An Analytic Approach in Identifying a Latent Structure to Determine Scoring Criteria for a Clinical Diagnosis of Traumatic Grief

Although reliably recognized as a psychiatric syndrome, traumatic grief has not been identified as a primary axis I diagnosis in the Diagnostic and Statistical Manual of Mental Disorders -fourth edition (DSM-IV). Due to the newness of recognition of this diagnosis, a universally accepted set of diagnostic criteria does not exist. The objective of this thesis was to evaluate the psychometric properties of a newly developed twenty-nine item structured clinical interview for the diagnosis of traumatic grief (SCI-TG) by: assessing its internal consistency; evaluating its inter-rater reliability; describing its factor structure; and determining its construct validity. The SCI-TG was administered to 166 patients enrolled in an ongoing traumatic grief therapy randomized clinical trial (TGTRCT) MH060783. The SCI-TG showed good internal consistency as assessed by the Cronbach's coefficient alpha (0.74), and good inter-rater reliability (0.81). Exploratory principal components factor analysis yielded the selection of three factors corresponding to symptoms of: "guilt", "failure to adapt", and "separation distress", respectively. Demonstrating convergent validity, the total score of the SCI-TG was significantly correlated with the Inventory of Complicated Grief (ICG), the Hamilton Depression Rating Scale (HDRS), the Structured Interview Guidelines for the Hamilton Rating Scale for Anxiety (SIGH-A), the Impact of Events Scale (IES), and the Adult Separation Anxiety Disorder (ASAD). The estimated factor scores on factor 1, "guilt", were not significantly correlated with any of these instruments, and the estimated factor scores on the "separation distress" factor was not significantly correlated with the ASAD, signifying the uniqueness of traumatic grief symptoms. The results of the factor analyses could be used to create subscales of the new 17-item SCI-TG. The distribution of the SCI-TG scores based on the reduced scale resulting from the factor analyses was proposed to be used in determining the scoring of this instrument. Studies of the treatment of bereavement with antidepressants have proven ineffective in treating grief symptoms. The public health relevance of this thesis is in defining these symptoms and developing an instrument to adequately identify such symptoms