Researchers believe implementation of newly developed diagnostic criteria will aid identification of bereaved persons at heightened risk for enduring distress and dysfunction.
The study illuminating the new methodology to detect prolonged grief disorder (PGD) is found in this week’s open access journal PLoS Medicine.
Dr. Holly Prigerson from the Dana Farber Cancer Institute in Boston and her colleagues conducted a field trial to develop and evaluate algorithms for diagnosing PGD based on a set of symptoms agreed upon by experts in bereavement, mood and anxiety disorders, and psychiatric nosology (a branch of medicine that deals with the classification of diseases).
The results support the psychometric validity of the criteria for PGD and should be included in the Diagnostic Statistical Manual of Mental Disorders, 5th Edition (DSM-V) and the International Statistical Classification of Diseases and Related Health Problems (ICD-11), say the authors.
In the study, 291 bereaved individuals were interviewed three times in the two years following the loss of a spouse about their experiences. Using item response theory and analysis, the researchers identified the most sensitive and specific algorithm for the diagnosis of PGD.
The model includes yearning (physical or emotional suffering because of an unfulfilled desire for reunion with the deceased) and at least five of nine additional symptoms including emotional numbness, feeling that life is meaningless, and avoidance of the reality of the loss.
To be included in the diagnosis, individuals must display the symptoms for at least 6 months after the bereavement and demonstrate functional impairment.
Researchers report individuals in their study given a diagnosis of PGD six months after a death had a higher subsequent risk of mental health and functional impairment than people not diagnosed with PGD.
Currently, grief is not recognized as a mental disorder in the DSM-IV or the ICD-10.
The authors say that their work confirms the distinctiveness of the symptoms of PGD, and “that PGD meets DSM criteria for inclusion as a distinct mental disorder on the grounds that it is a clinically significant form of psychological distress associated with substantial disability.”
In an accompanying Perspective article, Dr. Stephen Workman (not involved in the research) from the Queen Elizabeth II Health Sciences Center in Halifax, Nova Scotia, Canada, says that by persuasively establishing PGD as a uniquely identifiable illness that may require specific treatments, Dr. Prigerson and colleagues have separated PGD from normal grief and from other forms of pathologic grief responses. He says from a clinician’s perspective that the work is “rigorous, compassionate, and humane.”
Source: Public Library of Science