CardiovascularDetection Of "Prolonged Grief Disorder" May Help Bereaved Individuals
Identification of criteria for the detection of prolonged grief disorder
(PGD) appear able to identify bereaved persons at heightened risk for
enduring distress and dysfunction, says a new study in this week"s open
access journal PLoS Medicine. 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.
Dr. Holly Prigerson from the Dana Farber Cancer Institute in Boston,
Massachusetts 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.
They interviewed 291 bereaved individuals three times in the two years
following the loss of a spouse about their experiences of these symptoms.
Using
item response theory and combinatoric analysis, the researchers identified
the most sensitive and specific algorithm for the diagnosis of PGD. This
algorithm included 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, which had to have
persisted for at least 6 months after the bereavement and to be associated
with functional impairment.
In addition, the researchers report that individuals in their study given
a diagnosis of PGD 6-12 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."
Article by Dr Prigerson and Colleagues:
Funding: HGP was supported by National Institute of Mental Health grants
MH56529 and MH63892, and National Cancer Institute grant CA106370. PKM was
supported by NIH grant NS044316. The funder had no role in study design,
data collection and analysis, decision to publish, or preparation of the
manuscript.
Competing Interests: Michael First received consultant fees over the past
5 years from Roche, Corcept, Wyeth, Cephalon, Astra-Zeneca, Shire, GSK,
and
Eli Lilly for preparing diagnostic interviews and/or conducting diagnostic
trainings at investigator meetings.
Citation:
Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, et al. (2009)
"Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSMV and ICD-11."
PLoS Med 6(8): e1000121. doi:10.1371/journal.pmed.1000121
PLoS