Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11
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{"title"=>"Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11", "type"=>"journal", "authors"=>[{"first_name"=>"Holly G.", "last_name"=>"Prigerson", "scopus_author_id"=>"7007048974"}, {"first_name"=>"Mardi J.", "last_name"=>"Horowitz", "scopus_author_id"=>"7401749803"}, {"first_name"=>"Selby C.", "last_name"=>"Jacobs", "scopus_author_id"=>"7402313140"}, {"first_name"=>"Colin M.", "last_name"=>"Parkes", "scopus_author_id"=>"24600606600"}, {"first_name"=>"Mihaela", "last_name"=>"Aslan", "scopus_author_id"=>"8539375200"}, {"first_name"=>"Karl", "last_name"=>"Goodkin", "scopus_author_id"=>"7006272284"}, {"first_name"=>"Beverley", "last_name"=>"Raphael", "scopus_author_id"=>"7101959431"}, {"first_name"=>"Samuel J.", "last_name"=>"Marwit", "scopus_author_id"=>"6701845242"}, {"first_name"=>"Camille", "last_name"=>"Wortman", "scopus_author_id"=>"57200883070"}, {"first_name"=>"Robert A.", "last_name"=>"Neimeyer", "scopus_author_id"=>"7005719430"}, {"first_name"=>"George", "last_name"=>"Bonanno", "scopus_author_id"=>"7101685888"}, {"first_name"=>"Susan D.", "last_name"=>"Block", "scopus_author_id"=>"7103367371"}, {"first_name"=>"David", "last_name"=>"Kissane", "scopus_author_id"=>"26642965500"}, {"first_name"=>"Paul", "last_name"=>"Boelen", "scopus_author_id"=>"6701799789"}, {"first_name"=>"Andreas", "last_name"=>"Maercker", "scopus_author_id"=>"56059359000"}, {"first_name"=>"Brett T.", "last_name"=>"Litz", "scopus_author_id"=>"7003650902"}, {"first_name"=>"Jeffrey G.", "last_name"=>"Johnson", "scopus_author_id"=>"7406817596"}, {"first_name"=>"Michael B.", "last_name"=>"First", "scopus_author_id"=>"7102648764"}, {"first_name"=>"Paul K.", "last_name"=>"Maciejewski", "scopus_author_id"=>"7005036727"}], "year"=>2009, "source"=>"PLoS Medicine", "identifiers"=>{"pui"=>"355173291", "arxiv"=>"arXiv:1011.1669v3", "issn"=>"15491277", "isbn"=>"10.1371/journal.pmed.1000121", "doi"=>"10.1371/journal.pmed.1000121", "scopus"=>"2-s2.0-69349102731", "pmid"=>"19652695", "sgr"=>"69349102731"}, "id"=>"19ec3061-0c79-3dab-b0ce-30e57803e9f0", "abstract"=>"BACKGROUND Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction. METHODS AND FINDINGS A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment. CONCLUSIONS The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11. Please see later in the article for Editors' Summary.", "link"=>"http://www.mendeley.com/research/prolonged-grief-disorder-psychometric-validation-criteria-proposed-dsmv-icd11", "reader_count"=>276, "reader_count_by_academic_status"=>{"Unspecified"=>4, "Professor > Associate Professor"=>15, "Librarian"=>2, "Researcher"=>37, "Student > Doctoral Student"=>31, "Student > Ph. D. Student"=>57, "Student > Postgraduate"=>20, "Student > Master"=>45, "Other"=>12, "Student > Bachelor"=>37, "Lecturer"=>4, "Lecturer > Senior Lecturer"=>3, "Professor"=>9}, "reader_count_by_user_role"=>{"Unspecified"=>4, "Professor > Associate Professor"=>15, "Librarian"=>2, "Researcher"=>37, "Student > Doctoral Student"=>31, "Student > Ph. D. Student"=>57, "Student > Postgraduate"=>20, "Student > Master"=>45, "Other"=>12, "Student > Bachelor"=>37, "Lecturer"=>4, "Lecturer > Senior Lecturer"=>3, "Professor"=>9}, "reader_count_by_subject_area"=>{"Unspecified"=>15, "Agricultural and Biological Sciences"=>6, "Philosophy"=>1, "Arts and Humanities"=>2, "Business, Management and Accounting"=>1, "Veterinary Science and Veterinary Medicine"=>1, "Engineering"=>1, "Nursing and Health Professions"=>9, "Medicine and Dentistry"=>48, "Neuroscience"=>1, "Physics and Astronomy"=>1, "Psychology"=>161, "Social Sciences"=>29}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>48}, "Social Sciences"=>{"Social Sciences"=>29}, "Physics and Astronomy"=>{"Physics and Astronomy"=>1}, "Psychology"=>{"Psychology"=>161}, "Unspecified"=>{"Unspecified"=>15}, "Arts