An Investigation of the Clinical Utility of a Prolonged Grief Disorder Diagnosis

长期悲伤障碍诊断的临床实用性调查

• 批准号: 8469668
• 负责人: Wendy G. Lichtenthal
• 金额: $ 28.39万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8469668
• 关键词: Acute; Adjustment Disorders; Affect; American; American Psychiatric Association; Antidepressive Agents; Attitude; Belief; Bereavement; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Child; Clinical; Clinical Research; Clinical Treatment; Clinical Trials; Communication; Data; Development; Diagnosis; Diagnostic; Diagnostic and Statistical Manual; Disease; Distress; Etiology; Family; Goals; Grief reaction; Health Personnel; Health Professional; Impairment; Individual; International Classification of Diseases; Laboratory Study; Left; Life; Literature; Major Depressive Disorder; Manuals; Mental Health; Mental disorders; Modification; Nomenclature; Outcome; Participant; Patients; Phase; Post-Traumatic Stress Disorders; Procedures; Professional counselor; Provider; Psyche structure; Psychiatrist; Psychologist; Psychometrics; Recommendation; Research; Research Personnel; Robin bird; Sampling; Social Workers; Surveys; Survivors; Testing; Time; Trauma; United States; Work; clinical practice; diagnostic accuracy; effective intervention; effective therapy; evidence base; follow-up; improved; informant; meetings; mental disorder diagnosis; physical conditioning; prevent; public health relevance; research clinical testing; response; sound; stress related disorder; virtual; working group

DESCRIPTION (provided by applicant): Although the intense distress and impairment characteristic of acute grief typically dissipates over time, for approximately 10% to 20%--that is 1 to 2 million individuals--the grief reaction is protracted and dysfunctional. This enduring, severely debilitating response to death of a significant other, now known as prolonged grief disorder (PGD), has been associated with life-threatening conditions and may persist for years if left untreated. In order to advance bereavement research and clinical work, researchers have empirically validated diagnostic criteria for PGD over the past two decades, demonstrating its construct and predictive validity. Evidence of the clinical utility of PGD has, however, been lacking. A mental disorder with clinical utility facilitates communication and effective interventions, predicts management needs and outcomes, and differentiates disorder from non- disorder and from comorbid disorders. PGD is slated for inclusion in the next International Classification of Diseases, ICD-11. In DSM-5, it is proposed as a new subtype of Adjustment Disorder and included in the "Appendix for Further Study." Regardless of diagnostic manuals, however, as a newly defined and recognized disorder, it is of paramount importance to demonstrate that PGD proves clinically useful. Although the clinical utility of PGD is implied by a vast literature that has empirically demonstrated its distinctive etiology, phenomenology, course, outcomes and response to treatment, the clinical utility of the diagnosis, per se, has not been studied. This study will obtain pilot data for a large-scale field trial of PGD by examining the clinical utility (perceived need and usefulness) of this diagnosis. Phase 1 will develop 8 prototypical bereaved virtual standardized patient (VSP) cases with and without PGD (both with and without co-morbid major depressive disorder [MDD] and posttraumatic stress disorder [PTSD]; 4 cases of spousal loss and 4 cases of child loss) using key informants (8 mental health providers), who will help develop the VSP cases, clinical utility assessments, and Phase 2 recruitment strategies. Phase 2 procedures will then be piloted with 10 mental health providers. In Phase 2, we will survey a diverse sample of 100 mental health providers likely to care for bereaved individuals (e.g., psychiatrists, psychologists, social workers, grief counselors) about their attitudes regarding the clinical utility of a PGD diagnosis, ask them to diagnose 4 VSP cases, and evaluate the impact of a PGD diagnosis on their clinical recommendations for these cases. The specific aims of this study include 1) to assess the attitudes, practices, and beliefs related to the clinical utility of a PGD diagnosis among a variety of mental health professionals; 2) to evaluate the clinical utility of the proposed PGD diagnostic criteria by having a diverse set of mental health professionals diagnose patients with and without PGD, comorbid with MDD or PTSD and not, to assess user acceptability and diagnostic accuracy; and 3) to explore how mental health professionals are likely to treat individuals with PGD, both with comorbid MDD or PTSD and without. Findings from this study will inform development of a larger field trial to determine the impact of PGD on patient outcomes.

描述（由申请人提供）：尽管急性悲伤的强烈痛苦和损害特征通常会随着时间的推移而消散，但大约10%到20%——即100万到200万人——悲伤反应是持久的和功能失调的。这种对重要的另一半死亡的持久的、严重的衰弱反应，现在被称为长期悲伤障碍（PGD），与危及生命的疾病有关，如果不及时治疗，可能会持续数年。为了推进丧亲研究和临床工作，研究人员在过去二十年中对PGD的诊断标准进行了实证验证，证明了其结构和预测有效性。然而，缺乏PGD临床应用的证据。具有临床效用的精神障碍有助于沟通和有效的干预，预测管理需求和结果，并区分障碍与非障碍和共病障碍。PGD预计将被列入下一个国际疾病分类，ICD-11。在DSM-5中，它被提议作为一种新的适应障碍亚型，并列入“进一步研究附录”。无论诊断手册如何，然而，作为一种新定义和公认的疾病，证明PGD在临床上是有用的至关重要。虽然PGD的临床应用是隐含的