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Lechner-Meichsner F, Comtesse H, Olk M. Prevalence, comorbidities, and factors associated with prolonged grief disorder, posttraumatic stress disorder and complex posttraumatic stress disorder in refugees: a systematic review. Confl Health 2024; 18:32. [PMID: 38627778 PMCID: PMC11020800 DOI: 10.1186/s13031-024-00586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The number of refugees worldwide is at an all-time high with many being exposed to potentially traumatic events and the loss of loved ones. The 11th revision of the International Statistical Classification of Diseases and Related Health Problems now includes prolonged grief disorder and complex posttraumatic stress disorder and revised criteria for posttraumatic stress disorder. An overview of these stress-related disorders among people who have become refugees is therefore needed. Consequently, we conducted a systematic review to determine prevalence rates, comorbidities, and associated factors for each of the disorders. METHOD We systematically searched PubMed, Web of Science, and PsycArticles to identify studies that reported prevalence rates, predictors or associated factors, and/or comorbid mental disorders for either (1) prolonged grief disorder, (2) posttraumatic stress disorder, or (3) complex posttraumatic stress disorder among refugees. The selection process followed the PRISMA guidelines. RESULTS A total of 36 studies met the inclusion criteria. Most of the studies were of high quality. There was substantial variation in prevalence rates by disorder, with prolonged grief ranging from 6 to 54%, posttraumatic stress disorder ranging from 0.4 to 80%, and complex posttraumatic stress disorder ranging from 3 to 74.6%. Pooled prevalence for posttraumatic stress disorder was estimated at 29.8% in treatment seeking samples and 9.92% in population samples. For complex posttraumatic stress disorder, it was estimated at 57.4% in treatment seeking samples and 7.8% in population samples. Posttraumatic stress disorder was among the most frequent comorbidities for prolonged grief disorder while depressive symptoms were the most frequently occurring co-morbidity across all three disorders. Sociodemographic variables, trauma exposure, and loss characteristics were associated with higher symptom severity. Postmigration living difficulties played an important role in prolonged grief and complex posttraumatic stress disorder. CONCLUSION The review revealed substantial differences in prevalence rates between the three studied disorders but underscored a very high prevalence of ICD-11 stress-related disorders among refugees. The identified associated factors point to subgroups that may be particularly at risk and establishes a foundational basis for targeted interventions and potential policy changes. Future research should incorporate longitudinal investigations and emphasize culturally sensitive assessments.
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Affiliation(s)
- Franziska Lechner-Meichsner
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany.
- Clinical Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS, Netherlands.
| | - Hannah Comtesse
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Ostenstraße 26, 85072, Eichstätt, Germany
| | - Marie Olk
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany
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Li J, Gu H, Xia T. Childhood maltreatment and NSSI in prisoners: mediation through self-identity and moderation by sensation-seeking. Front Psychiatry 2024; 15:1303033. [PMID: 38370562 PMCID: PMC10869573 DOI: 10.3389/fpsyt.2024.1303033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/10/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction The prevalence of non-suicidal self-injury (NSSI) among prisoners is widely recognized. However, most research conducted in prisons setting has focused on lifetime engagement in NSSI, with limited knowledge about its correlates and risk factors during imprisonment. Methods Drawing on the integrated theoretical model of NSSI, this study aimed to examine the combined effects of childhood maltreatment (an environmental factor) and two intrapersonal factors, namely self-identity and sensation-seeking, on NSSI. 1042 Chinese male offenders participated in the current study, and regression analyses is used to examine the relationship among variables. Results The results revealed that self-identity mediated the association between childhood maltreatment and prisoners' NSSI. Sensation-seeking moderated the relationship between self-identity and NSSI, and this connection was only significant for offenders with high sensation-seeking. Discussion We discuss the results of the current research and possible practical implications.
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Affiliation(s)
- Juan Li
- School of Educational Science, Hunan Normal University, Changsha, China
| | - Honglei Gu
- School of Educational Science, Hunan Normal University, Changsha, China
- Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, China
| | - Tiansheng Xia
- School of Art and Design, Guangdong University of Technology, Guangzhou, China
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Duffy M, Wild J. Living with loss: a cognitive approach to prolonged grief disorder - incorporating complicated, enduring and traumatic grief. Behav Cogn Psychother 2023; 51:645-658. [PMID: 37170765 DOI: 10.1017/s1352465822000674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Michael Duffy
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Jennifer Wild
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Phoenix Australia, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Tay AK, Mohsin M, Foo CYS, Rees S, Silove D. Long-term efficacy of brief psychological treatments for common mental disorders in Myanmar refugees in Malaysia: 12-month follow-up of a randomized, active-controlled trial of integrative adapt therapy v. cognitive behavioral therapy. Psychol Med 2023; 53:6055-6067. [PMID: 36330832 DOI: 10.1017/s0033291722003245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Long-term efficacy of brief psychotherapies for refugees in low-resource settings is insufficiently understood. Integrative adapt therapy (IAT) is a scalable treatment addressing refugee-specific psychosocial challenges. METHODS We report 12-month post-treatment data from a single-blind, active-controlled trial (October 2017-August 2019) where 327 Myanmar refugees in Malaysia were assigned to either six sessions of IAT (n = 164) or cognitive behavioral treatment (CBT) (n = 163). Primary outcomes were posttraumatic stress disorder (PTSD), depression, anxiety, and persistent complex bereavement disorder (PCBD) symptom scores at treatment end and 12-month post-treatment. Secondary outcome was functional impairment. RESULTS 282 (86.2%) participants were retained at 12-month follow-up. For both groups, large treatment effects for common mental disorders (CMD) symptoms were maintained at 12-month post-treatment compared to baseline (d = 0.75-1.13). Although participants in IAT had greater symptom reductions and larger effect sizes than CBT participants for all CMDs at treatment end, there were no significant differences between treatment arms at 12-month post-treatment for PTSD [mean difference: -0.9, 95% CI (-2.5 to 0.6), p = 0.25], depression [mean difference: 0.1, 95% CI (-0.6 to 0.7), p = 0.89), anxiety [mean difference: -0.4, 95% CI (-1.4 to 0.6), p = 0.46], and PCBD [mean difference: -0.6, 95% CI (-3.1 to 1.9), p = 0.65]. CBT participants showed greater improvement in functioning than IAT participants at 12-month post-treatment [mean difference: -2.5, 95% CI (-4.7 to -0.3], p = 0.03]. No adverse effects were recorded for either therapy. CONCLUSIONS Both IAT and CBT showed sustained treatment gains for CMD symptoms amongst refugees over the 12-month period.
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Affiliation(s)
- Alvin Kuowei Tay
- The Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine, Sydney, Australia
| | - Mohammed Mohsin
- Mental Health Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Cheryl Yunn Shee Foo
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York City, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan Rees
- The Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine, Sydney, Australia
| | - Derrick Silove
- The Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine, Sydney, Australia
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Thomas FC, Divirgilio R, Jayawickreme N, Sivayokan S, McShane K, Jayawickreme E. Coping with the long-term impact of civil strife: A grief-centered analysis of Tamil Sri Lankan communities affected by ethnopolitical conflict. Appl Psychol Health Well Being 2023. [PMID: 37712290 DOI: 10.1111/aphw.12491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023]
Abstract
Limited research has examined coping mechanisms in response to chronic war-related stressors, as opposed to war-exposure trauma. The current study sought to investigate the types of losses experienced by communities affected by the Sri Lankan conflict, how participants responded to their losses, and what coping mechanisms they employed. Data consisted of interviews from two independent investigations conducted following the end of the conflict in Northern Sri Lanka (total N = 103). Interview transcripts were analyzed using a directed content analysis approach. Participants most frequently described experiencing material loss and loss of loved ones. Relatedly, participants commonly reported experiencing ambiguous loss, that is, living with the uncertainty of their loved one's death. These losses were particularly pronounced by gender, with women experiencing higher rates of loss. Common coping strategies included support-seeking, including informal support from social networks and religion, and formal mental health services. Additionally, participants described a range of longer term coping strategies from establishing a future-oriented cognitive style to a sense of helplessness and resignation. The findings shed light on how conflict-affected groups cope with profound loss. We provide recommendations for how such findings can inform grief-related clinical interventions.
