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Cited by 395Grief, Bereavement, and Mental HealthDeath, Funerary Practices, and MourningPosttraumatic Stress Disorder Research

The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis

Open access
Djelantik, A.A.A. Manik J., Smid, Geert E., Mroz, Anna, Kleber, Rolf J., Boelen, Paul A.·2020·Journal of Affective Disorders
DOI 10.1016/j.jad.2020.01.034
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Abstract

BACKGROUND Previous research has indicated that one out of ten naturally bereaved individuals develops prolonged grief disorder (PGD). Less is known about the prevalence of PGD following unnatural deaths, such as accidents, disasters, suicides, or homicides. The aim of this study was to compute the pooled prevalence of PGD and to determine possible causes of its varied estimates. METHODS A literature search was conducted in PsycINFO, Ovid Medline, PILOTS, Embase, Web of Science, and CINAHL. A meta-analysis using random effects models was performed to calculate the pooled prevalence rate of PGD. Multivariate meta-regression was used to explore heterogeneity among the studies. RESULTS Twenty-five articles met eligibility criteria. The random-effects pooled prevalence was 49%, 95% CI [33.6, 65.4]. Death of only child, violent killings and non-western study location were associated with a higher PGD prevalence. A longer time since loss and a loss in a natural disaster were associated with a lower PGD prevalence. LIMITATIONS These findings should be interpreted with caution, because of the heterogeneity in study methodology. CONCLUSIONS This first meta-analysis of PGD following unnatural losses indicated that nearly half of the bereaved adults experienced PGD. This illustrates the importance of assessing PGD in individuals affected by loss and trauma.

Integrity signals

Registry

Crossref · 10.1016/j.jad.2020.01.034

Cites

91 of 91 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

13 of 52 cited sources checked · 8 supported · 0 flagged · accuracy not yet measured

  • Interpretationown data

    The prevalence of PGD following unnatural loss is much higher than the earlier reported prevalence of 10% following non-violent loss.

    “This indicates a much higher prevalence of disturbed grief than the earlier reported prevalence of 10% by Lundorff et al. (2017), who investigated PGD in individuals bereaved due to non-violent death causes.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Lundorff et al. (2017) source
    • Rests on an assumption: All conceptualizations of disordered grief (PGD, PCBD, complicated grief) can be treated as equivalent for the purpose of estimating pooled prevalence.
  • Study design and conductcitation

    Risk of bias was assessed using a tool specifically developed for population-based prevalence studies.

    “To assess the included studies for possible risk of bias (RoB) and to rate the quality of evidence and study limitations, we used the risk of bias tool specifically developed for population-based prevalence studies (Hoy et al., 2012;Lundorff et al., 2017).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Hoy et al., 2012 source
    • cites Lundorff et al., 2017 source
  • Findingown data

    The meta-regression explained 56% of the between-study variance in PGD prevalence.

    “The meta-regression, shown in Table 3, explained 56% of the between study variance in PGD prevalence.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The meta-regression model itself was significant (Qm(10) = 34.6, p = .001).

    “The meta-regression model itself was significant (Q m (10) = 34.6,p = .001).”
    Quote in the paperSubstantial claim
  • Findingown data

    The random-effects pooled prevalence of PGD following unnatural loss was 49%, 95% CI [33.6, 65.4].

    “The random-effects pooled prevalence was 49%, 95% CI [33.6, 65.4].”
    • Also stated in: § 3.3. Meta-analysis · plain
      “The pooled prevalence rate of PGD was 49%, 95% CI [33.6, 65.4].”
    • Also stated in: § 4. Discussion · plain
      “A pooled prevalence of nearly 50% of individuals screening positive for PGD was found.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: All conceptualizations of disordered grief (PGD, PCBD, complicated grief) can be treated as equivalent for the purpose of estimating pooled prevalence.
  • Classified as probably not a substantial claim. 36
  • May combine two claims. 17

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Unnatural losses may cause more mental health difficulties because of the disruption of positive and self-evident assumptions about the world and due to more intrusive and negative memories.

