延长哀伤障碍是独立的诊断吗?——和创伤后应激障碍、抑郁、焦虑的关系

Is Prolonged Grief Disorder a Distinguishable Syndrome Distinct from Posttraumatic Stress Disorder, Depression and Anxiety?

目的:探究延长哀伤障碍(PGD)与创伤后应激障碍(PTSD)、抑郁和焦虑的区别与联系。方法:测查482名丧亲者的PGD、PTSD、抑郁和焦虑症状,测查工具包括延长哀伤问卷(PG-13)、创伤后应激障碍症状清单(PCL-C)、抑郁自评量表(SDS)以及焦虑自评量表(SAS)。从四个量表中分别选出题总相关最高的6个条目进行探索性因素分析和验证性因素。结果:PG-13的总分和PCL-C、SDS、SAS得分呈中至高度相关,分别为r=0.72(P<0.01),r=0.46(P<0.01)和r=0.55(P<0.01)。经探索性因素分析得到四个因素,分别为:PTSD、焦虑、抑郁和PGD。验证性因素分析中四因素模型拟合良好(χ2/df=2.37,RMSEA=0.076,CFI=0.96,NFI=0.93,NNFI=0.95)。结论:PGD和PTSD、抑郁、焦虑之间存在密切的联系,然而四种症候群相互独立表明PGD是独立于PTSD、焦虑、抑郁的诊断。在临床实践中应考虑鉴别PGD和PTSD、抑郁、焦虑,并探索专门针对PGD进行干预的治疗方案。

Objective To explore the relationship between prolonged grief disorder（PGD） and posttranmatic stress disor-der（PTSD）, depression and anxiety. Methods： 482 bereaved individuals completed Prolonged Grief-13（PG-13）, Posttran-marie Stress Checklist-Civil Version（PCL-C）, Zung Self-Rating Depression Scale（SDS） and Zung Self-Rating AnxietyScale（SAS）. For each scale, 6 items most highly correlated with the total score were chosen into an item list, in which an ex-ploratory factor analysis and a confirmatory factor analysis were conducted. Results： Total score on PG-13 was modestly/highly correlated with scores on PCL-C（r=0.72）, SDS（t=0.46） and SAS（r=0.55）. Principal axis factoring resulted in the emergence of 4 different factors. The symptoms of PTSD loaded on the first factor, anxiety on the second, depression on the third,and PGD on the fourth. In the confirmatory factor analysis, the four-factor model fit well（χ2/df=-2.37, RMSEA=0.076, CFI=0.96, NFI=0.93, NNFI=0.95）. Gonclusion： There are partial overlaps between the symptoms of PGD, PTSD, depressionand anxiety. PGD is a distinct syndrome different from PTSD, depression and anxiety since the four clusters of symptomsare relatively independent factors. These findings implicate that diagnostic discrimination of PGD with PTSD, depressionand anxiety should be carefully considered in clinical practice.