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Affiliation(s)
- Fiona C Thomas
- Department of Psychology, Faculty of Arts, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Richard Divirgilio
- Department of Psychology, School of Liberal Arts, Manhattan College, Bronx, New York, USA
| | - Nuwan Jayawickreme
- Department of Psychology, School of Liberal Arts, Manhattan College, Bronx, New York, USA
| | | | - Kelly McShane
- Department of Psychology, Faculty of Arts, Toronto Metropolitan University, Toronto, Ontario, Canada
- Human Resource Management and Organizational Behaviour, Ted Rogers School of Management, Toronto, Ontario, Canada
| | - Eranda Jayawickreme
- Department of Psychology and Program for Leadership and Character, Wake Forest University, Winston-Salem, North Carolina, USA
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Scalable interventions for refugees. Glob Ment Health (Camb) 2023; 10:e8. [PMID: 36843882 PMCID: PMC9947626 DOI: 10.1017/gmh.2022.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 02/10/2023] Open
Abstract
Refugees experience a greater rate of common mental disorders relative to most other populations, and there remains a need to address these needs. However, most refugees are hosted in low-and-middle-income countries, where there is a lack of resources and mental health providers who can deliver mainstream mental health services. This situation has led to the emergence of scalable mental health interventions that can deliver evidence-based programs to refugees in need. Many countries hosting refugees have implemented programs that train local lay providers in interventions that can be delivered at scale. This review provides a narrative overview of these scalable interventions and critiques the evidence for their efficacy. It is noted that there are limitations to currently available scalable interventions, and there is a need for greater attention to determining the longer-term benefits of interventions, addressing the mental health needs of refugees who do not respond to these interventions, assisting refugees with more severe psychological disorders, and understanding the specific mechanisms that underpin observed benefits of these interventions.
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O'Callaghan D, Lambert S, Conway N, Frost N. Posttraumatic growth following a drug-related death: A family perspective. DEATH STUDIES 2022; 47:574-584. [PMID: 35939527 DOI: 10.1080/07481187.2022.2108943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This paper explores the experience of posttraumatic growth in families who have lost a family member to a drug-related death. Seven family units (17 participants) were interviewed, and interviews were analyzed using reflexive thematic analysis. Analyses revealed themes that reflected positive adaptation and growth, including (a) reframing the loss, (b) open dialogue and social support, and (c) reclamation of purpose. Themes are presented in this paper for their pertinence in understanding how best to negotiate adaptation through complicated grief. The paper concludes that posttraumatic growth can occur once families begin a process of acceptance and receive support through the journey.
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Affiliation(s)
| | - Sharon Lambert
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Nora Conway
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Nollaig Frost
- School of Applied Psychology, University College Cork, Cork, Ireland
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Christy S, Siriwardhana C, Lohmann J, Roberts B, Smith S. Quality of mental health questionnaires in conflict-affected adult populations in low and middle income countries: A systematic review. J Migr Health 2021; 4:100068. [PMID: 34901899 PMCID: PMC8640451 DOI: 10.1016/j.jmh.2021.100068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Accurate measurement of mental health disorders in conflict-affected populations is crucial for improving mental health care for these populations. Most studies to develop mental health questionnaires for conflict-affected populations are conducted in high income countries despite the vast majority of conflict-affected populations residing in Low and Middle Income Countries (LAMICs). The aim of this systematic review is to assess the quality of questionnaires for mental disorders that have been either developed or validated in conflict- affected settings in LAMICs. METHODS A systematic review of 5 databases (CINAHL Plus, EMBASE, Global Health, MEDLINE and PsycINFO) was conducted to identify validation studies for questionnaires measuring mental health disorders in adult conflict-affected population in LAMICs. Well-established psychometric criteria evaluating reliability, validity and responsiveness of questionnaires were applied for quality appraisal. RESULTS Thirty validation studies were included in this review, which reported on data for 33 questionnaires. Twenty-four were questionnaires that had been originally developed in different settings and adapted for use with a new conflict-affected population and 9 had been newly developed for the conflict-affected population being studied. Overall, there was high variability in the quality of evidence for the questionnaires with moderate evidence for the validity and reliability of included questionnaires but no responsiveness data reported. CONCLUSION There has been increasing recognition of the particular importance of psychometrics in this field to facilitate the development of good quality mental health questionnaires suitable for use in LAMICs. However, this review highlighted the current limited quantity and quality of such questionnaires.
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Affiliation(s)
- Sharon Christy
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | | | - Julia Lohmann
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
- Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg 69120, Germany
| | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Sarah Smith
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
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9
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Bryant RA, Edwards B, Creamer M, O'Donnell M, Forbes D, Felmingham KL, Silove D, Steel Z, McFarlane AC, Van Hooff M, Nickerson A, Hadzi-Pavlovic D. Prolonged grief in refugees, parenting behaviour and children's mental health. Aust N Z J Psychiatry 2021; 55:863-873. [PMID: 33124446 DOI: 10.1177/0004867420967420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Many refugees experience bereavement, and as a result they suffer elevated rates of prolonged grief disorder. Evidence also indicates that elevated rates of psychological disturbance in refugee children can be associated with parental mental health. This study examined the extent to which prolonged grief disorder in refugees is associated with their parenting behaviour and in turn with their children's mental health. METHODS This study recruited participants from the Building a New Life in Australia prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015-2016 and comprised 1799 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, harsh and warm parenting, probable prolonged grief disorder and posttraumatic stress disorder. Children were administered the Strengths and Difficulties Questionnaire. The current analyses on bereaved refugees comprise 110 caregivers and 178 children. RESULTS In this cohort, 37% of bereaved refugees reported probable prolonged grief disorder. Path analysis indicated that caregivers' grief was directly associated with children's emotional difficulties. Caregiver warmth was associated with reduced emotional problems in children of refugees with minimal grief but associated with more emotional problems in caregivers with more severe grief. More harsh parenting was associated with children's conduct problems, and this was more evident in those with less severe grief. CONCLUSION Severity of prolonged grief disorder is directly linked to refugee children's mental health. The association between parenting style, grief severity and children's mental health highlights that managing grief reactions in refugees can benefit both refugees and their children.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Ben Edwards
- Centre for Social Research and Methods, The Australian National University, Canberra, ACT, Australia
| | - Mark Creamer
- Phoenix Australia, The University of Melbourne, Carlton, VIC, Australia
| | - Meaghan O'Donnell
- Phoenix Australia, The University of Melbourne, Carlton, VIC, Australia
| | - David Forbes
- Phoenix Australia, The University of Melbourne, Carlton, VIC, Australia
| | - Kim L Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Derrick Silove
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Zachary Steel
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Alexander C McFarlane
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, SA, Australia
| | - Miranda Van Hooff
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, SA, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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10
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Žukauskienė R, Kaniušonytė G, Bergman LR, Bakaitytė A, Truskauskaitė-Kunevičienė I. The Role of Social Support in Identity Processes and Posttraumatic Growth: A Study of Victims of Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:7599-7624. [PMID: 30896329 DOI: 10.1177/0886260519836785] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to explore the role of social support for posttraumatic growth (PTG) and identity processes in a sample of 217 women victims of intimate partner violence (IPV), recruited from women shelters, social support centers, and through counseling psychologists. The results of the study highlight the important role of social support in seeking positive personal resolutions after experiencing traumatic events of IPV. It indicates that social support, but not social nonsupport, predicts higher levels of PTG and the development of new positive identities. In particular, social support was positively associated with the manifestation of all five identity processes, that is, with identification with commitment, commitment making, exploration in breadth, exploration in depth, and ruminative exploration. Furthermore, contextual and socioeconomic factors, such as time after last violence, relationships with the perpetrator, place of residence, education, and age of the victims of IPV were also related to identity processes. Severity of the violence, time after the last violence, education, and personal income were related to PTG. Thus, this study indicated that there are significant contextual and socioeconomic differences in the PTG and reconsideration of one's identity. Recommendations for practitioners and future research have been suggested.