    “Theoretically, unnatural losses may cause more mental health difficulties because of the disruption of positive and self-evident assumptions about the world (i.e., 'the world is a safe place') and due to more intrusive and negative memories.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Boelen et al., 2016 source

      The Introduction (page unavailable) says unnatural or violent losses carry elevated risks of disturbed grief, PTSD, and depression, and discusses maladaptive cognitions and negative beliefs about the world and safety as possible contributors. It does not say that more intrusive and negative memories explain the greater difficulties; the paper’s reported findings concern negative cognitions, not memories. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites Boelen et al., 2006 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    PGD appears uniquely responsive to grief-specific treatments compared with existing treatments for MDD and PTSD.

    “Furthermore, in comparison with existing treatments for MDD and PTSD, PGD appears uniquely responsive to grief-specific treatments (Shear et al., 2005;Zisook and Shear, 2009).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites Shear et al., 2005 source

      The Results report a higher response rate to complicated grief treatment than to interpersonal psychotherapy (51% versus 28%), which the paper identifies as an established treatment for depression. The paper did not compare the grief-specific treatment with an existing PTSD treatment, so it does not support that part of the comparison. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Zisook and Shear, 2009 source

      The “complicated Grief” section reports that targeted complicated grief treatment produced better outcomes than standard psychotherapy. It does not compare grief-specific treatment with existing PTSD treatments, and its discussion of antidepressants does not establish the claimed comparison with MDD treatments. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    One out of ten bereaved adults following a non-violent loss is at risk of developing prolonged grief disorder (PGD).

    “Previous research has indicated that one out of ten naturally bereaved individuals develops prolonged grief disorder (PGD).”
    • Also stated in: § 1. Introduction · plain
      “A recent meta-analysis by Lundorff et al. (2017) showed that one out of ten bereaved adults following a non-violent loss is at risk of developing PGD.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Lundorff et al. (2017) source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The core underlying characteristic of PGD is yearning for the deceased, whereas anxiousness and depressed mood are central to PTSD or MDD.

    “The core underlying characteristic of PGD is 'yearning for the deceased', whereas 'anxiousness' and 'depressed mood' are central to PTSD or MDD (Maercker and Znoj, 2010;Shear, 2015).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Maercker and Znoj, 2010 source

      Table 2 in “Communalities and differences of CGD and PTSD” identifies yearning as the core symptom group for complicated grief, supporting the PGD portion of the claim. It identifies intrusive symptoms—not anxiousness—as the core symptom group for PTSD, and the paper does not establish depressed mood as central to MDD. Page numbers are unavailable in our copy. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites Shear, 2015 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Interrater agreement was evaluated using Cohen's Kappa statistic.

    “Following both the title and abstract screening, as well as the fulltext screening, the interrater agreement was evaluated using Cohen's Kappa statistic, κ (McHugh, 2012).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites McHugh, 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    PGD has been included in ICD-11 with a time criterion of 6 months following bereavement.

    “Recently, PGD has been included in the International Classification of Diseases, 11th revision (ICD-11) (Killikelly and Maercker, 2017;Prigerson et al., 2009;World Health Organization, 2018) with a time criterium of 6 months following bereavement.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Killikelly and Maercker, 2017 source
    • cites Prigerson et al., 2009 source

      Phase 5: proposing criteria for PGD specifies that diagnosis should not be made until at least six months after the death. The Conclusion describes these as proposed criteria for ICD-11 and calls for PGD’s consideration for inclusion; this 2009 paper does not establish that PGD was later included in ICD-11. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites World Health Organization, 2018

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is an ongoing discussion about which criteria best describe the phenomenon of pathological grief.

