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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 2024; 16:822-850. [PMID: 37712290 DOI: 10.1111/aphw.12491] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Ramli DB, Shahar S, Mat S, Ibrahim N, Tohit NM. The effectiveness of preventive home visits on resilience and health-related outcomes among community dwelling older adults: A systematic review. PLoS One 2024; 19:e0306188. [PMID: 38950029 PMCID: PMC11216600 DOI: 10.1371/journal.pone.0306188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/11/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND This research aimed to assess the effectiveness of preventive home visits (PHVs) in enhancing resilience and health-related outcomes among older adults living in the community. METHODS A comprehensive literature search was conducted in nine databases (PubMed, MEDLINE, CINAHL, Embase, Emcare, Web of Science (WOS), Scopus, PsycINFO and Cochrane Library. The search was undertaken between March 15 and 31, 2022 with subsequent updates performed on October 15, 2023 and April 10, 2024. This review also included grey literature sourced via Google, Google Scholar and backward citation searches. RESULTS Out of 5,621 records, 20 articles were found to meet the inclusion criteria with a total of 8,035 participants involved and the mean age ranged from 74.0 to 84.4 years. Using McMaster Critical Review Form for Quantitative Studies, we ascertained that the studies included in our analysis had moderate to high levels of quality. In addition to health-related outcomes, PHV interventions were also conducted to evaluate psychological effects (16 studies) and social outcomes (seven studies). Five studies conducted financial assessment to evaluate the costs of health and social care utilisation during PHV interventions. Regarding the results of the review, seven studies showed favourable outcomes, five indicated no effect and eight had equivocal findings. Only one study assessed resilience and determined that PHV had no effect on the resilience of the subjects. CONCLUSION This review found that the effectiveness of PHV interventions was uncertain and inconclusive. PHV interventions often prioritise health-related objectives. The incorporation of a holistic approach involving psychosocial health into PHV interventions is relatively uncommon. Due to the paucity of research on resilience as PHV outcome, we are unable to draw a conclusion on the effectiveness of PHV on resilience. Resilience should be prioritised as a psychological assessment in the future development of comprehensive PHV interventions, as it enables older adults to adapt, manage, and respond positively to adversities that may arise with age. Performing financial analysis such as costs and benefits analysis to incorporate the return on investment of PHV interventions is an added value for future research on this topic. CLINICAL TRIAL REGISTRATION PROSPERO registration number: CRD42022296919.
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Affiliation(s)
- Dayang Balkis Ramli
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Public Service Department, Prime Minister’s Office, Putrajaya, Malaysia
| | - Suzana Shahar
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sumaiyah Mat
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norhayati Ibrahim
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noorlaili Mohd Tohit
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan, Bangi, Malaysia
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Gunawan PK, Agustiani H, Qodariah L. Adaptation of PG-13 on Indonesian Adolescents. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:729-740. [PMID: 35350905 DOI: 10.1177/00302228221085187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Prolonged Grief (PG-13) Children Form was adapted, then went through basic validation to be applicable on Indonesian adolescents. The form was adapted based on the guidelines by Beaton et al. (2000). Pre-testing was done on 40 adolescents by online interviewing. PG-13 Indonesian Version and the Depression, Anxiety and Stress Scales (DASS) were then reconstructed into an online questionnaire for basic validation purposes. It was completed by 131 adolescents. Results prove a high internal consistency reliability and acceptable construct validity of the PG-13.
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Affiliation(s)
- Prudentia K Gunawan
- Department of Clinical Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Hendriati Agustiani
- Department of Clinical Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Laila Qodariah
- Department of Clinical Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
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Peinado V, Valiente C, Contreras A, Trucharte A, Butter S, Murphy J, Shevlin M. ICD-11 prolonged grief disorder: Prevalence, predictors, and co-occurrence in a large representative sample. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2024; 59:86-95. [PMID: 37828650 DOI: 10.1002/ijop.12951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
The International Classification of Diseases has recently defined Prolonged Grief Disorder (PGD) with symptoms such as longing, worry, and intense emotional pain that exceed sociocultural norms more than 6 months after the loss. This study aims to (a) estimate the prevalence of this new diagnostic category, (b) identify its sociodemographic and loss-related predictors, and (c) assess the co-occurrence of PGD with other psychological disorders and substance abuse. A large representative sample of Spanish adults (N = 1498) participated. Several multivariate binary logistic regression and multivariate logistic regression models were used. Results showed a 9.95% prevalence in the total sample. Catholic beliefs were a positive predictor, while higher income and more time since loss significantly decreased the odds of PGD. PGD significantly increased the likelihood of anxiety, depression, somatisation, post-traumatic stress disorder, loneliness and substance use. Our study contributes to assessing the multicultural PGD validity, as our results from a large representative sample are comparable to those in other countries with the PGDS. Our findings have direct implications for the assessment and treatment of bereavement, identifying for practitioners variables that make individuals more vulnerable to PGD. Results highlighted the high co-occurrence of PGD with other psychological illnesses and increased drug use.
