Prolonged grief disorder symptomology in three African countries: A network analysis and comparison

Abstract

Background: Bereavement is a globally prevalent life stressor, but in some instances, it may be followed by a persistent condition of grief and distress, codified within the 11th edition of the International Classification of Diseases (ICD-11) as prolonged grief disorder (PGD). Network analysis provides a valuable framework for understanding psychological disorders at a nuanced symptom-based level. Aim: This study novelly explores the network structure of ICD-11 PGD symptomology in a non-Western sample and assesses the replication of this across three African country sub-samples in these data. Methodology: Network models were estimated using the "Inventory of Complicated Grief-Revised" in a sample of trauma-exposed individuals who experienced bereavement throughout life (N = 1,554) from three African countries (Ghana, n = 290; Kenya, n = 619; Nigeria, n = 645). These networks were statistically evaluated using the network comparison test. Results: It was found that "Feelings of Loss" and "Difficulty moving on" were the most central symptoms in the combined sample network. These findings were largely consistent for the Ghana and Nigeria sub-samples, however, network structure differences were noted in the Kenya sub-sample. Conclusion:The identified PGD network highlights particular indicators and associations across three African samples. Implications for the assessment and treatment of PGD in these cultural contexts warrant consideration. Impact statementBereavement and loss, a nearly ubiquitous stressor, may lead to prolonged grief disorder (PGD) in a minority of individuals, marked by an extended period of yearning, preoccupation and emotional pain. This study identified "Feelings of Loss" and "Difficulty moving on" as critical factors influencing PGD, suggesting these as potentially valuable targets for intervention to alleviate disordered grief. Indeed, by addressing these factors, interventions may reduce distress linked to PGD through the prevention of the cascading effects within the symptom network. This study identified consistency in symptom networks across sub-samples drawn from three African nations, emphasising the global relevance of PGD. However, some divergence was observed when comparing the Kenyan sample to those from Nigeria and Ghana. This highlights the importance of recognising cultural nuances in the assessment of PGD, and the formulation of treatment approaches. The evidence supports the view that the criteria for PGD outlined in ICD-11 are relevant on a global scale, emphasising the need for psychological interventions that are sensitive to cultural considerations. Addressing "Feelings of Loss" and "Difficulty moving on" within psychological intervention and bereavement support may, however, be considered internationally relevant to enhance the effectiveness of psychological support for those grappling with prolonged grief. This experience is codified as prolonged grief disorder (PGD) in the 11th edition of the "International Classification of Diseases" (ICD-11), characterised primarily b...