Time elapsed since loss or grief persistency? Prevalence and predictors of ICD-11 prolonged grief disorder using different applications of the duration criterion
Abstract
Background Prolonged grief disorder (PGD), included in the ICD-11, encompasses a six-month duration criterion, but whether this covers 'time since loss' or 'grief persistency' is unclear. The study estimated prevalence and predictors of probable ICD-11 PGD using different applications of the duration criterion.Methods A register-sampled cohort of bereaved spouses completed self-report questionnaires at two (T1, N=847), six (T2, N=777), and eleven months (T3, N=753) post-loss. The duration criterion was operationalized as single-point PGD (meeting criteria minimally six months post-loss; T2 or T3) and dual-point PGD (meeting criteria at two assessments separated by months; T1+T2 or T2+T3).Results Single-point PGD prevalence rates (~15-20%) were significantly higher than dual-point prevalence rates (~10%). While single assessments of PGD varied between T2 and T3, the dual-point prevalence rates did not significantly differ. Early probable grief caseness emerged as the strongest predictor for later PGD.Limitations Without a structured clinical interview, only probable cases of PGD were identified. Caseness relied on a diagnostic algorithm, created by mapping items from different self-report questionnaires. Time frames between assessments did not cover an entire six-month period.Conclusions Momentarily assessed, six-month PGD symptomatology may represent a fluctuating, but remitting grief process for some individuals. Further research could test whether multiple diagnostic indicators during the first year of bereavement improve the identification of genuinely prolonged grief reactions.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
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?
Participants were recruited from a large representative cohort.
“with participants recruited from a large representative cohort (Lundorff et al., 2021).”
From Group-based compassion-focused therapy for prolonged grief symptoms in adults – Results from a randomized controlled trial (2022) · cites this paper as Lundorff et al., 2021
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
The Measurement of Observer Agreement for Categorical Data
Landis, J. R., & Koch, G. G. (1977) · Biometrics · doi:10.2307/2529310 · Cited by 81,148 · see citing works
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2008.08.010 · Cited by 51,384 · see citing works
Closing the gap in a generation: health equity through action on the social determinants of health
Marmot, M. G., Friel, S., Bell, R., Houweling, T. A. J., & Taylor, S. A. J. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61690-6 · Cited by 8,238 · see citing works
Using Effect Size—or Why the P Value Is Not Enough
Sullivan, G. M., & Feinn, R. (2012) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-12-00156.1 · Cited by 5,553 · see citing works
THE DUAL PROCESS MODEL OF COPING WITH BEREAVEMENT: RATIONALE AND DESCRIPTION
Schut, M. S. (1999) · Death Studies · doi:10.1080/074811899201046 · Cited by 2,560 · see citing works
Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11
Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., Raphael, B., Marwit, S. J., Wortman, C., Neimeyer, R. A., et al. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000121 · Cited by 1,863 · see citing works
Psychometric properties of the PTSD checklist—civilian version
Ruggiero, K. J., Ben, K. D., Scotti, J. R., & Rabalais, A. E. (2003) · Journal of Traumatic Stress · doi:10.1023/a:1025714729117 · Cited by 1,227 · see citing works
Complicated grief and related bereavement issues for DSM-5
Shear, M. K., Simon, N. M., Wall, M. M., Zisook, S., Neimeyer, R. A., Duan, N., Reynolds, C. F., Lebowitz, B. D., Sung, S. C., Ghesquiere, A., et al. (2011) · Depression and Anxiety · doi:10.1002/da.20780 · Cited by 1,022 · see citing works
Self-citationPrevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis
Lundorff, M., Holmgren, H., Zachariae, R., Farver-Vestergaard, I., & O’Connor, M. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.01.030 · Cited by 876 · see citing works
Self-citationDiagnosis and classification of disorders specifically associated with stress: proposals for ICD-11
Maercker, A., Brewin, C. R., Bryant, R. A., Cloitre, M., van Ommeren, M., Jones, L. M., Humayan, A., Kagee, A., Llosa, A. E., Rousseau, C., et al. (2013) · World Psychiatry · doi:10.1002/wps.20057 · Cited by 762 · see citing works
Searching for the meaning of meaning: Grief therapy and the process of reconstruction
Neimeyer, R. A. (2000) · Death Studies · doi:10.1080/07481180050121480 · Cited by 591 · see citing works