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Affiliation(s)
- Vanesa Peinado
- Facultad de Psicología Clínica, Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Valiente
- Facultad de Psicología Clínica, Universidad Complutense de Madrid, Madrid, Spain
| | - Alba Contreras
- Departamento de Psicología, Facultad de Medicina, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Almudena Trucharte
- Departamento de Psicología, Facultad de Salud, Universidad Camilo José Cela, Madrid, Spain
| | - Sarah Butter
- School of Psychology, Ulster University, Coleraine, UK
| | - Jamie Murphy
- School of Psychology, Ulster University, Coleraine, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, UK
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Ertanir B, Cobb CL, Unger JB, Celada-Dalton T, West AE, Zeledon I, Perazzo PA, Cano MÁ, Des Rosiers SE, Duque MC, Ozer S, Cruz N, Scaramutti C, Vos SR, Salas-Wright CP, Maldonado-Molina MM, Nehme L, Martinez CR, Zayas LH, Schwartz SJ. Crisis Migration Adverse Childhood Events: A New Category of Youth Adversity for Crisis Migrant Children and Adolescents. Res Child Adolesc Psychopathol 2023; 51:1871-1882. [PMID: 36626084 PMCID: PMC10661744 DOI: 10.1007/s10802-022-01016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 01/11/2023]
Abstract
The present article proposes an extension of the concept of adverse childhood experiences (ACEs) to apply to crisis migration - where youth and families are fleeing armed conflicts, natural disasters, community violence, government repression, and other large-scale emergencies. We propose that adverse events occurring prior to, during, and following migration can be classified as crisis-migration-related ACEs, and that the developmental logic underlying ACEs can be extended to the new class of crisis-migration-related ACEs. Specifically, greater numbers, severity, and chronicity of crisis-migration-related ACEs would be expected to predict greater impairments in mental and physical health, poorer interpersonal relationships, and less job stability later on. We propose a research agenda centered around definitional clarity, rigorous measurement development, prospective longitudinal studies to establish predictive validity, and collaborations among researchers, practitioners, and policymakers.
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Affiliation(s)
- Beyhan Ertanir
- School of Education, Institute Research and Development, University of Applied Sciences and Arts Northwestern Switzerland, Bahnhofstrasse 6, 5210, Windisch, Switzerland.
| | | | | | | | - Amy E West
- University of Southern California, Los Angeles, United States
| | - Ingrid Zeledon
- University of Southern California, Los Angeles, United States
| | | | | | | | - Maria C Duque
- University of Texas at Austin, Austin, United States
| | | | - Natalie Cruz
- Children's Hospital Los Angeles, Los Angeles, United States
| | | | - Saskia R Vos
- University of Miami (Florida), Miami, United States
| | | | | | - Lea Nehme
- Florida International University, Miami, United States
| | | | - Luis H Zayas
- University of Texas at Austin, Austin, United States
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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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7
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Killikelly C, Kagialis A, Henneman S, Coronado H, Demanarig D, Farahani H, Özdoğru AA, Yalçın B, Yockey A, Gosnell CL, Jia F, Maisel M, Stelzer E, Wilson D, Anderson J, Charles K, Cummings JP, Faas C, Knapp B, Koneczny B, Koch C, Bauer LM, Cuccolo C, Edlund JE, Heermans GF, McGillivray S, Shane-Simpson C, Staples A, Zheng Z, Zlokovich MS, Irgens MS. Measurement and assessment of grief in a large international sample. J Affect Disord 2023; 327:306-314. [PMID: 36736540 DOI: 10.1016/j.jad.2023.01.095] [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] [Received: 08/09/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND In 2022, the International Classification of Diseases (ICD-11) and an update of the Diagnostic Statistical Manual of Mental Disorders (DSM 5 TR) were released for implementation worldwide and now include the new Prolonged Grief Disorder (PGD). The newest definition of PGD is based on robust clinical research from the Global North yet until now has not been tested for global applicability. METHODS The current study assesses the new PGD ICD-11 criteria in a large international sample of 1393 bereaved adults. The majority of the sample was included from the USΑ. Additionally, we conduct a sub-sample analysis to evaluate the psychometric properties, probable caseness of PGD, and differences in network structure across three regions of residency (USA, Greece-Cyprus, Turkey-Iran). RESULTS The psychometric validity and reliability of the 33-item International Prolonged Grief Disorder Scale (IPGDS) were confirmed across the whole sample and for each regional group. Using the strict diagnostic algorithm, the probable caseness for PGD for the whole sample was 3.6 %. Probable caseness was highest for the Greece-Cyprus group (6.9 %) followed by Turkey-Iran (3.2 %) and the USA (2.8 %). Finally, the network structure of the IPGDS standard items and cultural supplement items (total of 33 items) confirmed the strong connection between central items of PGD, and revealed unique network connections within the regional groups. LIMITATIONS Future research is encouraged to include larger sample sizes and a more systematic assessment of culture. CONCLUSION Overall, our findings confirm the global applicability of the new ICD-11 PGD disorder definition as evaluated through the newly developed IPGDS. This scale includes culturally sensitive grief symptoms that may improve clinical precision and decision-making.
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Affiliation(s)
- C Killikelly
- University of Zurich, Switzerland; University of British Columbia, Canada.
| | - A Kagialis
- Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Greece
| | - S Henneman
- Johannes Gutenberg University Mainz, Germany.
| | | | | | | | | | | | - A Yockey
- University of North Texas Health Science Center, Department of Biostatistics and Epidemiology, USA.
| | | | - F Jia
- Seton Hall University, USA.
| | - M Maisel
- Mount St Mary's University, USA.
| | | | | | | | | | | | - C Faas
- Mount St Mary's University, USA.
| | - B Knapp
- Southeastern University, USA
| | | | - C Koch
- George Fox University, USA.
| | | | | | | | | | | | | | | | | | - M S Zlokovich
- Psi Chi, the International Honor Society in Psychology, USA.
