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

  • Alvin Kuowei TayEmail author
  • Susan Rees
  • Jack Chen
  • Moses Kareth
  • Derrick Silove
Original Paper



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.


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).


Conflict and loss associated with feelings of injustice may be especially pathogenic in generating the anger/negative appraisal component of complicated grief amongst refugees.


Complicated grief Prolonged grief Persistent complex bereavement Refugee ADAPT 



We thank the following contributors to this project: Mr Michael Kareth, Mr Paul Wandik, Mr Martinus Anari, Mr Freddy Waromi, Ms Dolly Songona, Ms Olvianna Fonataba, Drs Goiba Tieneng (Chief Psychiatrist of PNG), and Uma Ambi (Principal Mental Health Advisor, Department of Health, PNG).

Compliance with ethical standards

Funding support

NHMRC program number: RM08333.

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Psychiatry Research and Teaching Unit, Liverpool HospitalSchool of Psychiatry, University of New South WalesSydneyAustralia
  2. 2.Simpson Centre for Health Services ResearchUniversity of New South WalesSydneyAustralia
  3. 3.Centre for Population Mental Health ResearchLiverpool HospitalLiverpoolAustralia
  4. 4.The Ingham Institute, Applied Medical Research CentreLiverpoolAustralia

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