The cultural supplement: A new method for assessing culturally relevant prolonged grief disorder symptoms

Abstract

Background The new diagnosis of prolonged grief disorder (PGD) is both an opportunity and a challenge for researchers, clinicians, and bereaved individuals. The latest definition of PGD includes a refreshing and novel feature: the cultural caveat, i.e., clinicians must determine that the grief presentation is more severe and of longer duration than would be expected by an individual’s culture and context. Currently, there are no guidelines on how to operationalize the cultural caveat in mental health care settings. Method To respond to this important demand we have developed, piloted, and tested the cultural supplement module of the International Prolonged Grief Disorder scale (IPGDS). The cultural supplement aims to provide clinicians with a catalogue of culturally relevant symptoms of grief that indicate probable PGD alongside a simple framework for cultural adaptation for use in specific clinical settings. Results In this short report we outline the rationale and aim of the cultural supplement and provide a summary of our latest validation studies of the IPGDS with bereaved German-speaking, Chinese and Swiss migrant individuals. We also provide a step-by-step framework for adaptation of the cultural supplement that clinicians and researchers may use when working with different cultural groups. Conclusion To date, this is the first PGD questionnaire based on the ICD-11, and the first to include a cultural supplement that can be adapted to different contexts and groups. This cultural supplement will provide clinicians and researchers an easy-to-use assessment tool with the aim to improve the global applicability of the ICD-11 PGD definition.

Bereavement Issues and Prolonged Grief Disorder: A Global Perspective

“…The International Prolonged Grief Disorder Scale assesses PGD for the ICD-11 and includes a cultural supplement that offers information on culturally-relevant grief symptoms (Killikelly et al, 2020 ). This tool seems to be suitable for operationalizing the cultural caveat for PGD in specific clinical settings, and thus might improve global applicability for researchers and clinicians, although further research is needed (Killikelly and Maercker, 2022 ).…”

Prolonged grief disorder symptomology in three African countries: A network analysis and comparison

“…Although the ICGR was developed before the most recent classifications of PGD, the current study applied an algorithmic assessment of disorder grief symptomology in line with ICD-11 proposals (WHO, 2023 ). This method of screening assessment has been used in previous research using general measures of disordered grief, specifically the ICGR, and applying current criteria for ICD-11 PGD pathology (Killikelly and Maercker, 2023 ; Bagcaz and Kilic, 2023 ; Ben-Ezra et al, 2020 ).…”

“…However, its cross-sectional nature and lack of detailed assessment of time since bereavement limits the ability to infer causality, and the use of proxy measurement, while effectively used to screen and evidence PGD-related difficulties (see Killikelly and Maercker, 2023 ), may affect results. Future research should include longitudinal studies with diverse mental health indicators and culturally adapted PGD measures specific to current diagnostic criteria (see Eisma, 2023 ).…”

“…Conducted in English-speaking countries, the research may not fully represent non-English speakers, underscoring the need for studies in multiple languages to validate the findings across different cultural contexts. Including specific cultural adaptation, for instance, the International Prolonged Grief Disorder Scale (Killikelly et al, 2021 ) and cultural supplement (Killikelly and Maercker, 2023 ), developed to comprehensively measure specific ICD-11 PGD symptoms across diverse cultural contexts. Future work should also explore PGD in treatment-seeking populations and include clinician assessments to better capture the disorder’s clinical significance.…”