caseness. A binary logistic regression investigated predictors of PGD caseness, and a linear regression predictors of grief severity. ANCOVAs compared PGD symptoms between the groups who had experienced an "expected" vs. "unexpected" loss, while controlling for the relationship to the deceased and time since loss. The loss of a child (OR = 23.66; 95%CI, 6.03-68.28), or a partner (OR = 5.32; 95%CI, 1.79-15.83), the time since loss (OR = 0.99; 95%CI, 0.99-1.00) and the unexpectedness of the death (OR = 3.58; 95%CI, 1.70-7.69) were significant predictors of PGD caseness (Nagelkerke's R2 = 0.25) and grief severity. Participants who had experienced the loss as unexpected (vs. expected) reported higher scores on all PGD symptoms. Unexpectedness of the death emerged as significant risk factor for PGD, even after controlling for demographic and other loss-related variables. While our findings replicate previous research on the importance of the relationship to the deceased as a risk factor for PGD, they also highlight the importance of assessing the subjective unexpectedness of a death and may help to identify risk groups who can profit from preventive interventions.
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Affiliation(s)
- Bettina K Doering
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.,Clinical Psychology and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Antonia Barke
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Anna Vogel
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Hannah Comtesse
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rita Rosner
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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Treml J, Brähler E, Kersting A. Prevalence, Factor Structure and Correlates of DSM-5-TR Criteria for Prolonged Grief Disorder. Front Psychiatry 2022; 13:880380. [PMID: 35664467 PMCID: PMC9159802 DOI: 10.3389/fpsyt.2022.880380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/28/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prolonged Grief Disorder (PGD) is now included in Section II of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR). To understand the health burden and then allocate economic and professional resources, it is necessary to provide epidemiological data for this new disorder. This is especially relevant since the new diagnostic criteria differ from its predecessors, which may affect the generalizability of previous findings. More information on the characteristics of people suffering from PGD is also beneficial to better identify individuals at risk. This study, therefore, aimed to estimate the prevalence of the new PGD criteria in a representative population-based sample, evaluate the factor structure, sociodemographic, and loss-related correlates of PGD caseness and explore possible predictors. METHODS Out of a representative sample of the German general population (N = 2,531), n = 1,371 (54.2%) reported to have experienced a significant loss throughout lifetime. Participants provided sociodemographic data and loss-related characteristics. PGD symptoms were measured using items from the German versions of the Prolonged Grief Scale (PG-13) and the Inventory of Complicated Grief (ICG), which could be matched to the DSM-5-TR criteria for PGD. RESULTS The conditional prevalence of PGD was 3.4% (n = 47). The most frequently reported symptoms were intense emotional pain and intense yearning or longing for the deceased. The confirmatory factor analysis confirmed a unidimensional model of PGD. Regression analysis demonstrated that time since the death, the relationship to the deceased, and unpreparedness for the death were significant predictors of PGD. CONCLUSION Although the prevalence of 3.4% using the new diagnostic criteria is lower than the prevalence previously suggested by a meta-analysis, PGD remains a substantial disorder in the general population. In particular, the loss of a partner or child increases the risk for PGD, as does unpreparedness for the death of a loved one. Clinicians should pay particular attention to these high-risk groups. Further clinical implications are discussed.