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Killikelly C, Maercker A. The cultural supplement: A new method for assessing culturally relevant prolonged grief disorder symptoms. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e7655. [PMID: 37065001 PMCID: PMC10103155 DOI: 10.32872/cpe.7655] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/14/2022] [Indexed: 04/03/2023] Open
Abstract
Background
The new diagnosis of prolonged grief disorder (PGD) is both an opportunity and a challenge for researchers, clinicians, and bereaved individuals. The latest definition of PGD includes a refreshing and novel feature: the cultural caveat, i.e., clinicians must determine that the grief presentation is more severe and of longer duration than would be expected by an individual’s culture and context. Currently, there are no guidelines on how to operationalize the cultural caveat in mental health care settings.
Method
To respond to this important demand we have developed, piloted, and tested the cultural supplement module of the International Prolonged Grief Disorder scale (IPGDS). The cultural supplement aims to provide clinicians with a catalogue of culturally relevant symptoms of grief that indicate probable PGD alongside a simple framework for cultural adaptation for use in specific clinical settings.
Results
In this short report we outline the rationale and aim of the cultural supplement and provide a summary of our latest validation studies of the IPGDS with bereaved German-speaking, Chinese and Swiss migrant individuals. We also provide a step-by-step framework for adaptation of the cultural supplement that clinicians and researchers may use when working with different cultural groups.
Conclusion
To date, this is the first PGD questionnaire based on the ICD-11, and the first to include a cultural supplement that can be adapted to different contexts and groups. This cultural supplement will provide clinicians and researchers an easy-to-use assessment tool with the aim to improve the global applicability of the ICD-11 PGD definition.
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Bunn M, Samuels G, Higson-Smith C. Ambiguous loss of home: Syrian refugees and the process of losing and remaking home. WELLBEING, SPACE AND SOCIETY 2023; 4:100136. [PMID: 37476200 PMCID: PMC10358717 DOI: 10.1016/j.wss.2023.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
This constructivist-interpretive study examines social-relational dimensions of change and loss following experiences of political terror, war and forced migration from the perspective of Syrian refugee men and women who were presently living in Jordan (n=31). A process model derived from the analysis theorizes four dimensions of ambiguous loss (safety and security, social connections and identities, connection to place, and dreams and imagined future) and to capture the cyclical process of losing and remaking a sense of home in displacement. Our findings underscore a more complex set of processes that remain outside the array of supports and services provided by many current practices and policies with displaced populations generally, and Syrian refugees specifically. Thus, the findings highlight the need for ecological, integrative policies, interventions and services that support refugees' attempts to remake the multifaceted and stable phenomenon that is home as they transition into new communities.
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Affiliation(s)
- Mary Bunn
- Department of Psychiatry, University of Illinois Chicago, 1601W. Taylor Street, Chicago, IL 60637, USA
| | - Gina Samuels
- Crown Family School of Social Work, Policy and Practice, University of Chicago, 969 E. 60th Street, Chicago, IL 60637, USA
| | - Craig Higson-Smith
- Center for Victims of Torture, 2356 University Avenue West, St. Paul, MN 55114, USA
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Donnelly O, Leavey G. Screening Tools for Mental Disorders Among Female Refugees: a Systematic Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:209-219. [PMID: 35600514 PMCID: PMC9120328 DOI: 10.1007/s40653-021-00375-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 06/15/2023]
Abstract
Female refugees are particularly vulnerable to mental disorders but assessment may be complex and challenging. Various screening tools have been developed for this population, but little is known about their usefulness. The main aim is to examine the literature on the effectiveness of screening tools for mental health problems among female refugees. Systematic review of PubMed, PsycINFO and Embase to locate all published work. Comprehensive search terms were used and inclusion and exclusion criteria were formulated. The initial search yielded 877 articles, of which 757 were removed after titles and abstracts were reviewed. Then, 121 full-text versions of articles were examined and 96 excluded according to the criteria. A total of 25 articles were included in this systematic review in accordance with the PRIMSA guidelines. Twenty screening tools were evaluated. There is a lack of tools used to screen refugee women, and in particular those in emergency settings. Cultural factors may not be accounted for in the development of screening instruments. Further research in this field can help inform public health policies to address social, educational and occupational inclusion for refugee women in different contexts.