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Alim M, Due C, Strelan P. Relationship between experiences of systemic injustice and wellbeing among refugees and asylum seekers: a systematic review. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1942776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mastura Alim
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Clemence Due
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Peter Strelan
- School of Psychology, University of Adelaide, Adelaide, Australia
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12
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Bryant RA, Bawaneh A, Giardinelli L, Awwad M, Al‐Hayek H, Akhtar A. A prevalence assessment of prolonged grief disorder in Syrian refugees. World Psychiatry 2021; 20:302-303. [PMID: 34002523 PMCID: PMC8129832 DOI: 10.1002/wps.20876] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - Ahmad Bawaneh
- Jordan Country OfficeInternational Medical CorpsAmmanJordan
| | | | - Manar Awwad
- Jordan Country OfficeInternational Medical CorpsAmmanJordan
| | | | - Aemal Akhtar
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia,Clinical, Neuro and Developmental PsychologyVrije UniversiteitAmsterdamThe Netherlands
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Tay AK, Khat Mung H, Badrudduza M, Balasundaram S, Fadil Azim D, Arfah Zaini N, Morgan K, Mohsin M, Silove D. Psychosocial mechanisms of change in symptoms of Persistent Complex Bereavement Disorder amongst refugees from Myanmar over the course of Integrative Adapt Therapy. Eur J Psychotraumatol 2020; 11:1807170. [PMID: 33062211 PMCID: PMC7534324 DOI: 10.1080/20008198.2020.1807170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background: The ability to adapt to the psychosocial disruptions associated with the refugee experience may influence the course of complicated grief reactions. Objective: We examine these relationships amongst Myanmar refugees relocated to Malaysia who participated in a six-week course of Integrative Adapt Therapy (IAT). Method: Participants (n = 170) included Rohingya, Chin, and Kachin refugees relocated to Malaysia. At baseline and six-week post-treatment, we applied culturally adapted measures to assess symptoms of Prolonged Complex Bereavement Disorder (PCBD) and adaptive capacity to psychosocial disruptions, based on the Adaptive Stress Index (ASI). The ASI comprises five sub-scales of safety/security (ASI-1); bonds and networks (ASI-2); injustice (ASI-3); roles and identity (ASI-4); and existential meaning (ASI-5). Results: Multilevel linear models indicated that the relationship between baseline and posttreatment PCBD symptoms was mediated by the ASI scale scores. Further, ASI scale scores assessed posttreatment mediated the relationship between baseline and posttreatment PCBD symptoms. Mediation of PCBD change was greatest for the ASI II scale representing disrupted bonds and networks. Conclusion: Our findings are consistent with the informing model of IAT in demonstrating that changes in adaptive capacity, and especially in dealing with disrupted bonds and networks, may mediate the process of symptom improvement over the course of therapy.
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Affiliation(s)
- Alvin Kuowei Tay
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Perdana University-Centre for Global Health and Social Change (PU-GHSC), Kuala Lumpur, Malaysia
| | - Hau Khat Mung
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mohammad Badrudduza
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Darlina Fadil Azim
- Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Kuala Lumpur, Malaysia
| | - Nur Arfah Zaini
- Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Kuala Lumpur, Malaysia
| | - Karen Morgan
- Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Kuala Lumpur, Malaysia
| | - Mohammed Mohsin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Psychiatry Research and Teaching Unit, Liverpool Hospital, NSW Health, Sydney, Australia
| | - Derrick Silove
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Lee SA, Jobe MC, Mathis AA, Gibbons JA. Persistent Complex Bereavement Disorder Symptoms Predict Grief Interview Emotions. OMEGA-JOURNAL OF DEATH AND DYING 2020; 84:856-869. [PMID: 32295480 DOI: 10.1177/0030222820919013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined persistent complex bereavement disorder (PCBD) symptoms' ability to predict emotional reactions of 69 bereaved adults who participated in grief interviews. The results supported the predictive validity of PCBD symptoms for both self-report and behavioral observation measures of sadness but with only one behavioral measure of happiness. Furthermore, PCBD symptoms uniquely predicted sadness in all but one measure of that emotion while accounting for symptoms of depression, posttraumatic stress, and separation anxiety. Because interviews are the primary method of psychological evaluation for clinicians, these findings collectively support the validity of the PCBD construct.
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Affiliation(s)
- Sherman A Lee
- Department of Psychology, Christopher Newport University, Newport News, Virginia, United States
| | - Mary C Jobe
- Department of Psychology, Christopher Newport University, Newport News, Virginia, United States
| | - Amanda A Mathis
- Department of Psychology, Christopher Newport University, Newport News, Virginia, United States
| | - Jeffrey A Gibbons
- Department of Psychology, Christopher Newport University, Newport News, Virginia, United States
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15
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Kokou-Kpolou CK, Moukouta CS, Masson J, Bernoussi A, Cénat JM, Bacqué MF. Correlates of grief-related disorders and mental health outcomes among adult refugees exposed to trauma and bereavement: A systematic review and future research directions. J Affect Disord 2020; 267:171-184. [PMID: 32217217 DOI: 10.1016/j.jad.2020.02.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/02/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND With conflict driving millions of refugees away from their homes worldwide, there has been an increase in interest in the field of refugee trauma. However, while trauma and bereavement interlink, prior studies have focused on trauma and its related disorders (PTSD) and predictive factors. This paper reviewed up-to-date literature on the prevalence rates of prolonged grief disorder (PGD), its comorbidities, and associated risk factors among adult refugees. METHOD We systematically reviewed the literature using five databases (PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, Academic Search Elite, and PubMed). The process of study selection was designed according to PRISMA guidelines. RESULTS The initial search generated 126 articles, of which 12 met the inclusion criteria. The pooled prevalence of PGD was 33.2% (95% CI: 15.2-54.2%). Being an older refugee, traumatic and multiple losses implying the death of first-degree relatives appeared to be consistent risk factors for PGD, combined PTSD/PGD, depression, idioms of distress, and functional impairment. PGD, PTSD, and PTSD/PGD intersect on PTSD-intrusions and painful memories. LIMITATIONS All included studies adopted a cross-sectional design, thus limiting the understanding of causal pathways. CONCLUSIONS Our findings showed that the high prevalence of PGD and related comorbidities were influenced by the load of traumatic circumstances surrounding the death(s). The findings shed light on the current proposed grief-related diagnostic criteria . Psychopathological and transcultural aspects are discussed, and we provide concrete recommendations for improvements to future research in this field.
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Affiliation(s)
| | | | - Joanic Masson
- Department of Psychology, University of Picardy Jules Verne, Amiens, France
| | - Amal Bernoussi
- Department of Psychology, University of Picardy Jules Verne, Amiens, France
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Djelantik AAAMJ, Smid GE, Mroz A, Kleber RJ, Boelen PA. The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis. J Affect Disord 2020; 265:146-156. [PMID: 32090736 DOI: 10.1016/j.jad.2020.01.034] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/15/2019] [Accepted: 01/11/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous research has indicated that one out of ten naturally bereaved individuals develops prolonged grief disorder (PGD). Less is known about the prevalence of PGD following unnatural deaths, such as accidents, disasters, suicides, or homicides. The aim of this study was to compute the pooled prevalence of PGD and to determine possible causes of its varied estimates. METHODS A literature search was conducted in PsycINFO, Ovid Medline, PILOTS, Embase, Web of Science, and CINAHL. A meta-analysis using random effects models was performed to calculate the pooled prevalence rate of PGD. Multivariate meta-regression was used to explore heterogeneity among the studies. RESULTS Twenty-five articles met eligibility criteria. The random-effects pooled prevalence was 49%, 95% CI [33.6, 65.4]. Death of only child, violent killings and non-western study location were associated with a higher PGD prevalence. A longer time since loss and a loss in a natural disaster were associated with a lower PGD prevalence. LIMITATIONS These findings should be interpreted with caution, because of the heterogeneity in study methodology. CONCLUSIONS This first meta-analysis of PGD following unnatural losses indicated that nearly half of the bereaved adults experienced PGD. This illustrates the importance of assessing PGD in individuals affected by loss and trauma.