and Humanities"=>{"Arts and Humanities"=>2}, "Engineering"=>{"Engineering"=>1}, "Neuroscience"=>{"Neuroscience"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>6}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>9}, "Philosophy"=>{"Philosophy"=>1}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>1}}, "reader_count_by_country"=>{"Turkey"=>1, "Belgium"=>1, "Hong Kong"=>1, "United States"=>10, "Japan"=>1, "Brazil"=>1, "Denmark"=>1, "Italy"=>1, "United Kingdom"=>2, "Australia"=>1, "Germany"=>1, "Spain"=>1}, "group_count"=>13}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/889691"], "description"=>"<p>Criteria for PGD proposed for <i>DSM-V</i> and <i>ICD-11</i>.</p>", "links"=>[], "tags"=>["pgd"], "article_id"=>560128, "categories"=>["Mental Health"], "users"=>["Holly G. Prigerson", "Mardi J. Horowitz", "Selby C. Jacobs", "Colin M. Parkes", "Mihaela Aslan", "Karl Goodkin", "Beverley Raphael", "Samuel J. Marwit", "Camille Wortman", "Robert A. Neimeyer", "George Bonanno", "Susan D. Block", "David Kissane", "Paul Boelen", "Andreas Maercker", "Brett T. Litz", "Jeffrey G. Johnson", "Michael B. First", "Paul K. Maciejewski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000121.t003", "stats"=>{"downloads"=>6, "page_views"=>14, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Criteria_for_PGD_proposed_for_DSM_V_and_ICD_11_/560128", "title"=>"Criteria for PGD proposed for <i>DSM-V</i> and <i>ICD-11</i>.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 05:10:58"}
  • {"files"=>["https://ndownloader.figshare.com/files/889596"], "description"=>"<p>Each data point in this figure represents the performance, in terms of sensitivity and specificity with respect to a criterion standard for PGD, of a unique “<i>DSM</i>-style” diagnostic algorithm for meeting symptom criteria for PGD. Each algorithm is specified in terms of one common, mandatory symptom, yearning, a specific set of <i>n</i> other, nonmandatory symptoms, and some minimum number of nonmandatory symptoms within this set, <i>k</i>, which one must have to satisfy the symptom criterion for PGD. Based on the current data, the optimal, most efficient algorithm requires having yearning and at least five of the following nine symptoms: avoidance of reminders of the deceased; trouble accepting the death; a perception that life is empty or meaningless without the deceased; bitterness or anger related to the loss; emotional numbness; feeling stunned, dazed or shocked; feeling that part of oneself died along with the deceased; difficulty in trusting others; and difficulty moving on with life.</p>", "links"=>[], "tags"=>["diagnostic", "algorithms"], "article_id"=>560027, "categories"=>["Mental Health"], "users"=>["Holly G. Prigerson", "Mardi J. Horowitz", "Selby C. Jacobs", "Colin M. Parkes", "Mihaela Aslan", "Karl Goodkin", "Beverley Raphael", "Samuel J. Marwit", "Camille Wortman", "Robert A. Neimeyer", "George Bonanno", "Susan D. Block", "David Kissane", "Paul Boelen", "Andreas Maercker", "Brett T. Litz", "Jeffrey G. Johnson", "Michael B. First", "Paul K. Maciejewski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000121.g004", "stats"=>{"downloads"=>1, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Alternative_diagnostic_algorithms_for_meeting_symptom_criteria_for_PGD_/560027", "title"=>"Alternative diagnostic algorithms for meeting symptom criteria for PGD.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-21 05:10:28"}
