DSM-5-TR prolonged grief disorder and DSM-5 posttraumatic stress disorder are related, yet distinct: confirmatory factor analyses in traumatically bereaved people

Background: Prolonged grief disorder (PGD) is newly included in the text revision of the DSM-5 (DSM-5-TR). So far, it is unknown if DSM-5-TR PGD is distinguishable from bereavement-related posttraumatic stress disorder (PTSD). Prior research examining the distinctiveness of PTSD and pathological grief focused on non-traumatic loss samples, used outdated conceptualizations of grief disorders, and has provided mixed results. Objective: In a large sample of traumatically bereaved people, we first evaluated the factor structure of PTSD and PGD separately and then evaluated the factor structure when combining PTSD and PGD symptoms to examine the distinctiveness between the two syndromes. Methods: Self-reported data were used from 468 people bereaved due to the MH17 plane disaster (N = 200) or a traffic accident (N = 268). The 10 DSM-5-TR PGD symptoms were assessed with the Traumatic Grief Inventory-Self Report Plus (TGI-SR+). The 20-item Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) was used to tap PTSD symptoms. Confirmatory factor analyses were conducted. Results: For PTSD, a seven factor, so-called ‘Hybrid’ model yielded the best fit. For PGD, a univariate factor model fits the data well. A combined model with PGD items loading on one factor and PTSD items on seven factors (associations between PGD and PTSD subscales r ≥ .50 and ≤.71), plus a higher-order factor (i.e. PTSD factors on a higher-order PTSD factor) (association between higher-order PTSD factor and PGD factor r = .82) exhibited a better fit than a model with all PGD and PTSD symptom loading on a single factor or two factors (i.e. one for PGD and one for PTSD). Conclusions: This is the first study examining the factor structure of DSM-5-TR PGD and DSM-5 PTSD in people confronted with a traumatic loss. The findings provide support that PGD constitutes a syndrome distinguishable from, yet related with, PTSD. This is the first factor analytic study on PGD and PTSD after traumatic loss.PTSD and PGD factors are related, but distinguishable.DSM-5-TR PGD is distinct from DSM-5 PTSD. This is the first factor analytic study on PGD and PTSD after traumatic loss. PTSD and PGD factors are related, but distinguishable. DSM-5-TR PGD is distinct from DSM-5 PTSD.

背景：长期的悲伤障碍（PGD）已被纳入DSM-5-TR（DSM-5文本修订版）的修订文本中。截至目前，DSM-5-TR中的PGD是否可以与悲伤相关创伤后应激障碍（PTSD）相区分尚不得而知。先前研究在探讨PTSD与病理性悲伤的独特性时，聚焦于非创伤性丧失样本，采用了过时的悲伤障碍概念化方法，并得出了混杂的结果。目标：在一组因MH17航班灾难（N=200）或交通事故（N=268）而遭遇创伤性丧失的大规模样本中，我们首先分别评估了PTSD和PGD的因素结构，然后评估了结合PTSD和PGD症状时的因素结构，以检验两种综合征之间的差异性。方法：使用来自468名因MH17航班灾难或交通事故而丧亲的人的自我报告数据。使用创伤性悲伤清单-自我报告版（TGI-SR+）对10项DSM-5-TR PGD症状进行了评估。使用20项DSM-5 PTSD清单（PCL-5）来捕捉PTSD症状。进行了确认性因素分析。结果：对于PTSD，一个包含七个因子的所谓‘混合’模型提供了最佳拟合。对于PGD，一个单变量因素模型与数据拟合良好。一个结合模型，其中PGD项目负荷在一个因子上，而PTSD项目负荷在七个因子上（PGD与PTSD子量表之间的相关系数r≥.50且≤.71），加上一个更高阶的因素（即PTSD因子在更高阶的PTSD因子上）（更高阶PTSD因子与PGD因子之间的相关系数r=.82），比所有PGD和PTSD症状均负荷在一个因子或两个因子（即一个用于PGD，一个用于PTSD）上的模型具有更好的拟合度。结论：这是首次研究在遭遇创伤性丧失的人群中DSM-5-TR PGD和DSM-5 PTSD的因素结构。研究结果为PGD构成一种与PTSD相区别但又与其相关的综合征提供了支持。这是首次在创伤性丧失后对PGD和PTSD进行的因素分析研究。PTSD和PGD因子相互关联，但可以区分。DSM-5-TR PGD与DSM-5 PTSD不同。这是首次在创伤性丧失后对PGD和PTSD进行的因素分析研究。PTSD和PGD因子相互关联，但可以区分。DSM-5-TR PGD与DSM-5 PTSD不同。