An Investigation of the Clinical Utility of a Prolonged Grief Disorder Diagnosis

长期悲伤障碍诊断的临床实用性调查

基本信息

批准号：
8469668
负责人：
Wendy G. Lichtenthal
金额：
$ 28.39万
依托单位：
SLOAN-KETTERING INST CAN RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-07-01 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8469668
关键词：
Acute Adjustment Disorders Affect American American Psychiatric Association Antidepressive Agents Attitude Belief Bereavement Caring Centers for Disease Control and Prevention (U.S.)Cessation of life Characteristics Child Clinical Clinical Research Clinical Treatment Clinical Trials Communication Data Development Diagnosis Diagnostic Diagnostic and Statistical Manual Disease Distress Etiology Family Goals Grief reaction Health Personnel Health Professional Impairment Individual International Classification of Diseases Laboratory Study Left Life Literature Major Depressive Disorder Manuals Mental Health Mental disorders Modification Nomenclature Outcome Participant Patients Phase Post-Traumatic Stress Disorders Procedures Professional counselor Provider Psyche structure Psychiatrist Psychologist Psychometrics Recommendation Research Research Personnel Robin bird Sampling Social Workers Surveys Survivors Testing Time Trauma United States Work clinical practice diagnostic accuracy effective intervention effective therapy evidence base follow-up improved informant meetings mental disorder diagnosis physical conditioning prevent public health relevance research clinical testing response sound stress related disorder virtual working group

项目摘要

DESCRIPTION (provided by applicant): Although the intense distress and impairment characteristic of acute grief typically dissipates over time, for approximately 10% to 20%--that is 1 to 2 million individuals--the grief reaction is protracted and dysfunctional. This enduring, severely debilitating response to death of a significant other, now known as prolonged grief disorder (PGD), has been associated with life-threatening conditions and may persist for years if left untreated. In order to advance bereavement research and clinical work, researchers have empirically validated diagnostic criteria for PGD over the past two decades, demonstrating its construct and predictive validity. Evidence of the clinical utility of PGD has, however, been lacking. A mental disorder with clinical utility facilitates communication and effective interventions, predicts management needs and outcomes, and differentiates disorder from non- disorder and from comorbid disorders. PGD is slated for inclusion in the next International Classification of Diseases, ICD-11. In DSM-5, it is proposed as a new subtype of Adjustment Disorder and included in the "Appendix for Further Study." Regardless of diagnostic manuals, however, as a newly defined and recognized disorder, it is of paramount importance to demonstrate that PGD proves clinically useful. Although the clinical utility of PGD is implied by a vast literature that has empirically demonstrated its distinctive etiology, phenomenology, course, outcomes and response to treatment, the clinical utility of the diagnosis, per se, has not been studied. This study will obtain pilot data for a large-scale field trial of PGD by examining the clinical utility (perceived need and usefulness) of this diagnosis. Phase 1 will develop 8 prototypical bereaved virtual standardized patient (VSP) cases with and without PGD (both with and without co-morbid major depressive disorder [MDD] and posttraumatic stress disorder [PTSD]; 4 cases of spousal loss and 4 cases of child loss) using key informants (8 mental health providers), who will help develop the VSP cases, clinical utility assessments, and Phase 2 recruitment strategies. Phase 2 procedures will then be piloted with 10 mental health providers. In Phase 2, we will survey a diverse sample of 100 mental health providers likely to care for bereaved individuals (e.g., psychiatrists, psychologists, social workers, grief counselors) about their attitudes regarding the clinical utility of a PGD diagnosis, ask them to diagnose 4 VSP cases, and evaluate the impact of a PGD diagnosis on their clinical recommendations for these cases. The specific aims of this study include 1) to assess the attitudes, practices, and beliefs related to the clinical utility of a PGD diagnosis among a variety of mental health professionals; 2) to evaluate the clinical utility of the proposed PGD diagnostic criteria by having a diverse set of mental health professionals diagnose patients with and without PGD, comorbid with MDD or PTSD and not, to assess user acceptability and diagnostic accuracy; and 3) to explore how mental health professionals are likely to treat individuals with PGD, both with comorbid MDD or PTSD and without. Findings from this study will inform development of a larger field trial to determine the impact of PGD on patient outcomes.

描述（由申请人提供）：虽然急性悲伤的强烈痛苦和损伤特征通常会随着时间的推移而消失，但对于大约 10% 到 20%（即 1 到 200 万人）来说，悲伤反应是持久的且功能失调的。这种对重要他人死亡的持久、严重衰弱的反应，现在被称为长期悲伤障碍（PGD），与危及生命的情况有关，如果不及时治疗，可能会持续数年。为了推进丧亲之痛研究和临床工作，研究人员在过去二十年中对 PGD 的诊断标准进行了实证验证，证明了其构建和预测的有效性。然而，缺乏 PGD 临床实用性的证据。具有临床实用性的精神障碍有助于沟通和有效干预，预测管理需求和结果，并将障碍与非障碍和共病障碍区分开来。 PGD 预计将被纳入下一版国际疾病分类 ICD-11。在DSM-5中，它被提议为适应障碍的新亚型，并包含在“进一步研究的附录”中。然而，无论诊断手册如何，作为一种新定义和认可的疾病，证明 PGD 在临床上有用是至关重要的。尽管 PGD 的临床实用性是由尽管有大量文献实证证明了其独特的病因、现象、病程、结果和治疗反应，但该诊断的临床效用本身尚未得到研究。本研究将通过检查该诊断的临床效用（感知的需要和有用性）来获得大规模 PGD 现场试验的试点数据。第一阶段将开发 8 个典型的失去亲人的虚拟标准化患者 (VSP) 病例，有或没有 PGD（有或没有共病重度抑郁症 [MDD] 和创伤后应激障碍 [PTSD]；4 例失去配偶和 4 例失去子女损失）使用关键信息提供者（8 名心理健康提供者），他们将帮助制定 VSP 案例、临床效用评估和第 2 阶段招募策略。第二阶段程序将在 10 名心理健康服务提供者中进行试点。在第二阶段，我们将调查 100 名可能照顾丧亲者的心理健康提供者（例如精神科医生、心理学家、社会工作者、悲伤咨询师）的不同样本，了解他们对 PGD 诊断的临床效用的态度，要求他们做出诊断4 VSP 病例，并评估 PGD 诊断对其针对这些病例的临床建议的影响。本研究的具体目的包括 1) 评估各种心理健康专业人员对 PGD 诊断临床效用的态度、实践和信念； 2) 通过多样化的设置来评估所提出的 PGD 诊断标准的临床实用性的心理健康专业人员诊断是否患有 PGD、是否患有 MDD 或 PTSD 的患者，以评估用户的可接受性和诊断准确性； 3) 探讨心理健康专业人员如何治疗 PGD 患者，无论是否患有 MDD 或 PTSD。这项研究的结果将为更大规模的现场试验的开展提供信息，以确定 PGD 对患者结果的影响。