  • {"files"=>["https://ndownloader.figshare.com/files/889253"], "description"=>"<p>IRT IIF analysis of 22 binary candidate symptoms for PGD was performed using a 2-PL IRM. This figure displays item information as a function of the PG attribute for all 22 of these symptoms included in this IRM, relative to the maximum information for the most informative symptom, “inability to care about others since the death.” The horizontal line in the figure represents the standard used to discriminate between 16 informative candidate symptoms retained for further analysis, and six uninformative candidate symptoms excluded from further analysis (as indicated in <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000121#pmed-1000121-t001\" target=\"_blank\">Table 1</a>).</p>", "links"=>[], "tags"=>["prolonged", "22", "symptoms"], "article_id"=>559656, "categories"=>["Mental Health"], "users"=>["Holly G. Prigerson", "Mardi J. Horowitz", "Selby C. Jacobs", "Colin M. Parkes", "Mihaela Aslan", "Karl Goodkin", "Beverley Raphael", "Samuel J. Marwit", "Camille Wortman", "Robert A. Neimeyer", "George Bonanno", "Susan D. Block", "David Kissane", "Paul Boelen", "Andreas Maercker", "Brett T. Litz", "Jeffrey G. Johnson", "Michael B. First", "Paul K. Maciejewski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000121.g001", "stats"=>{"downloads"=>6, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Relative_item_information_as_a_function_of_the_prolonged_grief_attribute_for_22_candidate_symptoms_for_PGD_/559656", "title"=>"Relative item information as a function of the prolonged grief attribute for 22 candidate symptoms for PGD.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-21 05:08:23"}
  • {"files"=>["https://ndownloader.figshare.com/files/889860"], "description"=>"a<p>Sample sizes (<i>n</i>) varied due to missing data.</p><p>*<i>p</i><0.05; **<i>p</i><0.01; ***<i>p</i><0.001.</p><p>CI, confidence interval; RR, relative risk.</p>", "links"=>[], "tags"=>["impairment", "mo", "post-loss", "pgd", "gad"], "article_id"=>560297, "categories"=>["Mental Health"], "users"=>["Holly G. Prigerson", "Mardi J. Horowitz", "Selby C. Jacobs", "Colin M. Parkes", "Mihaela Aslan", "Karl Goodkin", "Beverley Raphael", "Samuel J. Marwit", "Camille Wortman", "Robert A. Neimeyer", "George Bonanno", "Susan D. Block", "David Kissane", "Paul Boelen", "Andreas Maercker", "Brett T. Litz", "Jeffrey G. Johnson", "Michael B. First", "Paul K. Maciejewski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000121.t004", "stats"=>{"downloads"=>4, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Mental_health_and_functional_impairment_at_12_24_mo_post_loss_associated_with_PGD_among_those_not_meeting_DSM_criteria_for_MDD_PTSD_or_GAD_at_6_12_mo_post_loss_n_215_/560297", "title"=>"Mental health and functional impairment at 12–24 mo post-loss associated with PGD among those not meeting <i>DSM</i> criteria for MDD, PTSD, or GAD at 6–12 mo post-loss (<i>n</i> = 215).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 05:11:53"}
  • {"files"=>["https://ndownloader.figshare.com/files/889807"], "description"=>"<p>Relatively uninformative (<i>I</i><sub>max</sub><0.20) or biased symptoms are displayed in <b>bold font</b>. All others are informative, unbiased symptoms and were retained for further analysis.</p>a<p>IRT IIF analysis was performed using all 22 symptoms, showing 16 to be informative (<i>I</i><sub>max</sub>≥0.20).</p>b<p>IRT DIF analysis was restricted to 16 relatively informative symptoms, showing four to be biased.</p>c<p><i>I</i><sub>max</sub> represents maximum item information relative to that of “inability to care about others….”</p>d<p>Θ<sub>max</sub> represents location of <i>I</i><sub>max</sub> for the item along the PG attribute scale.</p>", "links"=>[], "tags"=>["symptoms", "pgd"], "article_id"=>560241, "categories"=>["Mental Health"], "users"=>["Holly G. Prigerson", "Mardi J. Horowitz", "Selby C. Jacobs", "Colin M. Parkes", "Mihaela Aslan", "Karl Goodkin", "Beverley Raphael", "Samuel J. Marwit", "Camille Wortman", "Robert A. Neimeyer", "George Bonanno", "Susan D. Block", "David Kissane", "Paul Boelen", "Andreas Maercker", "Brett T. Litz", "Jeffrey G. Johnson", "Michael B. First", "Paul K. Maciejewski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000121.t001", "stats"=>{"downloads"=>13, "page_views"=>22, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Evaluation_of_candidate_symptoms_for_PGD_n_287_/560241", "title"=>"Evaluation of candidate symptoms for PGD (<i>n</i> = 287).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 05:11:35"}