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Affiliation(s)
- A A A Manik J Djelantik
- Department of Clinical Psychology, Utrecht University, 3508 TC Utrecht, Utrecht, 80140, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands; Foundation Centrum '45, Diemen, The Netherlands.
| | - Geert E Smid
- Arq Psychotrauma Expert Group, Diemen, The Netherlands; Foundation Centrum '45, Diemen, The Netherlands
| | - Anna Mroz
- Department of Clinical Psychology, Utrecht University, 3508 TC Utrecht, Utrecht, 80140, The Netherlands
| | - Rolf J Kleber
- Department of Clinical Psychology, Utrecht University, 3508 TC Utrecht, Utrecht, 80140, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, 3508 TC Utrecht, Utrecht, 80140, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands; Foundation Centrum '45, Diemen, The Netherlands
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Tay AK, Mung HK, Miah MAA, Balasundaram S, Ventevogel P, Badrudduza M, Khan S, Morgan K, Rees S, Mohsin M, Silove D. An Integrative Adapt Therapy for common mental health symptoms and adaptive stress amongst Rohingya, Chin, and Kachin refugees living in Malaysia: A randomized controlled trial. PLoS Med 2020; 17:e1003073. [PMID: 32231364 PMCID: PMC7108685 DOI: 10.1371/journal.pmed.1003073] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This randomised controlled trial (RCT) aims to compare 6-week posttreatment outcomes of an Integrative Adapt Therapy (IAT) to a Cognitive Behavioural Therapy (CBT) on common mental health symptoms and adaptive capacity amongst refugees from Myanmar. IAT is grounded on psychotherapeutic elements specific to the refugee experience. METHODS AND FINDINGS We conducted a single-blind RCT (October 2017 -May 2019) with Chin (39.3%), Kachin (15.7%), and Rohingya (45%) refugees living in Kuala Lumpur, Malaysia. The trial included 170 participants receiving six 45-minute weekly sessions of IAT (97.6% retention, 4 lost to follow-up) and 161 receiving a multicomponent CBT also involving six 45-minute weekly sessions (96.8% retention, 5 lost to follow-up). Participants (mean age: 30.8 years, SD = 9.6) had experienced and/or witnessed an average 10.1 types (SD = 5.9, range = 1-27) of traumatic events. We applied a single-blind design in which independent assessors of pre- and posttreatment indices were masked in relation to participants' treatment allocation status. Primary outcomes were symptom scores of Post Traumatic Stress Disorder (PTSD), Complex PTSD (CPTSD), Major Depressive Disorder (MDD), the 5 scales of the Adaptive Stress Index (ASI), and a measure of resilience (the Connor-Davidson Resilience Scale [CDRS]). Compared to CBT, an intention-to-treat analysis (n = 331) at 6-week posttreatment follow-up demonstrated greater reductions in the IAT arm for all common mental disorder (CMD) symptoms and ASI domains except for ASI-3 (injustice), as well as increases in the resilience scores. Adjusted average treatment effects assessing the differences in posttreatment scores between IAT and CBT (with baseline scores as covariates) were -0.08 (95% CI: -0.14 to -0.02, p = 0.012) for PTSD, -0.07 (95% CI: -0.14 to -0.01) for CPTSD, -0.07 for MDD (95% CI: -0.13 to -0.01, p = 0.025), 0.16 for CDRS (95% CI: 0.06-0.026, p ≤ 0.001), -0.12 (95% CI: -0.20 to -0.03, p ≤ 0.001) for ASI-1 (safety/security), -0.10 for ASI-2 (traumatic losses; 95% CI: -0.18 to -0.02, p = 0.02), -0.03 for ASI-3 (injustice; (95% CI: -0.11 to 0.06, p = 0.513), -0.12 for ASI-4 (role/identity disruptions; 95% CI: -0.21 to -0.04, p ≤ 0.001), and -0.18 for ASI-5 (existential meaning; 95% CI: -0.19 to -0.05, p ≤ 0.001). Compared to CBT, the IAT group had larger effect sizes for all indices (except for resilience) including PTSD (IAT, d = 0.93 versus CBT, d = 0.87), CPTSD (d = 1.27 versus d = 1.02), MDD (d = 1.4 versus d = 1.11), ASI-1 (d = 1.1 versus d = 0.85), ASI-2 (d = 0.81 versus d = 0.66), ASI-3 (d = 0.49 versus d = 0.42), ASI-4 (d = 0.86 versus d = 0.67), and ASI-5 (d = 0.72 versus d = 0.53). No adverse events were recorded for either therapy. Limitations include a possible allegiance effect (the authors inadvertently conveying disproportionate enthusiasm for IAT in training and supervision), cross-over effects (counsellors applying elements of one therapy in delivering the other), and the brief period of follow-up. CONCLUSIONS Compared to CBT, IAT showed superiority in improving mental health symptoms and adaptative stress from baseline to 6-week posttreatment. The differences in scores between IAT and CBT were modest and future studies conducted by independent research teams need to confirm the findings. TRIAL REGISTRATION The study is registered under Australian New Zealand Clinical Trials Registry (ANZCTR) (http://www.anzctr.org.au/). The trial registration number is: ACTRN12617001452381.
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Affiliation(s)
- Alvin Kuowei Tay
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
- Perdana University-Centre for Global Health and Social Change (PU-GHSC), Selangor, Malaysia
| | - Hau Khat Mung
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | | | - Susheela Balasundaram
- Health Unit, United Nations High Commissioner for Refugees (UNHCR), Kuala Lumpur, Malaysia
| | - Peter Ventevogel
- Public Health Section/ Division of Programme Support & Management, United Nations High Commissioner for Refugees (UNHCR), Geneva, Switzerland
| | - Mohammad Badrudduza
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Sanjida Khan
- Department of Psychology, Jagannath University, Dhaka, Bangladesh
| | - Karen Morgan
- Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Selangor, Malaysia
| | - Susan Rees
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Mohammed Mohsin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Derrick Silove
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
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Lee SA. Does the DSM-5 grief disorder apply to owners of deceased pets? A psychometric study of impairment during pet loss. Psychiatry Res 2020; 285:112800. [PMID: 32000103 DOI: 10.1016/j.psychres.2020.112800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/15/2020] [Accepted: 01/19/2020] [Indexed: 12/28/2022]
Abstract
This study aimed to validate the DSM-5 grief disorder construct to owners of deceased pets using a sample of 395 adults who were impaired during bereavement. Confirmatory factor analyzes indicated that the grief symptoms cohered into the symptom clusters proposed by the DSM-5, which were driven by a higher-order factor and were equivalent across gender. Grief disordered individuals exhibited more depression, loneliness, sleep difficulties, negative religious coping, and alcohol/drug coping compared to the rest of the sample. These findings support the application of the DSM-5 model of grief to owners of deceased pets.
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Affiliation(s)
- Sherman A Lee
- Department of Psychology, Christopher Newport University, 1 Avenue of the Arts, Newport News, VA 23606, United States.
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Stammel N, Heinzl L, Heeke C, Böttche M, Knaevelsrud C. Association Between Prolonged Grief and Attitudes Toward Reconciliation in Bereaved Survivors of the Khmer Rouge Regime in Cambodia. Front Psychiatry 2020; 11:644. [PMID: 32754059 PMCID: PMC7366248 DOI: 10.3389/fpsyt.2020.00644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/19/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND During the Khmer Rouge regime in Cambodia, about a quarter of the population died, resulting in many individuals losing close relatives. Still today, many individuals are suffering from the psychological consequences of these losses, which might also affect the process of reconciliation within the Cambodian society. The aim of this paper is therefore to investigate the association between symptoms of prolonged grief and attitudes toward reconciliation. METHODS A sample of 775 survivors of the Khmer Rouge regime who lost relatives during the conflict were interviewed about their losses and traumatic events, prolonged grief (PG; Complicated Grief Assessment Self-Report, CGA-SR), posttraumatic stress disorder (PTSD Checklist - Civilian Version) and attitudes toward reconciliation (Readiness to Reconcile Inventory, RRI). RESULTS A higher symptom severity of PG was significantly associated with readiness to reconcile even when controlling for other relevant variables (β = -0.22; p <.001). Persons who met caseness criteria for PG were significantly less ready to reconcile, t(773) = 5.47, p <.001, than persons who did not meet caseness for PG. CONCLUSION PG seems to be a relevant mental health correlate of attitudes toward reconciliation. The results of the current study underline the importance of also considering PG with regard to the reconciliation process in Cambodia and possibly also in other post-conflict regions.