Socioeconomic status and multimorbidity: a systematic review and meta‐analysis
Pathirana, T. I., & Jackson, C. A. (2018) · Australian and New Zealand Journal of Public Health · doi:10.1111/1753-6405.12762 · Cited by 475 · see citing works
Djelantik, A. A. A. M. J., Smid, G. E., Mroz, A., Kleber, R. J., & Boelen, P. A. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.034 · Cited by 395 · see citing works
The prevention and treatment of complicated grief: a meta-analysis
Wittouck, C., Van Autreve, S., De Jaegere, E., Portzky, G., & van Heeringen, K. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.09.005 · Cited by 361 · see citing works
Cost-Effectiveness of Interventions to Promote Physical Activity: A Modelling Study
Cobiac, L. J., Vos, T., & Barendregt, J. J. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000110 · Cited by 308 · see citing works
Maciejewski, P. K., Maercker, A., Boelen, P. A., & Prigerson, H. G. (2016) · World Psychiatry · doi:10.1002/wps.20348 · Cited by 298 · see citing works
The prevalence and characteristics of complicated grief in older adults
Newson, R. S., Boelen, P. A., Hek, K., Hofman, A., & Tiemeier, H. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.02.021 · Cited by 281 · see citing works
Nielsen, M. K., Neergaard, M. A., Jensen, A. B., Vedsted, P., Bro, F., & Guldin, M. (2016) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2016.09.013 · Cited by 225 · see citing works
Johannsen, M., Damholdt, M. F., Zachariae, R., Lundorff, M., Farver-Vestergaard, I., & O'Connor, M. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.04.065 · Cited by 214 · see citing works
Self-citationProlonged grief disorder for ICD-11: the primacy of clinical utility and international applicability
Killikelly, C., & Maercker, A. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1476441 · Cited by 187 · see citing works
The prevalence, comorbidity and risks of prolonged grief disorder among bereaved Chinese adults
He, L., Tang, S., Yu, W., Xu, W., Xie, Q., & Wang, J. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.05.022 · Cited by 153 · see citing works
Thomas, K., Hudson, P., Trauer, T., Remedios, C., & Clarke, D. (2014) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2013.05.022 · Cited by 147 · see citing works
Keeley, J. W., Reed, G. M., Roberts, M. C., Evans, S. C., Robles, R., Matsumoto, C., Brewin, C. R., Cloitre, M., Perkonigg, A., Rousseau, C., et al. (2016) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2015.09.002 · Cited by 134 · see citing works
Disturbed grief: prolonged grief disorder and persistent complex bereavement disorder
Boelen, P., & Smid, G. (2017) · British medical journal · doi:10.1136/bmj.j2016 · Cited by 131 · see citing works
Trajectories of grief: Comparing symptoms from the <i>DSM‐5</i> and ICD‐11 diagnoses
Bonanno, G. A., & Malgaroli, M. (2020) · Depression and Anxiety · doi:10.1002/da.22902 · Cited by 112 · see citing works
Are there gender differences in prolonged grief trajectories? A registry-sampled cohort study
Lundorff, M., Bonanno, G. A., Johannsen, M., & O'Connor, M. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.06.030 · Cited by 103 · see citing works
Self-citationEvaluation of the factor structure, prevalence, and validity of disturbed grief in DSM-5 and ICD-11
Boelen, P. A., Lenferink, L. I. M., Nickerson, A., & Smid, G. E. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.07.041 · Cited by 87 · see citing works
Comparison of six proposed diagnostic criteria sets for disturbed grief
Boelen, P. A., & Lenferink, L. I. M. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112786 · Cited by 83 · see citing works
Prolonged grief disorder: clinical utility of ICD-11 diagnostic guidelines
Mauro, C., Reynolds, C. F., Maercker, A. R. A., Skritskaya, N. A., Simon, N. M., Zisook, S., Lebowitz, B. D., Cozza, S. J., & Shear, M. K. (2018) · Psychological Medicine · doi:10.1017/s0033291718001563 · Cited by 80 · see citing works
Trajectories of prolonged grief one to six years after a natural disaster
Sveen, J., Johannesson, K. B., Cernvall, M., & Arnberg, F. K. (2018) · PLoS ONE · doi:10.1371/journal.pone.0209757 · Cited by 80 · see citing works
Smith, K. V., & Ehlers, A. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000438 · Cited by 73 · see citing works
The importance of harmonising diagnostic criteria sets for pathological grief
Lenferink, L. I. M., Boelen, P. A., Smid, G. E., & Paap, M. C. S. (2019) · The British Journal of Psychiatry · doi:10.1192/bjp.2019.240 · Cited by 72 · see citing works
Boelen, P. A., Lenferink, L. I. M., & Smid, G. E. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.01.006 · Cited by 71 · see citing works
Assessing prolonged grief disorder: A systematic review of assessment instruments.
