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Redican E, Hyland P, Shevlin M, Martsenkovskyi D, Karatzias T, Ben-Ezra M. Prevalence and correlates of ICD-11 prolonged grief disorder among adults living in Ukraine during the war with Russia. Acta Psychiatr Scand 2024; 149:425-435. [PMID: 38491862 DOI: 10.1111/acps.13678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Although high rates of bereavement are evident in war-affected populations, no study has investigated the prevalence and correlates of probable ICD-11 prolonged grief disorder (PGD) under these circumstances. METHODS Participants were 2050 adults who participated in a nationwide survey exploring the effects of the Ukraine-Russia war on the daily lives and mental health of Ukrainian people. RESULTS Of the total sample, 87.7% (n = 1797) of people indicated a lifetime bereavement. In the full sample, 11.4% met the diagnostic requirements for probable ICD-11 PGD, and amongst those with a lifetime bereavement, the conditional rate of probable ICD-11 PGD was 13.0%. Significant risk factors of ICD-11 PGD included the recent loss of a loved one (6 months to a year ago), being most affected by a partner or spouse's death, loved one dying in the war, no recent contact with the deceased prior to their death, and meeting depression and anxiety diagnostic requirements. CONCLUSION The study reveals that a significant percentage of Ukrainian bereaved individuals have probable ICD-11 PGD, and identifying risk factors, particularly war-related losses, will aid in the development of intervention and prevention programs for bereaved adults.
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Affiliation(s)
- Enya Redican
- School of Psychology, Ulster University, Coleraine, UK
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, UK
| | - Dmytro Martsenkovskyi
- Department of Psychiatry and Narcology, Bogomolets National Medical University, Kyiv, Ukraine
- SI "Institute of Psychiatry, Forensic Psychiatric Examination and Drug Monitoring of Ministry of Health of Ukraine", Kyiv, Ukraine
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
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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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Ennis N, Bottomley J, Sawyer J, Moreland AD, Rheingold AA. Measuring Grief in the Context of Traumatic Loss: A Systematic Review of Assessment Instruments. TRAUMA, VIOLENCE & ABUSE 2023; 24:2346-2362. [PMID: 35616367 PMCID: PMC9699905 DOI: 10.1177/15248380221093694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Following traumatic loss, defined as the death of a loved one due to unexpected or violent circumstances, adults may experience a myriad of grief-related problems. Given the addition of Prolonged Grief Disorders into the Diagnostic and Statistical Manual for Mental Disorders Fifth Edition, Text-Revision and influx of unexpected deaths due to the global Coronavirus pandemic, there is heightened interest in the measurement of grief-related processes. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify measures of grief used in studies of adults who experienced traumatic loss. Searches yielded 164 studies that used 31 unique measures of grief-related constructs. The most commonly used instrument was the Inventory of Complicated Grief-Revised. Half of the measures assessed constructs beyond diagnosable pathological grief responses. Given the wide variation and adaptations of measures reviewed, we recommend greater testing and uniformity of measurement across the field. Future research is needed to adapt and/or design measures to evaluate new criteria for Prolonged Grief Disorder.
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Affiliation(s)
- Naomi Ennis
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Jamison Bottomley
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Angela D. Moreland
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Alyssa A. Rheingold
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
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Hilberdink CE, Ghainder K, Dubanchet A, Hinton D, Djelantik AAAMJ, Hall BJ, Bui E. Bereavement issues and prolonged grief disorder: A global perspective. Glob Ment Health (Camb) 2023; 10:e32. [PMID: 37854407 PMCID: PMC10579660 DOI: 10.1017/gmh.2023.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 10/20/2023] Open
Abstract
The death of a loved one - bereavement - is a universal experience that marks the human mental health condition. Grief - the cognitive, emotional, and behavioral responses to bereavement - is thus experienced by virtually everyone at some point in life, while mourning is a process through which grievers come to terms with the loss envisioning life without the deceased. Although distress subsides over time among most bereaved individuals, a minority will develop a condition recently identified as prolonged grief disorder (PGD). The present review provides a global perspective on bereavement, grief reactions, and PGD. Although the loss of a loved one and grief reactions are in general experienced consistently across different cultures, differences and variations in their expression may exist across cultures. Especially within specific populations that may be more at risk for PGD, possibly due to risk factors associated with the mechanisms of loss (e.g., refugees, migrants, and conflict survivors). The diagnostic criteria for PGD are mostly based on Western grieving populations, and cultural adaptations of PGD treatments are limited. Therefore, cross-cultural development and validation of PGD screening/assessment is critical to support future research on grief reactions and PGD, especially in non-Western contexts, and concerning the potential future global changes and challenges that appear to have a major impact on PGD. More transcultural research on PGD is needed to contextualize and will lead to culture-bound symptom identification of PGD, and the adaptation of current treatment protocols, which may ultimately improve health at the individual level, and health-care systems.
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Affiliation(s)
- Charlotte E. Hilberdink
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), GIP Cyceron, Caen, France
| | - Kevin Ghainder
- Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | | | - Devon Hinton
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Brian J. Hall
- Center for Global Health Equity, New York University, Shanghai, 200122 People’s Republic of China
| | - Eric Bui
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), GIP Cyceron, Caen, France
- Centre Hospitalier Universitaire Caen Normandie, Caen, France
- Massachusetts General Hospital, Boston, MA, USA
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Gori A, Topino E, Imperatore P, Musetti A, Sim J, Machin L. Measuring Vulnerability in Grief: The Psychometric Properties of the Italian Adult Attitude to Grief Scale. Eur J Investig Health Psychol Educ 2023; 13:975-985. [PMID: 37366778 DOI: 10.3390/ejihpe13060074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/19/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
Although experiences of loss and the consequent grief are natural in human life, some individuals may have difficulty managing these events, to the point of developing significant impairment in their functioning in important life areas. Given this, the present research aimed to explore the psychometric properties of the Italian version of the Adult Attitude to Grief scale (AAG) to facilitate research on adult vulnerability to grief among Italian-speaking populations. A sample of 367 participants (Mage = 30.44, SD = 11.21; 78% females) participated in this research. A back-translation procedure was implemented to develop the Italian AAG. Then, participants completed the Italian AAG alongside a battery of other self-report psychometric scales in order to assess aspects of the construct validity of the AAG: the Forty-Item Defense Style Questionnaire, the Impact of Event Scale-Revised, and the Beck Depression Inventory-II. A bifactor structure was found to have the best fit to the data, supporting the possibility of using both the general factor (i.e., vulnerability) and three dimensions (i.e., overwhelmed, controlled, and resilient). Unlike the original version, the control dimension emerged as a "protective" factor in the Italian population, together with the resilient factor. Furthermore, results provided satisfactory indications of internal consistency and construct validity. In conclusion, the Italian AAG was shown to be a valid, reliable, quick, and easy-to-use scale that can be used both for research and clinical practice in the Italian context.
