Prevalence, comorbidities, and factors associated with prolonged grief disorder, posttraumatic stress disorder and complex posttraumatic stress disorder in refugees: a systematic review

Abstract

Background The number of refugees worldwide is at an all-time high with many being exposed to potentially traumatic events and the loss of loved ones. The 11th revision of the International Statistical Classification of Diseases and Related Health Problems now includes prolonged grief disorder and complex posttraumatic stress disorder and revised criteria for posttraumatic stress disorder. An overview of these stress-related disorders among people who have become refugees is therefore needed. Consequently, we conducted a systematic review to determine prevalence rates, comorbidities, and associated factors for each of the disorders. Method We systematically searched PubMed, Web of Science, and PsycArticles to identify studies that reported prevalence rates, predictors or associated factors, and/or comorbid mental disorders for either (1) prolonged grief disorder, (2) posttraumatic stress disorder, or (3) complex posttraumatic stress disorder among refugees. The selection process followed the PRISMA guidelines. Results A total of 36 studies met the inclusion criteria. Most of the studies were of high quality. There was substantial variation in prevalence rates by disorder, with prolonged grief ranging from 6 to 54%, posttraumatic stress disorder ranging from 0.4 to 80%, and complex posttraumatic stress disorder ranging from 3 to 74.6%. Pooled prevalence for posttraumatic stress disorder was estimated at 29.8% in treatment seeking samples and 9.92% in population samples. For complex posttraumatic stress disorder, it was estimated at 57.4% in treatment seeking samples and 7.8% in population samples. Posttraumatic stress disorder was among the most frequent comorbidities for prolonged grief disorder while depressive symptoms were the most frequently occurring co-morbidity across all three disorders. Sociodemographic variables, trauma exposure, and loss characteristics were associated with higher symptom severity. Postmigration living difficulties played an important role in prolonged grief and complex posttraumatic stress disorder. Conclusion The review revealed substantial differences in prevalence rates between the three studied disorders but underscored a very high prevalence of ICD-11 stress-related disorders among refugees. The identified associated factors point to subgroups that may be particularly at risk and establishes a foundational basis for targeted interventions and potential policy changes. Future research should incorporate longitudinal investigations and emphasize culturally sensitive assessments.

Cluster analysis of prolonged grief, posttraumatic stress, and depression symptoms in bereaved asylum seekers and refugees

“…Future analyses of symptom profiles in ASRs should be expanded to include complex PTSD, due to its high prevalence in this group (Lechner-Meichsner et al, 2024 ). Some studies with ASRs samples already investigated PTSD and complex PTSD together (e.g.…”

“…ASRs are often exposed to potentially traumatic events and loss (e.g. Nickerson et al, 2014 ) and are at increased risk for developing symptoms of post-traumatic stress disorder (PTSD), prolonged grief disorder (PGD), and depression, with pooled prevalence rates ranging from 30% to over 50% (Blackmore et al, 2020 ; Lechner-Meichsner et al, 2024 ).…”

“…Previous research has identified several predictors of specific symptom profiles in ASR samples. For ASRs, pre- and post-migration stressors are essential predictors of mental health problems (Knipscheer et al, 2015 ; Lechner-Meichsner et al, 2024 ). Residential status seems to be an especially important determinant of mental health (e.g.…”

“…ASRs face specific post-migration stressors in host countries, which have an impact on symptom levels (e.g. Lechner-Meichsner et al, 2024 ). An uncertain residence status, such as prolonged asylum proceedings, has been repeatedly linked to elevated PTSD (Borho et al, 2020 ; Georgiadou et al, 2018 ) and depressive symptoms (Hajak et al, 2021 ) in ASR samples.…”

Research breakdowns: A constructive critique of research practice involving grief, trauma and displaced people

“…One question that emerges from existing research findings is what high prevalence rates of PGD mean in refugee groups. Rates of PGD are often found to be higher than 50% (Killikelly et al, 2018;Lechner-Meichsner et al, 2024). Currently, PGD can only be diagnosed if the grief response violates the social and cultural norms of the individual's cultural context.…”