Posttraumatic stress disorder and prolonged grief in refugees exposed to trauma and loss

Abstract

BackgroundWhile a large proportion of conflict-affected populations have been dually exposed to trauma and loss, there is inadequate research identifying differential symptom profiles related to bereavement and trauma exposure in these groups. The objective of this study were to (1) determine whether there are distinct classes of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) symptoms in bereaved trauma survivors exposed to conflict and persecution, and (2) examine whether particular types of refugee experiences and stressors differentially predict symptom profiles.MethodsParticipants were 248 Mandaean adult refugees who were assessed at an average of 4.3 years since entering Australia following persecution in Iraq. PTSD, PGD, trauma exposure, adjustment difficulties since relocation, and English proficiency were measured. Latent class analysis was used to elucidate symptom profiles of PTSD and PGD in this sample.ResultsLatent class analysis revealed four classes of participants: a combined PTSD/PGD class (16%), a predominantly PTSD class (25%), a predominantly PGD class (16%), and a resilient class (43%). Whereas membership in the PTSD/PGD class was predicted by exposure to traumatic loss, those in the PGD class were more likely to have experienced adaptation difficulties since relocation, and individuals in the PTSD class were more likely to have experienced difficulties related to loss of culture and support.ConclusionsThis study provides evidence that specific symptom patterns emerge following exposure to mass trauma and loss. These profiles are associated with distinct types of traumatic experiences and post-migration living difficulties. These results have substantial public health implications for assessment and intervention following mass trauma.

Day patient treatment for traumatic grief: preliminary evaluation of a one-year treatment programme for patients with multiple and traumatic losses

“…First, refugees are more likely to suffer from ongoing stressors that – combined with their complex psychiatric symptoms – can have a detrimental effect on their daily functioning and that can challenge treatment outcome (Craig, Sossou, Schnak, & Essex, 2008; Nickerson et al, 2014; Steel et al, 2011). Legal procedures, being separated from family and socioeconomic disadvantages, may all contribute to increased symptom severity and block symptom reduction (Schock, Böttche, Rosner, Wenk-Ansohn, & Knaevelsrud, 2016; Schock, Rosner, & Knaevelsrud, 2015; Steel et al, 2009, 2011).…”

“…Adaptation to new life events and stressors seems to challenge refugees. Nickerson et al (2014) found that after exposure to trauma and loss, different post-migration living difficulties are associated with specific symptom patterns regarding PCBD and PTSD.…”

“…Traumatic experiences in which a loved one has died may lead to severe psychiatric problems in bereaved individuals, such as Posttraumatic Stress Disorder (PTSD), Persistent Complex Bereavement Disorder (PCBD) and Major Depression Disorder (MDD) (Boelen, Reijntjes, Djelantik, & Smid, 2016; Nickerson et al, 2014). Treatments for this group of bereaved individuals are mostly focused on PTSD and hardly address grief specifically (Smid et al, 2015).…”

“…the loss of a loved one who is missing and often presumed dead but whose remains have never been found (Boss, 2002). Studies have shown that traumatic losses in this group can lead to both PCBD and PTSD (Momartin, Silove, Manicavasagar, & Steel, 2004; Nickerson et al, 2014; Stammel et al, 2013). Comorbidity of PCBD and/or PTSD with other psychiatric disorders such as major depressive disorder (MDD) (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Schaal, Dusingizemungu, Jacob, Neuner, & Elbert, 2012), psychotic disorders (Sareen, Cox, Goodwin, & Asmundson, 2005) and substance abuse disorders (Kessler et al, 1995) is often observed.…”

Latent profiles of physical and psychological outcomes of bereaved parents in China who lost their only child

“…Previous research has used latent class analysis (LCA) to identify groups of individuals based on the symptoms or symptom clusters of PGD, PTSD and/or depression, e.g. a resilient class, a predominately PGD or PTSD class and a combined PGD/PTSD or PGD/depression or PGD/PTSD/depression class (Boelen, Reijntjes, Aaam, & Smid, 2016; Boelen, Spuij, & Reijntjes, 2017; Djelantik, Smid, Kleber, & Boelen, 2017; Lenferink, De Keijser, Smid, Djelantik, & Boelen, 2017; Maccallum & Bryant, 2018; Nickerson et al, 2014). To our knowledge, only one research project has examined the latent groups among bereaved parents and reported that bereaved parents can be categorised into three different subgroups (i.e.…”