Treml, J., Kaiser, J., Plexnies, A., & Kersting, A. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.05.049 · Cited by 66 · see citing works
Zordan, R., Bell, M. L., Price, M. A., Remedios, C., Lobb, E. A., Hall, C., & Hudson, P. (2019) · Palliative & Supportive Care · doi:10.1017/s1478951518001013 · Cited by 48 · see citing works
Killikelly, C., Lorenz, L., Bauer, S., Shamir, M. M., Ben‐Ezra, M., & Maercker, A. R. A. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.02.014 · Cited by 48 · see citing works
Let's be realistic: when grief counseling is effective and when it's not
Bonanno, G. A., & Lilienfeld, S. O. (2008) · Professional Psychology: Research and Practice · doi:10.1037/0735-7028.39.3.377 · Cited by 45 · see citing works
Cozza, S. J., Shear, M. K., Reynolds, C. F., Fisher, J. E., Zhou, J., Maercker, A., Simon, N., Mauro, C., Skritskaya, N., Zisook, S., et al. (2020) · Psychological Medicine · doi:10.1017/s0033291719000254 · Cited by 43 · see citing works
Determinants and Predictors of Grief Severity and Persistence: The Rotterdam Study
Milić, J., Muka, T., Ikram, M. A., Franco, O. H., & Tiemeier, H. W. (2017) · Journal of Aging and Health · doi:10.1177/0898264317720715 · Cited by 38 · see citing works
Prolonged grief: setting the research agenda
Rosner, R. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.27303 · Cited by 33 · see citing works
O’Connor, M., Lasgaard, M., Larsen, L. H., Johannsen, M., Lundorff, M., Farver-Vestergaard, I., & Boelen, P. A. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.01.056 · Cited by 30 · see citing works
Self-citationComteße, H., Vogel, A., Kersting, A., Rief, W., Steil, R., & Rosner, R. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1694348 · Cited by 30 · see citing works
Dietl, L., Wagner, B., & Fydrich, T. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.12.095 · Cited by 28 · see citing works
Eisma, M. C., & Lenferink, L. I. M. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1512249 · Cited by 16 · see citing works
Flagged first, then by citations
2 of the 47 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Komischke-Konnerup, K. B., Zachariae, R. H., Johannsen, M., Nielsen, L. D., & O’Connor, M. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100140 · Cited by 181 · see citing works
Self-citationRisk factors for prolonged grief symptoms: A systematic review and meta-analysis
Buur, C., Zachariae, R. H., Komischke-Konnerup, K. B., Marello, M. M., Schierff, L. H., & O’Connor, M. (2023) · Clinical Psychology Review · doi:10.1016/j.cpr.2023.102375 · Cited by 176 · see citing works
Self-citationPrevalence of prolonged grief disorder.