    “There is also an ongoing discussion about which criteria best describe the phenomenon of pathological grief (Boelen et al., 2018;Cozza et al., 2019;Maciejewski et al., 2016;Mauro et al., 2017).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Boelen et al., 2018 source
    • cites Cozza et al., 2019 source
    • cites Maciejewski et al., 2016 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    According to Prigerson et al. (2009), the PGD diagnosis can be set after 6 months' post-bereavement.

    “According to Prigerson et al. (2009), the PGD diagnosis can be set after 6 months' post-bereavement.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Prigerson et al. (2009) source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Twenty-five articles met eligibility criteria for the meta-analysis.

    “Twenty-five articles met eligibility criteria.”
    • Also stated in: § 3.3. Meta-analysis · plain
      “In total, twenty-five articles with thirty prevalence estimates were included in the overall meta-analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    The mean age of the included samples ranged from 20 to 72 years.

    “The mean age of the included samples ranged from 20 (Morina et al., 2011) to 72 years (Kristensen et al., 2012a).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The included studies comprised a total of 4774 participants, of whom 2296 (48%) were identified as PGD cases.

    “These studies comprised a total of 4774 participants (range n = 10 to 803) of whom 2296 (48%) were identified as PGD cases.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Seventeen studies were performed in OECD membership countries and eight in non-OECD membership countries.

    “Seventeen studies were performed in OECD membership countries: six in North America (USA), four in Norway, one in the Netherlands, one in Belgium, one in Portugal, one in Korea, one in Japan, and two in Australia.Eight studies were performed in non-OECD membership countries: three in Kosovo, three in China, one in Cambodia, and one in Rwanda.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Suicide, intentional killing, and accidents were not significant predictors for PGD.

    “With regard to the nature of traumatic events, we found that suicide, intentional killing, and accidents were not significant predictors for PGD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the study participants, 68% was female.

    “Of the study participants 68% was female.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The mean time post-loss in the studies varied from less than 1 month to 30 years.

    “The mean time post-loss in the studies varied from less than 1 month (Mitchell et al., 2004) to 30 years (Stammel et al., 2013) (Table 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Two studies used self-constructed questionnaires based on criteria of PGD.

    “Two studies (Neria et al., 2007;Shear et al., 2006) used selfconstructed questionnaires based on criteria of PGD.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Neria et al., 2007 source
    • cites Shear et al., 2006 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The included studies assessed PGD using either the Prolonged Grief-13 (PG-13), the Inventory of Complicated Grief (ICG), or the Inventory of Complicated Grief-Revised (ICG-R).

    “The studies assessed PGD using either the Prolonged Grief-13 (PG-13), the Inventory of Complicated Grief (ICG) or the Inventory of Complicated Grief-Revised (ICG-R) (Tables 1 and 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous research has shown that losing a child is one of the most painful and stressful events that an adult can experience.

    “Previous research has clearly shown that the experience of losing a child is one of the most painful and stressful events that an adult can experience (Keesee et al., 2008;Rubin and Malkinson, 2001;Wijngaards-de Meij et al., 2005).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Keesee et al., 2008 source
    • cites Rubin and Malkinson, 2001 source
    • cites Wijngaards-de Meij et al., 2005 source

  • May combine two claims.

    Premisecitation

    Grief symptoms normally decrease over time, and most bereaved individuals eventually adjust to the loss and return to adaptive functioning.

    “This finding accords with previous research which showed that grief symptoms normally decrease over time, and that most bereaved individuals eventually adjust to the loss and thereby return to adaptive functioning (Bonanno, 2004;Kristensen et al., 2012b).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Bonanno, 2004 source
    • cites Kristensen et al., 2012b

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    During full-text screening, researchers disagreed on 18 (5%) papers yielding κ = 0.89 (p < .001), indicating almost perfect agreement.

    “During the full-text screening, the researchers disagreed on 18 (5%) papers yielding an interrater reliability of κ = 0.89 (p < .001),indicating almost perfect agreement.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing). May combine two claims.

