Optimizing the clinical utility of four proposed criteria for a persistent and impairing grief disorder by emphasizing core, rather than associated symptoms
Open accessAbstract
BACKGROUND: Distinguishing a disorder of persistent and impairing grief from normative grief allows clinicians to identify this often undetected and disabling condition. As four diagnostic criteria sets for a grief disorder have been proposed, their similarities and differences need to be elucidated. METHODS: Participants were family members bereaved by US military service death (N = 1732). We conducted analyses to assess the accuracy of each criteria set in identifying threshold cases (participants who endorsed baseline Inventory of Complicated Grief ⩾30 and Work and Social Adjustment Scale ⩾20) and excluding those below this threshold. We also calculated agreement among criteria sets by varying numbers of required associated symptoms. RESULTS: All four criteria sets accurately excluded participants below our identified clinical threshold (i.e. correctly excluding 86-96% of those subthreshold), but they varied in identification of threshold cases (i.e. correctly identifying 47-82%). When the number of associated symptoms was held constant, criteria sets performed similarly. Accurate case identification was optimized when one or two associated symptoms were required. When employing optimized symptom numbers, pairwise agreements among criteria became correspondingly 'very good' (κ = 0.86-0.96). CONCLUSIONS: The four proposed criteria sets describe a similar condition of persistent and impairing grief, but differ primarily in criteria restrictiveness. Diagnostic guidance for prolonged grief disorder in International Classification of Diseases, 11th Edition (ICD-11) functions well, whereas the criteria put forth in Section III of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are unnecessarily restrictive.
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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).”
From The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis (2020) · cites this paper as Cozza et al., 2019
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- Authors
- Cozza, S. J., Shear, M. K., Reynolds, C. F., Fisher, J. E., Zhou, J., Maercker, A., Simon, N., Mauro, C., Skritskaya, N., Zisook, S., Lebowitz, B., Bloom, C. G., Fullerton, C. S., & Ursano, R. J.
- Affiliations
- Uniformed Services University of the Health Sciences (US)
- Columbia University (US)
- University of Pittsburgh (US)
- New York University (US)
- University of California San Diego (US)
- Corresponding author
- Cozza, Stephen J.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2019-03-04
- Volume
- 50
- Issue
- 3
- Pages
- 438-445
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC7025160
- OpenAlex
- W2919191908
- Cited by
- 43
- References
- 29
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 9 · 2023: 2 · 2022: 4 · 2021: 8 · 2020: 13 · 2019: 2
- FWCI
- 7.88
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich)
- 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, complicated grief, diagnostic criteria, bereavement, Inventory of Complicated Grief, Work and Social Adjustment Scale, ICD-11, DSM-5, diagnostic accuracy, associated symptoms, case finding
- MeSH terms
- Adult, Death, Family, Female, Grief, Humans, Male, Middle Aged, Military Personnel, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders
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