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Affiliation(s)
| | - Gerard Leavey
- Bamford Centre of Mental Health & Wellbeing, Ulster University, Coleraine, Northern Ireland
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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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Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Penninx BWJH, Xiao S, Trivedi M, Uher R, Vijayakumar L, Wolpert M. Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet 2022; 399:957-1022. [PMID: 35180424 DOI: 10.1016/s0140-6736(21)02141-3] [Citation(s) in RCA: 297] [Impact Index Per Article: 148.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Sangath, Goa, India; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Berk
- Deakin University, IMPACT Institute, Geelong, VIC, Australia
| | - Claudia Buchweitz
- Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania L Vanvitelli, Naples, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Myrna M Weissman
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe; Centre for Global Mental Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina W Hoven
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shuiyuan Xiao
- Central South University Xiangya School of Public Health, Changsha, China
| | - Madhukar Trivedi
- Peter O'Donnell Jr Brain Institute and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Lakshmi Vijayakumar
- Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India
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Asif Z, Kienzler H. Structural barriers to refugee, asylum seeker and undocumented migrant healthcare access. Perceptions of doctors of the world caseworkers in the UK. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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14
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Groen SPN, Menninga MC, Cath DC, Smid GE. Let's talk about grief: Protocol of a study on the recognition and psychoeducation of prolonged grief disorder in outpatients with common mental disorders. Front Psychiatry 2022; 13:944233. [PMID: 36159934 PMCID: PMC9492871 DOI: 10.3389/fpsyt.2022.944233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recognition that the loss of a loved one may result in prolonged grief disorder (PGD) has gained broad attention recently. PGD may disturb daily functioning to such a degree that mental health treatment is required. Because PGD symptoms often resemble symptoms of common mental disorders (CMD) such as anxiety, depressive, and post-traumatic stress disorder, clinicians may not consider a PGD diagnosis. Moreover, cultural varieties in expression of PGD may complicate recognition. This study explores the prevalence of PGD among both natives and refugees with anxiety, depressive, or trauma- and/or stressor-related disorders as well as clinicians' awareness and knowledge of PGD symptoms. In addition, a psychoeducation module on PGD symptoms is developed through patient expert collaboration. METHODS Prevalence of PGD symptoms is investigated among 50 participants who are referred to outpatient clinics for anxiety, depression, or post-traumatic stress, using the Traumatic Grief Inventory-Self Report Plus (TGI-SR+) and the Bereavement and Grief-Cultural Formulation Interview (BG-CFI). Clinicians will be interviewed on knowledge (gaps) with respect to PGD symptoms. Finally, focus groups with patient experts are held to develop a psychoeducation module tailored to the patients' needs, norms and values. RESULTS This study will show prevalence of PGD among patients who are referred for anxiety, depression, and post-traumatic stress, awareness and knowledge of clinicians on PGD symptoms, and will offer patient expert informed psychoeducation. DISCUSSION Research on prevalence and recognition of PGD is vital. Study results of the prevalence of PGD will be compared to previous studies. Recognition of PGD as distinct disorder from CMDs requires clinicians' awareness of symptoms related to the loss of a loved one. Thereby, clinicians need to take cultural aspects related to death, bereavement and mourning into consideration. ETHICS AND DISSEMINATION The study protocol will be carried out in accordance with relevant guidelines and regulations. Exploratory research to assess the prevalence of PGD in patients suffering from CMDs will facilitate adequate diagnosis by increasing clinician's awareness of PGD symptoms. Tailored PGD psychoeducation, co-created by culturally diverse patient experts and clinicians will be made publicly available.
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Affiliation(s)
- Simon P N Groen
- De Evenaar Center for Transcultural Psychiatry Drenthe Mental Health Care, Beilen, Netherlands
| | - Marijke C Menninga
- De Evenaar Center for Transcultural Psychiatry Drenthe Mental Health Care, Beilen, Netherlands
| | - Daniëlle C Cath
- Department of Psychiatry, University Medical Center Groningen, Rob Giel Onderzoekscentrum, Groningen, Netherlands.,Drenthe Mental Health Care, Assen, Netherlands.,Department of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Geert E Smid
- Department of Humanist Chaplaincy Studies, University of Humanistic Studies, Utrecht, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands
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15
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Harrison O, Windmann S, Rosner R, Steil R. Inclusion of the other in the self as a potential risk factor for prolonged grief disorder: A comparison of patients with matched bereaved healthy controls. Clin Psychol Psychother 2021; 29:1101-1112. [PMID: 34822735 DOI: 10.1002/cpp.2697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022]
Abstract
Pathological grief has received increasing attention in recent years, as about 10% of the bereaved suffer from one kind of it. Pathological grief in the form of prolonged grief disorder (PGD) is a relatively new diagnostic category which will be included into the upcoming ICD-11. To date, various risk and protective factors, as well as treatment options for pathological grief, have been proposed. Nevertheless, empirical evidence in that area is still scarce. Our aim was to identify the association of interpersonal closeness with the deceased and bereavement outcome. Interpersonal closeness with the deceased in 54 participants (27 patients suffering from PGD and 27 bereaved healthy controls) was assessed as the overlap of pictured identities via the inclusion of the other in the self scale (IOS scale). In addition to that, data on PGD symptomatology, general mental distress and depression were collected. Patients suffering from PGD reported higher inclusion of the deceased in the self. By contrast, they reported feeling less close towards another living close person. Results of the IOS scale were associated with PGD severity, general mental distress and depression. Inclusion of the deceased in the self is a significant statistical predictor for PGD caseness.