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Affiliation(s)
- Nadine Stammel
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany.,Research Department, CENTER ÜEBERLEBEN, Berlin, Germany
| | - Louisa Heinzl
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Carina Heeke
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Maria Böttche
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany.,Research Department, CENTER ÜEBERLEBEN, Berlin, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
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Tay AK, Rees S, Miah MAA, Khan S, Badrudduza M, Morgan K, Fadil Azim D, Balasundaram S, Silove D. Functional impairment as a proxy measure indicating high rates of trauma exposure, post-migration living difficulties, common mental disorders, and poor health amongst Rohingya refugees in Malaysia. Transl Psychiatry 2019; 9:213. [PMID: 31477686 PMCID: PMC6718407 DOI: 10.1038/s41398-019-0537-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/15/2019] [Accepted: 07/07/2019] [Indexed: 11/11/2022] Open
Abstract
A major challenge in the refugee field is to ensure that scarce mental health resources are directed to those in greatest need. Based on data from an epidemiological survey of 959 adult Rohingya refugees in Malaysia (response rate: 83%), we examine whether a brief screening instrument of functional impairment, the WHO Disability Assessment Schedule (WHODAS), prove useful as a proxy measure to identify refugees who typically attend community mental health services. Based on estimates of mental disorder requiring interventions from analyses of epidemiological studies conducted worldwide, we selected a WHODAS cutoff that identified the top one-fifth of refugees according to severity of functional impairment, the remainder being distributed to moderate and lower impairment groupings, respectively. Compared to the lower impairment grouping, the severe impairment category comprised more boat arrivals (AOR: 5.96 [95% CI 1.34-26.43); stateless persons (A20·11 [95% CI 7.14-10); those with high exposure to pre-migration traumas (AOR: 4.76 [95% CI 1.64-13.73), peri-migration stressors (AOR: 1.26 [95% CI 1.14-1.39]) and postmigration living difficulties (AOR: 1.43 [95% CI 1.32-1.55); persons with single (AOR: 7.48 [95% CI 4.25-13.17]) and comorbid (AOR: 13.54 [95% CI 6.22-29.45]) common mental disorders; and those reporting poorer general health (AOR: 2.23 [95% CI 1-5.02]). In addition, half of the severe impairment grouping (50.6%) expressed suicidal ideas compared to one in six (16.2 percent) of the lower impairment grouping (OR: 2.39 [95% CI 1.94-2.93]). Differences between the severe and moderate impairment groups were similar but less extreme. In settings where large-scale epidemiological studies are not feasible, the WHODAS may serve as readily administered and brief public health screening tool that assists in stratifying the population according to urgency of mental health needs.
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Affiliation(s)
- Alvin Kuowei Tay
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Susan Rees
- 0000 0004 4902 0432grid.1005.4Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW 2052 Australia
| | - Mohammed Abdul Awal Miah
- 0000 0004 4902 0432grid.1005.4Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW 2052 Australia
| | - Sanjida Khan
- grid.443016.4Department of Psychology, Jagannath University, Dhaka, Bangladesh
| | - Mohammad Badrudduza
- 0000 0004 4902 0432grid.1005.4Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW 2052 Australia
| | - Karen Morgan
- School of Medicine, Perdana University-Royal College of Surgeons in Ireland (PU-RCSI), Selangor, Malaysia
| | - Darlina Fadil Azim
- School of Medicine, Perdana University-Royal College of Surgeons in Ireland (PU-RCSI), Selangor, Malaysia
| | - Susheela Balasundaram
- Health Unit, United Nations High Commissioner for Refugees (UNHCR), Kuala Lumpur, Malaysia
| | - Derrick Silove
- 0000 0004 4902 0432grid.1005.4Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW 2052 Australia
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Theoretical background, first stage development and adaptation of a novel Integrative Adapt Therapy (IAT) for refugees. Epidemiol Psychiatr Sci 2019; 29:e47. [PMID: 31441397 PMCID: PMC8061213 DOI: 10.1017/s2045796019000416] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIMS Refugees are confronted with the task of adapting to the long-term erosion of psychosocial systems and institutions that in stable societies support psychological well-being and mental health. We provide an overview of the theoretical principles and practical steps taken to develop a novel psychotherapeutic approach, Integrative Adapt Therapy (IAT), which aims to assist refugees to adapt to these changes. This paper offers the background informing ongoing trials of IAT amongst refugees from Myanmar. METHODS A systematic process was followed in formulating the therapy and devising a treatment manual consistent with the principles of the Adaptation and Development After Persecution and Trauma (ADAPT) model. The process of development and refinement was based on qualitative research amongst 70 refugees (ten from West Papua and 60 Rohingya from Myanmar). The therapeutic process was then piloted by trained interventionists amongst a purposively selected sample of 20 Rohingya refugees in Malaysia. RESULTS The final formulation of IAT represented an integration of the principles of the ADAPT model and evidence-based techniques of modern therapies in the field, including a transdiagnostic approach and the selective use of cognitive behavioural treatment elements such as problem-solving and emotional regulation techniques. The steps outlined in refining the manual are outlined in relation to work amongst West Papuan refugees, and the process of cultural and contextual modifications described during early piloting with Rohingya refugees in Malaysia. CONCLUSIONS IAT integrates universal principles of the ADAPT model with the particularities of the culture, history of conflict and living context of each refugee community; this synthesis of knowledge forms the basis for participants gaining insights into their personal patterns of psychosocial adaptation to the refugee experience. Participants then apply evidence-based techniques to improve their capacity to adapt to the serial psychosocial changes they have encountered in their lives as refugees. The overarching goal of IAT is to provide refugees with a coherent framework that assists in making sense of their experiences and their emotional and interpersonal reactions to the challenges they confront within the family and community context. As such, the principles of a general model (ADAPT) are used as a springboard for making concrete, manageable and meaningful life changes at the individual level, a potentially novel approach for psychosocial interventions in the field.
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Abstract
AIMS Despite the frequency that refugees suffer bereavement, there is a dearth of research into the prevalence and predictors of problematic grief reactions in refugees. To address this gap, this study reports a nationally representative population-based study of refugees to determine the prevalence of probable prolonged grief disorder (PGD) and its associated problems. METHODS This study recruited participants from the Building a New Life in Australia (BNLA) prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015-2016, and comprised 1767 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, probable PGD, post-traumatic stress disorder (PTSD) and mental illness. Children were administered the Strengths and Difficulties Questionnaire. RESULTS In this cohort, 38.1% of refugees reported bereavement, of whom 15.8% reported probable PGD; this represents 6.0% of the entire cohort. Probable PGD was associated with a greater likelihood of mental illness, probable PTSD, severe mental illness, currently unemployed and reported disability. Children of refugees with probable PGD reported more psychological difficulties than those whose parents did not have probable PGD. Probable PGD was also associated with the history of imprisonment, torture and separation from family. Only 56.3% of refugees with probable PGD had received psychological assistance. CONCLUSIONS Bereavement and probable PGD appear highly prevalent in refugees, and PGD seems to be associated with disability in the refugees and psychological problems in their children. The low rate of access to mental health assistance for these refugees highlights that there is a need to address this issue in refugee populations.
