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

Figures & data

Table 1. Participant characteristics of Sample 1 and Sample 2

Characteristic	Total Sample (N = 468)	Sample 1: Bereaved by plane disaster (N = 200)	Sample 2: Bereaved by traffic accident (N = 268)	Test of difference
Gender (Female), N (%)	325 (69.4%)	124 (61.7%)	201 (75.0%)	χ^2(1) = 8.69, p = .003
Age, M (SD)	52.56 (14.06)	53.38 (15.43)	51.95 (12.95)	t(377) = 1.06, p = .292
Education (University), N (%)	253 (54.1%)	139 (69.2%)	114 (42.5%)	χ^2(1) = 34.31, p < .001
Time since loss (years), M (SD)	5.14 (4.62)	5.61 (0.02)	4.79 (6.06)	t(267) = 2.23, p = .027
Kinship (Deceased is child or partner), N (%)	225 (48.1%)	64 (31.8%)	161 (60.1%)	χ^2(1) = 36.16, p < .001
DSM-5-TR PGD levels, M (SD)	29.58 (9.47)	26.96 (9.56)	31.51 (8.95)	t(466) = −5.32, p < .001
PTSD levels, M (SD)	21.56 (15.89)	19.53 (16.12)	22.91 (15.60)	t(460) = −2.26, p = .024

PGD = prolonged grief disorder; PTSD = posttraumatic stress disorder.

Table 2. Model fit statistics for PGD and PTSD models

	χ^2	df	Δχ^2	CFI	TLI	RMSEA (90% CI)	SRMR	AIC	BIC	SS-BIC	Nested in
PTSD
Sample 1: Bereaved by plane disaster (N = 194*)
1. DSM-5	368.61***	164		.890	.873	0.08 (0.07–0.09)	.06	9816.79	10032.47	9823.39	-
2. Anhedonia	283.32***	155	72.84***	.931	.915	0.07 (0.05–0.08)	.05	9721.04	9966.13	9728.54	1
3. Externalization	303.40***	155	60.38***	.920	.902	0.07 (0.06–0.08)	.05	9748.81	9993.90	9756.31	1
4. Hybrid	249.58***	149	2 vs. 4: 32.09***	.946	.931	0.06 (0.05–0.07)	.05	9689.48	9954.17	9697.58	2,3
			3 vs 4: 34.41***
Sample 2: Bereaved by traffic accident (N = 268)
1. DSM-5	400.79***	164		.892	.875	0.07 (0.06–0.08)	.06	14428.60	14665.61	14456.35	-
2. Anhedonia	305.03***	155	80.43***	.932	.916	0.06 (0.05–0.07)	.05	14323.90	14593.23	14355.43	1
3. Externalization	349.39***	155	45.93***	.912	.892	0.07 (0.06–0.08)	.06	14378.27	14647.59	14409.80	1
4. Hybrid	279.30***	149	2 vs. 4: 23.12***	.941	.924	0.06 (0.05–0.07)	.05	14301.83	14592.70	14335.88	2,3
			3 vs. 4: 57.78***
Measurement invariance PTSD Hybrid Model (N = 462*)
Configural	528.14***	298		.943
Metric	555.26***	311	27.33*	.940
Scalar	579.44***	324	24.40*	.937
PGD
Sample 1: Bereaved by plane disaster (N = 200)
1. One-factor	95.02***	35		.936	.918	0.09 (0.07–0.12)	.04	5361.94	5460.89	5365.84	-
2. Two-factor	85.38***	34	10.97***	.945	.928	0.09 (0.06–0.11)	.04	5352.35	5454.60	5356.39	1
Sample 2: bereaved by traffic accident (N = 268)
1. One-factor	88.64***	35		.956	.944	0.08 (0.06–0.10)	.04	6953.86	7061.59	6966.47
2. Two-factor	85.84***	34	2.78	.958	.944	0.08 (0.06–0.10)	.03	6952.03	7063.35	6965.06	1
Measurement invariance one-factor PGD model (N = 468)
Configural	183.60***	70		.947
Metric	198.56***	79	10.83	.945
Scalar	242.26***	89	46.87***	.929
Combined PTSD and PGD models (N = 468)
1. One-factor	2249.04***	405		.754	.736	0.10 (0.10–0.10)	.07	37301.00	37674.37	37388.72	-
2. Two-factor	1789.76***	404	155.10***	.815	.801	0.09 (0.08–0.09)	.06	36750.25	37127.76	36838.95	1
3. Higher-order	1182.74***	397	614.46***	.895	.885	0.07 (0.06–0.07)	.06	36036.61	36443.16	36132.13	1,2

