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Prospective evaluation of the DSM-5 persistent complex bereavement disorder criteria in adults: dimensional and diagnostic approaches

Published online by Cambridge University Press:  16 January 2020

Elie G. Aoun ,
Giovanna Porta ,
Nadine M. Melhem Open the ORCID record for Nadine M. Melhem [Opens in a new window]  and
David A. Brent Open the ORCID record for David A. Brent [Opens in a new window]
Elie G. Aoun
Affiliation:
Columbia University, Department of Psychiatry, Division of Law, Ethics and Psychiatry, New York, NY, USA New York University, Department of Psychiatry, New York, NY, USA Sex Offender Treatment Program, New York State Office of Mental Heath
Giovanna Porta
Affiliation:
University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Nadine M. Melhem*
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
David A. Brent
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
*
Author for correspondence: Nadine M. Melhem, E-mail: melhemnm@upmc.edu
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Abstract

Background

We examine the performance of the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) persistent complex bereavement-related disorder (PCBD) criteria in bereaved adults to identify prolonged grief cases determined prospectively.

Methods

Bereaved adults (n = 138) were assessed at 8, 21, 32, 67, and 90 months after the sudden death of a spouse or close relative. We used latent class growth analysis to identify the longitudinal trajectories of grief assessed using the Inventory for Complicated Grief. To validate the trajectory that corresponded to prolonged grief, we examined the baseline predictors of these trajectories and their relationship with functional impairment.

Results

We found three distinct trajectories of grief reactions. One of these trajectories (13.8%) showed high and sustained grief reactions that persisted for almost 7.5 years after the death. Participants with prolonged grief showed greater functional impairment [relative risk ratio (RRR) = 0.82, 95% confidence interval (CI): 0.70 to −0.97; p = 0.02] and higher self-reported depression (RRR = 1.21, 95% CI 1.09 to 1.96; p = 0.001) than participants whose grief reactions subsided over time. The original PCBD (requiring 6 criterion C symptoms) criteria correctly identified cases (57.9–94.7%) with perfect specificity (100%) but low to high sensitivity (5.6–81.3%); however, its sensitivity increased when revising criterion C to require ⩾3 (45.5–94.1%). The dimensional approach showed high sensitivity (0.50–1) and specificity (0.787–0.97).

Conclusions

We recommend revisions to the PCBD criteria, which are overly restrictive and may exclude cases with clinically significant grief-related distress and impairment. In the meantime, clinicians need to monitor grief symptoms over time using available dimensional approaches to reduce the burden of grief.

Keywords

AdultsbereavementdepressionDSM-5griefPCBD criteriaPTSDsuicidetrauma
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 5 , April 2021 , pp. 825 - 834
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Copyright
Copyright © The Authors, 2020. Published by Cambridge University Press

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Footnotes

*

Co-Senior authors.

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