    Premisecitation

    Several researchers argue that the 6-month time frame is too short and may lead to over-inclusion of the recently bereaved.

    “However, several other researchers argue that the 6month time frame is too short and may lead to over-inclusion of the recently bereaved (Rubin et al., 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Rubin et al., 2008 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All disagreements were discussed until both researchers agreed about inclusion or exclusion.

    “All disagreements were discussed until both researchers agreed about the in-or exclusion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Publication bias was examined using Egger's t statistics.

    “Therefore, to examine the publication bias, Egger's t statistics was used (Egger et al., 1997).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Egger et al., 1997 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Robustness of findings was tested with a permutation test in 1000 iterations.

    “Finally, we tested the robustness of our findings with a permutation test in 1000 iterations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Higgins and Thompson, 2004 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Persistent complex bereavement disorder (PCBD) in DSM-5 and complicated grief include time criteria of 12 and 6 months following bereavement, respectively.

    “Similar concepts with slightly different criteria are called persistent complex bereavement disorder (PCBD), included in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), (American Psychiatric Association, 2013) and complicated grief (Shear, 2015), and include time criteria of 12 and 6 months following bereavement, respectively.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites American Psychiatric Association, 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Shear, 2015 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    During title and abstract screening, researchers disagreed on 326 (9%) papers yielding κ = 0.64 (p < .001), indicating substantial agreement.

    “During the title and abstract screening, the researchers disagreed on 326 (9%) papers yielding an interrater reliability of κ = 0.64 (p < .001),indicating substantial agreement.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A meta-analysis of correlates of PGD following violent loss found significant effect sizes for comorbid psychopathology, suicidality, rumination, relationship with the deceased, exposure to earlier traumatic events, age, and prior history of counseling.

    “In one of the most recent reviews about correlates of PGD following a violent loss, a meta-analysis was conducted in which significant effect sizes were found with regard to the following correlates: comorbid psychopathology, suicidality, rumination, the relationship with the deceased, exposure to earlier traumatic events, age and prior history of counseling (Heeke et al., 2019).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Heeke et al., 2019

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Multicollinearity was assessed with an intercorrelation matrix before including predictors in the meta-regression analysis.

    “Therefore, before we included these predictors in the meta-regression analysis, we assessed the multicollinearity with an inter correlation matrix (Harrer et al., 2019).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Harrer et al., 2019 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    In the correlation matrix, no correlations of more than 0.8 were found and all predictors could be included in the meta-regression analysis.

    “In the correlation matrix we did not find correlations of more than 0.8 and all predictors could be included in the meta-regression analysis (Supplementary Materials C).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Eligibility of abstracts and full-text articles was independently reviewed by two reviewers (MD and AM).

    “Then, the eligibility of both the abstracts and full-text articles were independently reviewed by MD and AM using this software.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The protocol was registered in PROSPERO in January 2018 (registration number CRD42018084631).

    “The protocol was registered in PROSPERO -an international prospective register for review protocols -in January 2018 (registration number CRD42018084631).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Risk of bias was evaluated and double-checked independently by MD and AM.

    “The risk of bias was evaluated and double-checked independently by MD and AM.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Acceptance in the first year of loss predicted a more favorable grief trajectory across the second year.

    “In a prior study, we have found that acceptance in the first year of the loss predicted a more favorable grief trajectory across the second year (Djelantik et al., 2017a).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Djelantik et al., 2017a

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The meta-analysis was performed and reported in accordance with the PRISMA guidelines for systematic reviews and meta-analyses.

    “The meta-analysis was performed and reported in accordance with the PRISMA guidelines for systematic reviews and meta-analyses (Moher et al., 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moher et al., 2010 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    According to quality assessment, four studies scored low, twelve moderate, and nine high on Risk of Bias.

