Study Supports Validity of Prolonged Grief Disorder, Persistent Complex Bereavement in Children

A recent study offers the first evaluation of prevalence rates and psychometric properties of prolonged grief disorder and persistent complex bereavement in children.

Researchers support the validity of persistent complex bereavement disorder (PCBD), a new diagnosis added to the Diagnostic and Statistical Manual of Psychiatric Disorders, 5th edition (DSM-5), and prolonged grief disorder (PGD), which is included in the 11th edition of the International Classification of Diseases (ICD-11), according to study data published in the Journal of Affective Disorders.

Investigators abstracted data from 332 children and adolescents (aged 8-18 years) participating in a research program on grief. Participants were recruited via bereavement support organizations (n=126) and outpatient clinics (n=206). At baseline, participants self-reported sociodemographic characteristics and described their relationship to the deceased and cause of death. The Inventory of Prolonged Grief for Children and Inventory of Prolonged Grief for Adolescents were used to diagnose PCBD and PGD in participants. Additional clinical variables were assessed, including symptoms of post-traumatic stress disorder, depression, and problem behavior. Confirmatory factor analyses were conducted to evaluate the fit of 1-factor, 2-factor, and 3-factor models of DSM-5 PCBD items and 1-factor and 2-factor models of ICD-11 PGD items. Prevalence of PCBD/PGD, along with concurrent depression, posttraumatic stress, and parent-reported problem behavior were also assessed.

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The final cohort comprised 291 children (mean age, 11.7±2.7 years), among whom 164 (56.4%) were girls. Most children had experienced the loss of a father (58.4%) or mother (23.4%), whereas 8.9% lost a sibling and 7.9% lost another relative. Deaths occurred an average of 34.6±25.1 months before data collection. For both PCBD and PGD, 1-factor models were best fit for data, suggesting that covariance among PCBD and PGD symptoms as listed in the DSM-5 and ICD-11, respectively, were the result of a “unidimensional factor” of grief. That is, PCBD and PGD items were found to represent 1 factor, rather than distinct factors of separation distress, reactive distress, or other symptoms as described in the DSM-5 and ICD-11.

The prevalence of probable DSM-5 PCBD (3.4%) was significantly lower than the prevalence of probable ICD-11 PGD (12.4%). Ten (3.4%) children met criteria for both PCBD and PGD, indicating “fair” diagnostic agreement (κ =.40; P <.001). No differences in sociodemographic or loss variables were observed between PCBD and PCD cases, although children meeting criteria for PCBD more often experienced an unexpected loss compared with their PCD counterparts (P =.035). Both PCBD and PGD were significantly associated with overall disturbed grief, depression, and posttraumatic stress (all P <.001). Moderate associations were also detected between PCBD/PGD and parent-rated problem behavior.

The use of a sample of children already seeking support may limit generalizability to bereaved children in general. In addition, although these data support the validity of PCBD and PGD, prevalence rates for each diagnosis differed, supporting further research on their utility as clinical tools.


Boelen PA, Spuij M, Lenferink LIM. Comparison of DSM-5 criteria for persistent complex bereavement disorder and ICD-11 criteria for prolonged grief disorder in help-seeking bereaved children. J Affect Disord. 2019;250:71-78.