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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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Wen FH, Prigerson HG, Chou WC, Huang CC, Hu TH, Chiang MC, Chuang LP, Tang ST. ICU Bereaved Surrogates' Transition Through States of Co-Occurring Prolonged Grief Disorder, Posttraumatic Stress Disorder, and Depression Symptoms. Crit Care Med 2023; 51:1159-1167. [PMID: 37114931 DOI: 10.1097/ccm.0000000000005884] [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: 04/29/2023]
Abstract
OBJECTIVES Grief-related psychological distress often co-occurs to conjointly impair function during bereavement. Knowledge of comorbid grief-related psychological distress is limited: no longitudinal study has examined dynamic patterns of co-occurring prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression, and previous assessment time frames have been variable and potentially inadequate given the duration criterion for PGD. Therefore, the purpose of this study was to investigate the transition of distinct symptom states based on the co-occurrence of PGD, PTSD, and depression symptoms for ICU bereaved surrogates over their first two bereavement years. DESIGN Prospective, longitudinal, observational study. SETTING Medical ICUs at two academically affiliated medical centers in Taiwan. PATIENTS/PARTICIPANTS Three hundred three family surrogates responsible for decision-making for critically ill patients at high risk of death (Acute Physiology and Chronic Evaluation II scores > 20) from a disease. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Participants were assessed by 11 items of the Prolonged Grief Disorder (PG-13) scale, the Impact of Event Scale-Revised, and the depression subscale of the Hospital Anxiety and Depression Scale at 6, 13, 18, and 24 months postloss. PGD-PTSD-depression-symptom states and their evolution were examined by latent transition analysis. The following four distinct PGD-PTSD-depression-symptom states (prevalence) were initially identified: resilient (62.3%), subthreshold depression-dominant (19.9%), PGD-dominant (12.9%), and PGD-PTSD-depression comorbid (4.9%) states. These PGD-PTSD-depression-symptom states remained highly stable during the first two bereavement years, with transitions predominantly toward resilience. Prevalence for each state at 24 months postloss was 82.1%, 11.4%, 4.0%, and 2.5%, respectively. CONCLUSIONS Four highly stable PGD-PTSD-depression-symptom states were identified, highlighting the importance of screening for subgroups of ICU bereaved surrogates with increased PGD or comorbid PGD, PTSD, and depression symptoms during early bereavement.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taiwan, Republic of China
| | | | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, Republic of China
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China
| | - Chung-Chi Huang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, Republic of China
- Department of Respiratory Therapy, Chang Gung University, Tao-Yuan, Taiwan, Republic of China
| | - Tsung-Hui Hu
- Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, Republic of China
| | - Ming Chu Chiang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Republic of China
| | - Li-Pang Chuang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, Republic of China
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, Republic of China
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Eberle DJ, Maercker A. Stress-associated symptoms and disorders: A transdiagnostic comparison. Clin Psychol Psychother 2023; 30:1047-1057. [PMID: 37092756 DOI: 10.1002/cpp.2858] [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: 11/14/2022] [Revised: 03/16/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
The ICD-11 features a new group of disorders specifically associated with stress, which are interlinked by various symptoms, such as intrusive memory symptoms. Although research interest in these new ICD-11 diagnoses is growing rapidly, so far, no studies have systematically investigated the transdiagnostic distribution of stress-associated symptoms in these disorders. In the present study, 447 individuals completed a series of online questionnaires, which measured various stress-associated symptoms, e.g., flashbacks, preoccupation or yearning. Findings showed that the majority of correlations between the measured psychopathological constructs was between 0.30 and 0.60. Furthermore, with regard to specific diagnostic groups, a complex variation of stress-associated symptoms was observed, with preoccupation as a predominant symptom in all disorders. Results demonstrate that stress-associated symptoms are inherently interconnected yet possess an individual variation in different disorders. Furthermore, findings illustrate that preoccupation represents a major feature in all stress-associated disorders.
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Affiliation(s)
- David J Eberle
- Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zürich, Switzerland
| | - Andreas Maercker
- Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zürich, Switzerland
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Boelen PA, Giannopoulou I, Papadatou D. Patterns and predictive value of acute prolonged grief and posttraumatic stress in youngsters confronted with traumatic loss: A latent class analysis. Psychiatry Res 2023; 319:114961. [PMID: 36446220 DOI: 10.1016/j.psychres.2022.114961] [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: 07/22/2022] [Revised: 10/15/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
Deaths of relatives and peers in potentially traumatizing circumstances may lead to symptoms of prolonged grief (PG, e.g.,yearning, preoccupation) and posttraumatic stress (PTS, e.g., re-experiencing, hypervigilance). There is limited knowledge about how symptoms of PG and PTS co-occur following such events. The current study aimed to identify patterns of DSM-5-TR defined PG symptomatology and PTS in a sample of 213 youngsters, involved in a school bus accident killing seven peers 2 months earlier. Using latent class analysis, three groups were identified evidencing moderate endorsement of most symptoms (Class 1), high endorsement of almost all but the avoidance symptoms (Class 2), and high endorsement of almost all symptoms (Class 3), respectively. Classes differed in terms of levels of grief, PTS, and depression, assessed concurrently, and-in a subgroup of n=137 participants-assessed at 16 month follow-up. E.g., Class 3 membership was associated with a greater likelihood of meeting criteria for DSM-5-TR defined prolonged grief disorder at follow-up. Gender (fewer females in Class 1) but not age and proximity to the accident were associated with class membership. Findings indicate that it is important to identify groups with elevated PG and PTS early after traumatic bereavement who may be en route to persistent mental health problems.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, PO Box 80140, 3508 TC Utrecht, the Netherlands; ARQ National Psychotrauma Centre, Nienoord 5, NL-1112 XE Diemen, the Netherlands.
