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

描述(由申请人提供)：尽管急性悲痛的强烈痛苦和损害特征通常会随着时间的推移而消散，但对于大约10%到20%的人--即100万到200万人--悲痛反应是持久的和功能失调的。这种对另一半死亡的持久、严重衰弱的反应，现在被称为长期悲伤障碍(PGD)，与威胁生命的情况有关，如果不治疗，可能会持续数年。为了推进丧亲研究和临床工作，在过去的二十年里，研究人员对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，关于PGD临床应用的证据一直很缺乏。具有临床实用价值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，它被提议作为适应障碍的一个新的亚型，并被列入“附录以供进一步研究”。然而，无论诊断手册如何，作为一种新定义和公认的疾病，证明PGD被证明在临床上是有用的是至关重要的。尽管PGD的临床效用是由一个 尽管已有大量文献经验性地证明了其独特的病因、现象学、病程、结果和治疗反应，但诊断本身的临床实用价值尚未被研究。这项研究将通过检查这种诊断的临床效用(感知的需要和有用性)来获得用于PGD的大规模现场试验的先导数据。第一阶段将利用主要信息者(8名精神卫生提供者)开发8个有和没有PGD(有或没有共病的严重抑郁障碍[MDD]和创伤后应激障碍[PTSD]；4例配偶和4例儿童丧失)的典型丧亲虚拟标准化患者(VSP)病例，他们将帮助制定VSP病例、临床效用评估和第二阶段招募战略。然后，将在10名精神健康提供者中试行第二阶段程序。在第二阶段，我们将调查100名可能照顾丧亲人士的精神健康提供者(例如精神病学家、心理学家、社会工作者、悲伤顾问)的不同样本，了解他们对PGD诊断的临床效用的态度，要求他们诊断4例VSP病例，并评估PGD诊断对他们对这些病例的临床建议的影响。本研究的具体目的包括：1)评估不同精神卫生专业人员对PGD诊断的态度、实践和信念；2)通过一套不同的诊断标准，评估建议的PGD诊断标准的临床实用性 精神卫生专业人员对患有和不患有PGD的患者进行诊断，与MDD或PTSD共存或不共存，以评估用户的可接受性和诊断准确性；以及3)探索心理健康专业人员可能如何治疗患有PGD的个体，包括患有MDD或PTSD和不患有PGD的个体。这项研究的结果将有助于开展更大规模的现场试验，以确定PGD对患者预后的影响。

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.