Performance characteristics and clinical utility of diagnostic criteria proposals in bereaved treatment-seeking patients.
BACKGROUND
Persistent complex bereavement disorder (PCBD) is a protracted form of grief included in DSM Section 3 indicating a need for more research. Two other criteria sets [prolonged grief disorder (PGD) and complicated grief (CG) disorder] are also currently in use by researchers. This study evaluates rates of diagnosis of each proposed criteria set in a clinical sample of bereaved individuals participating in clinical research.


METHODS
Two groups in which persistent grief was judged to be present or absent completed an assessment instrument that included items needed to diagnose PCBD as well as PGD and CG. One group included grief treatment-seeking participants in our multicenter National Institute of Mental Health (NIMH)-sponsored study who scored ⩾30 on the Inventory of Complicated Grief (ICG) and the other comprised bereaved adults enrolled in clinical research studies who scored <20 on the ICG. Rates of diagnosis were determined for proposed PCBD, PGD and CG criteria.


RESULTS
PCBD criteria diagnosed 70 [95% confidence interval (CI) 64.2-75.8] % of the grief treatment-seeking group, PGD criteria identified 59.6 (95% CI 53.4-65.8) % of these individuals and CG criteria identified 99.6 (95% CI 98.8-100.0) %. None of the three proposed criteria identified any cases in the bereaved comparison group.


CONCLUSIONS
Both proposed DSM-5 criteria for PCBD and criteria for PGD appear to be too restrictive as they failed to identify substantial numbers of treatment-seeking individuals with clinically significant levels of grief-related distress and impairment. Use of CG criteria or a similar algorithm appears to be warranted.
Department of Biostatistics,Mailman School of Public Health,Columbia University,New York, NY,USA.
C
C
Mauro
Columbia University School of Social Work,New York, NY, USA.
M K
MK
Shear
Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh, PA,USA.
C F
CF
Reynolds
Center for Anxiety and Traumatic Stress Disorders,Massachusetts General Hospital,Boston, MA,USA.
N M
NM
Simon
Department of Psychiatry,University of California,San Diego,La Jolla, CA,USA.
S
S
Zisook
Columbia University School of Social Work,New York, NY, USA.
N
N
Skritskaya
Department of Biostatistics,Mailman School of Public Health,Columbia University,New York, NY,USA.
Y
Y
Wang
Department of Psychiatry,University of California,San Diego,La Jolla, CA,USA.
B
B
Lebowitz
Division of Biostatistics,Department of Psychiatry,Columbia University,New York, NY,USA.
N
N
Duan
Department of Psychiatry,Columbia University,College of Physicians and Surgeons,New York State Psychiatric Institute and New York Presbyterian Hospital,New York, NY,USA.
M B
MB
First
Brookdale Center for Healthy Aging,Hunter College,New York, NY,USA.
A
A
Ghesquiere
Columbia University School of Social Work,New York, NY, USA.
C
C
Gribbin
Department of Social Work,York College/CUNY,Jamaica, NY,USA.
K
K
Glickman
D000328:Adult; D000368:Aged; D001601:Bereavement; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017410:Practice Guidelines as Topic / Q000592:standards*; D011569:Psychiatric Status Rating Scales; D000067073:Psychological Trauma / Q000175:diagnosis*; D013577:Syndrome
Complicated grief; DSM-5 criteria; functional impairment; persistent complex bereavement disorder; stress