    “According to the quality assessment scores, four studies scored low (score = 9-10), twelve studies scored moderate (score = 7-8), and nine studies scored high (score = 6 or less), on Risk of Bias (See Supplementary Material B for the detailed scores for the RoB of each study).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Data extraction was performed and double-checked independently by MD and AM.

    “The data-extraction was performed and double-checked independently by MD and AM.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Only two studies included participants in the first year after loss, so PGD rates could not be compared between 0-6, 6-12, and more than 12 months after the loss.

    “In the present meta-analysis, only two studies included participants in the first year after loss (Mitchell et al., 2004;Tsutsui et al., 2014), therefore we were not able to compare PGD rates between 0-6, 6-12 and more than 12 months after the loss.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Death of only child was a strong predictor in the model but was not considered robust in the permutation test, most likely because it was assessed in only one included study.

    “Death of only child was a strong predictor for experiencing PGD in our model.However, this predictor was not considered robust in the permutation test, most likely because this predictor was only assessed in one included study (Xu et al., 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Xu et al., 2014

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    Bereaved parents who lost their only child, and bereaved individuals following violent killings such as suicide, accidents, homicide, and war-related deaths are most vulnerable for developing prolonged grief disorder.

    “Our results imply that bereaved parents who lost their only child, and bereaved individuals following violent killings such as suicide, accidents, homicide, and war-related deaths are most vulnerable for developing PGD.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The self-report questionnaires used in the included studies provide valid estimates of prolonged grief disorder prevalence.
    • Rests on an assumption: The pooled sample of included studies is representative of bereaved individuals following unnatural losses globally.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Other core symptoms of PGD include avoidance of reminders of the death, difficulties accepting the loss, and significant impairment of daily functioning.

    “Other core symptoms of PGD include 'avoidance of reminders of the death', 'difficulties accepting the loss', and 'significant impairment of daily functioning' (Boelen and Prigerson, 2007;Silverman et al., 2000).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Boelen and Prigerson, 2007 source
    • cites Silverman et al., 2000 source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The search syntax was aimed at finding studies with a reported prevalence for prolonged grief disorder and not at finding all possible correlates for prolonged grief disorder.

    “our search syntax was aimed to finding studies with a reported prevalence for PGD and not to finding all possible correlates for PGD.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The included studies had limitations at review level due to varying sample sizes, sets of criteria, and sampling bias.

    “Because of the limitations on review level due to varying sample sizes, sets of criteria and sampling bias in the included studies, future studies on the prevalence of PGD are highly recommended.”
    Quote in the paperSubstantial claim
42 of 42

  • The paper relies on this without support.

    All conceptualizations of disordered grief (PGD, PCBD, complicated grief) can be treated as equivalent for the purpose of estimating pooled prevalence.

    “For consistency, we will use the term PGD for all conceptualizations of disordered grief in this paper.”

  • The paper relies on this without support.

    The self-report questionnaires used in the included studies provide valid estimates of prolonged grief disorder prevalence.

    “in most included studies the prevalence rates were based on self-report questionnaires”
    “Scoring above a clinical cut-off of a self-report questionnaire should be recognized as an indication of disorder.”

  • The paper relies on this without support.

    The pooled sample of included studies is representative of bereaved individuals following unnatural losses globally.

    “Globally, approximately half of the bereaved individuals might develop symptoms which meet the diagnostic criteria for PGD following unnatural losses.”
    “Because of the limitations on review level due to varying sample sizes, sets of criteria and sampling bias in the included studies, future studies on the prevalence of PGD are highly recommended.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Approximately fifty per cent of people who experience the loss of a loved one due to unnatural causes subsequently suffered prolonged grief disorder, associated with increased morbidity.

    “Approximately fifty per cent of people who experience the loss of a loved one due to unnatural causes subsequently suffered prolonged grief disorder, associated with increased morbidity.”

