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Melhem et al.

Identifying Prolonged Grief Reactions in Children: Dimensional and Diagnostic Approaches
Melhem NM, Porta G, Payne MW, and Brent DA

When children and adolescents experience the sudden death of a parent, they are at risk for prolonged grief reactions, also known as complicated grief.  Identifying such reactions is important because children with this condition are at increased risk for depression and for decline in their functioning.  Until now there was not an assessment tool for prolonged grief reactions in children.  In this study, Dr. Nadine Melhem and her colleagues evaluated their adapted instrument, the Inventory of Complicated Grief–Revised for Children, in identifying children with prolonged grief reactions; evaluated the proposed DSM-5 criteria for bereavement-related disorder; and created a screening tool for prolonged grief reactions.

Within this study of 182 children between the ages of 8 and 17, assessments occurred at 9, 21, and 33 months following the sudden (within 24 hours) death of a parent.  Throughout these intervals, the DSM-5 proposed criteria for bereavement-related disorder were decreasingly effective (41.7%, 22.2%, and 20% at the respective times) at correctly identifying cases, whereas the dimensional approach with the established cut-off was more sensitive (96.2%, 90%, 83.3% at the respective times).  This study was the first to evaluate the effectiveness of the proposed DSM-5 criteria to identify children with prolonged grief reactions.  Dr. Melhem and her colleagues also derived a six-item tool to screen for prolonged grief reactions in children, consisting of the following items:  longing and yearning for the deceased, inability to accept the death, shock, disbelief, loneliness, and an altered worldview.

This research is significant because children who have experienced the early loss of a parent are at increased risk for psychiatric disorders.  Moreover, early diagnosis and interventions for children with prolonged grief reactions are crucial to addressing these problems.  By introducing new assessment and screening tools with cut-offs and analyzing the DSM-5 criteria, Dr. Melhem and her colleagues have provided clinicians with a dimensional approach to improve evaluation of these children.

Contributors: Nadine M. Melhem, PhD; Giovanna Porta, MS; Monica Walker Payne, MA; and David A. Brent, MD  (Department of Psychiatry, University of Pittsburgh)

The results of this investigation were published in the Journal of the American Academy of Child & Adolescent Psychiatry.  Click here for a link to the abstract.