Rosner, R., Comtesse, H., Vogel, A., & Doering, B. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.03.058 · Cited by 149 · see citing works
Cross-national analysis of the prevalence of prolonged grief disorder
Comteße, H., Smid, G. E., Rummel, A.-M., Spreeuwenberg, P. M. M., Lundorff, M., & Dückers, M. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.01.094 · Cited by 71 · see citing works
Self-citationIt’s not who you lose, it’s who you are: Identity and symptom trajectory in prolonged grief
Harris, C. B., Brookman, R., & O’Connor, M. (2021) · Current Psychology · doi:10.1007/s12144-021-02343-w · Cited by 36 · see citing works
Self-citationShevlin, M. E., Redican, E., Hyland, P., Murphy, J., Karatzias, T., McBride, O., Bennett, K. M., Butter, S., Hartman, T. K., Vallières, F., et al. (2023) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-023-02469-1 · Cited by 39 · see citing works
Johannsen, M., Schlander, C., Farver-Vestergaard, I., Lundorff, M., Wellnitz, K. B., Komischke-Konnerup, K. B., & O'Connor, M. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114683 · Cited by 23 · see citing works
Self-citationOn the Classification and Reporting of Prolonged Grief: Assessment and Research Guidelines
Stroebe, M., Schut, H. A. W., & Eisma, M. C. (2024) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000389 · Cited by 25 · see citing works
Grief trajectories after loss in pregnancy and during the neonatal period
Mørk, S., Hvidtjørn, D., Möller, S., Henriksen, T. B., O’Connor, M., & Bonanno, G. A. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.10.052 · Cited by 25 · see citing works
Self-citationKomischke-Konnerup, K. B., Vang, M. L., Lundorff, M., Elklit, A., & O’Connor, M. (2023) · Journal of Psychopathology and Clinical Science · doi:10.1037/abn0000859 · Cited by 24 · see citing works
Self-citationLacasta, M., & Cruzado, J. A. (2023) · Palliative & Supportive Care · doi:10.1017/s147895152300010x · Cited by 11 · see citing works
Brodbeck, J., Jacinto, S., Gouveia, A., Mendonça, N., Madörin, S., Brandl, L., Schokking, L., Rodrigues, A. M., Gonçalves, J., Mooser, B., et al. (2022) · JMIR Research Protocols · doi:10.2196/37827 · Cited by 12 · see citing works
Redican, E., Hyland, P., Shevlin, M. E., Martsenkovskyi, D., Karatzias, T., & Ben‐Ezra, M. (2024) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13678 · Cited by 13 · see citing works
Vang, M. L., Prigerson, H. G., Elklit, A., Komischke-Konnerup, K. B., & O’Connor, M. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114937 · Cited by 13 · see citing works
Self-citationShevlin, M., Redican, E., Murphy, J., Hyland, P., & Karatzias, T. (2023) · Journal of Traumatic Stress · doi:10.1002/jts.22972 · Cited by 11 · see citing works
Bağcaz, A., & Kılıç, C. (2023) · Journal of Traumatic Stress · doi:10.1002/jts.22998 · Cited by 13 · see citing works
O’Connor, M., Vang, M. L., Bryant, R. A., Buur, C., Komischke-Konnerup, K. B., Frostholm, L., & Ladegaard, N. (2025) · European Journal of Psychotraumatology · doi:10.1080/20008066.2025.2511373 · Cited by 9 · see citing works
Self-citationA role for event centrality in prolonged grief disorder
Brookman, R., Harris, C. B., & O’Connor, M. (2024) · Scientific Reports · doi:10.1038/s41598-024-72754-9 · Cited by 8 · see citing works
Self-citationRedican, E., Vang, M. L., Komischke-Konnerup, K. B., Elklit, A., Shevlin, M. E., & O’Connor, M. (2023) · Death Studies · doi:10.1080/07481187.2023.2297061 · Cited by 8 · see citing works
Self-citationNafarieh, K., Krüger, S., Deutscher, K., Schreiter, S., Mundt, A. P., Jung, A., Fazel, S., Heinz, A., & Gutwinski, S. (2025) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-025-02046-4 · Cited by 4 · see citing works
Peak, A. M., Martin, L. A., Post, K. M., & Hua, W. (2024) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228241275195 · Cited by 4 · see citing works
