Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11.
Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11.
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DOI：
10.1371/journal.pmed.1000121
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发表时间：
2009-08
期刊：
影响因子：
15.8
通讯作者：
Maciejewski PK
中科院分区：
文献类型：
--
作者：
Prigerson HG;Horowitz MJ;Jacobs SC;Parkes CM;Aslan M;Goodkin K;Raphael B;Marwit SJ;Wortman C;Neimeyer RA;Bonanno GA;Block SD;Kissane D;Boelen P;Maercker A;Litz BT;Johnson JG;First MB;Maciejewski PK
Holly Prigerson 及其同事测试了长期悲伤障碍 (PGD) 标准的心理测量有效性，以加强对持续痛苦和功能障碍风险较高的丧亲者的发现和护理。丧亲之痛是一种普遍的经历，其与发病率和死亡率过高之间的联系是众所周知的。然而，对于相对少数人来说，悲伤已成为严重的健康问题。对于这些人来说，强烈的悲伤持续存在，令人痛苦和丧失能力，并且可能符合一种独特的精神障碍的标准。目前，DSM-IV 或 ICD-10 中并未将悲伤视为精神障碍。本研究的目的是确定长期悲伤障碍（PGD）标准的心理测量有效性，以加强对持续痛苦和功能障碍风险较高的丧亲者的检测和潜在治疗。共有 291 名失去亲人的受访者接受了 3 次访谈，按失去亲人后 0-6、6-12 和 12-24 个月分组。项目反应理论 (IRT) 分析得出信息最丰富、最公正的 PGD 症状。组合分析确定了最敏感和最具体的 PGD 算法，然后对其进行测试以评估其心理测量的有效性。标准要求对重大损失的反应，包括渴望的经历（例如，由于渴望但未实现与死者团聚而遭受身体或情感上的痛苦），以及至少每天经历以下九种症状中的至少五种或达到残疾程度：感觉情绪麻木、震惊或生活毫无意义；经历不信任；因失去而感到痛苦；难以接受损失；身份混乱；避免损失的现实；或难以继续生活。症状必须在死亡后至少六个月内以足够高的水平出现，并且与功能障碍相关。 PGD 设定的标准似乎能够识别出遭受痛苦和功能障碍风险较高的丧亲者。结果支持我们建议纳入 DSM-V 和 ICD-11 的 PGD 标准的心理测量有效性。 请参阅本文后面的编辑摘要 几乎每个人都会在一生中失去所爱的人。悲伤是对这种损失的不可避免的正常反应。亲人去世后，失去亲人的人可能会感到悲伤、愤怒、内疚、焦虑和绝望。他们可能会不断地想起死者以及导致死者死亡的事件。他们经常会对失去亲人产生身体反应——例如睡眠问题——并且可能会生病。在社交方面，他们可能会发现很难重返工作岗位或见到朋友和家人。对于大多数人来说，这些痛苦的情绪和想法通常会在死亡后 6 个月左右的时间内逐渐消失。但对于一些人来说，正常的悲伤反应仍然存在，并且变得越来越虚弱。专家将这种现象称为复杂性悲伤或长期悲伤障碍（PGD）。典型地，患有 PGD 的人会对死者产生侵入性的想法和形象，并且痛苦地渴望他或她的存在。他们也可能否认自己的损失，感到极度孤独和漂泊，并想自杀。尽管 PGD 符合美国精神病学协会精神疾病诊断和统计手册第 4 版 (DSM-IV) 和世界卫生组织国际疾病和相关健康问题统计分类第 10 版 (ICD-10) 中给出的要求，但目前尚未将其视为精神障碍。在 PGD 被认定为精神障碍之前（并纳入 DSM-V 和 ICD-11），丧亲和心理健康专家需要就 PGD 的标准化标准达成一致。这些标准很有用，因为它们可以让研究人员和临床医生识别 PGD 的风险因素并找到预防 PGD 的方法。他们还将帮助确保 PGD 患者获得适当的治疗，例如心理治疗，以帮助他们改变对失去亲人的看法并重新融入世界。最近，专家小组就 PGD 症状达成共识。在这项研究中，研究人员进行了一项现场试验，以开发和评估根据这些症状诊断 PGD 的算法（规则集）。研究人员使用“项目反应理论”(IRT)，对近 300 名最近失去亲密家庭成员的人进行结构化访谈，得出信息最丰富的 PGD 症状。这些访谈包含有关症状共识清单的问题；每个参与者在其配偶去世后的两年内接受了两到三次访谈。然后，研究人员使用“组合”分析来确定诊断 PGD 的最敏感和最具体的算法。该算法规定，患有 PGD 的失去亲人的人必须经历渴望（由于与死者团聚的愿望未得到满足而造成的身体或情感上的痛苦）以及九种附加症状中的至少五种。这些症状（包括情绪麻木、感觉生活毫无意义以及回避失去亲人的现实）必须在丧亲之痛后持续至少 6 个月，并且必须与功能障碍有关。最后，研究人员表明，与未诊断出 PGD 的人相比，在死亡后 6-12 个月内被诊断为 PGD 的人随后出现心理健康和功能障碍的风险更高。这些发现验证了 PGD 的一系列症状和诊断算法。由于大多数研究参与者都是失去丈夫的老年妇女，因此需要进一步验证以检查这些症状和算法是否也适用于其他类型的失去亲人的人，例如失去孩子的人。但目前，这些发现支持将 PGD 作为一种公认的精神障碍纳入 DSM-V 和 ICD-11。此外，诊断 PGD 的标准化方法的可用性将有助于临床医生识别少数未能成功适应失去亲人的人。希望通过识别这些人并帮助他们避免 PGD 的发生（也许通过在死后不久提供心理治疗）和/或为 PGD 提供更好的治疗，现在应该可以减少与长期悲伤相关的相当大的个人和社会成本。请通过此摘要的在线版本访问这些网站：http://dx.doi.org/10.1371/journal.pmed.1000121。 Stephen Workman 在 PLoS Medicine Perspective 中进一步讨论了这项研究。 Dana Farber 癌症研究所有一个页面介绍了其心理肿瘤学和姑息治疗研究中心。 英国皇家精神科医师学院有一份关于丧亲之痛的传单（英语、威尔士语、乌尔都语和中文）。 美国国家癌症研究所也有关于患者和卫生专业人员应对丧亲之痛的信息（英语和西班牙语）。 有关丧亲之痛的其他信息（英语和西班牙语） 《美国医学会杂志》有一个关于异常悲伤的患者页面 哈佛医学院提供了有关复杂悲伤的简短家庭健康指南 有关 DSM-IV 和 ICD-10 的信息已提供
Holly Prigerson and colleagues tested the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and care of bereaved individuals at heightened risk of persistent distress and dysfunction. 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. 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. 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 ICD-11. Please see later in the article for Editors' Summary Virtually everyone loses someone they love during their lifetime. Grief is an unavoidable and normal reaction to this loss. After the death of a loved one, bereaved people may feel sadness, anger, guilt, anxiety, and despair. They may think constantly about the deceased person and about the events that led up to the person's death. They often have physical reactions to their loss—problems sleeping, for example—and they may become ill. Socially, they may find it difficult to return to work or to see friends and family. For most people, these painful emotions and thoughts gradually diminish, usually within 6 months or so of the death. But for a few people, the normal grief reaction lingers and becomes increasingly debilitating. Experts call this complicated grief or prolonged grief disorder (PGD). Characteristically, people with PGD have intrusive thoughts and images of the deceased person and a painful yearning for his or her presence. They may also deny their loss, feel desperately lonely and adrift, and want to die themselves. PGD is not currently recognized as a mental disorder although it meets the requirements for one