*Six people had missing data on all PTSD items in Sample 1 and were not included in analyses (using the default option in Mplus). AIC = Akaike’s information criterion; BIC = Bayesian information criterion; CFI = Comparative Fit Index; CI = confidence interval; df = degrees of freedom; PGD = Prolonged Grief Disorder; PTSD = Post Traumatic Stress Disorder; RMSEA = root-mean-square error of approximation; SRMR = standardized root mean square residual; SS-BIC = Sample-size adjusted information criterion; TLI = Tucker Lewis Index.

Figure 1. Factor loadings for the Hybrid PTSD model (N = 462*)

Note: *Six people had missing data on all PTSD items in Sample 1 and were not included in analyses (using the default option in Mplus). AA = Anxious Arousal; AV = avoidance; AN = anhedonia; DA = dysphoric arousal; EB = externalizing behaviour; NAF = negative affect; PTSD = posttraumatic stress disorder; RE-EX = re-experiencing.

Figure 2. Factor loadings for the one-factor PGD model (N = 468)

Note: PGD = Prolonged grief disorder.

Table 3. Factor loadings for the higher-order combined model (N = 468)

	PTSD RE-EX	PTSD AV	PTSD NAF	PTSD AN	PTSD EB	PTSD AA	PTSD DA	PGD
Memories	.76
Flashbacks	.68
Dreams	.76
Cued distress	.82
Cued physical reaction	.80
Avoiding internal cues		.90
Avoiding external cues		.84
Dissociative amnesia			.46
Negative beliefs			.70
Blame			.61
Negative feelings			.83
Loss of interest				.87
Detachment				.82
Numbing				.83
Irritability					.79
Reckless behaviour					.64
Hypervigilance						.76
Startle						.85
Concentration							.84
Sleep							.69
Persistent yearning								.75
Preoccupation with thoughts								.67
Identity disruption								.78
Disbelief								.72
Avoidance of reminders								.54
Intense emotional pain								.81
Difficulty moving on								.81
Emotional numbness								.81
Life is meaningless								.85
Intense loneliness								.73

AA = anxious arousal; AV = avoidance; AN = anhedonia; DA = dysphoric arousal; EB = externalizing behaviour; NAF = negative affect; PGD = prolonged grief disorder; PTSD = posttraumatic stress disorder; RE-EX = re-experiencing.

Table 4. Pearson’s correlations among PTSD subscales and PGD (N = 462*)

	PTSD RE-EX	PTSD AV	PTSD NAF	PTSD AN	PTSD EB	PTSD AA	PTSD DA	PGD
PTSD RE-EX		.55	.70	.59	.53	.59	.58	.71
PTSD AV			.56	.52	.47	.39	.39	.50
PTSD NAF				.65	.59	.57	.60	.63
PTSD AN					.61	.54	.67	.70
PTSD EB						.53	.51	.54
PTSD AA							.62	.53
PTSD DA								.60
PTSD								.77

*Six people had missing data on all PTSD items in Sample 1 and were not included in analyses. AA = Anxious Arousal; AV = avoidance; AN = anhedonia; DA = dysphoric arousal; EB = externalizing behaviour; NAF = negative affect; PGD = prolonged grief disorder; PTSD = posttraumatic stress disorder; RE-EX = re-experiencing. All correlations are significant at p < .001.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [LL], upon reasonable request. The data cannot be made publicly available because of privacy reasons. Syntax/input files for analyses are available, see https://osf.io/3smdw/.