The Aarhus Prolonged Grief Disorder Scale (A-PGDs): identification of a clinically validated cut-off score for identifying bereaved at risk of PGD

Background: Prolonged Grief Disorder (PGD) is a new stress-related disorder included in both the ICD-11 and DSM-5-TR. It is characterised by persistent longing for and preoccupation with the deceased, accompanied by associated emotional symptoms. The Aarhus Prolonged Grief Disorder scale (A-PGDs) is a self-report measure based on these diagnostic criteria. A clinically validated straightforward scoring method may increase its clinical utility.Objective: This study aimed to establish a scoring procedure for identifying probable ICD-11 and DSM-5-TR PGD cases using the A-PGDs. Specifically, we sought to develop a two-step approach requiring endorsement of core symptoms and exceeding a cut-off score on associated symptoms.Method: Participants included bereaved adults (n = 122; 89.9% female) experiencing grief-related difficulties more than six months post loss. Optimal item thresholds for core symptoms were identified, and receiver operator characteristic (ROC) curve analyses determined the optimal cut-off score for associated symptoms. The Aarhus Structured Clinical Interview (A-PGDi) served as the gold standard.Results: Endorsing core symptoms at a threshold of ≥3 identified 81.1% (n = 99) of participants. For these individuals, a cut-off score of ≥27 on the associated symptom items produced sensitivity and specificity of 80% and 61%, respectively, for ICD-11 PGD, and a cut-off score of ≥29 produced sensitivity and specificity of 81% and 66%, respectively, for DSM-5-TR PGD. Using the full two-step method, sensitivity and specificity were 80% and 70% for ICD-11 PGD, and 78% and 74% for DSM-5-TR PGD. Prevalence estimates were 34.4% for probable ICD-11 PGD and 36.0% for DSM-5-TR PGD.Conclusion: This two-step scoring method provides a simple, easy-to-use approach for clinicians to identify probable PGD cases.