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Prolonged grief disorder: clinical utility of ICD-11 diagnostic guidelines

Published online by Cambridge University Press:  18 June 2018

Christine Mauro
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, 6th floor, New York, NY 10032, USA
Charles F. Reynolds III
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, 6th floor, New York, NY 10032, USA
Andreas Maercker
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, 6th floor, New York, NY 10032, USA
Natalia Skritskaya
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, 6th floor, New York, NY 10032, USA
Naomi Simon
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, 6th floor, New York, NY 10032, USA
Sidney Zisook
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, 6th floor, New York, NY 10032, USA
Barry Lebowitz
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, 6th floor, New York, NY 10032, USA
Stephen J. Cozza
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, 6th floor, New York, NY 10032, USA
M. Katherine Shear*
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, 6th floor, New York, NY 10032, USA
*
Author for correspondence: M. Katherine Shear, E-mail: ks2394@columbia.edu

Abstract

Background

The World Health Organization (WHO) International Classification of Disease (ICD-11) is expected to include a new diagnosis for prolonged grief disorder (ICD-11PGD). This study examines the validity and clinical utility of the ICD-11PGD guideline by testing its performance in a well-characterized clinical sample and contrasting it with a very different criteria set with the same name (PGDPLOS).

Methods

We examined data from 261 treatment-seeking participants in the National Institute of Mental Health (NIMH)-sponsored multicenter clinical trial to determine the rates of diagnosis using the ICD-11PGD guideline and compared these with diagnosis using PGDPLOS criteria.

Results

The ICD-11PGD guideline identified 95.8% [95% confidence interval (CI) 93.3–98.2%] of a treatment-responsive cohort of patients with distressing and impairing grief. PGDPLOS criteria identified only 59.0% (95% CI 53.0–65.0%) and were more likely to omit those who lost someone other than a spouse, were currently married, bereaved by violent means, or not diagnosed with co-occurring depression. Those not diagnosed by PGDPLOS criteria showed the same rate of treatment response as those who were diagnosed.

Conclusions

The ICD-11PGD diagnostic guideline showed good performance characteristics in this sample, while PGDPLOS criteria did not. Limitations of the research sample used to derive PGDPLOS criteria may partly explain their poor performance in a more diverse clinical sample. Clinicians and researchers need to be aware of the important difference between these two identically named diagnostic methods.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2018 

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