Hughes, E. (2024) · Contributions to phenomenology · doi:10.1007/978-3-031-66264-5_7 · Cited by 4 · see citing works
Redican, E., Shevlin, M., Ben-Ezra, M., Karatzias, T., & Hyland, P. (2025) · Death Studies · doi:10.1080/07481187.2025.2468822 · Cited by 2 · see citing works
Thomsen, D. K., Bluck, S., Lundorff, M., & O’Connor, M. (2024) · Cognitive Therapy and Research · doi:10.1007/s10608-024-10541-6 · Cited by 2 · see citing works
Self-citationSymptoms of prolonged grief in chronic pain patients: Results of a cross-sectional study
Arévalo‐Martínez, A., Barbosa‐Torres, C., Sánchez, M. E. G.-B., Díaz‐Muñoz, C. L., & Manso, J. M. M. (2025) · Death Studies · doi:10.1080/07481187.2025.2487797 · Cited by 2 · see citing works
Mindfulness and Relaxation Interventions Reduce Depression, Negative Affect and Stress in Widow(er)s
Knowles, L. M., Kaplan, D. M., Flores, M. A., Friedman, S. E., & O'Connor, M. (2025) · Journal of Loss and Trauma · doi:10.1080/15325024.2025.2504951 · Cited by 2 · see citing works
Self-citationLudwikowska-Świeboda, K. (2022) · Kwartalnik Naukowy Fides et Ratio · doi:10.34766/fetr.v49i1.1049 · Cited by 2 · see citing works
Bereavement versus health loss: the relationship of loss type with psychological growth
Şen, D. T., Bağcaz, A., & Koçak, O. M. (2025) · Psychology Health & Medicine · doi:10.1080/13548506.2025.2460335 · Cited by 1 · see citing works
Carmellini, P., Cuomo, A., Cartocci, A., Cevenini, G., & Fagiolini, A. M. (2025) · International Journal of Social Psychiatry · doi:10.1177/00207640251339508 · Cited by 1 · see citing works
Relationship Between Emotional Intelligence, Personality, and grief in Bereaved Mothers
Monteiro, A. P., & Miguel, F. K. (2025) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228251371768 · Cited by 1 · see citing works
Development and validation of a brief Aarhus Prolonged Grief Disorder Scale
Redican, E., Vang, M. L., & O’Connor, M. (2025) · Death Studies · doi:10.1080/07481187.2025.2572746
Self-citationProlonged grief among Turkish migrants in Germany: prevalence and the role of migratory grief
Schmidt, V., Linde, K., Renner, A., Siegel, P. M., & Kersting, A. (2026) · European Journal of Psychotraumatology · doi:10.1080/20008066.2026.2627054
Spezifisch Belastungs-assoziierte Störungen
Kapfhammer, H., Eberle, D. J., & Maercker, A. (2026) · Springer Reference Medizin · doi:10.1007/978-3-642-45028-0_71-2
Grief reactions the first year after termination of pregnancy due to fetal anomaly
Eklund, M. V., O’Connor, M., Hammer, A., Prinds, C., Möller, S., & Hvidtjørn, D. (2026) · Death Studies · doi:10.1080/07481187.2026.2676995
Self-citationTanguay-Sela, M., Thérond, A., & Brillon, P. (2026) · Homicide Studies · doi:10.1177/10887679261462121
- Authors
- Lundorff, M., Johannsen, M., & O'Connor, M.
- Affiliations
- Aarhus University (DK)
- Corresponding author
- Lundorff, Marie
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 279
- Pages
- 89-97
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W3089643208
- Cited by
- 35
- References
- 47
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 7 · 2023: 8 · 2022: 4 · 2021: 3
- FWCI
- 1.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Aarhus Universitets Forskningsfond (AUFF - E - 2015 - FLS - 8 - 63)
- 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, ICD-11, bereavement, time since loss, prevalence, predictive factors, bereaved spouses, diagnostic algorithm, self-report questionnaire
- MeSH terms
- Bereavement, Grief, Humans, Prevalence, Spouses, International Classification of Diseases
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.
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 ›
Are you an author, or do you see a problem with this page? Request a review