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Affiliation(s)
- Octavia Harrison
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Sabine Windmann
- Department of Cognitive Psychology II, Goethe University Frankfurt, Frankfurt, Germany
| | - Rita Rosner
- Department of Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany.,Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany
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16
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Jannesari S, Lotito C, Turrini G, Oram S, Barbui C. How does context influence the delivery of mental health interventions for asylum seekers and refugees in low- and middle-income countries? A qualitative systematic review. Int J Ment Health Syst 2021; 15:80. [PMID: 34702334 PMCID: PMC8546788 DOI: 10.1186/s13033-021-00501-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) host the majority of the world's refugees. Evidence suggests that refugees and asylum seekers have high mental health needs compared to the host country population. However, they face many social, economic and culture barriers to receiving mental health care and benefitting from mental health interventions. This paper examines how these contextual factors affect the implementation of mental health interventions for refugees and asylum seekers in LMICs. METHODS We conducted a qualitative systematic review searching 11 databases and 24 relevant government and non-governmental organisation (NGO) websites. We spoke with academic experts and NGO professionals for recommendations, and conducted forwards and backwards citation tracking. RESULTS From 2055 records in abstract and title screening, and then 99 in full-text screening, 18 eligible studies were identified. Qualitative thematic synthesis was conducted on eligible papers. Three main thematic clusters were identified around: (1) support during a time of pressure and insecurity, and the need for intervention flexibility through facilitator and participant autonomy; (2) different cultural conceptions of mental health, and how interventions negotiated these differences; and (3) the importance of facilitator skills, knowledge, characteristics and relationships to intervention implementation. CONCLUSION Evidence suggests that intervention coordinators and developers should continue to: (1) think broadly about the range of social influences on mental health, addressing structural issues where possible; (2) offer flexibility with intervention style, content and timings; and (3) encourage building research capacity in LMICs while acknowledging pre-existing mental health knowledge and practice.
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Affiliation(s)
- Sohail Jannesari
- Institute of Psychiatry, Psychology and Neuroscience, Department of Health Services and Population Research, King’s College London, David Goldberg Building, Kings College London, De Crespigny Park, London, SE5 8AF UK
| | - Claudia Lotito
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Siân Oram
- Institute of Psychiatry, Psychology and Neuroscience, Department of Health Services and Population Research, King’s College London, David Goldberg Building, Kings College London, De Crespigny Park, London, SE5 8AF UK
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
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Smith-Greenaway E, Alburez-Gutierrez D, Trinitapoli J, Zagheni E. Global burden of maternal bereavement: indicators of the cumulative prevalence of child loss. BMJ Glob Health 2021; 6:e004837. [PMID: 33824177 PMCID: PMC8030478 DOI: 10.1136/bmjgh-2020-004837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND We provide country-level estimates of the cumulative prevalence of mothers bereaved by a child's death in 170 countries and territories. METHODS We generate indicators of the cumulative prevalence of mothers who have had an infant, under-five-year-old or any-age child ever die by using publicly available survey data in 89 countries and an indirect approach that combines formal kinship models and life-table methods in an additional 81 countries. We label these measures the maternal cumulative prevalence of infant mortality (mIM), under-five mortality (mU5M) and offspring mortality (mOM) and generate prevalence estimates for 20-44-year-old and 45-49-year-old mothers. RESULTS In several Asian and European countries, the mIM and mU5M are below 10 per 1000 mothers yet exceed 200 per 1000 mothers in several Middle Eastern and African countries. Global inequality in mothers' experience of child loss is enormous: mothers in high-mortality-burden African countries are more than 100 times more likely to have had a child die than mothers in low-mortality-burden Asian and European countries. In more than 20 African countries, the mOM exceeds 500 per 1000 mothers, meaning that it is typical for a surviving 45-49-year-old mother to be bereaved. DISCUSSION The study reveals enormous global disparities in mothers' experience of child loss and identifies a need for more research on the downstream mental and physical health risks associated with parental bereavement.
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Affiliation(s)
- Emily Smith-Greenaway
- Sociology & Spatial Sciences, University of Southern California, Los Angeles, California, USA
| | | | | | - Emilio Zagheni
- Max Planck Institute for Demographic Research, Rostock, Germany
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Surkan PJ, Garrison-Desany HM, Rimal D, Luitel NP, Kim Y, Prigerson HG, Shrestha S, Tol W, Murray SM. Adaptation and psychometric validation of the Prolonged Grief Disorder scale among widows in central Nepal. J Affect Disord 2021; 281:397-405. [PMID: 33352410 DOI: 10.1016/j.jad.2020.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 11/10/2020] [Accepted: 12/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Symptoms of grief vary by culture and societal reactions to death may be gender specific. We aimed to validate a Nepali language version of the Prolonged Grief-13 item scale (PG-13) among widows. METHODS We tested two adapted versions of a Prolonged Grief Disorder (PGD) instrument with 204 Nepali-speaking widows: one was a Nepali translation of the original PG-13 items, while the other contained five additional items derived from qualitative research. We evaluated internal consistency, factor structure, and construct and criterion validity. RESULTS Participants were on average 44 years old (SD=9.3), completed 6.7 years of school (SD=3.3) and had survived their husbands by 10 years (SD=8.1). Thirteen percent met global criteria for PGD. The removal of one original PG-13 item (felt emotionally numb) from both versions due to poor discriminant validity resulted in 12- and 17-item versions. Exploratory factor analysis supported a one-factor structure for the PG-12 and PG-17. Both versions of the scale exhibited high internal consistency (0.89 and 0.93 respectively). Confirmatory factor analysis suggested that symptoms of PGD were distinct from post-traumatic stress disorder (PTSD), anxiety and depressive symptoms. The PG-12 had lower sensitivity (74.1%) but higher specificity (83.6%) compared to the PG-17 (81.5% and 73.5% respectively). LIMITATIONS Psychosocial counselors' clinical interview global ratings were used as the standard for comparison in criterion validity analyses. Generalizability to other socio-cultural (e.g. non-widowed, low-caste) populations and men in Nepal cannot be assumed. CONCLUSIONS Results indicate satisfactory psychometric properties and validity of both versions of the PG instruments, supporting their use with Nepali speaking widows.
