A JAMA Psychiatry Viewpoint suggests that a major AHRQ review may underrepresent what is already known about prolonged grief disorder—and that gap could have implications for clinical care.
The response rate for prolonged grief disorder–specific interpersonal psychotherapy across three National Institute of Mental Health–sponsored randomized clinical trials was 71%, compared with 44% for citalopram.
A 2025 Agency for Healthcare Research and Quality (AHRQ) systematic review of bereavement interventions serves as the starting point for the Viewpoint. Four prominent grief researchers argue that its conclusions may understate aspects of the existing evidence base. The review analyzed 219 studies and found only moderate strength of evidence for the positive effects of psychotherapy on grief disorder symptoms—a finding the Viewpoint authors describe as technically accurate but potentially misleading.
Their concern is that the AHRQ review grouped a highly heterogeneous mix of psychotherapy studies without distinguishing those specifically designed for prolonged grief disorder (PGD). According to the authors, this approach may dilute signals from more targeted interventions. PGD—now formally recognized in DSM-5-TR and the International Classification of Diseases, 11th Revision—has validated diagnostic tools, a defined clinical profile, and therapies that have demonstrated efficacy in randomized trials, according to the authors.
The authors also point to progress in assessment and treatment. The PG-13–Revised scale maps onto DSM-5-TR criteria, and a summary score of 30 or higher is considered consistent with PGD, warranting further clinical evaluation and likely indicating the need for PGD-specific treatment. The therapy itself is grounded in established frameworks—including dual process coping, attachment, self-determination, and emotion regulation theories—and has been studied in 641 participants ranging in age from 20 to 93 years.
“[J]ust 2 years after establishment of the diagnosis, PGD can, in fact, be accurately diagnosed and effectively treated,” wrote lead author Charles F. Reynolds III, MD, of the University of Pittsburgh, and colleagues.
At the same time, important gaps remain. Digital grief interventions show promise; for example, a recent meta-analysis found significant reductions in prolonged grief symptoms with effects sustained at 3-month follow-up. However, questions around scalability and implementation persist. The authors further suggest that how evidence is synthesized may influence uptake: if systematic reviews treat grief psychotherapies as interchangeable, PGD-specific approaches may be less visible in clinical practice.
The takeaway: PGD is a diagnosable and treatable condition with validated tools and evidence from randomized trials. How that evidence is interpreted and communicated may shape whether those advances are reflected in care.
Disclosures can be found in the published Viewpoint.
Source: JAMA Psychiatry