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Affiliation(s)
- Alessio Gori
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135 Florence, Italy
- Integrated Psychodynamic Psychotherapy Institute (IPPI), Via Ricasoli 32, 50122 Florence, Italy
| | - Eleonora Topino
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy
| | - Pierluigi Imperatore
- Integrated Psychodynamic Psychotherapy Institute (IPPI), Via Ricasoli 32, 50122 Florence, Italy
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, 43121 Parma, Italy
| | - Julius Sim
- School of Medicine, Keele University, Staffordshire ST5 5BG, UK
| | - Linda Machin
- School of Medicine, Keele University, Staffordshire ST5 5BG, UK
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Comtesse H, Killikelly C, Hengst SMC, Lenferink LIM, de la Rie SM, Boelen PA, Smid GE. The Ambiguous Loss Inventory Plus (ALI+): Introduction of a Measure of Psychological Reactions to the Disappearance of a Loved One. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5117. [PMID: 36982023 PMCID: PMC10049427 DOI: 10.3390/ijerph20065117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The disappearance of a significant person is an ambiguous loss due to the persistent uncertainty about the whereabouts of the person. Measures specifically capturing the psychological consequences of ambiguous loss are lacking. Therefore, this study aimed to develop the Ambiguous Loss Inventory Plus (ALI+) and evaluated its suitability for use with relatives of missing persons. METHODS ALI+ items were generated based on established measures for prolonged grief symptoms and literature on psychological responses to ambiguous loss. Eight relatives of missing persons (three refugees, five non-refugees) and seven international experts on ambiguous loss rated all items in terms of understandability and relevance on a scale from 1 (not at all) to 5 (very well). RESULTS On average, the comprehensibility of the items was rated as high (all items ≥ 3.7). Likewise, all items were rated as relevant for the assessment of common responses to the disappearance of a loved one. Only minor changes were made to the wording of the items based on the experts' feedback. CONCLUSIONS These descriptive results indicate that the ALI+ seems to cover the intended concept, thus showing promising face and content validity. However, further psychometric evaluations of the ALI+ are needed.
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Affiliation(s)
- Hannah Comtesse
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, 85072 Eichstaett, Germany
| | - Clare Killikelly
- Department of Psychiatry, University British Columbia, Vancouver, BC V6T 2A1, Canada
| | | | - Lonneke I. M. Lenferink
- Department of Clinical Psychology, Utrecht University, 3584 CS Utrecht, The Netherlands
- Department of Psychology, Health & Technology, University of Twente, 7522 NB Enschede, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, 9747 AE Groningen, The Netherlands
| | | | - Paul A. Boelen
- ARQ National Psychotrauma Centre, 1112 XE Diemen, The Netherlands
- Department of Clinical Psychology, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Geert E. Smid
- ARQ National Psychotrauma Centre, 1112 XE Diemen, The Netherlands
- Department of Humanist Chaplaincy Studies, University of Humanistic Studies, 3512 HD Utrecht, The Netherlands
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Walg M, Löwer F, Bender S, Hapfelmeier G. Domain-specific discrepancies between self- and caseworkers’ proxy- reports of emotional and behavioral difficulties in unaccompanied refugees. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2022. [DOI: 10.1080/13632752.2022.2129369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Marco Walg
- Department of Child and Adolescent Psychiatry, Sana-Klinikum , Remscheid, Germany
| | | | - Stephan Bender
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Gerhard Hapfelmeier
- Department of Child and Adolescent Psychiatry, Sana-Klinikum , Remscheid, Germany
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Comtesse H, Lechner-Meichsner F, Haneveld J, Vogel A, Rosner R. Prolonged grief in refugees living in Germany confronted with ambiguous or confirmed loss. ANXIETY, STRESS, AND COPING 2022; 35:259-269. [PMID: 34410851 DOI: 10.1080/10615806.2021.1967936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES People often disappear in the context of displacement or armed conflicts. Although such an ambiguous loss is accompanied by persistent uncertainty about the whereabouts, the psychological consequences are not well understood. This study investigated the effects of ambiguous compared to a confirmed loss on prolonged grief disorder (PGD) and its correlates in refugees to Germany. METHODS AND DESIGN We investigated data on mental health outcomes of refugees from Syria, Iraq, Iran and Afghanistan who had applied for/were granted asylum in Germany. In a secondary analysis, we compared 87 refugees with disappeared (n = 33) and deceased relatives (n = 54) who had completed questionnaire-based interviews. RESULTS Participants with ambiguous loss displayed more severe symptoms of PGD than those with confirmed loss. However, we found no group differences in terms of probable disorder rates and the number of traumatic experiences. Even after controlling for several correlates of PGD, higher PGD symptom severity was associated with ambiguous loss, more PTSD symptoms and low perceived social support. CONCLUSIONS These results show a higher prolonged grief symptom severity after the loss of a significant other due to disappearance, indicating that this type of loss could be a specific risk factor for PGD severity.