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Affiliation(s)
- Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Henri M Garrison-Desany
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Damodar Rimal
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal, GPO Box 8974/CPC Box 612
| | - Nagendra P Luitel
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal, GPO Box 8974/CPC Box 612
| | - Yoona Kim
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Holly G Prigerson
- Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, NY, USA
| | - Sumeera Shrestha
- Women for Human Rights, single women's group, P.O. Box 8973 NPC 427, Baluwatar, Kathmandu, Nepal
| | - Wietse Tol
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA; Section of Global Health, Department of Public Health, University of Copenhagen
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Naal H, Nabulsi D, El Arnaout N, Abdouni L, Dimassi H, Harb R, Saleh S. Prevalence of depression symptoms and associated sociodemographic and clinical correlates among Syrian refugees in Lebanon. BMC Public Health 2021; 21:217. [PMID: 33499834 PMCID: PMC7836044 DOI: 10.1186/s12889-021-10266-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Since the outbreak of the Syrian war in 2011, close to 6 million Syrian refugees have escaped to Syria's neighbouring countries, including Lebanon. Evidence suggests rising levels of mental health disorders among Syrian refugee populations. Yet, to the best of our knowledge, large-scale studies addressing the mental health of adult Syrian refugees in Lebanon are lacking. We examined the prevalence of depression symptoms, which represent a common and debilitating mental health disorder among Syrian refugee populations in Lebanon, along with their sociodemographic and clinical correlates. METHODS A cross-sectional survey design was conducted as part of a collaborative project-"Sijilli"- led by the Global Health Institute at the American University of Beirut (Beirut, Lebanon) across 4 informal tented settlements for refugees (Beirut, Bekaa, North, South) in Lebanon among adult Syrian refugees (≥18), over a period extending from 2018 to 2020. The survey inquired about participants' sociodemographic and clinical characteristics, and screened participants for symptoms of depression through sequential methodology using the Patient Health Questionnaire (PHQ-2 and PHQ-9). RESULTS A total of 3255 adult Syrian refugees were enrolled in the study. Of those refugees, 46.73% (n = 1521) screened positive on the PHQ-2 and were therefore eligible to complete the PHQ-9. In the entire sample (n = 3255), the prevalence of moderate to severe depression symptoms (PHQ-2 ≥ 2 and then PHQ-9 ≥ 10) was 22% (n = 706). Further analyses indicate that being ≥45 years of age (OR 1.61, 95% CI 1.13-2.30), a woman (OR 1.34, 95% CI 1.06-1.70), widowed (OR 2.88, 95% CI 1.31-6.32), reporting a neurological (OR 1.73, 95% CI 1.15-2.60) or a mental health condition (OR 3.98, 95% CI 1.76-8.97) are major risk factors for depression. CONCLUSION Our study suggests that an estimated one in four Syrian refugees in Lebanon shows moderate to severe depression symptoms, and our findings have important public health and clinical implications on refugee health. There is a need to enhance screening efforts, to improve access and referral to mental health services, and to improve post-migration factors among Syrian refugees in Lebanon.
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Affiliation(s)
- Hady Naal
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dana Nabulsi
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Lina Abdouni
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Hani Dimassi
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Ranime Harb
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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Comtesse H, Ertl V, Hengst SMC, Rosner R, Smid GE. Ecological Grief as a Response to Environmental Change: A Mental Health Risk or Functional Response? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E734. [PMID: 33467018 PMCID: PMC7830022 DOI: 10.3390/ijerph18020734] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/09/2021] [Accepted: 01/13/2021] [Indexed: 11/18/2022]
Abstract
The perception of the impact of climate change on the environment is becoming a lived experience for more and more people. Several new terms for climate change-induced distress have been introduced to describe the long-term emotional consequences of anticipated or actual environmental changes, with ecological grief as a prime example. The mourning of the loss of ecosystems, landscapes, species and ways of life is likely to become a more frequent experience around the world. However, there is a lack of conceptual clarity and systematic research efforts with regard to such ecological grief. This perspective article introduces the concept of ecological grief and contextualizes it within the field of bereavement. We provide a case description of a mountaineer in Central Europe dealing with ecological grief. We introduce ways by which ecological grief may pose a mental health risk and/or motivate environmental behavior and delineate aspects by which it can be differentiated from related concepts of solastalgia and eco-anxiety. In conclusion, we offer a systematic agenda for future research that is embedded in the context of disaster mental health and bereavement research.
