Journal
AMERICAN JOURNAL OF PSYCHIATRY
Volume 173, Issue 9, Pages 919-929Publisher
AMER PSYCHIATRIC PUBLISHING, INC
DOI: 10.1176/appi.ajp.2016.15111442
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Funding
- Department of Defense [W81XWH-11-2-0119, CDMRP W81XWH-15-2-0043]
- NIMH [R01MH60783]
- Guilford Press
- Tragedy Assistance Program for Survivors
- U.S. Army Survivor Outreach Services
- American Gold Star Mothers
- Gold Star Wives of America
- American Widow Project
- Travis Manion Foundation
- Snowball Express
- Military Families United
- Children of Fallen Patriots Foundation
- Honor and Remember
- Honoring Our Fallen
- Knights of Heroes Foundation
- Captain Scott Corwin Foundation
- National Military Family Association
- Military Child Education Coalition
- Compassionate Friends
- Suicide Awareness Voices of Education
- Alliance of Hope
- American Association of Suicidology
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Objective: The purpose of this article was to examine the accuracy of DSM-5 proposed criteria for persistent complex bereavement disorder in identifying putative cases of clinically impairing grief and in excluding non clinical cases. Performance of criteria sets for prolonged grief disorder and complicated grief were similarly assessed. Method: Participants were family members of U.S. military service members who died of any cause since September 11, 2001 (N=1,732). Putative clinical and nonclinical samples were derived from this community sample using cutoff scores from the Inventory of Complicated Grief and the Work and Social Adjustment Scale. Items from a self report grief measure (Complicated Grief Questionnaire) were matched to DSM-5 persistent complex bereavement disorder, prolonged grief disorder, and complicated grief criteria. Endorsed items were used to identify cases. Results: Criteria sets varied in their ability to identify clinical cases. DSM-5 persistent complex bereavement disorder criteria identified 53%, prolonged grief disorder criteria identified 59%, and complicated grief criteria identified more than 90% of putative clinical cases. All criteria sets accurately excluded virtually all nonclinical grief cases and accurately excluded depression in the absence of clinical grief. Conclusions: The DSM-5 persistent complex bereavement disorder criteria accurately exclude nonclinical, normative grief, but also exclude nearly half of clinical cases, whereas complicated grief criteria exclude nonclinical cases while identifying more than 90% of clinical cases. The authors conclude that significant modification is needed to improve case identification by DSM-5 persistent complex bereavement disorder diagnostic criteria. Complicated grief criteria are superior in accurately identifying clinically impairing grief.
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