Prolonged grief disorder in DSM-5-TR:Early predictors and longitudinal measurement invariance

OBJECTIVE: The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision includes prolonged grief disorder as a novel disorder. Prolonged grief disorder can be diagnosed when acute grief stays distressing and disabling, beyond 12 months following bereavement. Evidence indicates that elevated prolonged grief disorder symptoms in the first year of bereavement predict pervasive grief later in time; targeting early elevated grief may potentially prevent symptoms getting chronic. There is limited knowledge about the characteristics of people in the first year of bereavement who have an elevated chance of developing full prolonged grief disorder beyond the 12-month time point. This study examined these characteristics. METHODS: We used self-reported data from 306 adults who all completed questions on socio-demographic and loss-related characteristics plus a measure of prolonged grief disorder within the first year of bereavement (Wave 1; time since loss: M = 4.97, SD = 3.13 months) and again 1 year later (Wave 2; time since loss: M = 17.84, SD = 3.38 months). We examined the prevalence rates of probable prolonged grief disorder (Wave 2), measurement invariance of prolonged grief disorder symptoms between waves, and associations of socio-demographic and loss-related variables, and Wave 1 prolonged grief disorder with probable prolonged grief disorder at Wave 2. RESULTS: Regarding prevalence, 10.1% (n = 31) met criteria for probable prolonged grief disorder (Wave 2). Multigroup confirmatory factor analysis supported longitudinal measurement invariance of prolonged grief disorder symptoms. People meeting criteria at Wave 1 (except the time criterion) had a significantly increased risk of meeting criteria at Wave 2. Variables best predicting probable prolonged grief disorder at Wave 2 were prolonged grief disorder at Wave 1, lower education, loss of a child and loss to unnatural/violent causes (sensitivity = 56.67%, specificity = 98.12%, 93.92% correct classifications). CONCLUSION: People meeting criteria for prolonged grief disorder (except the time criterion) before the first anniversary of the death are at risk of full-blown prolonged grief disorder beyond this time point, particularly those who have lower education, confronted the death of a child and confronted unnatural/violent loss. Findings may inform advances in preventive bereavement care

Comparison of six proposed diagnostic criteria sets for disturbed grief

Increased recognition that grief may turn into a disorder led to the inclusion of Persistent Complex Bereavement Disorder (PCBD) in DSM-5 and Prolonged Grief Disorder (PGD) in ICD-11. Four additional criteria sets for disturbed grief have been proposed in recent years: Prigerson et al. proposed criteria for PGD (“PGD-2009″), Maercker et al. presented an ICD-11 beta draft version of PGD (“PGD-BD”), Shear et al. put forth criteria for complicated grief (“CG”), and, recently, criteria for PGD in DSM-5-TR have been proposed. This study sought to evaluate these six sets in one sample, which has not been done before. Using self-reported data from 855 bereaved individuals, we examined the (i) dimensionality, (ii) number of possible symptom combinations to meet criteria for caseness, (iii) prevalence rates and diagnostic agreement, (iv) concurrent validity, and (v) socio-demographic and loss-related correlates for each set. Criteria for PCBD were best represented by a three-factor structure and CG by a two-factor structure. Symptoms of ICD-11 PGD, PGD-2009, PGD-BD, and PGD-DSM-5-TR formed a single dimension. Prevalence rates varied between ~10% and ~20%. Diagnostic agreement between sets was substantial. Sets differed in terms of possible symptom combinations and had comparable concurrent validity and socio-demographic and loss-related correlates

Associations of depressive rumination and positive affect regulation with emotional distress after the death of a loved one

