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

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

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.

Keywords

Complicated grief Prolonged grief Persistent complex bereavement Refugee ADAPT 

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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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