  • {"files"=>["https://ndownloader.figshare.com/files/889746"], "description"=>"<p>Acute = meeting symptom criteria at 0–6 mo, but not at 6–12 mo, post-loss; Delayed = not meeting symptom criteria at 0–6 mo, but meeting symptom criteria at 6–12 mo post-loss; Persistent = meeting symptom criteria at 0–6 and 6–12 mo post-loss.</p>a<p>The denominator included those assessed at both 0–6 and 6–12 mo post-loss.</p>b<p>The denominator included all those assessed at 6–12 mo post-loss, regardless of the 0–6-mo post-loss assessment.</p>c<p>Sample sizes (<i>n</i>) varied due to missing data. The first number in the parenthesis represents <i>n</i> for those assessed at both 0–6 and 6–12 mo post-loss, the second number after the colon represents <i>n</i> for those assessed at 6–12 mo post-loss regardless of the 0–6-mo post-loss assessment.</p><p>*<i>p</i><0.05; **<i>p</i><0.01; ***<i>p</i><0.001.</p><p>CI, confidence interval; RR, relative risk.</p>", "links"=>[], "tags"=>["consequences", "pgd", "temporal"], "article_id"=>560180, "categories"=>["Mental Health"], "users"=>["Holly G. Prigerson", "Mardi J. Horowitz", "Selby C. Jacobs", "Colin M. Parkes", "Mihaela Aslan", "Karl Goodkin", "Beverley Raphael", "Samuel J. Marwit", "Camille Wortman", "Robert A. Neimeyer", "George Bonanno", "Susan D. Block", "David Kissane", "Paul Boelen", "Andreas Maercker", "Brett T. Litz", "Jeffrey G. Johnson", "Michael B. First", "Paul K. Maciejewski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000121.t002", "stats"=>{"downloads"=>1, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Mental_health_and_functional_consequences_of_meeting_symptom_criteria_for_PGD_by_temporal_subtype_/560180", "title"=>"Mental health and functional consequences of meeting symptom criteria for PGD by temporal subtype.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 05:11:16"}
  • {"files"=>["https://ndownloader.figshare.com/files/889499"], "description"=>"<p>Dichotomized IRM PG attribute scores provide objective, reliable criterion standard diagnoses for PGD. This figure illustrates how rater diagnoses were used to establish a minimum-threshold cutoff PG attribute score for diagnosis of PGD (i.e., PG attribute score≥minimum-threshold cutoff PG attribute score). An optimal cutoff PG attribute score of 1 maximized agreement between rater diagnoses and dichotomized IRM PG attribute score diagnoses of PGD.</p>", "links"=>[], "tags"=>["rater", "diagnoses", "dichotomized", "prolonged", "pgd", "cutoff", "pg"], "article_id"=>559928, "categories"=>["Mental Health"], "users"=>["Holly G. Prigerson", "Mardi J. Horowitz", "Selby C. Jacobs", "Colin M. Parkes", "Mihaela Aslan", "Karl Goodkin", "Beverley Raphael", "Samuel J. Marwit", "Camille Wortman", "Robert A. Neimeyer", "George Bonanno", "Susan D. Block", "David Kissane", "Paul Boelen", "Andreas Maercker", "Brett T. Litz", "Jeffrey G. Johnson", "Michael B. First", "Paul K. Maciejewski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000121.g003", "stats"=>{"downloads"=>0, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Agreement_between_rater_diagnoses_and_dichotomized_prolonged_grief_attribute_score_diagnoses_of_PGD_as_a_function_of_cutoff_PG_attribute_score_for_diagnosis_/559928", "title"=>"Agreement between rater diagnoses and dichotomized prolonged grief attribute score diagnoses of PGD as a function of cutoff PG attribute score for diagnosis.