| | | | - Danai Papadatou
- National and Kapodistrian University of Athens, Athens, Greece
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Bardideh F, Jarareh J, Mofrad M, Bardideh K. The Effectiveness of Integrated Group Therapy on Prolonged Grief Disorder of Bereaved People from COVID-19 Randomized Controlled Trial. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221141126. [PMID: 38124328 PMCID: PMC9703023 DOI: 10.1177/00302228221141126] [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] [Indexed: 09/01/2023]
Abstract
This study aimed to evaluate the integrated cognitive-behavioral group therapy and Gestalt empty chair technique on bereaved individuals with COVID-19-caused PGD (prolonged grief disease). Thirty-six patients with PGD resultant from COVID-19 were randomly assigned intervention and control groups. The intervention group underwent 16 90-minute integrated group therapy sessions twice a week. Both groups completed the BDI II depression, NAI anger, and GASP guilt scale before, after, and 2 months after the study's conclusion. The intervention and control groups significantly differed in the depression, anger, and guilt indices after the therapeutic intervention (p < .001). This difference remained in the follow-up phase. Integrated group therapy in treating could help with some of the symptoms of PGD resulting from the corona-caused loss of loved ones. This reduction in symptoms was also stable over time.
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Affiliation(s)
- Fatemeh Bardideh
- Department of Counselling and Psychology, Islamic Azad University, Kish International, Kish, Iran
| | - Jamshid Jarareh
- Department of Teacher Training, Shahid Rajaee University, Tehran, Iran
| | - Mohammad Mofrad
- Department of Psychology, Khayyam Institute of Higher Education, Mashhad, Iran
| | - Kosar Bardideh
- Department of Counselling and Psychology, Islamic Azad University, Kish International, Kish, Iran
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Lenferink LIM, van Eersel JHW, Franzen M. Is it acceptable and feasible to measure prolonged grief disorder symptoms in daily life using experience sampling methodology? Compr Psychiatry 2022; 119:152351. [PMID: 36341747 DOI: 10.1016/j.comppsych.2022.152351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/07/2022] [Accepted: 10/16/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Current grief research is dominated by cross-sectional studies assessing prolonged grief disorder (PGD) symptoms retrospectively. Examining grief in daily life, using Experience Sampling Methodology (ESM), may advance the field. Because of the lack of ESM-research on PGD, we evaluated the acceptability and feasibility of assessing PGD symptoms in daily life of bereaved people. MATERIALS AND METHODS ESM-items assessing PGD symptoms were developed using cognitive interviewing with five ESM/grief experts. Eighty bereaved adults completed these ESM-items five times a day for two weeks. Before and after this ESM-phase, interviews were administered assessing PGD retrospectively (using the Traumatic Grief Inventory-Clinical Administered). t-tests were performed comparing symptom severity of aggregated moment-to-moment recall (using ESM-items) with retrospective recall (based on interviews) of PGD symptoms. Acceptability of participating in ESM-research (assessed with the Reactions to Research Participation Questionnaire) was examined using descriptive statistics. Feasibility was evaluated by reporting compliance and retention rates. RESULTS Minor changes were made to the ESM-items based on expert interviews. Average levels of aggregated moment-to-moment recall of the symptoms "yearning" (d = -1.04), "preoccupation with the deceased" (d = -0.91), "marked sense of disbelief" (d = -0.43), and "intense loneliness" (d = -0.28) were lower compared with retrospective recalling these symptoms. On average, bereaved people were neutral about personal benefits gained through participation in this EMS-study. They indicated that participation did not raise emotional reactions. Compliance and retention rates were 60% and 65%, respectively. DISCUSSION Our findings indicate that whereas compliance and retention is challenging, using ESM to study PGD symptoms in daily life might be useful. Nevertheless, more research is needed.
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Affiliation(s)
- L I M Lenferink
- Department of Psychology, Health & Technology, Faculty of Behavioural Management and Social Sciences, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands; Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands.
| | - J H W van Eersel
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, the Netherlands
| | - M Franzen
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; Department of Psychology, Education & Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, 3062 PA Rotterdam, the Netherlands
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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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Kokou-Kpolou CK, Adansikou K, Park S, Hajizadeh S, Iorfa SK, Cénat JM. Prolonged grief and posttraumatic growth among middle-aged and older widowed persons: A latent class analysis and testing for the role of social support. DEATH STUDIES 2021; 46:1401-1413. [PMID: 34554058 DOI: 10.1080/07481187.2021.1978115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Evidence has shown that symptoms of grief co-occur with posttraumatic growth following loss. Using latent class analysis among a Togolese sample of middle-aged/older widowed persons, we identified three classes along their experiences of grief-growth interaction (combined grief/growth, predominantly growth, and low-medium growth classes). The combined grief/growth class members were more likely to have lost their spouses recently and to report greater marital relationship satisfaction with their spouse before their death. The perceived social support from family was predictive of the predominantly growth class membership. The findings provide a nuanced understanding of grief, which is dominated by psychopathology and negative outcomes.
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Affiliation(s)
| | | | - Sunyoung Park
- Graduate School of Psychology, California Lutheran University, Thousand Oaks, California, USA
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