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Affiliation(s)
- Hannah Comtesse
- Section of Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, 85072 Eichstaett, Germany; (H.C.); (V.E.); (R.R.)
| | - Verena Ertl
- Section of Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, 85072 Eichstaett, Germany; (H.C.); (V.E.); (R.R.)
| | | | - Rita Rosner
- Section of Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, 85072 Eichstaett, Germany; (H.C.); (V.E.); (R.R.)
| | - 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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21
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Rometsch C, Denkinger JK, Engelhardt M, Windthorst P, Graf J, Nikendei C, Zipfel S, Junne F. Care providers' views on burden of psychosomatic symptoms of IS-traumatized female refugees participating in a Humanitarian Admission Program in Germany: A qualitative analysis. PLoS One 2020; 15:e0239969. [PMID: 33017408 PMCID: PMC7535032 DOI: 10.1371/journal.pone.0239969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 09/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Traumatized refugees often suffer from diverse psychosomatic symptoms. Female Yazidi refugees from Northern Iraq who survived attacks of the so-called "Islamic State" were brought to Germany to receive special medical and psychotherapeutic treatment in a unique worldwide humanitarian admission program (HAP). Here, we report on their psychosomatic symptoms and helpful strategies from the perspective of care providers. METHODS Care providers (N = 84) in this HAP were interviewed in an individual setting as well as in focus groups to gather information about the HAP beneficiaries' psychosomatic symptoms. Data analysis followed Qualitative Content Analysis by Mayring. RESULTS The care providers reported five main psychological burdens of the Yazidis: 1) insecurity regarding loss, 2) worries about family members, 3) ambivalence about staying in Germany or returning to Iraq, 4) life between two worlds and 5) re-actualization of the traumatic experiences. The predominant psychological symptoms the care providers noticed were fear, depressive symptoms, feelings of guilt, and sleep and eating disorders. Regarding somatic symptoms, the care providers mainly received complaints about pain in the head, back, chest and stomach. Helpful strategies for providing adequate health care were care providers' cooperating with physicians, precise documentation of beneficiaries' symptoms, and additional support in directing the beneficiaries through the health care system. Regarding psychotherapy, interpreters help to overcome language barriers, onsite psychotherapy, flexible therapy appointments, psychoeducational methods, time for stabilization, and support in coping with daily life aspects. In the care providers' experience, psychotherapists have to build a relationship of trust. After grief therapy, a trauma-specific therapy in a culturally adapted way is possible. CONCLUSION The HAP is a unique model health care program to offer highly traumatized refugees medical and psychological help. Care providers reported on several (psycho-)somatic symptoms of the traumatized women. The strategies the HAP care providers perceived as helpful can be recommended for similar projects in the future.
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Affiliation(s)
- Caroline Rometsch
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Jana Katharina Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martha Engelhardt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Petra Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, 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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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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Echterhoff G, Hellmann JH, Back MD, Kärtner J, Morina N, Hertel G. Psychological Antecedents of Refugee Integration (PARI). PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2020; 15:856-879. [DOI: 10.1177/1745691619898838] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The successful management of refugee immigration, including refugee integration in host societies, requires a sound understanding of underlying psychological processes. We propose the psychological antecedents of refugee integration (PARI) model, highlighting perceived forcedness (i.e., coercion and loss of control from “push” factors) and ensuing perils (risks and potential suffering during migration) as distinctive factors of refugee (vs. voluntary) migration. According to our model, perceptions and subjective representations of forcedness and associated perils activate specific psychological processes relevant to refugee integration and thus moderate responses to the demands and stressors of the immigration situation. We conceptualize these distinctive influences for integration-relevant processes in both refugees and in residents. By pinpointing the unique features of refugee migration, PARI generates novel and specific hypotheses about psychological processes predicting refugee integration. For instance, refugees’ memories of forcedness and associated perils should lead to a high level of preoccupation with the restoration of basic needs after arrival in a receiving country that interferes with integration-related activities. Conversely, residents’ perceptions of forcedness and related perils may enhance empathy with refugees but may also magnify feelings of anxiety and threat. Implications for refugee integration are discussed for the domains of occupational work, education, and mental health.
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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: 145] [Impact Index Per Article: 36.3] [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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Shimizu K. Risk factors of severe prolonged grief disorder among individuals experiencing late-life bereavement in Japan: A qualitative study. DEATH STUDIES 2020; 46:351-359. [PMID: 32065049 DOI: 10.1080/07481187.2020.1728427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article explored how severe prolonged grief disorder (PGD) is associated with psychological and social variables using an interpretative phenomenological analysis. From a sample of 225 Japanese hospitalized adults with depression, seven participants were identified as having PGD based on their medical records and semi-structured interviews. Risk factors appeared to be psychological factors associated with the deceased (dependence on the deceased, feeling sorry for the deceased, intense self-blame, and infrequent expression of anger) and environmental factors (loneliness and isolation, lack of opportunity to determine separation, and release from practical burdens). These findings are discussed in relation to Japanese culture.
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Affiliation(s)
- Kanako Shimizu
- Department of Psychiatry, Jichi Medical University, Tochigi, Japan
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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: 23] [Impact Index Per Article: 5.8] [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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Seiler A, von Känel R, Slavich GM. The Psychobiology of Bereavement and Health: A Conceptual Review From the Perspective of Social Signal Transduction Theory of Depression. Front Psychiatry 2020; 11:565239. [PMID: 33343412 PMCID: PMC7744468 DOI: 10.3389/fpsyt.2020.565239] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/28/2020] [Indexed: 12/11/2022] Open
Abstract
Losing a spouse is considered one of the most stressful life events a person can experience. Particularly in the immediate weeks and months after the loss, bereavement is associated with a significantly increased risk of morbidity and mortality. Despite an abundance of research aimed at identifying risk factors for adverse health outcomes following marital death, the mechanisms through which mental and physical health problems emerge following bereavement remain poorly understood. To address this issue, the present review examines several pathways that may link bereavement and health, including inflammation and immune dysregulation, genetic and epigenetic changes, gut microbiota activity, and biological aging. We then describe how these processes may be viewed from the perspective of the Social Signal Transduction Theory of Depression to provide a novel framework for understanding individual differences in long-term trajectories of adjustment to interpersonal loss. Finally, we discuss several avenues for future research on psychobiological mechanisms linking bereavement with mental and physical health outcomes.
