International Prolonged Grief Disorder S

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International Prolonged Grief Disorder Scale (IPGDS)

Killikelly, Stelzer, Zhou and Maercker (2019 in preparation)

The WHO ICD-11 Working Group on Disorders specifically associated with stress developed clinical
guidelines for the prolonged grief disorder (PGD) (Maercker et al. 2013). These guidelines are
structured following the remit of the new ICD-11 to provide: a narrative definition, to include cultural
features, to provide core symptoms and be easy to use in the clinical setting (Reed 2010).

The IPGDS seeks to operationalize the ICD-11 definition of PGD in a self-report questionnaire
format. The ICD-11 PGD definition is structured to have two core symptoms (item 1, item 2) and
examples of emotional pain (accessory items 3-12). Item 13 indicates functional impairment and item
14 indicates cultural norms. The core and accessory symptoms are represented questions from
previous measures (i.e. the integration of items from the PG-13 (Prigerson et al. 2008) and the SCI-
CG (Bui et al. 2015). A new question on culture norms of bereavement is also included.
The threshold for clinical diagnosis of PGD is currently under investigation.

As an exploratory step this draft of the scale pilots the introduction of the cultural supplement (page
3). These cultural supplement items provide further examples of emotional pain that may be more
acceptable or representative of grief in different cultural groups. Following the best practice of scale
development (Boateng et al. 2018) and guidelines for the development of culturally sensitive
measures (Bolton 2008) these items are based on key informant interviews with grief and
bereavement professionals from Switzerland and China. Additional supplementary items are currently
in development.
Guidelines on how to score the cultural supplement items and how to integrate the cultural items into
the standard scale are pending.

Here are draft guidelines:

Scoring key (in development)


STANDARD SCALE
Below you will find instructions on how to score items in order to:
1. obtain a global score for grief severity: Create a summed score over items 1 - 13. The higher the
value, the more severe the grief.
2. distinguish individuals with Prolonged Grief Disorder (PGD) from those without:
Core symptoms:
At least one of items 1 or 2 must be endorsed with often (4) or always (5).
Accessory symptoms:
Provisory Regulation: At least one of items 3-12 must be endorsed with often (4) or always (5).
Functional impairment criterion:
Item 13 must be endorsed with often (4) or always (5).
Culture criterion:
Item 14 must be endorsed with often (4) or always (5).

Criteria Description:
Items 1-2: Core symptoms
Items 3-12: Accessory symptoms
Item 13: Functional impairment criterion
Item 14: Culture criterion
Item 15: Time criterion
Boateng, Godfred O, Torsten B Neilands, Edward A Frongillo, Hugo R Melgar-Quiñonez,
and Sera L Young 2018 Best Practices for Developing and Validating Scales for Health,
Social, and Behavioral Research: A Primer. Frontiers in public health 6: 149. Retrieved.
September 25, 2019. from http://www.ncbi.nlm.nih.gov/pubmed/29942800.
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OF CROSS-CULTURAL HIV-RELATED MENTAL HEALTH AND
PSYCHOSOCIAL ASSISTANCE PROGRAMS: A USER’S MANUAL FOR
RESEARCHERS AND PROGRAM IMPLEMENTERS (ADULT VERSION).
Retrieved. August 27, 2018. from https://www.jhsph.edu/research/centers-and-
institutes/research-to-prevention/dime-manual/DIME-MODULE-1.pdf.
Bui, Eric, Christine Mauro, Donald J. Robinaugh, Natalia A. Skritskaya, Yuanjia J Wang,
Colleen Gribbin, Angela Ghesquiere, et al. 2015 The Structured Clinical Interview for
Complicated Grief: Reliability, Validity, and Exploratory Factor Analysis. Depress
Anxiety 32(7): 485–492. Retrieved. April 5, 2017. from
http://doi.wiley.com/10.1002/da.22385.
Maercker, Andreas, Chris R. Brewin, Richard A. Bryant, Marylene Cloitre, Mark van
Ommeren, Lynne M. Jones, Asma Humayan, et al. 2013 Diagnosis and classification of
disorders specifically associated with stress: proposals for ICD-11. World Psychiatry
12(3): 198–206. Retrieved. January 11, 2017. from
http://doi.wiley.com/10.1002/wps.20057.
Prigerson, HG, Lauren C. Vanderwerker, and Paul K. Maciejewski 2008 A case for inclusion
of prolonged grief disorder in DSM-V. In Handbook of bereavement research and
practice: Advances in theory and intervention. MS Stroebe, RO Hansson, H Schut, and
W Stroebe, eds., pp. 165–186. Washington: American Psychological Association.
Retrieved. May 29, 2018. from http://content.apa.org/books/14498-008.
Reed, Geoffrey M. 2010 Toward ICD-11: Improving the clinical utility of WHO’s
International Classification of mental disorders. Professional Psychology: Research and
Practice 41(6): 457–464. Retrieved. April 10, 2017. from http://doi.apa.org/getdoi.cfm?
doi=10.1037/a0021701.

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