Social Psychiatry and Psychiatric Epidemiology
Volume 51, Issue 3, 2016, Pages 395-406

Factorial structure of complicated grief: associations with loss-related traumatic events and psychosocial impacts of mass conflict amongst West Papuan refugees (Article)

Tay A.K.* , Rees S. , Chen J. , Kareth M. , Silove D.
  • a Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia, Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170, Australia
  • b Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia, Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170, Australia, The Ingham Institute, Applied Medical Research Centre, Liverpool, NSW, Australia
  • c Simpson Centre for Health Services Research, University of New South Wales, Sydney, Australia, The Ingham Institute, Applied Medical Research Centre, Liverpool, NSW, Australia
  • d Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia, Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170, Australia
  • e Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia, Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170, Australia, The Ingham Institute, Applied Medical Research Centre, Liverpool, NSW, 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. © 2015, Springer-Verlag Berlin Heidelberg.

Author Keywords

ADAPT complicated grief Refugee Persistent complex bereavement prolonged grief

Index Keywords

refugee Factor Analysis, Statistical human factor analysis middle aged Refugees Warfare statistics and numerical data International Classification of Diseases diagnostic and statistical manual of mental disorders Surveys and Questionnaires Humans psychology male female reproducibility Reproducibility of Results questionnaire cultural factor Papua New Guinea adult posttraumatic stress disorder Stress Disorders, Post-Traumatic Cultural Characteristics grief
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84938527565&doi=10.1007%2fs00127-015-1099-x&partnerID=40&md5=b87c86baeecbec86aed2a19b940f14fc
DOI: 10.1007/s00127-015-1099-x
ISSN: 09337954
Cited by: 16
Original Language: English