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Tay AK, Mohsin M, Rees S, Tam N, Kareth M, Silove D. The structure and psychosocial correlates of complicated bereavement amongst refugees from West Papua. Soc Psychiatry Psychiatr Epidemiol 2019; 54:771-780. [PMID: 30778622 DOI: 10.1007/s00127-019-01666-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Refugees may be at risk of experiencing a complicated form of bereavement. As yet, however, the nosological status of this putative category across cultures remains in question. We apply qualitative and quantitative methods to investigate the manifestations, prevalence, factorial structure and psychosocial correlates of complicated bereavement amongst refugees from West Papua, a population with no past exposure to western concepts of grief or to formal mental health services. METHODS Qualitative methods (focus groups and informant interviews) were used to identify cultural expressions of complicated bereavement derived from international classification systems, that is, DSM 5 persistent complex bereavement disorder (PCBD) and ICD-11 prolonged grief disorder (PGD) in developing a structured interview applied by trained field workers. Participants were adult West Papuan refugees and their offspring recruited from households (n = 486, response 85.8%) across nine villages in a remote town in Papua New Guinea. RESULTS The qualitative data obtained from focus groups (n = 20) and informant interviews (n = 4) with local psychiatrists supported the cultural validity of complicated bereavement. 16% (n = 78) of the sample met criteria for PCBD based on DSM-5 criteria and 103 (21%) met criteria for PGD based on ICD-11 criteria. Confirmatory factor analysis yielded a six-factor model of complicated bereavement with a moderately good fit to the data. The model included dimensions of anger/negative appraisal (AN), avoidance/giving up, estrangement from others, and confusion and diminished identity. In contrast, the DSM-5 three-factor model and the ICD-11 two-factor model each yielded a poor fit. Cumulative traumatic losses (β = 0.16, P = 0.03), duration since displacement [(β = 0.10, P = 0.02)] and postmigration living difficulties (β = 0.20, P = 0.01) were associated with an aggregated index of complicated bereavement, supporting the concurrent validity of the structure identified. CONCLUSIONS Culture and exposure to persecution and displacement may contribute to the content and configuration of the complicated bereavement reaction, an issue that requires recognition in international classification systems and clinical practice.
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Affiliation(s)
- Alvin Kuowei Tay
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia.
| | - Mohammed Mohsin
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Susan Rees
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Natalino Tam
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Moses Kareth
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Derrick Silove
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
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Boelen PA, Spuij M, Lenferink LIM. Comparison of DSM-5 criteria for persistent complex bereavement disorder and ICD-11 criteria for prolonged grief disorder in help-seeking bereaved children. J Affect Disord 2019; 250:71-78. [PMID: 30836282 DOI: 10.1016/j.jad.2019.02.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/25/2019] [Accepted: 02/16/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Persistent complex bereavement disorder (PCBD) is a disorder of grief that newly entered DSM-5. Prolonged grief disorder (PGD) is a disorder of grief included in ICD-11. No prior studies examined and compared the dimensionality, prevalence, and concurrent validity of both conditions among bereaved children. METHODS With data from 291 help-seeking bereaved 8-18 year old children, we used confirmatory factor analysis to evaluate the fit of different factor models for PCBD and PGD. In addition, we determined diagnostic rates for probable PCBD and PGD and calculated associations of PCBD and PGD caseness with concurrently assessed symptoms of overall disturbed grief, depression, posttraumatic stress, and parent-rated problem behavior. RESULTS For PCBD and PGD, one-factor models-with all symptoms forming a unidimensional factor of disturbed grief-fit the data best. The prevalence of probable DSM-5 PCBD (3.4%) was significantly lower than ICD-11 PGD (12.4%). Both PCBD and PGD were significantly associated with concurrently assessed overall disturbed grief, depression, and posttraumatic stress; associations with parent-rated problems were moderate. LIMITATIONS Findings were based on self-reported ratings of symptoms, obtained from three different scales not specifically designed to assess PCBD and PGD. The use of a help-seeking sample limits the generalization of findings to bereaved children generally. CONCLUSIONS Findings support the validity of DSM-5 PCBD and ICD-11 PGD. Prevalence rates of both constructs differ. This needs further scrutiny.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands; Arq Psychotrauma Expert Group, Diemen, the Netherlands.
| | - Mariken Spuij
- Department of Child and Adolescent Studies, Utrecht University, the Netherlands
| | - Lonneke I M Lenferink
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
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Tay AK, Rees S, Tam N, Kareth M, Silove D. Developing a measure of adaptive stress arising from the psychosocial disruptions experienced by refugees based on a sample of displaced persons from West Papua. Int J Methods Psychiatr Res 2019; 28:e1770. [PMID: 30740811 PMCID: PMC6877204 DOI: 10.1002/mpr.1770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/23/2018] [Accepted: 12/01/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES We report the testing and refinement of the Adaptive Stress Index (ASI), a psychosocial assessment tool designed to measure the longer terms stressors of adapting to the psychosocial disruptions experienced by refugees. METHODS The ASI is based on a theoretical model, the Adaptation and Development After Persecution and Trauma (ADAPT), which postulates that five psychosocial domains are disrupted by conflict and displacement, namely, safety and security, attachment, access to justice, roles and identities, and existential meaning. We used confirmatory factor analysis (CFA) and item response theory (IRT) to shorten and refine the measure based on data obtained from 487 refugees participating in a household survey in Papua New Guinea (response rate: 85.8%). RESULTS CFA allowed the exclusion of low loading items (<0.5) and locally dependent items. A good fit was found for single models representing each of the five ASI domains. A graded response IRT model identified items with the highest discrimination and information content in each of the five derived scales. CONCLUSIONS The analysis produced a shortened and refined ASI for use amongst refugee populations. The study offers a guide to adapting measures of stress for application to diverse populations exposed to mass conflict and refugee displacement.
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Affiliation(s)
- Alvin Kuowei Tay
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Rees
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Natalino Tam
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Moses Kareth
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Derrick Silove
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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Miah MA, Mahmuda M, Elshazly M, Khan S, Tay A, Ventevogel P. Contextual adaptation and piloting of Group Integrative Adapt Therapy (IAT-G) amongst Rohingya refugees living in Bangladesh. INTERVENTION-INTERNATIONAL JOURNAL OF MENTAL HEALTH PSYCHOSOCIAL WORK AND COUNSELLING IN AREAS OF ARMED CONFLICT 2019. [DOI: 10.4103/intv.intv_48_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Comtesse H, Rosner R. Prolonged grief disorder among asylum seekers in Germany: the influence of losses and residence status. Eur J Psychotraumatol 2019; 10:1591330. [PMID: 30988893 PMCID: PMC6450486 DOI: 10.1080/20008198.2019.1591330] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Besides the high exposure to traumatic events, many refugees to Europe experienced tremendous interpersonal losses. Objective: The aim of this study was to investigate the rate and potential risk factors of prolonged grief disorder (PGD) in recently fled asylum seekers who lived in collective accommodations in Germany. Method: Three groups of asylum seekers from different countries (N = 99) completed the Traumatic Grief Inventory Self-Report Version (TGI-SR), Posttraumatic Stress Disorder Checklist-5 (PCL-5), and Patient Health Questionnaire depression module (PHQ-9). Individuals in Group 1 were waiting for asylum decisions (n = 29), Group 2 members were in appeal against rejected asylum claims (n = 32), and Group 3 members had been permitted temporary residence status (n = 38). Results: The loss of a loved person was reported by 92% of participants. The criteria for provisional PGD diagnosis according to Prigerson criteria were met by 20% of participants, 16% fulfilled the criteria for DSM-5 persistent complex bereavement disorder. Probable posttraumatic stress disorder (45%) and depression (42%) rates were high. The total number of lost nuclear family members and PTSD symptoms were associated with higher and temporary residence status was predicted lower PGD symptom levels. Conclusions: These results show that a substantial proportion of asylum seekers suffer from PGD. This points to the need to screen for problematic grief in the current refugee population in Europe.
