Alvin Kuowei Tay1,2, Susan Rees3,4,5, Jack Chen6,5, Moses Kareth3,4, Derrick Silove3,4,5. 1. Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia. alvin.tay@unsw.edu.au. 2. Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia. alvin.tay@unsw.edu.au. 3. Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia. 4. Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia. 5. The Ingham Institute, Applied Medical Research Centre, Liverpool, NSW, Australia. 6. Simpson Centre for Health Services Research, University of New South Wales, Sydney, Australia.
Abstract
INTRODUCTION: Definitions of complicated grief vary across diagnostic systems, being represented as persistent complex bereavement (PCB) in DSM-5 and prolonged grief disorder (PGD) in the proposed revision of the ICD system. A past study in a high-income country has identified a six-factor structure for complicated grief, but there are no data testing this or any other model across cultures. The present study reports findings from a survey amongst West Papuan refugees (n = 230, response rate = 92 %) residing in Port Moresby, Papua New Guinea. MATERIALS AND METHODS: We applied culturally adapted measures of conflict-related traumatic event (TEs) (drawing specifically on domains of conflict and loss), symptoms of complicated grief adapted and modified to the culture, and a multidimensional psychosocial index of the broader effects of conflict and displacement. RESULTS: Confirmatory factor analysis yielded a single higher order construct of complicated grief comprising six factors of yearning/preoccupation; shock/disbelief; anger/negative appraisal; behavioural change; estrangement from others/impairment; and a novel dimension of confusion/diminished identity. In contrast, our analysis failed to support DSM or ICD models of PCB or PGD. A Multiple Indicators Multiple Causes (MIMIC) model revealed that traumatic loss and the sense of injustice each were associated with the unitary construct of complicated grief and its subdomains of yearning/preoccupation; shock/disbelief; anger/negative appraisal (exclusive to injustice); and estrangement from others/social impairment (exclusive to TE domain of conflict and loss). CONCLUSIONS: Conflict and loss associated with feelings of injustice may be especially pathogenic in generating the anger/negative appraisal component of complicated grief amongst refugees.
INTRODUCTION: Definitions of complicated grief vary across diagnostic systems, being represented as persistent complex bereavement (PCB) in DSM-5 and prolonged grief disorder (PGD) in the proposed revision of the ICD system. A past study in a high-income country has identified a six-factor structure for complicated grief, but there are no data testing this or any other model across cultures. The present study reports findings from a survey amongst West Papuan refugees (n = 230, response rate = 92 %) residing in Port Moresby, Papua New Guinea. MATERIALS AND METHODS: We applied culturally adapted measures of conflict-related traumatic event (TEs) (drawing specifically on domains of conflict and loss), symptoms of complicated grief adapted and modified to the culture, and a multidimensional psychosocial index of the broader effects of conflict and displacement. RESULTS: Confirmatory factor analysis yielded a single higher order construct of complicated grief comprising six factors of yearning/preoccupation; shock/disbelief; anger/negative appraisal; behavioural change; estrangement from others/impairment; and a novel dimension of confusion/diminished identity. In contrast, our analysis failed to support DSM or ICD models of PCB or PGD. A Multiple Indicators Multiple Causes (MIMIC) model revealed that traumatic loss and the sense of injustice each were associated with the unitary construct of complicated grief and its subdomains of yearning/preoccupation; shock/disbelief; anger/negative appraisal (exclusive to injustice); and estrangement from others/social impairment (exclusive to TE domain of conflict and loss). CONCLUSIONS: Conflict and loss associated with feelings of injustice may be especially pathogenic in generating the anger/negative appraisal component of complicated grief amongst refugees.
Authors: Andreas Maercker; Chris R Brewin; Richard A Bryant; Marylene Cloitre; Mark van Ommeren; Lynne M Jones; Asma Humayan; Ashraf Kagee; Augusto E Llosa; Cécile Rousseau; Daya J Somasundaram; Renato Souza; Yuriko Suzuki; Inka Weissbecker; Simon C Wessely; Michael B First; Geoffrey M Reed Journal: World Psychiatry Date: 2013-10 Impact factor: 49.548
Authors: A K Tay; M A A Miah; S Khan; M Badrudduza; K Morgan; S Balasundaram; D Silove Journal: Epidemiol Psychiatr Sci Date: 2019-08-23 Impact factor: 6.892
Authors: Alvin Kuowei Tay; Hau Khat Mung; Mohammad Abdul Awal Miah; Susheela Balasundaram; Peter Ventevogel; Mohammad Badrudduza; Sanjida Khan; Karen Morgan; Susan Rees; Mohammed Mohsin; Derrick Silove Journal: PLoS Med Date: 2020-03-31 Impact factor: 11.069