given in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and in the World Health Organization's International Statistical Classification of Diseases and Related Health Problems, 10thEdition (ICD-10). Before PGD can be recognized as a mental disorder (and included in DSM-V and ICD-11), bereavement and mental-health experts need to agree on standardized criteria for PGD. Such criteria would be useful because they would allow researchers and clinicians to identify risk factors for PGD and to find ways to prevent PGD. They would also help to ensure that people with PGD get appropriate treatments such as psychotherapy to help them change their way of thinking about their loss and re-engage with the world. Recently, a panel of experts agreed on a consensus list of symptoms for PGD. In this study, the researchers undertake a field trial to develop and evaluate algorithms (sets of rules) for diagnosing PGD based on these symptoms. The researchers used “item response theory” (IRT) to derive the most informative PGD symptoms from structured interviews of nearly 300 people who had recently lost a close family member. These interviews contained questions about the consensus list of symptoms; each participant was interviewed two or three times during the two years after their spouse's death. The researchers then used “combinatoric” analysis to identify the most sensitive and specific algorithm for the diagnosis of PGD. This algorithm specifies that a bereaved person with PGD must experience yearning (physical or emotional suffering because of an unfulfilled desire for reunion with the deceased) and at least five of nine additional symptoms. These symptoms (which include emotional numbness, feeling that life is meaningless, and avoidance of the reality of the loss) must persist for at least 6 months after the bereavement and must be associated with functional impairment. Finally, the researchers show that individuals given a diagnosis of PGD 6–12 months after a death have a higher subsequent risk of mental health and functional impairment than people not diagnosed with PGD. These findings validate a set of symptoms and a diagnostic algorithm for PGD. Because most of the study participants were elderly women who had lost their husband, further validation is needed to check that these symptoms and algorithm also apply to other types of bereaved people such as individuals who have lost a child. For now, though, these findings support the inclusion of PGD in DSM-V and ICD-11 as a recognized mental disorder. Furthermore, the availability of a standardized way to diagnose PGD will help clinicians identify the minority of people who fail to adjust successfully to the loss of a loved one. Hopefully, by identifying these people and helping them to avoid the onset of PGD (perhaps by providing psychotherapy soon after a death) and/or providing better treatment for PGD, it should now be possible to reduce the considerable personal and societal costs associated with prolonged grief. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000121. This study is further discussed in a PLoS Medicine Perspective by Stephen Workman The Dana Farber Cancer Institute has a page describing its Center for Psycho-oncology and Palliative Care Research The UK Royal College of Psychiatrists has a leaflet on bereavement (in English, Welsh, Urdu, and Chinese) The US National Cancer Institute also has information about coping with bereavement for patients and health professionals (in English and Spanish) MedlinePlus has links to other information about bereavement (in English and Spanish) The Journal of the American Medical Association has a patient page on abnormal grief Harvard Medical School provides a short family health guide about complicated grief Information on DSM-IV and ICD-10 is available
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影响因子：
11.3
作者：
Boelen, Paul A.;van den Bout, Jan
通讯作者：
van den Bout, Jan
影响因子：
17.7
作者：
Boelen, PA;van den Bout, J;de Keijser, J
通讯作者：
de Keijser, J
影响因子：
5.9
作者：
Boelen, Paul A.;de Keijser, Jos;van den Bout, Jan
通讯作者：
van den Bout, Jan
DOI：
10.1007/s10862-005-9016-3
发表时间：
2006-12-01
影响因子：
1.6
作者：
Johnson, Jeffrey G.;Vanderwerker, Lauren C.;Prigerson, Holly G.
通讯作者：
Prigerson, Holly G.
影响因子：
3.7
作者：
Holland, Jason M.;Currier, Joseph M.;Gallagher-Thompson, Dolores
通讯作者：
Gallagher-Thompson, Dolores