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Affiliation(s)
- Annina Seiler
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Steil R, Gutermann J, Harrison O, Starck A, Schwartzkopff L, Schouler-Ocak M, Stangier U. Prevalence of prolonged grief disorder in a sample of female refugees. BMC Psychiatry 2019; 19:148. [PMID: 31088419 PMCID: PMC6518607 DOI: 10.1186/s12888-019-2136-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/30/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Prolonged Grief Disorder (PGD) is a distinct syndrome that follows bereavement. It is different from other mental disorders and is characterized by symptoms such as yearning for the bereaved, or intense emotional pain or distress. Violent loss is one major risk factor for the development of PGD. OBJECTIVES PGD has been studied in different populations, mostly in small samples, with only a few of them being representative. Although research highlighted that traumatic experiences paired with challenges related to migration make refugees particularly vulnerable to PGD, PGD has only rarely been studied in refugees. Thus, this article a) examines the prevalence of PGD in female refugees in Germany according to the criteria proposed by Prigerson and colleagues in 2009, and b) associates PGD with other common psychopathology (e.g. anxiety, depression, somatization and trauma). METHOD A total of 106 female refugees were assessed for bereavement and PGD. Of these 106 individuals, 85 were interviewed using the Prolonged Grief Disorder Scale (PG-13). Symptoms of anxiety and depression were assessed by the Hopkins Symptom Checklist-25 (HSCL-25), somatization was assessed by the Somatization Subscale of the Symptom-Checklist-90 (SCL-90), and the number of witnessed and experienced trauma was assessed by the Posttraumatic Diagnostic Scale (PDS/HTQ). RESULTS Ninety of the 106 participants had experienced bereavement, and among those, 9.41% met criteria for PGD. The most frequent PGD symptoms were bitterness, longing or yearning for the bereaved, and lack of acceptance of the loss. Furthermore, grief symptoms were significantly associated with symptoms of depression, anxiety, somatization, and the number of experienced traumatic events. CONCLUSION The PGD prevalence rate found corresponds with previous studies, demonstrating that prevalence rates for PGD are especially high in refugees. High prevalence rates of bereavement as well as PGD highlight the need for assessment and specifically tailored treatment of PGD in refugees. PGD goes along with significant psychopathology, which further emphasizes the need for treatment.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany.
| | - Jana Gutermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
| | - Octavia Harrison
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
| | - Annabelle Starck
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
| | - Laura Schwartzkopff
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
| | - Meryam Schouler-Ocak
- Department of Psychiatry, Institute of Medicine, University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
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Killikelly C, Lorenz L, Bauer S, Mahat-Shamir M, Ben-Ezra M, Maercker A. Prolonged grief disorder: Its co-occurrence with adjustment disorder and post-traumatic stress disorder in a bereaved Israeli general-population sample. J Affect Disord 2019; 249:307-314. [PMID: 30797123 DOI: 10.1016/j.jad.2019.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/18/2019] [Accepted: 02/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Prolonged grief disorder (PGD) is a new disorder included in the WHO International Classification of Diseases 11th version (ICD-11). This study is the first to use these new ICD-11 PGD guidelines to examine prevalence rates, predictors of PGD and disorder co-occurrence with other stress-related disorders in a survey of 544 bereaved Israelis. METHODS Descriptive statistics, correlation, linear regression and mediation analysis examined the validity of the ICD-11 diagnostic algorithm. RESULTS Prevalence of PGD in the Israeli population sample is low (2%). The prevalence rate of post-traumatic stress disorder (PTSD) was 7.2% and for adjustment disorder (AjD) was 17.8%. A significant positive correlation found between scores on these measures indicates concurrent validity. Mediation analysis found that symptoms of PGD were predicted by serious life events, and significantly mediated by symptoms of PTSD and AjD. A regression analysis found significant predictors of PGD symptom severity, including socio-demographic and person-specific predictors. LIMITATIONS This study did not assess the index-death of the grief questionnaire. No conclusions could be made regarding the relationship between the type of loss and grief severity. Furthermore, the time since loss (time criterion) was not assessed. CONCLUSIONS This study is the first to examine prevalence rates of ICD-11 PGD in a population-based survey. The mediation relationship between serious life events, AjD, PTSD and PGD supports a vulnerability model of stress related disorders whereby the number of stressful life events may predict symptoms of stress related disorders.
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Affiliation(s)
- Clare Killikelly
- University of Zürich, Department of Psychology, Division Psychopathology and Clinical Intervention, CH-8050 Zürich, Switzerland.
| | - Louisa Lorenz
- University of Zürich, Department of Psychology, Division Psychopathology and Clinical Intervention, CH-8050 Zürich, Switzerland; Klinik im Hasel, Stationäre Therapie, Gontenschwil, Switzerland
| | - Susanna Bauer
- University of Zürich, Department of Psychology, Division Psychopathology and Clinical Intervention, CH-8050 Zürich, Switzerland
| | | | | | - Andreas Maercker
- University of Zürich, Department of Psychology, Division Psychopathology and Clinical Intervention, CH-8050 Zürich, Switzerland
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