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Context 1
... total of four of 16 informative symptoms were found to be biased with respect to time from loss, gender, and/or relationship to the deceased. Table 1 provides a summary of results for these IRT IIF and DIF analyses of candidate symptoms for assessing and diagnosing PGD. ...
Context 2
... figure displays item information as a function of the PG attribute for all 22 of these symptoms included in this IRM, relative to the maximum information for the most informative symptom, ''inability to care about others since the death.'' The horizontal line in the figure represents the standard used to discriminate between 16 informative candidate symptoms retained for further analysis, and six uninformative candidate symptoms excluded from further analysis (as indicated in Table 1 absence of an established, standard method for diagnosing PGD, there was a need to develop a criterion standard for ''caseness'' of PGD by which the performance of alternative algorithms for PGD could be evaluated. As a potential criterion standard for PGD, the rater determination of caseness of PGD had the advantage of reflecting experienced clinical judgment. ...
Context 3
... horizontal error bar associated with each ICC represents the standard error in the estimate of the location of the ICC with respect to the PG attribute. Of 16 informative symptoms examined, four symptoms displayed DIF and were excluded from further analysis (as indicated in Table 1 empty or meaningless without the deceased; bitterness or anger related to the loss; emotional numbness; feeling stunned, dazed, or shocked; feeling part of oneself had died along with the deceased; difficulty trusting others; difficulty moving on with life (sensitivi- ty = 1.00; specificity = 0.99; positive predictive value = 0.94; neg- ative predictive value = 1.00). The optimal algorithm displayed convergent validity with respect to the previously proposed diagnostic algorithm for PGD (k = 0.68) and the rater diagnosis of PGD (k = 0.68), and discriminant validity with respect to other mood and anxiety disorders (W with MDD = 0.36; PTSD = 0.31; GAD = 0.17). ...
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This article brings together the psychiatric and psychoanalytic views of mental illness to deepen the understanding of mental disorder. The intention is to bring to the fore the importance of loss and mourning in clinical practice. Looking for the loss event that underpins the disorder helps determine therapeutic treatment options and increases the...
Citations
... While grief is considered a normal experience [5], a minority develops Prolonged Grief Disorder (PGD). PGD is a pervasive grief response that persists for an atypically long period of time, clearly exceeding expected social, cultural, or religious norms and causing significant impairment in important areas of functioning [6,7]. It is associated with suicidality, shortened life expectancy, intense distress, and decreased general health and vitality [8][9][10]. ...
... It is worth noticing that the previously mentioned symptoms have to be endure for at least 6 months after the loss. As a disorder, nevertheless, prolonged grief has been initially examined in Europe and North America and the existent research basis for the validity and reliability of the diagnostic criteria and PGD prevalence have been developed by their researchers (Boelen et al. 2018;Maciejewski et al. 2016;Prigerson et al. 2009). Thus, the newest definition of PGD in ICD-11 is mainly based on the existing symptoms in the Western world; in addition, the diagnostic instructions are majorly appropriate for European, North American, and some Chinese cases . ...
Objectives
This study aimed to evaluate the psychometric properties of the Persian version of the International ICD-11 Prolonged Grief Disorder Scale (IPGDS).
Methods
A total of 554 participants (18 years and older, 326 women) completed the Persian IPGDS along with other measures. Participants were recruited through convenience sampling. The study assessed confirmatory factor analysis (CFA), convergent validity, and reliability of the Persian IPGDS.
Results
CFA supported a 4-dimensional model, indicating good structural validity of the Persian IPGDS. Convergent validity was established through correlations with measures of depression, anxiety, and PTSD.
Significance of results
These findings suggest that the Persian IPGDS exhibits satisfactory psychometric properties, making it a valid tool for measuring Prolonged Grief Disorder (PGD) in Persian-speaking Iranian adults.
... Dette er senere blevet kaldt sorgarbejdshypotesen (8). (8,(14)(15)(16)(17). Sorgforstyrrelse menes at ramme 5-10% af sørgende (8,(14)(15)(16)(17). ...
... (8,(14)(15)(16)(17). Sorgforstyrrelse menes at ramme 5-10% af sørgende (8,(14)(15)(16)(17). Senere er lige så mange studier gået ind i at undersøge interventioner til sørgende med sorgforstyrrelse og effektive behandlingsformer til de 5-10% ramte (12,13,18). ...
