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Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-20277

Prigerson, H G; Horowitz, M J; Jacobs, S C; Parkes, C M; Aslan, M; Goodkin, K; Raphael, B; Marwit, S J; Wortman, C; Neimeyer, R A; Bonanno, G; Block, S D; Kissane, D; Boelen, P; Maercker, Andreas; Litz, B T; Johnson, J G; First, M B; Maciejewski, P K (2009). Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11. PLoS Medicine, 6(8):e1000121.

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Background: Bereavement is a universal experience, and its association with excess morbidity and mortality is well
established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief
persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized
as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for
prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk
of persistent distress and dysfunction.
Methods and Findings: A total of 291 bereaved respondents were interviewed three times, grouped as 0–6, 6–12, and 12–
24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric
analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity.
Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as
a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms
experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless;
experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of
the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the
death and be associated with functional impairment.
Conclusions: The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and
dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and
Please see later in the article for the Editors’ Summary.
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
Academic Editor: Carol Brayne, University of Cambridge, United Kingdom
Received March 10, 2008; Accepted June 25, 2009; Published August 4, 2009
Copyright: 2009 Prigerson et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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: MBF 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.
Abbreviations: 2-PL, two-parameter logistic; DIF, differential item functioning; DSM-IV, Diagnostic Statistical Manual of Mental Disorders, 4th Edition; GAD,
generalized anxiety disorder; ICD-10, International Statistical Classification of Diseases and Related Health Problems; ICG-R, Inventory of Complicated Grief—Revised;
IIF, item information function; IRM, item response model; IRT, item response theory; MDD, major depressive disorder; PG, prolonged grief; PGD, prolonged grief
disorder; PTSD, posttraumatic stress disorder; SCID, Structured Clinical Interview for DSM-IV; WPS, Widowed Persons Service; YBS, Yale Bereavement Study.


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Item Type:Journal Article, refereed, original work
Communities & Collections:06 Faculty of Arts > Institute of Psychology
Dewey Decimal Classification:150 Psychology
Date:August 2009
Deposited On:21 Aug 2009 15:35
Last Modified:05 Apr 2016 13:19
Publisher:Public Library of Science (PLoS)
Publisher DOI:10.1371/journal.pmed.1000121

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