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Affiliation(s)
- Hannah Comtesse
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | | | - Julia Haneveld
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Anna Vogel
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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Lechner-Meichsner F, Comtesse H. Beliefs About Causes and Cures of Prolonged Grief Disorder Among Arab and Sub-Saharan African Refugees. Front Psychiatry 2022; 13:852714. [PMID: 35479495 PMCID: PMC9037322 DOI: 10.3389/fpsyt.2022.852714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many refugees have experienced the death of a loved one under traumatic circumstances. Accordingly, the prevalence of Prolonged Grief Disorder (PGD) among refugees is high. Culture-specific symptoms of PGD have been described previously, but beliefs about causes and cures of PGD among refugees remain unknown. We therefore aimed at identifying illness beliefs and treatment expectations regarding PGD among refugees. Method We focused on refugees from Arab countries (n = 14) and from Sub-Sahara Africa (n = 9) and applied qualitative and quantitative methods. In a semi-structured interview, participants first answered questions about assumed causes and potential cures for prototypical PGD symptoms according to ICD-11 that were presented in a vignette as representatives of their own culture. In the quantitative part, they completed the Cause Subscale of the Illness Perception Questionnaire (IPQ-R) that included additional culture-specific items. Interviews were analyzed with Qualitative Content Analysis. Results In both groups of refugees, PGD symptoms were predominantly attributed to a close relationship to the deceased, lack of social support, personal vulnerabilities, and circumstances of the death. Participants also named a number of flight-related causes (e.g., inability to perform or participate in rituals, feeling isolated in the host country). None of the participants attributed PGD symptoms to supernatural causes. Descriptive analyses of responses on the IPQ-R indicated that participants predominantly attributed PGD symptoms to psychological causes. Participants believed that PGD can be cured and predominantly mentioned social and religious support. Psychological help was only mentioned by a minority of participants. In both groups, participants emphasized that a therapist must be familiar with the patient's culture and rituals. Participants also mentioned stigma associated with seeking psychological help. Conclusion Results suggest specific beliefs of refugees regarding causes and cures of PGD as well as similarities with Western conceptualizations. A culture-sensitive approach to the treatment of PGD in refugees that can include knowledge of culture-specific rituals and incorporating religious beliefs as well as decreasing stigma and increasing mental health literacy seem important. The study is limited by its focus on only two groups of refugees and its small sample size.
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Affiliation(s)
- Franziska Lechner-Meichsner
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Hannah Comtesse
- Clinical and Biological Psychology, Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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Duden GS, de Smet S, Martins-Borges L. Psychologists' Perspectives on the Psychological Suffering of Refugee Patients in Brazil. Cult Med Psychiatry 2022; 46:364-390. [PMID: 33886043 PMCID: PMC9035004 DOI: 10.1007/s11013-021-09717-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/27/2022]
Abstract
Worldwide there are 79.5 million displaced people, many of which face war, violence, tragic flights and struggles in host countries. Research shows augmented prevalence rates of mental disorders among refugees internationally, but little is known about refugee mental health in Latin American countries. Furthermore, only a few studies have taken into consideration the knowledge of clinical psychologists who treat refugee patients. The present study examines the experiences of 32 psychologists in Brazil regarding their refugee patients' psychological suffering and mental disorders. Semi-structured interviews were conducted in various locations in Brazil and analysed following a consensual qualitative research approach. Four clusters of refugee patients' suffering were synthesised: post-migration stressors, traumatic experiences, flight as life rupture, and the current situation in the country of origin. The most frequently described conditions in patients were anxiety and depression. However, the results also show that the use of manuals for the classification of mental disorders is contested among psychologists in Brazil. Most psychologists stressed patients' socio-political suffering and saw patients' symptoms as normal reactions to their experiences. There is a need to acknowledge the socio-political suffering of refugees in Brazil and foster their mental health by tackling current post-migration stressors such as discrimination.
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Affiliation(s)
- Gesa Solveig Duden
- Department of Psychology, University of Osnabrück, Neuer Graben, 49074, Osnabrück, Germany. .,Departamento de Psicologia, Universidade Federal de Santa Catarina, Campus Universitário - Trindade, Florianópolis, SC, CEP: 88040-500, Brazil.
| | - Sofie de Smet
- Parental and Special Education Research Unit, Refugee Trauma Care-Clinical Centre PraxisP, Faculty of Psychology & Educational Sciences, University of Leuven, Leopold Vanderkelenstraat 32 bus 3764, Louvain, 3000 Belgium
| | - Lucienne Martins-Borges
- Departamento de Psicologia, Universidade Federal de Santa Catarina, Campus Universitário – Trindade, Florianópolis, SC CEP: 88040-500 Brazil ,École de Travail Social et de Criminologie, Faculté des sciences sociales, Université Laval, Avenue des Sciences-Humaines, Quebec, G1V 0A6 Canada
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Rosner R, Hagl M, Bücheler L, Comtesse H. Homesickness in asylum seekers: The role of mental health and migration-related factors. Front Psychiatry 2022; 13:1034370. [PMID: 36386971 PMCID: PMC9659899 DOI: 10.3389/fpsyt.2022.1034370] [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: 09/01/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND While homesickness in refugees is a recurring theme in clinical practice, respective research in this population is scarce. The Utrecht Homesickness Scale (UHS) allows distinguishing between certain aspects of homesickness, namely genuine separation distress like missing family and friends or yearning for home on the one side and problems regarding adjustment to the new situation on the other; so far, the instrument was applied mainly in samples of university students, and never in refugees. OBJECTIVE We aimed to explore homesickness in a refugee population and its association with mental health symptoms and migration-related factors. In addition, we wanted to evaluate the UHS's factor structure in a sample other than students. METHODS Individuals from different countries (N = 99) seeking asylum in Germany were assessed for homesickness, migration-related variables (e.g., number of losses and stage of the asylum proceedings), and mental health symptoms (symptoms of depression, posttraumatic stress and prolonged grief). After exploratory factor analysis, standardized mean factors scores were fed into subsequent correlational and regression analyses to identify the most prominent predictors of homesickness scores. RESULTS The participants showed substantial levels of homesickness. We found a three-factor solution that implied distinct factors regarding (1) adjustment difficulties and loneliness, (2) ruminations about home, and (3) missing family and/or friends. The total homesickness score was associated with mental health but regression analyses with the three mean factor scores showed differential associations with mental health and migration-related variables. While adjustment difficulties and loneliness were-besides time since arrival in Germany-associated with mental health problems (depressive and posttraumatic stress symptoms), ruminating about home was predicted by migration-related variables (number of losses and asylum status). For the factor scores regarding missing family and/or friends, the regression model was not significant. CONCLUSION The assessment of homesickness in refugee populations is feasible and of clinical importance, especially when distinguishing between separation distress and difficulties with adjusting to the new situation.
