and Social sciences psychology health amp technology 1 New tools to assess DSM5TR and ICD11 prolonged grief disorder in research and practice Research in about 1000 bereaved people ID: 1044488
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1. Behavioural, Management and Social sciences/psychology, health & technology1New tools to assess DSM-5-TR and ICD-11 prolonged grief disorder in research and practice: Research in about 1000 bereaved peopleLonneke I.M. LenferinkSeptember 2022
2. 2blablaHolly Prigerson199520092011Katharine Shear(Prolonged) grief
3. 3Implications of multiple “grief disorders”Not in main text16 symptoms12 months post-lossRelatively low prevalence rates37650 ways to meet criteriaMain text (narrative)12 symptoms6 months post-lossPrevalence rates > 2x higher than DSM-53096 ways to meet criteriaPersistent complex bereavement disorder Prolonged grief disorderBoelen, Lenferink, Nickerson, & Smid (2018). doi:10.1016/j.jad.2018.07.041Boelen, Lenferink, & Smid (2019). doi: 10.1016/j.psychres.2019.01.006Boelen, Spuij, & Lenferink (2019). doi: 10.1016/j.jad.2019.02.046Boelen. & Lenferink (2020). doi: 10.1016/j.psychres.2020.112786Main text 10 symptoms12 months post-lossPrevalence rates somewhat lower than ICD-11219 ways to meet criteria
4. 4Six grief disordersLenferink, Boelen, Smid, & Paap (2019). doi:10.1192/bjp.2019.240Brief symptom description1 Persistent yearning/longing for the deceased.2 Intense sorrow and emotional pain3 Preoccupation with the deceased4 Preoccupation with the circumstances of the death5 Marked difficulty accepting the death6 Experiencing disbelief/emotional numbness over the loss7 Difficulty with positive reminiscing about the deceased8 Bitterness or anger related to the loss9 Maladaptive appraisals about oneself (e.g., self-blame)10 Excessive avoidance of reminders of the loss11 A desire to die in order to be with the deceased12 Difficulty trusting other individuals since the death13 Feeling alone or detached from others14 Feeling that life is meaningless or empty without deceased15 Confusion about one’s role in life (e.g., feeling that a part of oneself died)16 Difficulty to pursue interests or to plan for the future17 Guilt18 Denial19 Blame20 An inability to experience positive mood21 Feeling stunned, dazed or shocked by the loss22 Feeling envious of others who have not experienced a loss23 Frequently experiencing pain or other symptoms that the deceased person had, or hearing the voice or seeing the deceased person24 Experiencing intense emotional or physiological reactivity to memories of the person who died or to reminders of the loss25 Change in behavior due to excessive proximity seeking (e.g., doing things that are reminders of the loss)Eisma, Janshen, & Lenferink (2022). doi:10.1080/20008198.2021.2011691
5. 5Freely available in 15 languages from: https://osf.io/rqn5k/African French, Canadian French, Chinese, Dutch, English, German, Greek, Italian, Norwegian, Persian, Russian, Spanish, Swedish, Turkish, Ukrainian, Traumatic Grief Inventory-Self Report plusTGI-SR+
6. 6Validation of Dutch TGI-SR+Index of validityBereaved community sample (N = 278)Bereaved by traffic accident (N = 270)Factor structure1 factor for DSM-5-TR and ICD-111 factor for DSM-5-TR and ICD-11Internal consistencygoodgoodTemporal stabilityStrong associations at 6 monthsNot assessedConvergent validityStrong associations with depressionStrong associations with depression and PTSDKnown-groups validityGroup-differences for educational level, time since loss and kinship to the deceasedGroup-differences for educational level, time since loss and kinship to the deceasedProbable casenessDSM-5-TR: 25%ICD-11: 34% / 27%DSM-5-TR: 30%ICD-11: 33% / 24%Optimal cut-off≥71Lenferink et al. (2022). doi: 10.1016/j.comppsych.2021.152281
7. 7Freely available in Dutch, English, and German from: https://osf.io/a6hmc/?view_only=Traumatic Grief Inventory-Clinician AdministeredTGI-CA
8. 8Validation of Dutch and German TGI-CAIndex of validityDutch (N = 211) and German (N = 222) community sampleFactor structure1 factor for DSM-5-TR and ICD-11Internal consistencyGoodMeasurement invarianceSimilar factor structure across language, gender, education…and moreTemporal stabilityStrong associations at 12 monthsConvergent validityStrong associations with depression, PTSD, and functional impairmentKnown-groups validityGroup-differences for gender, time since loss and kinship to the deceasedProbable casenessDSM-5-TR: 5%ICD-11: 6%Pre-print available from
9. 9drs. Minita Franzendr. Carina Heekeprof. dr. Paul Boelenprof. dr. Christine Knaevelsruddr. Maarten Eismaprof. dr. Geert Smidprof. dr. Jos de Keijser
10. 10To concludeLonneke I.M. Lenferinkl.i.m.lenferink@utwente.nlFree access to all papers, see my Researchgate profileThe TGI-SR+ and TGI-CA seem to be reliable and valid tools for assessing PGD severity using DSM-5-TR and ICD-11 criteriaMore validation studies are needed in more diverse samplesCutoff score determination should be based on diagnostic interviewsValidation in multiple languages is on-goingTool for bereaved kids is underway
11. 11Table TGI-SR+ characteristics Sample 1: Community bereaved sampleSample 2: People who lost loved ones in a traffic accidentGender, N (%) Male23 (8)67 (25) Female255 (92)203 (75)Age, M (SD)52.70 (13.74)51.90 (12.93)Level of education, N (%) Lower than university124 (45)156 (58) University154 (55)114 (42)Cause of death, N (%) Natural cause (e.g., illness)208 (75) Suicide46 (17) Accident22 (8)270 (100) Homicide2 (1) Number of people that died due to a traffic accident, N (%)n.a. 1 248 (92) 2 17 (6) 3 2 (1) 4 3 (1)Deceased relative is my…, N (%) Partner/spouse124 (45)58 (22) Child36 (13)104 (39) Parent75 (27)37 (14) Sibling28 (10)46 (17) Other15 (5)25 (9)Time since loss in years, M (SD)2.73 (1.46)4.79 (6.06)
12. Dutch sample (n = 211)German sample (n = 222)Gender, N (%) Man40 (19.0)41 (18.5) Woman171 (81.0)181 (81.5) Other0 (0)(0)Age, M (SD)41.3 (16.7)44.8 (16.9)Level of education, N (%) Primary school2 (0.9)1 (0.5) High school51 (24.2)62 (27.9) Vocational education41 (19.4)60 (27.0) University117 (55.5)99 (44.6)Deceased relative is my… N (%) Partner/spouse64 (30.3)55 (24.8) Child16 (7.6)35 (15.8) Parent63 (29.9)67 (30.2) Sibling4 (1.9)12 (5.4) Grandparent39 (18.5)34 (15.3) Friend11 (5.2)8 (3.6) Other14 (6.6)11 (5.0)Time since loss in years, M (SD)5.28 (6.6)7.2 (9.3)Cause of death Natural cause165 (78.2)169 (76.1)Expectedness of death…, M (SD)3.1 (1.6)3.2 (1.7)Number of losses 1125 (59.2)73 (33.0) 244 (20.9)53 (24.00) 328 (13.3)48 (21.7) 411 (5.2)36 (16.3) 5 or more3 (1.4)11 (5.0)Table TGI-CA characteristics