Introduktion Tab og sorg bliver ofte betragtet som noget vi enten skal arbejde os igennem, komme videre fra eller lære at leve med. Disse idéer er opstået via teorier som har formet vores forståelse af hvad tab og sorg betyder i et menneskeliv. Alle de dominerende teorier om sorg er opstået indenfor bestemte discipliner eller teoriretninger og fokuserer på bestemte aspekter af tab og sorg, men der er faktisk ikke nogen af dem, der har søgt en helhedsorienteret forståelse af fænomenet sorg. I denne artikel beskriver vi på baggrund af den originale artikel om The integrated Process Model of loss and Grief hvorfor det kan være hjælpsomt at søge en mere helhedsorienteret tilgang til sorg og flytte vores forståelse fremad, hvis vi vil forstå og støtte mennesker i sorg bedre. Vi præsenterer en ny forståelse af tab og sorg som integrerer de eksisterende teorier med ny forskning. I vores egen forskning har vi bl.a. sat fokus på en bredere undersøgelse af sorgreaktioner, men også at følge sørgende længere både inden og efter tabet, for at blive klogere på fænomenet sorg.
... Indeed, prolonged grief disorder (PGD) is characterized by this intense and persistent grief that causes problems and interferes with daily life, and an estimated 7-10% of bereaved adults will experience the persistent symptoms of prolonged grief disorder 19. The PGD is included in the International Classification of Diseases, 11th Revision (ICD-11), with diagnostic criteria also accepted for inclusion in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5 TR) (identity disruption, such as feeling as though part of oneself has died; marked sense of disbelief about the death; avoidance of reminders that the person is dead; intense emotional pain related to the death; difficulty with reintegration, such as problems engaging with friends, pursuing interests, planning for the future; emotional numbness; feeling that life is meaningless or intense loneliness) [24][25][26][27][28][29][30][31]. To be significant, symptoms must be present nearly every day during the prior month and the relative's death had to have occurred for at least 6 months. ...
Background
Bereavement is a crucial physiological process in palliative care; grief-processing disorders can be diagnosed at least 6 months after death and can have severe clinical or psychological consequences. This study aims to verify how adequate management of anticipatory mourning and condolence conversations can be protective in the early stages of grief.
Methods
Patients and caregivers are supported by a multidisciplinary team through semi-structured interviews. In condolence conversations within one month of the death, we identify signs of psychological fragility that require support for adequate processing of the loss.
Results
From the condolence conversations, only 2–4% of caregivers who had received psychological support during the hospital stay and showed a good level of acceptance of their relative’s end of life exhibited grief problems within 1 month of death; none showed excessive avoidance of memories, difficulties with trust, or feelings of emotional loneliness.
Conclusions
Despite the limitations, the preliminary data of our study clearly suggest the protective potential of multidisciplinary support, particularly in reducing the risk of developing grief processing disorders. These considerations encourage us to implement our model of clinical and psychological support systems and develop pathways dedicated to caregivers experiencing greater difficulty.
... Research [7][8][9][10][11][12][13][14][15][16][17][18][19][20] shows that after the loss of a loved one, PGD symptoms evolve in complex ways characterized as distinct PGD-symptom trajectories. Resilient, recovery, and chronic trajectories are common across studies [7][8][9][10][11][12][13][14][15][16][17][18][19][20], except that the resilient trajectory was absent in one [15], and the recovery trajectory was absent in two [10,16] studies. ...
... Research [7][8][9][10][11][12][13][14][15][16][17][18][19][20] shows that after the loss of a loved one, PGD symptoms evolve in complex ways characterized as distinct PGD-symptom trajectories. Resilient, recovery, and chronic trajectories are common across studies [7][8][9][10][11][12][13][14][15][16][17][18][19][20], except that the resilient trajectory was absent in one [15], and the recovery trajectory was absent in two [10,16] studies. The resilience trajectory shows low and stable PGD symptoms throughout bereavement. ...
... Bereaved in the chronic trajectory suffer PGD symptoms well above threshold throughout bereavement. Bereaved in more distressed PGD-symptom trajectories (i.e., recovery and chronic trajectories) report worse mental health [7,14], greater suicidal ideation [8], poorer quality of life [8] coupled with impaired psychological, social, and occupational functioning [14,16,17], greater use of preloss primary care and psychotropic medications (sedatives/ antidepressants) [21], and poorer responses to postloss psychotherapy [7], highlighting the necessity to identify Graphical abstract bereaved vulnerable to more distressed PGD-symptom trajectories. ...