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Affiliation(s)
- Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | | | - Leonie Bücheler
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Hannah Comtesse
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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Spaaij J, Schick M, Bryant RA, Schnyder U, Znoj H, Nickerson A, Morina N. An exploratory study of embitterment in traumatized refugees. BMC Psychol 2021; 9:96. [PMID: 34112232 PMCID: PMC8193876 DOI: 10.1186/s40359-021-00599-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refugees and asylum seekers are frequently exposed to violence, human rights violations and unstable living conditions before, during, and after their displacement. Elevated prevalence rates of psychiatric disorders in forcibly displaced persons are well documented. However, less is known about other problems related to common refugee experiences, such as embitterment, moral injury, and diminished self-efficacy, and how they are related to trauma exposure and post-migration living difficulties. METHODS A cross-sectional sample of 71 refugees and asylum seekers in treatment were examined regarding exposure to potentially traumatic events, post-migration living difficulties, moral injury appraisals, self-efficacy, and embitterment. RESULTS Elevated levels of embitterment were reported by 68% of participants. The regression analysis revealed that greater moral injury appraisals and low levels of self-efficacy were significantly associated with higher levels of embitterment. CONCLUSION The results provide first insights into embitterment and associated factors in refugee populations. Furthermore, they highlight the significance of moral transgressions and low levels of self-efficacy emerging from displacement and traumatic experiences for the development of mental health problems in a clinical sample of refugees. The findings have implications for future research, policy development and clinical practice.
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Affiliation(s)
- Julia Spaaij
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich (USZ), University of Zurich (UZH), Culmannstrasse 8, 8091, Zurich, Switzerland.
| | - Matthis Schick
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich (USZ), University of Zurich (UZH), Culmannstrasse 8, 8091, Zurich, Switzerland
| | | | | | - Hansjörg Znoj
- Department of Psychology, University of Bern, Bern, Switzerland
| | | | - Naser Morina
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich (USZ), University of Zurich (UZH), Culmannstrasse 8, 8091, Zurich, Switzerland
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Duden GS, Martins-Borges L. Psychologists’ perspectives on providing psychological care for refugees in Brazil. COUNSELLING PSYCHOLOGY QUARTERLY 2021. [DOI: 10.1080/09515070.2021.1933909] [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)
- Gesa Solveig Duden
- Department of Psychology, University of Osnabrück, Osnabrück, Germany
- Departamento De Psicologia, Universidade Federal De Santa Catarina, Campus Universitário –trindade, Florianópolis, Brazil
| | - Lucienne Martins-Borges
- Departamento De Psicologia, Universidade Federal De Santa Catarina, Campus Universitário –trindade, Florianópolis, Brazil
- École De Travail Social Et De Criminologie, Faculté Des Sciences Sociales, Université Laval, Avenue Des Sciences-Humaines, Québec, Canada
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14
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Rosner R, Comtesse H, Vogel A, Doering BK. Prevalence of prolonged grief disorder. J Affect Disord 2021; 287:301-307. [PMID: 33812243 DOI: 10.1016/j.jad.2021.03.058] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/27/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prolonged grief is a disorder (PGD) characterized by severe and disabling grief reactions for an extended period of time after the loss of a significant person. ICD-11 and DSM-5-TR differ substantially in individual criteria. OBJECTIVE Estimation of the respective prevalence of PGDICD-11 and PGDDSM-5-TR and the frequency with which single symptoms of prolonged grief occur in the general population. METHODS Out of a representative sample of the German general population (N=2498), n = 914 reported a significant loss and prolonged grief symptoms based on the extended version of the self-reported Prolonged Grief Disorder-13+9 (PG13+9). Sociodemographic and loss-related characteristics were collected. RESULTS The probable prevalence of PGDICD-11 was 1.5% and that of PGDDSM-5-TR was 1.2% in the general sample. Among bereaved persons (n=914), the prevalence of developing PGDICD-11 was 4.2% and that of PGDDSM-5-TR was 3.3%. Diagnostic agreement between the two criteria-sets was very high and did not increase after heightening the accessory symptom threshold for PGDICD-11. Difficulties accepting the loss was the most frequent single symptom (14-25%) and grief-related impairment was common (10-16%). Over 60% of participants with a probable PGD diagnosis utilized health care services. LIMITATIONS Results are based on self-reported data. The PG13+9 was not designed to assess grief symptoms according to ICD-11 and DSM-5-TR diagnostic criteria. CONCLUSIONS Prolonged grief according to ICD-11 and DSM-5-TR is a notable disorder in the general population. Among bereaved persons, single symptoms of prolonged grief are relatively frequent and cause substantial degrees of impairment.
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Affiliation(s)
- Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.
| | - Hannah Comtesse
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.
| | - Anna Vogel
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Bettina K Doering
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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15
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Hoell A, Kourmpeli E, Salize HJ, Heinz A, Padberg F, Habel U, Kamp-Becker I, Höhne E, Böge K, Bajbouj M. Prevalence of depressive symptoms and symptoms of post-traumatic stress disorder among newly arrived refugees and asylum seekers in Germany: systematic review and meta-analysis. BJPsych Open 2021; 7:e93. [PMID: 33938425 PMCID: PMC8142547 DOI: 10.1192/bjo.2021.54] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In total numbers, Germany has faced the largest number of refugees and asylum seekers (RAS) in Europe in the past decade. Although a considerable proportion have experienced traumatic and stressful life events, there is no systematic review to date examining the prevalence of depressive symptoms and post-traumatic stress disorder (PTSD) symptoms in RAS in Germany. AIMS To calculate the prevalence of depressive symptoms and PTSD symptoms in the general population of RAS living in Germany after the year 2000 and explore the impact of study- and participant-related characteristics on prevalence estimates. METHOD We systematically searched PubMed, CINAHL, PsycINFO, PSYNDEX, Academic Search Complete, Science Direct and Web of Science from January 2000 to May 2020 to identify articles reporting prevalence of depressive symptoms and PTSD in RAS in Germany (PROSPERO registration number: CRD42020182796). RESULTS In total, 31 different surveys met inclusion criteria with 20 surveys reporting prevalence estimates of depressive symptoms and 25 surveys symptoms of PTSD. Based on screening tools, the pooled prevalence estimate of PTSD symptoms was 29.9% (95% CI 20.8-38.7%) and of depressive symptoms 39.8% (95% CI 29.8-50.1%). Heterogeneity was large within and between subgroups. In multivariate meta-regressions on depressive symptoms, heterogeneity was largely explained by survey period, length of field period and study quality. CONCLUSIONS Prevalence rates of depressive symptoms and PTSD symptoms in RAS are notably large. They exceed the prevalence in the general German population. As a result of high heterogeneity, however, pooled prevalence rates should be interpreted with caution.