The death of a loved one may precipitate symptoms of prolonged grief disorder (PGD), post-traumatic stress disorder (PTSD) and depression. Brooding about the causes and consequences of one's negative affect (NA), also termed depressive rumination, has been linked to distress after loss. The role of dysregulation of positive affect (PA) has received less attention. We examined (1) the factor structure of depressive rumination and PA dysregulation and (2) to what extent these factors were related to PGD, PTSD and depression symptom levels. Self-report data were included from 235 Dutch bereaved people who completed measures tapping symptoms of PGD, PTSD and depression. Depressive rumination and PA regulation strategies were assessed with the Ruminative Response Scale (RRS) Brooding Scale and the Response to Positive Affect (RPA) Questionnaire (including three subscales: emotion-focused and self-focused rumination and dampening), respectively. Confirmatory factor analyses and structural equation modelling were used for data analyses. The four-factor model (i.e., depressive rumination and the three RPA subscales) showed the best fit. An increase in depressive rumination was related to higher distress levels (across all outcomes in univariate and multivariate analyses). An increase in emotion-focused rumination about PA was associated with less depression. More dampening of PA was related to higher PTSD levels. Findings suggest that, alongside the regulation of NA, the regulation of PA plays a role in how people respond to the death of a loved one. This points to the need for more research on NA and PA regulation in grief

Symptoms of prolonged grief, posttraumatic stress, and depression in recently bereaved people:Symptom profiles, predictive value, and cognitive behavioural correlates

Purpose: Prior latent class analyses (LCA) have focused on people who were bereaved more than 6 months earlier. Research has yet to examine patterns and correlates of emotional responses in the first few months of bereavement. We examined whether subgroups could be identified among very recently (≤ 6 months) bereaved adults, based on their endorsement of symptoms of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression. Associations of class membership with overall disturbed grief, PTSD, and depression—assessed concurrently and at 6 months follow-up—were examined. Furthermore, we examined differences between classes regarding socio-demographics, loss-related, and cognitive behavioural variables. Methods: PGD, PTSD, and depression self-report data from 322 Dutch individuals bereaved ≤ 6 months earlier were subjected to LCA; N = 159 completed the follow-up assessment. Correlates of class membership were examined. Results: Three classes were identified: a low symptom class (N = 114; 35.4%), a predominantly PGD class (N = 96; 29.8%), and a high symptom class (N = 112; 34.8%). PGD, PTSD, and depression scores (assessed concurrently and at 6 months follow-up) differed significantly between classes, such that low symptom class &lt; predominantly PGD class &lt; high symptom class. Being a woman, younger, more recently bereaved, experiencing deaths of a partner/child and unnatural losses, plus maladaptive cognitions and avoidance behaviours were associated with membership of the pervasive symptom classes. Conclusion: In the first 6 months of bereavement, meaningful subgroups of bereaved people can be distinguished, which highlights the relevance of early detection of people with elevated bereavement-related distress and offering them preventive interventions that foster adaptation to loss.</p

Reciprocal Relations of Worry, Rumination, and Psychopathology Symptoms After Loss:A Prospective Cohort Study

Bereavement can precipitate symptoms of depression, prolonged grief disorder, and posttraumatic stress disorder. Targeting repetitive negative thought (i.e., worry, rumination) in treatment may help reduce post-loss psychopathology. Yet, evidence on longitudinal associations of depressive rumination and worry with post-loss psychopathology symptoms has been mixed and the directions of effects are still unclear. Recently bereaved adults (78% female) completed questionnaires assessing depressive rumination (brooding), worry, and depression, prolonged grief and posttraumatic stress symptoms 11 times in 1.5 month intervals. We applied random-intercept cross-lagged panel models (RICLPMs) to examine reciprocal within-person associations between worry and psychopathology symptoms, between rumination and these symptoms, and between worry and rumination. Main findings were that worry showed reciprocal relationships with psychopathology symptoms (although worry did not consistently predict prolonged grief symptoms). Depressive rumination was predicted by psychopathology symptoms, but not vice versa. Worry showed reciprocal relations with depressive rumination. Findings suggest that worry may be part of a downward spiral, enhancing psychopathology symptoms following loss, whereas depressive rumination is solely a consequence of such symptoms

Comparison of DSM-5 criteria for persistent complex bereavement disorder and ICD-11 criteria for prolonged grief disorder in help-seeking bereaved children