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Affiliation(s)
- Hannah Comtesse
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, D-Eichstaett, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, D-Eichstaett, Germany
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Tuomisto MT, Roche JE. Beyond PTSD and Fear-Based Conditioning: Anger-Related Responses Following Experiences of Forced Migration-A Systematic Review. Front Psychol 2018; 9:2592. [PMID: 30619002 PMCID: PMC6306035 DOI: 10.3389/fpsyg.2018.02592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 12/03/2018] [Indexed: 01/27/2023] Open
Abstract
Introduction: Experiences of forced migration include traumas that are interpersonal in nature, as well as ongoing emotional responses, stress, and frustration in post-migration setti ngs. Open questions exist, regarding anger/anger-like responses following experiences of persecution and ongoing stress. The aim of this study was to explore the adaptive and maladaptive underlying mechanisms of anger/anger-like responses, cultural, linguistic, and social contingencies, and possible interventions for problematic anger behavior. Method: We searched two databases (PsycINFO and PILOTS) with the following search terms: (refugee OR "asylum seek*" OR IDP OR "internal* displac*" OR "forced migra*" OR "involuntary migra*") AND anger. Findings: This search yielded 34 studies that were included in the final review. Although, anger is a moral, adaptive, and prosocial response, dysfunctional anger/anger-like responses arise from PTSD, "moral injury," complicated grief, and independent forms of anger behavior. Cultural, linguistic, and social issues also emerged from the search. Finally, considerations for treatment and intervention are discussed. Discussion: Anger responses following experiences of forced migration may require assessment beyond PTSD models currently framed by DSM and ICD. A very promising framework is the Adaptation and Development after Persecution and Trauma (ADAPT) model. Implications: Further longitudinal and epidemiological research will be necessary to continue testing the ADAPT model and to begin the process of assessing its cross-cultural coherence in other refugee populations (e.g., see Hinton et al., 2003). As anger behavior is also a societal issue, avenues for reconciliation, expression of grievances, employment, civic participation, and integration are needed.
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Affiliation(s)
- Martti T. Tuomisto
- Faculty of Social Sciences (Psychology), University of Tampere, Tampere, Finland
| | - Jane E. Roche
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Boelen PA, Lenferink LIM, Nickerson A, Smid GE. Evaluation of the factor structure, prevalence, and validity of disturbed grief in DSM-5 and ICD-11. J Affect Disord 2018; 240:79-87. [PMID: 30059938 DOI: 10.1016/j.jad.2018.07.041] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/01/2018] [Accepted: 07/14/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Persistent complex bereavement disorder (PCBD) is a disorder of grief included in DSM-5 Section 3. Prolonged Grief Disorder (PGD) is a disorder of grief that will enter the forthcoming ICD-11. This study evaluated the factor structure, prevalence, and validity of disturbed grief as per DSM-5 and ICD-11. METHODS With data from a community sample (N =512), we used confirmatory factor analysis (CFA) to evaluate the fit of different factor models for PCBD and PGD, determined diagnostic rates for probable PCBD and PGD, and used sensitivity/specificity analyses to evaluate the performance of individual items as indicators of PCBD and PGD. We calculated associations of PCBD-caseness and PGD-caseness with concurrently assessed symptoms of posttraumatic stress disorder (PTSD) and depression and, in a subset of 280 participants, with these same symptoms assessed one year later, to examine concurrent and predictive validity of PCBD and PGD. RESULTS For PCBD-symptoms, a three-factor model with distinct factors of separation distress, reactive distress, and social/identity disruption fit the data well; for PGD-symptoms a two-factor model with distinct separation distress symptoms and additional symptom (e.g., guilt, anger, blame) yielded acceptable model fit. Overall, items evidenced strong sensitivity and negative predictive power, and relatively poor specificity and positive predictive power. The prevalence of probable DSM-5 PCBD (6.4%) was significantly lower than the prevalence of ICD-11 PGD (18.0%). Both PCBD and PGD were significantly associated with concurrent overall grief, depression, and PTSD; PCBD but not PGD was associated with symptoms one year beyond baseline. LIMITATIONS Limitations include our reliance on self-reported data and symptoms of PCBD and PGD being derived from two questionnaires. CONCLUSIONS Findings provide preliminary evidence for the validity of both the PCBD and PGD constructs, albeit that prevalence rates of both constructs and predictive validity differ-which needs further scrutiny.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands.
| | - Lonneke I M Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, The Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | | | - Geert E Smid
- Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands; Foundation Centrum '45, Nienoord 5, 1112 XE, Diemen, The Netherlands
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Killikelly C, Bauer S, Maercker A. The Assessment of Grief in Refugees and Post-conflict Survivors: A Narrative Review of Etic and Emic Research. Front Psychol 2018; 9:1957. [PMID: 30405474 PMCID: PMC6204364 DOI: 10.3389/fpsyg.2018.01957] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/21/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Prolonged grief disorder (PGD) is a new mental health disorder that will be recognized by the World Health Organization’s disorder classification, the ICD-11, in 2018. Current assessment measures of PGD are largely based on North American and European conceptualizations of grief (etic i.e., from the perspective of the observer). However, research is emerging from communities outside of the Global North, in particular, conflict-exposed communities, exploring local models (emic i.e., from within the cultural group), assessment measures and symptoms of grief. Several reviews have found that refugees have higher rates of mental illness, defined by etic standards as depression, post-traumatic stress disorder (PTSD), anxiety disorders and psychotic symptoms. Yet, presently there are no reviews documenting the assessment of PGD in refugees and post conflict survivors. Method: This narrative review will provide an overview of studies that assess grief in refugees to (1) identify current assessment measures of grief in refugees (i.e., type and frequency of questionnaires used, whether Global North-based, etic, or locally developed, emic, and the level of cultural adaptation) and (2) to document the variety and rate of grief symptoms identified with Global North standard measures and/or local measures (i.e., the endorsement of standard symptom items and the identification of culturally specific symptoms of grief). Results: This review revealed 24 studies that assessed disordered grief in refugee or post conflict samples. Studies were heterogeneous in their assessment methods; the majority (n = 17) used an etic approach, four used a combined etic/emic approach, and three used a predominantly emic approach. The rate of disordered grief was high depending on cultural adaptation approach (31–76%) and when standard etic measures were used the disordered grief rate was 32%. Conclusion: These findings will help to guide future studies to provide accurate assessment of grief in refugee and post conflict populations and has implications for improving cultural knowledge in clinical practice.
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Affiliation(s)
- Clare Killikelly
- Division Psychopathology and Clinical Intervention, Department of Psychology, University of Zürich, Zürich, Switzerland
| | - Susanna Bauer
- Division Psychopathology and Clinical Intervention, Department of Psychology, University of Zürich, Zürich, Switzerland
| | - Andreas Maercker
- Division Psychopathology and Clinical Intervention, Department of Psychology, University of Zürich, Zürich, Switzerland
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Yun JA, Huh HJ, Han HS, Huh S, Chae JH. Bereaved families are still embittered after the Sewol ferry accident in Korea: A follow-up study 18 and 30months after the disaster. Compr Psychiatry 2018; 82:61-67. [PMID: 29407360 DOI: 10.1016/j.comppsych.2017.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/15/2017] [Accepted: 12/29/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The Sewol ferry accident that occurred in April 2014 was one of the most tragic human-made disasters in Korean history. Due to the deaths of hundreds of children, bereaved families likely feel embittered; however, there is little extant research documenting embitterment among those who experienced the disaster. Consequently, we investigated bereaved family members' embitterment and other psychiatric symptoms 18months and 30months after the disaster. METHODS Data from a cross-sectional survey were obtained 18months (Time 1) and 30months (Time 2) after the disaster. We ascertained socio-demographic variables and variables obtained from a self-reporting questionnaire (i.e., depression, anxiety, posttraumatic stress disorder, complicated grief, and embitterment) among 56 bereaved family members. RESULTS Bereaved families showed substantial embitterment at Time 1 (64.3%), which increased at Time 2 (76.8%, t=1.761, p=0.084). The participants who displayed increased embitterment at Time 2 also increased in anxiety, post-traumatic stress symptoms, and complicated grief (but not depression). Furthermore, participants who displayed decreased embitterment at Time 2 also decreased in all other psychiatric symptoms. (time×group interaction in depression (F 0.644, p=0.426), anxiety (F 4.970, p=0.030), PTSD (F 10.699, p=0.002), and complicated grief (F 8.389, p=0.005)). CONCLUSIONS Embitterment of bereaved families had not ceased after 18months and even increased 1year later. Additionally, as embitterment increased, many other psychiatric symptoms also increased, and vice versa. Our results suggest that embitterment is associated or can even influence other psychiatric symptoms; therefore, embitterment should be examined after disasters.