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Affiliation(s)
- Andreas Hoell
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Germany
| | - Eirini Kourmpeli
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Germany
| | - Hans Joachim Salize
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Campus Innenstadt, Clinic of the Ludwig-Maximilians-University (LMU) Munich, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human Medicine, Philipps-University Marburg, Germany
| | - Edgar Höhne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human Medicine, Philipps-University Marburg, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité Universitätsmedizin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité Universitätsmedizin, Germany
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16
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McQuaid JH, Silva MA, McKenzie KC. Surviving violent, traumatic loss after severe political persecution: lessons from the evaluation of a Venezuelan asylum seeker. BMJ Case Rep 2021; 14:e239025. [PMID: 33758042 PMCID: PMC7993358 DOI: 10.1136/bcr-2020-239025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2021] [Indexed: 11/03/2022] Open
Abstract
In July 2019, the United Nations High Commissioner for Refugees (UNHCR) released a report urging the Venezuelan government to take immediate action to address the 'grave violations of economic, social, civil, political and cultural rights' occurring in the country. This case study highlights the human rights violations occurring in Venezuela through the case of a Venezuelan woman who experienced political persecution and traumatic loss resulting from her opposition to the ruling socialist party. As the clinical team of evaluators explored the mental health effects of surviving threats on her own life and the politically motivated assassination of her husband, it was agreed that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition did not fully capture the extent of her suffering. Case discussion broadens the lens beyond the client's experiences of posttraumatic stress disorder (PTSD) and depression to include persistent complex bereavement disorder, and emphasises the importance of addressing the sequelae of traumatic loss in a multifaceted way that broadens understanding of emotional functioning postmigration.
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Affiliation(s)
- Jennifer H McQuaid
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Katherine C McKenzie
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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17
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Hajak VL, Sardana S, Verdeli H, Grimm S. A Systematic Review of Factors Affecting Mental Health and Well-Being of Asylum Seekers and Refugees in Germany. Front Psychiatry 2021; 12:643704. [PMID: 33815176 PMCID: PMC8012840 DOI: 10.3389/fpsyt.2021.643704] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Since the onset of the 2015 European refugee crisis, ~4. 46 million people have sought asylum in the European Union, with Germany logging the largest share of all asylum applications. In addition to the severe adversities before and during flight, the process of settling into a new environment involves stressors that affect psychological well-being and mental health. The aim of this systematic review was to examine contextual factors during post-migration that influence the mental health and well-being of asylum seekers and refugees (ASRs) in Germany. Methods: Following PRISMA guidelines, a systematic review was conducted across multiple databases for English and German studies published between 2015 and 2020 with index keywords. Results: From a total of 303 articles, 156 duplicates were removed and, after title review, another 87 were excluded for not meeting the inclusion criteria. After assessing the abstracts of the remaining 60 articles, 39 were excluded. Full texts of 21 articles were assessed for eligibility and after excluding 8 articles, 13 articles were included in the review. The results demonstrate high rates of psychological distress among ASRs in Germany and the significant influence of contextual factors on their mental health and psychological well-being. The risk factors for poor mental health include an uncertain asylum status, living in shared asylum accommodations, separation from the nuclear family, lack of German language skills, integration issues and discrimination, while employment is a protective factor. Conclusion: Asylum seekers and refugees have high prevalence rates of psychological distress directly influenced by contextual factors in Germany. Based on these findings, policy makers are strongly recommended to apply preventive strategies to reduce mental health problems of ASRs in Germany.
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Affiliation(s)
- Vivien L. Hajak
- Department of Psychology, Medical School Berlin, Berlin, Germany
| | - Srishti Sardana
- Global Mental Health Laboratory, Teachers College, Columbia University, New York, NY, United States
| | - Helen Verdeli
- Global Mental Health Laboratory, Teachers College, Columbia University, New York, NY, United States
| | - Simone Grimm
- Department of Psychology, Medical School Berlin, Berlin, Germany
- Department of Psychiatry, Charité, Campus Benjamin Franklin, Berlin, Germany
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18
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Killikelly C, Smid GE, Wagner B, Boelen PA. Responding to the new International Classification of Diseases-11 prolonged grief disorder during the COVID-19 pandemic: a new bereavement network and three-tiered model of care. Public Health 2021; 191:85-90. [PMID: 33556639 DOI: 10.1016/j.puhe.2020.10.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
The field of bereavement research and care is at a tipping point. The introduction of prolonged grief disorder (PGD) in the International Classification of Diseases (ICD-11) has ignited clinical interest in this new disorder, along with debate over challenges in validating and implementing these new criteria. At the same time, the global COVID-19 pandemic has launched several local and international efforts to provide urgent support and comfort for individuals and communities suffering from grief. Recently, grief experts have called for a collective response to these complicated bereavements and possible increase in PGD due to COVID-19. Here we outline a new European network that aims to unite a community of grief researchers and clinicians to provide accessible, evidence-based support particularly during times of unprecedent crisis. The Bereavement Network Europe (BNE) has been developed with two main aims. Firstly, to develop expert agreed, internationally acceptable guidelines for bereavement care through a three-tiered approach. Secondly, to provide a platform for researchers and clinicians to share knowledge, collaborate, and develop consensus protocols to facilitate the introduction of PGD to diverse stakeholders. This article outlines the current status and aims of the BNE along with the plans for upcoming network initiatives and the three-tiered bereavement care guidelines in response to the COVID-19 pandemic.