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Affiliation(s)
- Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
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Heeke C, Franzen M, Hofmann H, Knaevelsrud C, Lenferink LIM. A Latent Class Analysis on Symptoms of Prolonged Grief, Post-Traumatic Stress, and Depression Following the Loss of a Loved One. Front Psychiatry 2022; 13:878773. [PMID: 35693969 PMCID: PMC9184516 DOI: 10.3389/fpsyt.2022.878773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/05/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The loss of a significant other can lead to variety of responses, including prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression. The aim of this study was to replicate and extend previous research that indicated that three subgroups of bereaved individuals can be distinguished based one similar post-loss symptom profiles using latent class analysis (LCA). The second aim was to examine whether sociodemographic and loss-related characteristics as well as the extent of meaning making were related to classes with more pervasive psychopathology. METHODS Telephone-based interviews with 433 Dutch and German speaking persons who had lost a significant other at last 6 months earlier were conducted. Self-rated PGD, PTSD, and depression symptoms were assessed. LCA was conducted and correlates of class-membership were examined using the 3step approach. RESULTS The LCA resulted in three distinct classes: a no symptoms class (47%), a moderate PGD, low depression/PTSD class (32%), and a high PGD, moderate depression/PTSD class (21%). A multivariate analysis indicated that female gender, a shorter time since loss, an unexpected loss and less meaning made to a loss were significantly associated with membership to the moderate PGD, low depression/PTSD and high PGD, moderate depression/PTSD class compared to membership to the no symptom class. Losing a child or spouse, a shorter time since loss, and having made less meaning to the loss further distinguished between the high PGD, moderate depression/PTSD symptom class and the moderate PGD, low depression/PTSD class. DISCUSSION We found that the majority of individuals coped well in response to their loss since the no symptom class was the largest class. Post-loss symptoms could be categorized into classes marked by different intensity of symptoms, rather than qualitatively different symptom patterns. The findings indicate that perceiving the loss as more unexpected, finding less meaning in the loss, and loss-related factors, such as the recentness of a loss and the loss of a partner or child, were related to class membership more consistently than sociodemographic factors.
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Affiliation(s)
- Carina Heeke
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Minita Franzen
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Hendrik Hofmann
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Christine Knaevelsrud
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Lonneke I M Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands.,Department of Psychology, Health, and Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands
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Lenferink LIM, van den Munckhof MJA, de Keijser J, Boelen PA. DSM-5-TR prolonged grief disorder and DSM-5 posttraumatic stress disorder are related, yet distinct: confirmatory factor analyses in traumatically bereaved people. Eur J Psychotraumatol 2021; 12:1-14. [PMID: 34912501 PMCID: PMC8667936 DOI: 10.1080/20008198.2021.2000131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Prolonged grief disorder (PGD) is newly included in the text revision of the DSM-5 (DSM-5-TR). So far, it is unknown if DSM-5-TR PGD is distinguishable from bereavement-related posttraumatic stress disorder (PTSD). Prior research examining the distinctiveness of PTSD and pathological grief focused on non-traumatic loss samples, used outdated conceptualizations of grief disorders, and has provided mixed results. OBJECTIVE In a large sample of traumatically bereaved people, we first evaluated the factor structure of PTSD and PGD separately and then evaluated the factor structure when combining PTSD and PGD symptoms to examine the distinctiveness between the two syndromes. METHODS Self-reported data were used from 468 people bereaved due to the MH17 plane disaster (N = 200) or a traffic accident (N = 268). The 10 DSM-5-TR PGD symptoms were assessed with the Traumatic Grief Inventory-Self Report Plus (TGI-SR+). The 20-item Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) was used to tap PTSD symptoms. Confirmatory factor analyses were conducted. RESULTS For PTSD, a seven factor, so-called 'Hybrid' model yielded the best fit. For PGD, a univariate factor model fits the data well. A combined model with PGD items loading on one factor and PTSD items on seven factors (associations between PGD and PTSD subscales r ≥ .50 and ≤.71), plus a higher-order factor (i.e. PTSD factors on a higher-order PTSD factor) (association between higher-order PTSD factor and PGD factor r = .82) exhibited a better fit than a model with all PGD and PTSD symptom loading on a single factor or two factors (i.e. one for PGD and one for PTSD). CONCLUSIONS This is the first study examining the factor structure of DSM-5-TR PGD and DSM-5 PTSD in people confronted with a traumatic loss. The findings provide support that PGD constitutes a syndrome distinguishable from, yet related with, PTSD.
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Affiliation(s)
- L I M Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.,Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, The Netherlands
| | - M J A van den Munckhof
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,Foundation Centrum '45, Diemen, the Netherlands.,ARQ National Psychotrauma Centre, Diemen, the Netherlands
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