Background
Bereaved people experience distinct trajectories of prolonged-grief-disorder (PGD) symptoms. A few studies from outside critical care investigated limited factors of PGD-symptom trajectories without a theoretical framework. We aimed to characterize factors associated with ICU bereaved surrogates’ PGD-symptom trajectories, drawing from the integrative framework of predictors for bereavement outcomes, emphasizing factors modifiable by ICU care.
Methods
Prospective cohort study of 291 family surrogates. Multinomial logistic regression was used to determine associations of three previously identified PGD-symptom trajectories (resilient [n = 242, 83.2%] as reference group, recovery [n = 35, 12.0%], and chronic [n = 14, 4.8%]) with risk factors. Factors included intrapersonal (demographics, personal vulnerabilities), interpersonal (perceived social support), bereavement-related (patient demographics, clinical characteristics, and patient-surrogate relationship), and death-circumstance (surrogate-perceived quality of patient dying and death [QODD] in ICUs classified as high, moderate, poor-to-uncertain, and worst QODD classes) factors.
Results
Most surrogates were female (59.1%), the patient’s adult child (54.0%), and about (standard deviation) 49.63 (12.53) years old. As surrogate age increased, recovery-trajectory membership decreased (adjusted odds ratio [95% confidence interval] = 0.918 [0.849, 0.993]) and chronic-trajectory membership increased (1.230 [1.010, 1.498]). Being married decreased membership in the recovery (0.186 [0.047, 0.729]) trajectory. Higher anxiety symptoms 1 month post loss increased membership in recovery (1.520 [1.256, 1.840]) and chronic (2.022 [1.444, 2.831]) trajectories. Spouses were more likely and adult–child surrogates were less likely than other relationships to be in the two more profound PGD-symptom trajectories. Membership in the chronic trajectory decreased (0.779 [0.614, 0.988]) as patient age increased. The poor-to-uncertain QODD class was associated with a nearly significant increase (4.342 [0.980, 19.248]) in membership in the recovery trajectory compared to the high QODD class.
Conclusions
Membership in the PGD-symptom trajectories was associated with factors modifiable by high-quality ICU care, including anxiety symptoms at early bereavement and surrogate-perceived QODD in the ICU. Clinicians should be sensitive to the psychological needs of at-risk family surrogates, provide high-quality end-of-life care to facilitate QODD, and promptly refer bereaved surrogates who suffer anxiety symptoms and profound and/or persistent PGD-symptoms for psychological support.
Graphical abstract
Supplementary Information
The online version contains supplementary material available at 10.1186/s13054-024-05160-2.
... Similar to the strong positive associations between the total score of the TGI-SR+ and an existing pathological grief symptoms scale (i.e., PG-13;Prigerson et al. 2009) found in the Swedish TGI-SR+ validation study (Lenferink et al. 2024), we found that the total score of the Chinese TGI-SR+ was strongly correlated with the total score of the IPGDS, a scale developed to assess the ICD-11 prolonged grief symptoms (Killikelly et al. 2020), providing evidence for convergent validity. We found strong correlations between the Chinese TGI-SR+ total score and PTSD, anxiety, and depressive symptoms, similar to the French (for PTSD and anxiety symptoms) and Dutch (for depressive symptoms) validation studies Kokou-Kpolou et al. 2022). ...
Objective
The Traumatic Grief Inventory‐Self Report Plus (TGI‐SR+) measures the most recent prolonged grief disorder (PGD) symptom sets defined in the 11 th edition of the International Statistical of Diseases and Related Health Problems (ICD‐11) and the text revision of the fifth edition of the Diagnostical and Statistical Manual of Mental Disorders (DSM‐5‐TR). However, the TGI‐SR+ has not yet been translated and validated in Chinese. This study aims to evaluate the psychometric properties of the Chinese translation of the TGI‐SR+.
Methods
We examined the Chinese TGI‐SR+'s factor structure, internal consistency, convergent validity, discriminant validity, known‐groups validity, and optimal clinical cut‐off scores in 443 Chinese bereaved adults.