    From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Djelantik et al., 2020

    The Abstract reports a pooled PGD prevalence of 49% (95% CI 33.6–65.4) following unnatural losses, supporting “approximately fifty per cent.” The Introduction describes PGD as associated with impaired daily functioning, but the paper does not establish the claim’s broader assertion of increased morbidity. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • PGD is characterized by an overwhelming, persistent sense of longing and concern for the deceased and significant emotional distress, together with impaired functionality.

    “This type of grief is characterized by an overwhelming, persistent sense of longing and concern for the deceased and significant emotional distress, together with impaired functionality (Djelantik, Smid, Mroz, Kleber, & Boelen, 2020;Lundorff, Holmgren, Zachariae, Farver-Vestergaard, & O՚Connor, 2017).”

    From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Djelantik et al., 2020

    The Introduction describes yearning for the deceased as PGD’s core characteristic and significant impairment of daily functioning as another core symptom; it also gives a six-month duration criterion. It does not explicitly describe concern or preoccupation with the deceased or significant emotional distress as defining features, so those parts of the cited description are not established by our copy. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • COVID-19 deaths are usually unexpected, which has led to higher levels of prolonged grief symptoms in mourners in various countries.

    “COVID-19 deaths are usually unexpected, which has led to higher levels of prolonged grief symptoms in mourners in various countries (Djelantik et al., 2020).”

    From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Djelantik et al., 2020

    The Introduction (page unavailable) says sudden and violent losses are among unnatural deaths and reports a greater risk of prolonged grief disorder after unnatural than non-violent losses. It does not establish that COVID-19 deaths are usually unexpected or that they have caused higher prolonged-grief symptoms among mourners in various countries; a search for COVID-19 and coronavirus found no such passage. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Approximately 10% of bereaved patients experience intense grief that persists longer than expected after a natural death, while 50% do so when death is due to unnatural causes.

    “Approximately 10% of a group of bereaved patients experience intense grief that persists longer than expected after a natural death, while 50% do so when death is due to unnatural causes.”

    From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Djelantik et al., 2020

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Full-text screening counts do not reconcile

    Major

    Of 375 full-text studies, excluding 85 would leave 290, not 32 considered for inclusion. The account does not explain the other 258 studies.

    Reported 32 · recomputed 290

  • Time-since-loss coefficient falls outside its confidence interval

    Major

    Table 3 reports a coefficient of −0.1, but its 95% confidence interval is −0.02 to 0.00. The estimate lies outside that interval, whose midpoint is −0.01.

    Reported -0.1 · recomputed -0.01

  • Egger-test confidence interval is inconsistent with its estimate

    Minor

    The stated confidence interval has a midpoint of −179.09, far from the reported intercept of −0.104. It is not a confidence interval centered on that estimate.

    Reported -0.104 · recomputed -179.09

  • An included study postdates the stated publication range

    Minor

    The paper says the included studies were published no later than December 2017, but its included-study table lists Yun et al. as published in 2018.

4 of 4

Cites

Flagged first, then by citations

1 of the 92 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Djelantik, A. A. A. M. J., Smid, G. E., Mroz, A., Kleber, R. J., & Boelen, P. A.
Affiliations
  • Utrecht University (NL)
  • Arq Psychotrauma Expert Group (NL)
Corresponding author
Djelantik, A.A.A. Manik J.
ORCID
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2020-03
Volume
265
Pages
146-156
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2020.01.034
OpenAlex
W3000501628
Cited by
395
References
92
Citations by year
2026: 54 · 2025: 67 · 2024: 115 · 2023: 56 · 2022: 49 · 2021: 37 · 2020: 15
FWCI
3.10
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • University of Humanistic Studies OAI Repository (submittedVersion)
  • Utrecht University Repository (Utrecht University) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
prolonged grief disorder, unnatural death, bereavement, prevalence, suicide, homicide, natural disasters, accidental death, only children, time since loss, trauma
MeSH terms
Adult, Bereavement, Child, Grief, Humans, Regression Analysis, Stress Disorders, Post-Traumatic, Suicide, Prevalence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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