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Persistent Complex Bereavement Disorder Symptom Domains Relate Differentially to PTSD and Depression: A Study of War-Exposed Bosnian Adolescents

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Abstract

Persistent Complex Bereavement Disorder (PCBD) is a newly proposed diagnosis placed in the Appendix of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an invitation for further research. To date, no studies have examined the dimensionality of PCBD or explored whether different PCBD criteria domains relate in similar, versus differential, ways to other psychological conditions common to war-exposed bereaved youth, including symptoms of Posttraumatic Stress Disorder (PTSD) and depression. We evaluated the dimensionality of proposed PCBD B and C symptom domains, and their respective relations with measures of PTSD and depression, in 1142 bereaved Bosnian adolescents exposed to the 1992–1995 Bosnian civil war. Instruments included the UCLA PTSD Reaction Index, the Depression Self-Rating Scale, and the UCLA Grief Screening Scale (a prototype measure of PCBD symptoms). We investigated potential differences in grief, PTSD, and depression scores as a function of cause of death. We then examined hypothesized differential relations between PCBD B and C symptom domain subscales and selected external correlates, specifically measures of depression and the four-factor emotional numbing model of PTSD. Results of both analyses provide preliminary evidence of a multidimensional structure for PCBD in this population, in that the PCBD Criterion C subscale score covaried more strongly with each of the four PTSD factors and with depression than did PCBD Criterion B. We conclude by discussing theoretical, methodological, clinical, and policy-related implications linked to the ongoing study of essential features of PCBD.

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Notes

  1. We assessed a 1-factor and 2-factor CFA model of PCBD Criterion B and Criterion C, but did not include the analyses here because the prototype nature of the GSS measure provides insufficient item coverage to be considered a content-valid representation of PCBD. Nonetheless, for the CFA of the 2-factor PCBD model, we obtained the following results: χ2 (df = 19) = 136.34, Scaled χ2 = 150.25, CFI/TLI = 0.96/0.94, RMSEA = 0.08, 90 % CI [0.065, 0.089], SRMR = 0.04, BIC = 23,801.96. All factor loadings were above 0.30, and the factor correlation was 0.99. The one-factor model of PCBD did not converge. Further results are available upon request from the corresponding author.

  2. Due to the larger percentage of females in this study (70 %), we conducted analyses showing that the same joint model fit in females and males. The joint model for males, χ2 = 257.41, Scaled χ2 = 313.08, CFI/TLI = 0.94/0.93, RMSEA = 0.045, 90 % CI [0.035, 0.054], SRMR = 0.05, BIC = 21,861.57), and for females, χ2 = 522.68, Scaled χ2 = 597.37, CFI/TLI = 0.94/0.92, RMSEA = 0.055, 90 % CI [0.05, 0.06], SRMR = 0.04, BIC = 51,978.22) indicated adequate fit indices for the model. The factor loadings of the PTSD Emotional numbing model ranged from 0.28–0.74 among males, and 0.36–0.78 among females. The correlation between factors of PTSD and scores on criteria B and C of PCBD, and depression ranged from 0.33–0.87 in males and 0.40–0.92 in females. The adequate fit indices along with the range of correlations across males and females indicates that the relationship found between the variables is similar across males and females.

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Authors and Affiliations

  1. Department of Psychology, University of Toledo, Mail Stop #948, 2801 W. Bancroft St., Toledo, OH, 43606, USA

    Meredith A. Claycomb

  2. Department of Psychology, University of Nebraska-Lincoln, 213 Burnett Hall, Lincoln, NE, 68588-0308, USA

    Ruby Charak

  3. Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, 1941 East Rd, Houston, TX, 77054, USA

    Julie Kaplow

  4. UCLA/Duke University National Center for Child Traumatic Stress, and Department of Psychiatry and Biobehavioral Sciences, University of California, 11150 W. Olympic Blvd., Suite 650, Los Angeles, CA, 90064, USA

    Christopher M. Layne & Robert Pynoos

  5. Department of Psychology and Department of Psychiatry, University of Toledo, Mail Stop #948, 2801 W. Bancroft St., Toledo, OH, 43606, USA

    Jon D. Elhai

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  1. Meredith A. Claycomb
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  2. Ruby Charak
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  3. Julie Kaplow
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  4. Christopher M. Layne
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  5. Robert Pynoos
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  6. Jon D. Elhai
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Correspondence to Jon D. Elhai.

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Funding

The funding organization was UNICEF Bosnia & Herzegovina.

Disclosure

Drs. Layne, Kaplow, and Pynoos are the authors of the Persistent Complex Bereavement Disorder (PCBD) Checklist, a measure of child and adolescent grief reactions, as well as co-authors of Trauma and Grief Component Therapy for Adolescents (in press, Cambridge University Press).

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The authors declare that they have no conflict of interest.

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Claycomb, M.A., Charak, R., Kaplow, J. et al. Persistent Complex Bereavement Disorder Symptom Domains Relate Differentially to PTSD and Depression: A Study of War-Exposed Bosnian Adolescents. J Abnorm Child Psychol 44, 1361–1373 (2016). https://doi.org/10.1007/s10802-015-0107-7

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