Results
Confirmatory factor analyses showed that the two‐factor models showed the best fit for the Chinese TGI‐SR+ items assessing ICD‐11 and DSM‐5‐TR prolonged grief symptoms. Items assessing ICD‐11 and DSM‐5‐TR prolonged grief symptoms demonstrated good internal consistency. Associations of TGI‐SR+ scores with symptom levels of prolonged grief (assessed by the International Prolonged Grief Disorder Scale), posttraumatic stress, anxiety, and depression supported convergent and discriminant validity. Associations with background/loss‐related variables provided evidence for known‐groups validity. Cut‐off points for probable ICD‐11 PGD (liberal scoring rule), probable ICD‐11 PGD (conservative scoring rule), and probable DSM‐5‐TR PGD were ≥67, ≥75, and ≥68, respectively.
Discussion
The Chinese TGI‐SR+ appears to be a reliable and valid measure to assess prolonged grief symptoms per ICD‐11 and DSM‐5‐TR among Chinese bereaved adults.
... According to ICD-11 this is after around 6 months whereas according to DSM-5-TR it is only after 12 months. The rationale for this requirement in ICD-11 was derived from the largest longitudinal study available at the time, 5 whereas the DSM-5-TR adopted a more conservative approach that allowed for some cultural expectations of a 12-month mourning period. The ICD-11 requires at least one core feature, consisting of either persistent and pervasive yearning for or preoccupation with the dead person accompanied by signs of emotional pain. ...
The release of ICD-11 has resulted in an expansion of diagnostic entities for trauma- and stress-related disorders. This resulted, at least temporarily, in discrepancies with the DSM-5. This situation is outlined and a look is taken at the potential diagnosis of ‘continuous traumatic stress reaction’.
... People who grieve May develop a form of excessive and prolonged grief-referred to as complicated grief (CG)-that interferes with daily activities (Mason and Duffy, 2018). This condition is also known as persistent complex bereavement disorder and is mentioned in the Diagnostic and Statistical Manual of Mental Disorders (Lichtenthal et al., 2004;Prigerson et al., 2009;Shear et al., 2011;American Psychiatric Association, 2013). CG is characterized by such symptoms as longing for the deceased, intense grief, preoccupation with the circumstances of death, recurring intrusive thoughts of death, disbelief, avoidance of memories of the deceased and a sense of life's meaninglessness. ...
... Some studies suggest that CG has a negative impact on physical health and chronic conditions (Prigerson et al., 1997;Kristensen et al., 2015;Dell'Osso et al., 2011). In particular, Prigerson et al. (2009) have proposed an association between CG symptoms and the risk of developing heart problems. In support of this relationship, Pini et al. (2015) noted that a large percentage (79.2%) of individuals who experienced an acute MI (ACS-acute coronary syndrome), with no prior history of previous CHD, had suffered from the loss of a loved one and showed symptoms of persistent and CG (Pini et al., 2015). ...
Objectives
Cardiovascular diseases (CVDs) are a leading cause of death worldwide, emerging from a combination of several factors. The aim of this review is to define the psychological factors that are significant in the development and progression of these disorders.
Methods
Studies published through 2023 concerning adults with psychological vulnerability factors and/or cardiovascular disease were selected through searches of PubMed, PsychINFO, Science Direct, and Google Scholar.
Results
Psychological stress may influence CVD, in combination with other risk factors, or it can act independently, as in cases of workplace stress, post-traumatic stress disorder, Takotsubo syndrome and bereavement. Coping strategies, anxiety and depression have also been identified as relevant psychological factors in cardiac patients. Adverse childhood experiences are linked to a reduced quality of life and have been identified as significant risk factors for the development of acquired CVDs.
Conclusion
This review demonstrates that several psychological factors affect cardiovascular function. An in-depth study of the psychological correlates of CVDs would allow healthcare professionals to design more effective prevention and intervention programs.
... PGD symptoms: the prolonged grief-13 scale Symptoms were measured using the Prolonged Grief-13 (PG-13) 3 . The PG-13 is a 13-item scale designed to measure the severity and frequency of PGD symptoms based on the DSM-5-TR 7 diagnostic criteria, such as yearning for the deceased, shock, numbness, intense sadness, difficulty accepting the loss, avoidance of reminders of the loss, difficulty engaging in life, difficulty finding meaning and purpose, and identity disturbance. ...