BackgroundPersistent complex bereavement disorder (PCBD) is a disorder of grief that newly entered DSM-5. Prolonged grief disorder (PGD) is a disorder of grief included in ICD-11. No prior studies examined and compared the dimensionality, prevalence, and concurrent validity of both conditions among bereaved children.MethodsWith data from 291 help-seeking bereaved 8-–18 year old children, we used confirmatory factor analysis to evaluate the fit of different factor models for PCBD and PGD. In addition, we determined diagnostic rates for probable PCBD and PGD and calculated associations of PCBD and PGD caseness with concurrently assessed symptoms of overall disturbed grief, depression, posttraumatic stress, and parent-rated problem behavior.ResultsFor PCBD and PGD, one-factor models—with all symptoms forming a unidimensional factor of disturbed grief—fit the data best. The prevalence of probable DSM-5 PCBD (3.4%) was significantly lower than ICD-11 PGD (12.4%). Both PCBD and PGD were significantly associated with concurrently assessed overall disturbed grief, depression, and posttraumatic stress; associations with parent-rated problems were moderate.LimitationsFindings were based on self-reported ratings of symptoms, obtained from three different scales not specifically designed to assess PCBD and PGD. The use of a help-seeking sample limits the generalization of findings to bereaved children generally.ConclusionsFindings support the validity of DSM-5 PCBD and ICD-11 PGD. Prevalence rates of both constructs differ. This needs further scrutiny

Job loss-related complicated grief symptoms: A cognitive-behavioral framework

In a significant minority of people, involuntarily job loss can result in symptoms of job loss-related complicated grief (JLCG). The present cognitive-behavioral framework is introduced to explain the underlying processes that may lead to the development and maintenance of JLCG symptoms. Three core processes play a central role, namely (1) negative cognitions related to the job loss and misinterpretation of one's grief reactions; (2) anxious and depressive avoidance strategies to cope with the job loss and its consequences; and (3) insufficient integration of the job loss into the autobiographical memory. These core processes are assumed to interact and reinforce each other, leading to JLCG symptoms. The three core processes can be influenced by certain risk factors, including circumstances surrounding the loss, personality traits, and characteristics of the social environment. JLCG symptoms can lead to additional psychological and practical problems, such as anxiety and depressive symptoms, lower employability, and reduced likelihood of re-employment. This paper explains and illustrates the three core processes with vignettes. Implications of the model for preventive measures and psychological interventions are introduced. It concludes with suggestions for future research on JLCG symptoms

Cognitive therapy and EMDR for reducing psychopathology in bereaved people after the MH17 plane crash:Findings from a randomized controlled trial

Experiencing a sudden/violent loss of a significant other is a risk factor for developing persistent complex bereavement disorder (PCBD), depression, and/or posttraumatic stress disorder (PTSD). Cognitive therapy (CT) combined with eye movement desensitization and reprocessing (EMDR) might be an effective treatment for bereaved people with PCBD, depression, and/or PTSD symptoms after sudden/violent loss. We tested the effects of CT + EMDR versus waitlist controls in disaster-bereaved people. In a multicenter randomized controlled trial, changes in self-rated PCBD, depression, and PTSD levels were compared between an immediate treatment and waitlist control group in 39 Dutch people who experienced loss(es) in the disaster with flight MH17, using multilevel modeling. Associations between reductions in symptom levels and reductions in maladaptive cognitive- behavioral variables were examined using regression analyses. The immediate treatment group showed a significantly stronger decline in depression (Hedges' g = 0.61) compared with waitlist controls (Hedges' g = 0.15). No significant between-groups differences were found in PCBD and PTSD levels. Symptom reductions were correlated with reductions in maladaptive cognitive- behavioral variables. Although CT + EMDR coincided with symptom reductions associated with reductions in negative cognitions and avoidance behaviors, more research with larger samples is needed to further examine the effectiveness of CT + EMDR in bereaved people after sudden/violent loss