Table 1.
Overview of ICD-11 diagnostic criteria for PGD and results of multiverse analyses of PGDICD-11.
| ICD-11 criteria for PGD | Study | Sample | Measure 1 | Results |
|---|---|---|---|---|
| A. At least one of the following: a persistent and pervasive longing for the deceased or a persistent and pervasive preoccupation with the deceased. |
Boelen and Lenferink (2) | 855 bereaved community members | ICG-R, SCL-90 depression scale |
Prevalence rate of PGDICD-11 and diagnostic agreement with PCBD, PGD2009, PGDICD-11 BD, CG, and PGDDSM-52, respectively, for various additional symptom thresholds: 1+ = 19.8%, κ = .66,.67,.98,.92,.93; 2+ = 18.1%, κ = .69,.73,.96,.89,.94; 3+ = 16.1%, κ = .75,.79,.89,.82,.89; 4+ = 13.4%, κ = .78,.82,.79,.72,.81; 5+ = 10.8%, κ = .83,.82,.67,.61,.72; 6+ = 7.8%, κ = .76,.76,.52,.47,.56; 7+ = 5.0%, κ = .59,.57,.36,.32,.39 Number of possible symptom combinations to meet PGDICD-11 caseness for various additional symptom thresholds: 1+ = 3069, 2+ = 3039, 3+ = 2904, 4+ = 2544, 5+ = 1914, 6+ = 1158, 7+ = 528 |
| B. Examples of intense emotional pain Accompanied by intense emotional pain e.g. sadness, guilt, anger, denial, blame; difficulty accepting the death; feeling one has lost a part of one’s self; an inability to experience positive mood; emotional numbness; difficulty in engaging with social or other activities. |
Boelen et al. (3) | 551 bereaved community members | ICG-R, SCL-90 depression scale | Prevalence rate of PGDICD-11 and diagnostic agreement with PCBD for various additional symptom thresholds: 1+ = 19.2%, κ = .51, 2+ = 17.6%, κ = .56; 3+ = 15.4%, κ = .62; 4+ = 11.1%, κ = .75; 5+ = 8.3%, κ = .84, 6+ = 5.3%, κ = .71 |
| Bonanno and Malgaroli (4) | 282 bereaved community members | “Structured clinical interview” | Prevalence rate of PGDICD-11 and diagnostic agreement with PCBD for various symptom thresholds: 1+ = 11.7%, percentage match = 36.4%, 3+ = 8.8%, percentage match = 48.0%; 5+ = 4.6%, percentage match = 76.9% | |
| C. Time and impairment Persisted for an abnormally long period of time (more than 6 months at a minimum): following the loss, clearly exceeding expected social, cultural or religious norms for the individual’s culture and context. |
Comtesse et al. (5) | 113 bereaved treatment-seekers | ICG, PG-13 |
Sensitivity and specificity values from ROC analysis of PGDICD-11 for various additional symptoms thresholds (interview-diagnosed PGD2009 as criterion standard): 1+ = 100% and 6%, 2+ = 100% and 9%, 3+ = 100% and 30%, 4+ = 98% and 56%, 5+ = 88% and 75%, 6+ = 82% and 92%, 7+ = 65% and 96%, 8+ = 37% and 100%, 9+ = 15% and 100%, 10+ = 7% and 100% Prevalence rate of PGDICD-11 and diagnostic agreement with PCBD for various additional symptom thresholds: 1+ = 69.1%, κ = .51; 6+ = 46.9%, κ = .77 |
| The disturbance causes significant impairment in personal, family, social, educational, occupational or other important areas of functioning. | Cozza et al. (6) | 1732 bereaved military family members | CGQ | Diagnostic agreement of PGDICD-11 with PCBD, PGD2009, and CG, respectively, for thresholds of one or two additional symptoms for all criteria-sets: κ for PGDICD-11 and PCBD = .90 or.87, κ for PGDICD-11 and PGD2009 = .89 or.86, κ for PGDICD-11 and CG = .93 or.89 |
| Mauro et al. (7) | 261 bereaved treatment-seekers | SCI-CG | Diagnostic agreement of PGDICD-11 with ICG cut-off ≥ 30 and clinician-rated CG and functional impairment for various additional symptom thresholds: 0+ = 95.8%, 1+ = 95.8%, 2+ = 95.0%, 3+ = 91.6%, 4+ = 86.2%, 5+ = 72.8%, 6+ = 45.2% (5+ and 6+ estimates fall in between PGD2009 rates of agreement: 59.0%) |
PGD, prolonged grief disorder; PGDICD-11, ICD-11 diagnostic criteria for PGD; PGDICD-11 BD, diagnostic criteria according to the ICD-11 beta draft [or a description see (2)]; PGD2009, diagnostic criteria for PGD according to Prigerson et al. (8); PCBD, DSM-5 diagnostic criteria for persistent complex bereavement disorder; CG, diagnostic criteria for complicated grief (9); CGQ, Complicated Grief Questionnaire; ICG, Inventory of Complicated Grief; ICG-R, Inventory of Complicated Grief Revised; PG-13, Interview for Prolonged Grief-13; SCI-CG, Structured Clinical Interview for Complicated Grief; SCL-90, Symptom-Checklist-90. 1 In all cited studies, items of the respective measure(s) were used to assess (approximations of) PGDICD-11 symptoms. Symptoms were regarded as present if judged as ‘present’ by an interviewer (4) or if an item was scored higher than a specific value (e.g., ≥ 4) on the respective scale(s) (e.g., five-point Likert scale). Each symptom score was dichotomously coded as “absent” (0) or “present” (1). PGDICD-11 caseness was then determined following the ICD-11 diagnostic rule. 2 PGDDSM-5 was interpreted here according to proposed guidelines [(10), i.e., three additional symptoms].