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Affiliation(s)
- Ji-Ae Yun
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 222 Banpodaero, Seocho-Gu, Seoul 137-701, Republic of Korea
| | - Hyu-Jung Huh
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 222 Banpodaero, Seocho-Gu, Seoul 137-701, Republic of Korea
| | - Hye-Sung Han
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 222 Banpodaero, Seocho-Gu, Seoul 137-701, Republic of Korea
| | - Seung Huh
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 222 Banpodaero, Seocho-Gu, Seoul 137-701, Republic of Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 222 Banpodaero, Seocho-Gu, Seoul 137-701, Republic of Korea.
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Identifying a combined construct of grief and explosive anger as a response to injustice amongst survivors of mass conflict: A latent class analysis of data from Timor-Leste. PLoS One 2017; 12:e0175019. [PMID: 28430793 PMCID: PMC5400232 DOI: 10.1371/journal.pone.0175019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/20/2017] [Indexed: 11/19/2022] Open
Abstract
Previous studies have identified high rates of explosive anger amongst post-conflict populations including Timor-Leste. We sought to test whether explosive anger was integrally associated with symptoms of grief amongst the Timorese, a society that has experienced extensive conflict-related losses. In 2010 and 2011 we recruited adults (n = 2964), 18-years and older, living in an urban and a rural village in Timor-Leste. We applied latent class analysis to identify subpopulations based on symptoms of explosive anger and grief. The best fitting model comprised three classes: grief (24%), grief-anger (25%), and a low symptom group (51%). There were more women and urban dwellers in the grief and grief-anger classes compared to the reference class. Persons in the grief and grief-anger classes experienced higher rates of witnessing murder and atrocities and traumatic losses, ongoing poverty, and preoccupations with injustice for the two historical periods of conflict (the Indonesian occupation and the later internal conflict). Compared to the reference class, only the grief-anger class reported greater exposure to extreme deprivations during the conflict, ongoing family conflict, and preoccupations with injustice for contemporary times; and compared to the grief class, greater exposure to traumatic losses, poverty, family conflict and preoccupations with injustice for both the internal conflict and contemporary times. A substantial number of adults in this post-conflict country experienced a combined constellation of grief and explosive anger associated with extensive traumatic losses, deprivations, and preoccupations with injustice. Importantly, grief-anger may be linked to family conflict in this post-conflict environment.
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The ADAPT model: bridging the gap between psychosocial and individual responses to mass violence and refugee trauma. Epidemiol Psychiatr Sci 2017; 26:142-145. [PMID: 27974083 PMCID: PMC6998693 DOI: 10.1017/s2045796016000925] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Silove D, Tay AK, Kareth M, Rees S. The Relationship of Complex Post-traumatic Stress Disorder and Post-traumatic Stress Disorder in a Culturally Distinct, Conflict-Affected Population: A Study among West Papuan Refugees Displaced to Papua New Guinea. Front Psychiatry 2017; 8:73. [PMID: 28620322 PMCID: PMC5449451 DOI: 10.3389/fpsyt.2017.00073] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 04/13/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Controversy continues about the validity of the construct of complex post-traumatic stress disorder (C-PTSD). In particular, questions remain whether C-PTSD can be differentiated from post-traumatic stress disorder (PTSD) and, secondarily, other common mental disorders. The examination of these issues needs to be expanded to populations of diverse cultural backgrounds exposed to prolonged persecution. We undertake such an inquiry among a community sample of West Papuan refugees exposed to extensive persecution and trauma. METHODS We interviewed over 300 West Papuan refugees using the Refugee-Mental Health Assessment Package to record symptoms of PTSD, C-PTSD, major depressive disorder (MDD), and complex grief (CG). We used first- and second-order confirmatory factor analysis (CFA) to test aspects of the convergent and discriminant validity of C-PTSD. RESULTS The CFA analysis supported both a one-factor and two-factor model of PTSD and C-PTSD. Nested model comparison tests provide support for the parsimonious one-factor model solution. A second-order CFA model of PTSD and C-PTSD produced a poor fit. The modified three-factor multi-disorder solution combining a traumatic stress (TS) factor (amalgamating PTSD and C-PTSD), MDD, and CG yielded a good fit only after removing three CG domains (estrangement, yearning, and behavioral change), a model that produced large standardized residuals (>0.20). CONCLUSION The most parsimonious model yielded a single TS factor combining symptom domains of C-PTSD and PTSD in this culturally distinct community exposed to extensive persecution and conflict-related trauma. There may be grounds for expanding the scope of psychological treatments for refugees to encompass this wider TS response. Our findings are consistent with theoretical frameworks focusing on the wider TS reaction of refugees exposed to human rights-related traumas of mass conflict, persecution, and displacement.
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Affiliation(s)
- Derrick Silove
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Moses Kareth
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Susan Rees
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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Kim J, Tol WA, Shrestha A, Kafle HM, Rayamajhi R, Luitel NP, Thapa L, Surkan PJ. Persistent Complex Bereavement Disorder and Culture: Early and Prolonged Grief in Nepali Widows. Psychiatry 2017; 80:1-16. [PMID: 28409713 DOI: 10.1080/00332747.2016.1213560] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Persistent complex bereavement disorder (PCBD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), has not been well studied in socioculturally diverse populations. Thus, this qualitative study examined (a) how widows in Nepal understand grief, (b) whether a local construct of PCBD exists, and (c) its comparability with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), terminology. METHODS Using an adapted Explanatory Model Interview Catalogue (EMIC) framework, semistructured interviews with 25 widows and 12 key informants, as well as three focus-group discussions (n = 20), were conducted between October 2014 and April 2015. Through an inductive grounded theory-based approach, we used the constant comparative method, iteratively coding transcripts to identify themes and patterns in the data. Also, we created two lists of grief responses, one of early reactions and another all reactions to grief, based on the frequency of mention. RESULTS No single term for grief was reported. Widows reported a local construct of PCBD, which was broadly compatible with DSM-5 terminology but with important variation reflecting societal influence. Surviving torture during conflict, economic and family stressors, and discrimination were mentioned as important determinants that prolong and complicate grief. Suicidal ideation was common, with about 31% and 62% of widows reporting past-year and lifetime suicidality, respectively. Findings may not be generalizable to all Nepali widows; participants were recruited from a non-governmental organization, from Kathmandu and its neighboring districts, and were primarily of reproductive age. CONCLUSIONS While PCBD symptoms proposed in DSM-5 were mentioned as relevant by study participants, some components may need adaptation for use in non-Western settings, such as Nepal.
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Abstract
Annually, over 80,000 refugees enter the United States as a result of political or religious persecution. Of these, approximately 35% to 40% are children and adolescents. Refugees are faced with challenges associated with living conditions, cultural and social norms, and socioeconomic status due to problems occurring in their homelands. These challenges include but are not limited to malnutrition, communicable disease, questionable immunization status, lack of formal education, sexual abuse, violence, torture, human trafficking, homelessness, poverty, and a lack of access to health care. Moreover, the psychological impact of relocation and the stress of acculturation may perpetuate many of these existing challenges, particularly for refugee youth, with limited or underdeveloped coping skills. School nurses are uniquely poised to support refugee youth in the transition process, improve overall health, and facilitate access to primary health services. The purpose of this article is to provide an overview of the unique refugee experience, examine the key health care needs of the population, and present school nurses with timely and relevant resources to assist in caring for refugee youth.
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Affiliation(s)
| | - Joyce Beard
- Assistant Professor, University of North Carolina at Pembroke, Pembroke, NC
| | - Dena Evans
- Associate Professor, University of North Carolina at Charlotte, Charlotte, NC
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