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-21 05:09:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/889366"], "description"=>"<p>IRT DIF analysis of candidate symptoms for PGD was performed with respect to age (less than 65 y versus greater than or equal to 65 y), gender (male versus female), education (beyond versus not beyond high school), relationship to the deceased (spouse versus nonspouse), and time from loss (0–6 mo versus 6–12 mo post-loss). This figure displays IRT item characteristic curves (ICCs) for two symptoms found to differ with respect to relationship to the deceased (spouse versus nonspouse). The horizontal error bar associated with each ICC represents the standard error in the estimate of the location of the ICC with respect to the PG attribute. Of 16 informative symptoms examined, four symptoms displayed DIF and were excluded from further analysis (as indicated in <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000121#pmed-1000121-t001\" target=\"_blank\">Table 1</a>).</p>", "links"=>[], "tags"=>["functioning", "biased"], "article_id"=>559803, "categories"=>["Mental Health"], "users"=>["Holly G. Prigerson", "Mardi J. Horowitz", "Selby C. Jacobs", "Colin M. Parkes", "Mihaela Aslan", "Karl Goodkin", "Beverley Raphael", "Samuel J. Marwit", "Camille Wortman", "Robert A. Neimeyer", "George Bonanno", "Susan D. Block", "David Kissane", "Paul Boelen", "Andreas Maercker", "Brett T. Litz", "Jeffrey G. Johnson", "Michael B. First", "Paul K. Maciejewski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000121.g002", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Differential_item_functioning_for_two_biased_symptoms_/559803", "title"=>"Differential item functioning for two biased symptoms.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-21 05:09:16"}

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  • {"unique-ip"=>"106", "full-text"=>"116", "pdf"=>"41", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"3", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"4"}
  • {"unique-ip"=>"123", "full-text"=>"149", "pdf"=>"40", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"5", "supp-data"=>"0", "cited-by"=>"1", "year"=>"2019", "month"=>"5"}

Relative Metric

{"start_date"=>"2009-01-01T00:00:00Z", "end_date"=>"2009-12-31T00:00:00Z", "subject_areas"=>[{"subject_area"=>"/Medicine and health sciences", "average_usage"=>[332, 584, 719, 824, 927, 1030, 1139, 1233, 1322, 1402, 1483, 1570, 1649, 1730, 1806, 1873, 1939, 2003, 2068, 2130, 2191, 2248, 2302, 2362, 2427, 2485, 2544, 2599, 2653, 2709, 2778, 2840, 2896, 2950, 3013, 3073, 3137, 3189, 3253, 3305, 3364, 3423, 3489, 3557, 3606, 3668, 3742, 3797, 3852, 3907, 3962, 4027, 4072, 4132, 4193, 4256, 4308, 4366, 4427, 4493, 4556]}, {"subject_area"=>"/Medicine and health sciences/Diagnostic medicine", "average_usage"=>[320, 582, 740, 833, 924, 1044, 1161, 1254, 1351, 1429, 1516, 1596, 1678, 1771, 1862, 1947, 2014, 2085, 2154, 2229, 2307, 2357, 2431, 2489, 2547, 2613, 2668, 2729, 2797, 2843, 2896, 2940, 2983, 3054, 3129, 3184, 3261, 3322, 3380, 3443, 3504, 3545, 3598, 3663, 3737, 3802, 3867, 3912, 3987, 4033, 4079, 4139, 4189, 4239, 4292, 4371, 4462, 4478, 4559, 4625, 4664, 4709]}, {"subject_area"=>"/Medicine and health sciences/Health care", "average_usage"=>[431, 762, 948, 1112, 1293, 1471, 1604, 1742, 1899, 2018, 2170, 2270, 2387, 2470, 2586, 2727, 2812, 2919, 3041, 3154, 3222, 3295, 3367, 3416, 3496, 3550, 3618, 3690, 3752, 3798, 3870, 3945, 4007, 4073, 4132, 4195, 4251, 4349, 4481, 4564, 4637, 4763, 4869, 5007, 5101, 5190, 5254, 5340, 5415, 5499, 5582, 5634, 5686, 5756, 5845, 5917, 5986, 6093, 6196, 6295, 6397]}, {"subject_area"=>"/Social sciences", "average_usage"=>[422, 688, 808, 943, 1033, 1166, 1296, 1375, 1481, 1566, 1664, 1767, 1833, 1924, 2011, 2092, 2138, 2185, 2279, 2344, 2397, 2433, 2482, 2545, 2590, 2638, 2703, 2792, 2853, 2908, 2965, 3028, 3092, 3163, 3258, 3351, 3404, 3455, 3501, 3562, 3631, 3699, 3762, 3822, 3872, 3921, 3978, 4020, 4098, 4158, 4223, 4292, 4383, 4450, 4549, 4609, 4649, 4705, 4784, 4849, 4934, 4981]}]}
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