Supplementary Material for: Towards centrality evaluation of yearning symptoms for Prolonged Grief Disorder: a cross-cultural approach

Background: The new ICD-11 diagnosis of Prolonged Grief Disorder (PGD) is characterized by the prominent role of yearning as hallmark symptom. A secondary analysis of eight international datasets on PGD was conducted to evaluate this assumption. Additionally, cross-cultural comparison explored whether the centrality of yearning differs across world regions.
Methods: Primary studies originated from German-speaking countries (n = 4 samples), other European countries and Israel (n = 3 samples), as well as China (n = 1 samples). Different PGD measures were used, including yearning and longing as symptoms. For the centrality assessment of yearning, PGD symptoms were ranked by their factor loadings from confirma-tory factor analyses (CFA), followed by statistical testing to determine significant differences between yearning and other symptoms of PGD in their factor loading estimates. Subsequently, ranking positions of yearning in three world regions (German-speaking, Other Europe-Israel, and China) were compared. Finally, proxy thresholds for individuals at high-risk states for PGD were defined for the different datasets, and sensitivity-specificity analyses of yearn-ing were performed.
Results: Yearning was ranked high in five out of 12 models tested. In the German-speaking region, it was predominantly ranked among the most central symptoms; in the Other Europe-Israel region as well as China it tended to fall into the middle or lower rankings of symptom cen-trality. Sensitivity values were consistently high, while specificity values indicated moderate levels.
Discussion: In line with previous research on the general outcomes of grief, the present study showed that yearning may be subject to a culture-specific distribution. Other central symptoms such as feeling as if a part of oneself died have also been shown to potentially play a central role in PGD across world regions. On the other hand, the sensitivity-specificity analyses revealed that yearning can be considered a significant (diagnostically highly sensi-tive) symptom for individuals in high-risk states for PGD, although it has only moderate spec-ificity (i.e., its absence does not necessarily indicate individuals experiencing normative grief). Nonetheless, a culture-sensitive approach to psychopathology should consider the cul-tural differences in the centrality of this symptom group. More research is needed to better understand the role of yearning and its determinants across world regions.