Having a traumatic or negative event at the centre of one’s identity is associated with adverse psychological outcomes including post-traumatic stress, depression, and prolonged grief disorder (PGD). However, direct investigation of the role of centrality of a bereavement-event in the maintenance of PGD symptoms is scarce and has not compared immediate and long-term changes in event centrality nor examined the nature of the loss. Data from bereaved partners and adult children in The Aarhus Bereavement Study at four time points over 26 months post-loss were included in this study. Participants completed a PGD symptom measure and the Centrality of Events Scale (CES) on each occasion. Results suggest that bereaved partners had higher PGD and CES scores than bereaved adult children at all four post-bereavement time points. Regardless of relationship type, maintaining higher CES scores over time predicted PGD symptoms, over and above initial symptoms. Our findings suggest a risk factor for maintaining PGD symptoms is the continued centrality of the bereavement to ones’ life story and autobiographical memory. This finding links the mechanisms for maintaining PGD symptoms to those involved in other disorders such as post-traumatic stress, with implications for theoretical models of prolonged grief as well as treatment.
... QODD was assessed at 1 month post-loss. Surrogates' grief-related psychologic distress (including anxiety symptoms) and perceived social support were assessed by phone interviews at 1, 3, 6, 13, 18, and 24 months post-loss to comply with the greater than or equal to 1 month duration criterion for PTSD (33) and to avoid measuring the anniversary effect. ...
... Loss of the long-lasting, more intimate spousal relationship than other relationships may bring family surrogates painful grief reactions of yearning, longing for and/or a persistent preoccupation with www.ccmjournal.org XXX 2024 • Volume 52 • Number 12 thoughts and memories of the deceased; marked sense of disbelief; difficulties with acceptance; and angercharacterized as PG symptoms (33). In addition, we found PGD-dominant state membership declined over time consistent with reports that less time since loss brought increased membership in the PGD class (22,25,26) or the high-PGD moderatedepression/PTSD class (21), despite no significant difference in time since loss across classes reported in prior studies (19,24). ...
Objectives
Scarce research explores factors of concurrent psychologic distress (prolonged grief disorder [PGD], post-traumatic stress disorder [PTSD], and depression). This study models surrogates’ longitudinal, heterogenous grief-related reactions and multidimensional risk factors drawing from the integrative framework of predictors for bereavement outcomes (intrapersonal, interpersonal, bereavement-related, and death-circumstance factors), emphasizing clinical modifiability.
Design
Prospective cohort study.
Setting
Medical ICUs of two Taiwanese medical centers.
Subjects
Two hundred eighty-eight family surrogates.
Interventions
None.
Measurements and Main Results
Factors associated with four previously identified PGD-PTSD-depressive-symptom states (resilient, subthreshold depression-dominant, PGD-dominant, and PGD-PTSD-depression concurrent) were examined by multinomial logistic regression modeling (resilient state as reference). Intrapersonal: Prior use of mood medications correlated with the subthreshold depression-dominant state. Financial hardship and emergency department visits correlated with the PGD-PTSD-depression concurrent state. Higher anxiety symptoms correlated with the three more profound psychologic-distress states (adjusted odds ratio [95% CI] = 1.781 [1.562–2.031] to 2.768 [2.288–3.347]). Interpersonal: Better perceived social support was associated with the subthreshold depression-dominant state. Bereavement-related: Spousal loss correlated with the PGD-dominant state. Death circumstances: Provision of palliative care (8.750 [1.603–47.768]) was associated with the PGD-PTSD-depression concurrent state. Surrogate-perceived quality of patient dying and death as poor-to-uncertain (4.063 [1.531–10.784]) correlated with the subthreshold depression-dominant state, poor-to-uncertain (12.833 [1.231–133.775]), and worst (12.820 [1.806–91.013]) correlated with the PGD-PTSD-depression concurrent state. Modifiable social-worker involvement (0.004 [0.001–0.097]) and a do-not-resuscitate order issued before death (0.177 [0.032–0.978]) were negatively associated with the PGD-PTSD-depression concurrent and the subthreshold depression-dominant state, respectively. Apparent unmodifiable buffering factors included surrogates’ higher educational attainment, married status, and longer time since loss.
Conclusions
Surrogates’ concurrent bereavement distress was positively associated with clinically modifiable factors: poor quality dying and death, higher surrogate anxiety, and palliative care—commonly provided late in the terminal-illness trajectory worldwide. Social-worker involvement and a do-not-resuscitate order appeared to mitigate risk.
