Pamela J Surkan1, Henri M Garrison-Desany2, Damodar Rimal3, Nagendra P Luitel3, Yoona Kim4, Holly G Prigerson5, Sumeera Shrestha6, Wietse Tol7, Sarah M Murray8. 1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Electronic address: psurkan@jhu.edu. 2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 3. Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal, GPO Box 8974/CPC Box 612. 4. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 5. Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, NY, USA. 6. Women for Human Rights, single women's group, P.O. Box 8973 NPC 427, Baluwatar, Kathmandu, Nepal. 7. Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA; Section of Global Health, Department of Public Health, University of Copenhagen. 8. Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Abstract
BACKGROUND: Symptoms of grief vary by culture and societal reactions to death may be gender specific. We aimed to validate a Nepali language version of the Prolonged Grief-13 item scale (PG-13) among widows. METHODS: We tested two adapted versions of a Prolonged Grief Disorder (PGD) instrument with 204 Nepali-speaking widows: one was a Nepali translation of the original PG-13 items, while the other contained five additional items derived from qualitative research. We evaluated internal consistency, factor structure, and construct and criterion validity. RESULTS: Participants were on average 44 years old (SD=9.3), completed 6.7 years of school (SD=3.3) and had survived their husbands by 10 years (SD=8.1). Thirteen percent met global criteria for PGD. The removal of one original PG-13 item (felt emotionally numb) from both versions due to poor discriminant validity resulted in 12- and 17-item versions. Exploratory factor analysis supported a one-factor structure for the PG-12 and PG-17. Both versions of the scale exhibited high internal consistency (0.89 and 0.93 respectively). Confirmatory factor analysis suggested that symptoms of PGD were distinct from post-traumatic stress disorder (PTSD), anxiety and depressive symptoms. The PG-12 had lower sensitivity (74.1%) but higher specificity (83.6%) compared to the PG-17 (81.5% and 73.5% respectively). LIMITATIONS: Psychosocial counselors' clinical interview global ratings were used as the standard for comparison in criterion validity analyses. Generalizability to other socio-cultural (e.g. non-widowed, low-caste) populations and men in Nepal cannot be assumed. CONCLUSIONS: Results indicate satisfactory psychometric properties and validity of both versions of the PG instruments, supporting their use with Nepali speaking widows.
BACKGROUND: Symptoms of grief vary by culture and societal reactions to death may be gender specific. We aimed to validate a Nepali language version of the Prolonged Grief-13 item scale (PG-13) among widows. METHODS: We tested two adapted versions of a Prolonged Grief Disorder (PGD) instrument with 204 Nepali-speaking widows: one was a Nepali translation of the original PG-13 items, while the other contained five additional items derived from qualitative research. We evaluated internal consistency, factor structure, and construct and criterion validity. RESULTS:Participants were on average 44 years old (SD=9.3), completed 6.7 years of school (SD=3.3) and had survived their husbands by 10 years (SD=8.1). Thirteen percent met global criteria for PGD. The removal of one original PG-13 item (felt emotionally numb) from both versions due to poor discriminant validity resulted in 12- and 17-item versions. Exploratory factor analysis supported a one-factor structure for the PG-12 and PG-17. Both versions of the scale exhibited high internal consistency (0.89 and 0.93 respectively). Confirmatory factor analysis suggested that symptoms of PGD were distinct from post-traumatic stress disorder (PTSD), anxiety and depressive symptoms. The PG-12 had lower sensitivity (74.1%) but higher specificity (83.6%) compared to the PG-17 (81.5% and 73.5% respectively). LIMITATIONS: Psychosocial counselors' clinical interview global ratings were used as the standard for comparison in criterion validity analyses. Generalizability to other socio-cultural (e.g. non-widowed, low-caste) populations and men in Nepal cannot be assumed. CONCLUSIONS: Results indicate satisfactory psychometric properties and validity of both versions of the PG instruments, supporting their use with Nepali speaking widows.
Authors: Yoona Kim; Asmita Ghimire; Molly E Lasater; Brandon A Kohrt; Pamela J Surkan; Nagendra P Luitel Journal: Glob Ment Health (Camb) Date: 2021-09-15