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Affiliation(s)
- C Killikelly
- Department of Psychology, University of Zurich, Switzerland.
| | - G E Smid
- University of Humanistic Studies, the Netherlands; ARQ National Psychotrauma Centre, Diemen, the Netherlands
| | - B Wagner
- MSB Medical School Berlin, Germany
| | - P A Boelen
- ARQ National Psychotrauma Centre, Diemen, the Netherlands; Department of Clinical Psychology, Utrecht University, Netherlands
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19
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Steil R, Lechner-Meichsner F, Johow J, Krüger-Gottschalk A, Mewes R, Reese JP, Schumm H, Weise C, Morina N, Ehring T. Brief imagery rescripting vs. usual care and treatment advice in refugees with posttraumatic stress disorder: study protocol for a multi-center randomized-controlled trial. Eur J Psychotraumatol 2021; 12:1872967. [PMID: 34992749 PMCID: PMC8725706 DOI: 10.1080/20008198.2021.1872967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Many refugees have experienced multiple traumatic events in their country of origin and/or during flight. Trauma-related disorders such as posttraumatic stress disorder (PTSD) or complex PTSD (CPTSD) are prevalent in this population, which highlights the need for accessible and effective treatment. Imagery Rescripting (ImRs), an imagery-based treatment that does not use formal exposure and that has received growing interest as an innovative treatment for PTSD, appears to be a promising approach. Objective: This randomized-controlled trial aims to investigate the efficacy of ImRs for refugees compared to Usual Care and Treatment Advice (UC+TA) on (C)PTSD remission and reduction in other related symptoms. Method: Subjects are 90 refugees to Germany with a diagnosis of PTSD according to DSM-5. They will be randomly allocated to receive either UC+TA (n = 45) or 10 sessions of ImRs (n = 45). Assessments will be conducted at baseline, post-intervention, three-month follow-up, and 12-month follow-up. Primary outcome is the (C)PTSD remission rate. Secondary outcomes are severity of PTSD and CPTSD symptoms, psychiatric symptoms, dissociative symptoms, quality of sleep, and treatment satisfaction. Economic analyses will investigate health-related quality of life and costs. Additional measures will assess migration and stress-related factors, predictors of dropout, therapeutic alliance and session-by-session changes in trauma-related symptoms. Results and Conclusions: Emerging evidence suggests the suitability of ImRs in the treatment of refugees with PTSD. After positive evaluation, this short and culturally adaptable treatment can contribute to close the treatment gap for refugees in high-income countries such as Germany. Trial registration: German Clinical Trials Register under trial number DRKS00019876, registered prospectively on 28 April 2020.
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Affiliation(s)
- Regina Steil
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | | | - Johannes Johow
- Coordinating Centre for Clinical Trials (KKS), Philipps-University of Marburg, Marburg, Germany
| | | | - Ricarda Mewes
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Jens-Peter Reese
- Coordinating Centre for Clinical Trials (KKS), Philipps-University of Marburg, Marburg, Germany
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität of Würzburg, Würzburg, Germany
| | - Hannah Schumm
- Department of Psychology, LMU Munich, Munich, Germany
| | - Cornelia Weise
- Department of Psychology, Philipps-University of Marburg, Marburg, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
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20
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Scocco P, Idotta C, Mareschi T, Preti A. Do interpersonal events buffer or worsen depressive and grief related symptoms in people bereaved through suicide? DEATH STUDIES 2020; 46:1344-1353. [PMID: 33287686 DOI: 10.1080/07481187.2020.1855608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Life events can heighten emotional suffering related to the loss of a close relative or friend by suicide, while supportive social relationships may promote coping. We investigated the impact of stressful events and perceived social support on depressive and grief symptoms in 378 help-seeking Italians bereaved through suicide. While we did not observe a significant effect of interpersonal stressors, perceived social support did have a buffering role on the intensity of depressive symptoms but not of grief-related suffering. Focusing on expanding and capitalizing on clients' perceived social networks could strengthen postvention programs. Further research on the role of interpersonal factors is needed.
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Affiliation(s)
- Paolo Scocco
- SOPROXI Onlus, Padova, Italy
- Mental Health Department, Padova, Italy
| | | | - Tea Mareschi
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
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21
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Treml J, Linde K, Engel C, Glaesmer H, Hinz A, Luck T, Riedel-Heller S, Sander C, Kersting A. Loss and grief in elderly people: Results from the LIFE-Adult-Study. DEATH STUDIES 2020; 46:1621-1630. [PMID: 32972330 DOI: 10.1080/07481187.2020.1824203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We evaluated 2,865 elderly people to investigate the prevalence of prolonged grief disorder (PGD), examine predictors and mental health correlates. The conditional prevalence of PGD varied between 0.8% and 5.2% (diagnostic algorithm vs. cut-off). PG-13 scores were related to depressive symptoms, sleep disturbances, reduced life satisfaction, and quality of life. Predictors were female gender, less time since death, more losses, having lost a child, partner, or sibling, and less social support. PGD is associated with adverse mental health consequences. Practitioners should pay special attention to elderly women who lost a close loved one and lack social support.
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Affiliation(s)
- Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Katja Linde
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Tobias Luck
- Department of Economic and Social Sciences and Institute of Social Medicine, Rehabilitation Sciences and Healthcare Research, Nordhausen University of Applied Sciences, Nordhausen, Germany
| | - Steffi Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
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22
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Atiyeh S, Choudhuri DD, Dari T. Considerations for Facilitating Refugee Acculturation through Groups. JOURNAL FOR SPECIALISTS IN GROUP WORK 2020. [DOI: 10.1080/01933922.2020.1800879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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23
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Lacour O, Morina N, Spaaij J, Nickerson A, Schnyder U, von Känel R, Bryant RA, Schick M. Prolonged Grief Disorder Among Refugees in Psychological Treatment-Association With Self-Efficacy and Emotion Regulation. Front Psychiatry 2020; 11:526. [PMID: 32581893 PMCID: PMC7291948 DOI: 10.3389/fpsyt.2020.00526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/22/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND While Prolonged Grief Disorder (PGD) among refugees has recently started to attract scientific attention, knowledge regarding associated psychological factors remains limited. Given the multifactorial context of persecution, trauma, displacement, and exile-related difficulties, obtaining a better understanding of PGD in refugees is crucial because PGD may affect psychological well-being, level of functioning, and social integration. METHODS In a sample of refugees receiving psychological treatment in Switzerland (N = 88), we examined the relationship between severity of PGD and potentially associated factors such as emotion regulation, perceived self-efficacy, as well as potentially traumatic events and post-migration living difficulties. RESULTS In a regression analysis, difficulties in emotion regulation and lower perceived self-efficacy were associated with greater severity of PGD, while post-migration living difficulties and potentially traumatic events did not emerge as significant factors. CONCLUSION These findings suggest that emotion regulation and perceived self-efficacy are associated with PGD in refugees in psychological treatment and are thus potential targets for treatment interventions.
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Affiliation(s)
- Oriane Lacour
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Julia Spaaij
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Ulrich Schnyder
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Matthis Schick
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
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24
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Stelzer EM, Zhou N, Maercker A, O’Connor MF, Killikelly C. Prolonged Grief Disorder and the Cultural Crisis. Front Psychol 2020; 10:2982. [PMID: 31998204 PMCID: PMC6967836 DOI: 10.3389/fpsyg.2019.02982] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
Prolonged grief disorder (PGD) is included as a new mental health disorder in the 11th edition of the International Classification of Diseases (ICD-11). Understandably, this has boosted research efforts to investigate this newcomer to psychopathology. However, the use of different diagnostic algorithms has resulted in substantially different prevalence rates both within and across cultural groups. Furthermore, global applicability of the new criteria outside of the Global North has not been yet been established. This perspective presents key findings from Asian research groups and discusses the roadblocks to unified PGD research, including the heterogeneric use of diagnostic algorithms and the lack of cultural compatibility of ICD-11 items. The authors discuss the key issues and address implications for practice.
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Affiliation(s)
- Eva-Maria Stelzer
- Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
- Department of Psychology, University of Arizona, Tucson, AZ, United States
| | - Ningning Zhou
- Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Andreas Maercker
- Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | | | - Clare Killikelly
- Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
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25
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Djelantik AAAMJ, de Heus A, Kuiper D, Kleber RJ, Boelen PA, Smid GE. Post-Migration Stressors and Their Association With Symptom Reduction and Non-Completion During Treatment for Traumatic Grief in Refugees. Front Psychiatry 2020; 11:407. [PMID: 32547428 PMCID: PMC7273964 DOI: 10.3389/fpsyt.2020.00407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/21/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Resettled refugees exposed to trauma and loss are at risk to develop mental disorders such as posttraumatic stress disorder (PTSD) and persistent complex bereavement disorder (PCBD). Post-migration stressors have been linked to poor mental health and smaller treatment effects. AIM Our aim was to evaluate reductions in PTSD and PCBD symptoms and to explore the presence of post-migration stressors and their associations with symptom change and non-completion in a traumatic grief focused treatment in a cohort of refugees. METHODS Paired sample t-tests were used to test the significance of the symptom reductions in PTSD and PCBD symptoms during treatment. The presence of post-migration stressors was derived from a qualitative analysis of the patient files. Associations between post-migration stressors and symptom reductions as well as non-completion were calculated. RESULTS In this uncontrolled study, 81 files of consecutive patients were included. Significant reductions in both PCBD and PTSD symptomatology with medium effect sizes were found. Patients experienced a mean of three different post-migration stressors during the treatment. Undocumented asylum seekers were more likely to be non-completers. Ongoing conflict in the country of origin was associated with smaller PTSD symptom reductions and the total number of post-migration stressors was associated with smaller PCBD symptom reductions. CONCLUSIONS Treatment for resettled refugees for traumatic grief coincides with alleviations in both PCBD and PTSD symptomatology. Specific post-migration stressors were associated with reduced treatment effects and increased non-completion. This is a first step towards well-informed improvements of mental health interventions for resettled refugees.
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Affiliation(s)
- A A A Manik J Djelantik
- ARQ Centrum'45, Diemen, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands
| | - Annemiek de Heus
- ARQ Centrum'45, Diemen, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - Diede Kuiper
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands
| | - Rolf J Kleber
- ARQ National Psychotrauma Centre, Diemen, Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands
| | - Paul A Boelen
- ARQ Centrum'45, Diemen, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands
| | - Geert E Smid
- ARQ Centrum'45, Diemen, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands.,University of Humanistic Studies, Utrecht, Netherlands
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26
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Comtesse H, Vogel A, Kersting A, Rief W, Steil R, Rosner R. When does grief become pathological? Evaluation of the ICD-11 diagnostic proposal for prolonged grief in a treatment-seeking sample. Eur J Psychotraumatol 2020; 11:1694348. [PMID: 32002134 PMCID: PMC6968549 DOI: 10.1080/20008198.2019.1694348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/19/2019] [Accepted: 10/07/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Prolonged grief disorder (PGD) will be newly included in the ICD-11, while a clinically similar diagnosis, persistent complex bereavement disorder (PCBD), has already been added to the DSM-5. Only few studies have evaluated these criteria-sets for prolonged grief. Objective: The aim of this study was to evaluate the ICD-11 accessory symptom threshold and compare the diagnostic performance of the two criteria-sets in treatment-seeking bereaved persons. Method: 113 grief treatment-seeking bereaved persons completed the Interview for Prolonged Grief-13. We used receiver operator characteristic analysis to determine an optimum ICD-11 accessory symptom threshold. We calculated diagnostic rates for PGD and PCBD and examined associations of PGD and PCBD caseness with concurrently assessed psychopathology and prolonged grief symptoms assessed one month later. Results: An ICD-11 threshold of six accessory symptoms distinguished optimally between interview-diagnosed participants with and without prolonged grief. The prevalence of PGD (69%) was significantly higher than that of PCBD (48%) and of PGD with a 6-symptom threshold (47%). PGD caseness was associated with the relation to the deceased, 6-symptom threshold PGD and PCBD caseness with the time since loss. All criteria-sets were linked to concurrent prolonged grief, depression, and general mental distress. PCBD and 6-symptom threshold PGD but not PGD were associated with prolonged grief severity one month later. Conclusions: The results support the validity of PGD and PCBD but, at the same time, they provide further support for differing prevalence rates. Using an empirically determined ICD-11 accessory symptom threshold could prevent the pathologisation of grief reactions.
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Affiliation(s)
- Hannah Comtesse
- Department of Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Germany
| | - Anna Vogel
- Department of Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany
| | - Winfried Rief
- Department of Psychology, University of Marburg, Marburg, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Rita Rosner
- Department of Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Germany
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27
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Olff M, Amstadter A, Armour C, Birkeland MS, Bui E, Cloitre M, Ehlers A, Ford JD, Greene T, Hansen M, Lanius R, Roberts N, Rosner R, Thoresen S. A decennial review of psychotraumatology: what did we learn and where are we going? Eur J Psychotraumatol 2019; 10:1672948. [PMID: 31897268 PMCID: PMC6924542 DOI: 10.1080/20008198.2019.1672948] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
On 6 December 2019 we start the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma. This editorial is part of a special issue/collection celebrating the 10 years anniversary of the journal where we will acknowledge some of our most impactful articles of the past decade (also discussed below and marked with * in the reference list). In this editorial the editors present a decennial review of the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline. These include neurobiological developments (genomics, neuroimaging and neuroendocrine research), forms of trauma exposure and impact across the lifespan, mass trauma and early interventions, work-related trauma, trauma in refugee populations, and the potential consequences of trauma such as PTSD or Complex PTSD, but also resilience. We address innovations in psychological, medication (enhanced) and technology-assisted treatments, mediators and moderators like social support and finally how new research methods help us to gain insights in symptom structures or to better predict symptom development or treatment success. We aimed to answer three questions 1. Where did we stand in 2010? 2. What did we learn in the past 10 years? 3. What are our knowledge gaps? We conclude with a number of recommendations concerning top priorities for the future direction of the field of psychotraumatology and correspondingly the journal.
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Affiliation(s)
- Miranda Olff
- Department of Psychiatry, Amsterdam
University Medical Centers (location AMC), University of Amsterdam, Amsterdam
Neuroscience, Amsterdam, The Netherlands
- ARQ National Psychotrauma
Centre, Diemen, The Netherlands
| | - Ananda Amstadter
- Departemnts of Psychiatry, Psychology, &
Human and Molecular Genetics, Virginia Commonwealth University, Richmond,
USA
| | - Cherie Armour
- School of Psychology, Queens University
Belfast, Belfast, Northern Ireland, UK
| | - Marianne S. Birkeland
- Section for implementation and treatment
research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo
Norway
| | - Eric Bui
- Department of Psychiatry, Massachusetts
General Hospital & Harvard Medical School, Boston, MA,
USA
| | - Marylene Cloitre
- National Center for PTSD Dissemination and
Training Division, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral
Sciences, Stanford University, Palo Alto, CA, USA
| | - Anke Ehlers
- Department of Experimental Psychology,
University of Oxford, Oxford, UK
| | - Julian D. Ford
- Department of Psychiatry, University of
Connecticut Health Center, Farmington, USA
| | - Talya Greene
- Department of Community Mental Health,
University of Haifa, Haifa, Israel
| | - Maj Hansen
- Department of Psychology,
Odense, Denmark
| | - Ruth Lanius
- Posttraumatic Stress Disorder (PTSD) Research
Unit, Western University of Canada, London, ON,
Canada
| | - Neil Roberts
- Psychology and Psychological Therapies
Directorate, Cardiff & Vale University Health Board, Cardiff,
UK
- Division of Psychological Medicine &
Clinical Neurosciences, Cardiff University, Cardiff,
UK
| | - Rita Rosner
- Department of Clinical and Biological
Psychology, KU Eichstaett-Ingolstadt, Eichstaett,
Germany
| | - Siri Thoresen
- Section for trauma, catastrophes and forced
migration – children and youth, Norwegian Centre for Violence and Traumatic Stress
Studies, Oslo, Norway
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28
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Nickerson A, Byrow Y, O'Donnell M, Mau V, McMahon T, Pajak R, Li S, Hamilton A, Minihan S, Liu C, Bryant RA, Berle D, Liddell BJ. The association between visa insecurity and mental health, disability and social engagement in refugees living in Australia. Eur J Psychotraumatol 2019; 10:1688129. [PMID: 32002133 PMCID: PMC6968544 DOI: 10.1080/20008198.2019.1688129] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/29/2022] Open
Abstract
Background: The vast majority of the world's refugees and people seeking asylum live in a state of sustained displacement. Little is known, however, about the mental health impact of prolonged insecurity. Objective: This study aimed to investigate the association between insecure visa status and mental health, suicidality, disability and social engagement in a sample of refugees and asylum-seekers living in Australia Method: Participants were 1,085 refugees with secure (i.e. permanent residency or Australian citizenship, n = 826, 76.1%) and insecure (i.e. asylum-seeker claim, bridging visa, temporary visa, n = 259, 23.9%) visa status who had arrived in Australia since January 2011, and were from Arabic, Farsi, Tamil or English-speaking backgrounds. Participants completed an online survey assessing pre- and post-migration experiences, mental health, disability and social engagement. Results: Results indicated that, after controlling for background factors, refugees with insecure visas had significantly greater PTSD symptoms, depression symptoms, thoughts of being better off dead and suicidal intent compared to those with secure visas. There were no group differences in disability. Refugees with insecure visas received support from significantly more groups in the Australian community than those with secure visas. Further, refugees with insecure visa status who had low group membership showed greater depression symptoms and suicidal intent than those with secure visa status who had low group membership. Conclusion: Findings highlight the negative mental health consequences of living in a state of protracted uncertainty for refugees and people seeking asylum, and the key role of social engagement in influencing mental health amongst insecure visa holders. Results also underscore the importance of designing and implementing policies and services that facilitate improved mental health for those with visa insecurity.
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Affiliation(s)
| | - Yulisha Byrow
- School of Psychology, UNSW Sydney, Sydney, Australia
| | | | - Vicki Mau
- Australian Red Cross, North Melbourne, Australia
| | - Tadgh McMahon
- Settlement Services International, Ashfield, Australia
| | - Rosanna Pajak
- School of Psychology, UNSW Sydney, Sydney, Australia
| | - Susan Li
- School of Psychology, UNSW Sydney, Sydney, Australia
| | | | | | - Candy Liu
- School of Psychology, UNSW Sydney, Sydney, Australia
| | | | - David Berle
- School of Psychology, University of Technology Sydney, Sydney, Australia
| | - Belinda J Liddell
- School of Psychology, UNSW Sydney, Sydney, Australia.,Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
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