Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Maercker A, Brewin CR, Bryant RA, Cloitre M, van Ommeren M et al (2013) Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11. World Psychiatry 12:198–206

    Article  PubMed  PubMed Central  Google Scholar 

  2. Jacobs S, Mazure C, Prigerson H (2000) Diagnostic criteria for traumatic grief. Death Studies 24:185–199

    Article  CAS  PubMed  Google Scholar 

  3. Stroebe M, van Son M, Stroebe W, Kleber R, Schut H et al (2000) On the classification and diagnosis of pathological grief. Clin Psychol Rev 20:57–75

    Article  CAS  PubMed  Google Scholar 

  4. Lichtenthal WG, Cruess DG, Prigerson HG (2004) A case for establishing complicated grief as a distinct mental disorder in DSM-V. Clin Psychol Rev 24:637–662

    Article  PubMed  Google Scholar 

  5. Prigerson HG, Shear MK, Jacobs SC, Reynolds CF 3rd, Maciejewski PK et al (1999) Consensus criteria for traumatic grief. A preliminary empirical test. Br J Psychiatry 174:67–73

    Article  CAS  PubMed  Google Scholar 

  6. Carmassi C, Shear MK, Massimetti G, Wall M, Mauro C et al (2014) Validation of the Italian version Inventory of Complicated Grief (ICG): a study comparing CG patients versus bipolar disorder, PTSD and healthy controls. Compr Psychiatry 55:1322–1329

    Article  PubMed  Google Scholar 

  7. Ito M, Nakajima S, Fujisawa D, Miyashita M, Kim Y et al (2012) Brief measure for screening complicated grief: reliability and discriminant validity. PLoS One 7:e31209

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, et al. (2009) Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Med 6

  9. Simon NM, Wall MM, Keshaviah A, Dryman MT, LeBlanc NJ et al (2011) Informing the symptom profile of complicated grief. Depress Anxiety 28:118–126

    Article  PubMed  PubMed Central  Google Scholar 

  10. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association Press, Washington

    Google Scholar 

  11. Budiardjo C, Liem S (1988) West Papua: the obliteration of a people, Tapol

  12. Brundige E, King W, Vahali P, Vladek S, Yuan X (2004) Indonesian Human Rights Abuses in West Papua: Application of the Law of Genocide to the History of Indonesian Control. Allard K. Lowenstein International Human Rights Clinic, Yale Law School, New Haven

  13. Rees, Silove D, Tay AK, Moses K (2013) Human rights trauma and the mental health of West Papuan refugees resettled in Australia. Med J Aust 199

  14. Human Rights Watch (2014) Letter to the Chair and Members of the European Parliament’s Subcommittee on Human Rights ahead of the Hearing on the Human Rights situation in West Papua and Papua provinces. Human Rights Watch

  15. Cordell M (2013) West Papuans tortured, killed and dumped at sea, citizens’ tribunal hears. The Guardian

  16. Tay AK, Rees S, Chen J, Kareth M, Lahe S et al (2015) Associations of conflict-related trauma and ongoing stressors with the mental health and functioning of West Papuan refugees in Port Moresby, Papua New Guinea (PNG). PLoS One 10:e0125178

    Article  PubMed  PubMed Central  Google Scholar 

  17. Silove D (2013) The ADAPT model: a conceptual framework for mental health and psychosocial programming in post conflict settings Intervention 11

  18. Rees Silove D, Verdial T, Tam N, Savio E et al (2013) Intermittent explosive disorder amongst women in conflict affected Timor-Leste: associations with human rights trauma, ongoing violence, poverty, and injustice. PLoS One 8:e69207

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Silove D, Liddell B, Rees S, Chey T, Nickerson A et al (2014) Effects of recurrent violence on post-traumatic stress disorder and severe distress in conflict-affected Timor-Leste: a 6-year longitudinal study. Lancet Glob Health 2:e293–e300

    Article  PubMed  Google Scholar 

  20. Silove D, Brooks R, Bateman Steel CR, Steel Z, Hewage K et al (2009) Explosive anger as a response to human rights violations in post-conflict Timor-Leste. Soc Sci Med 69:670–677

    Article  PubMed  Google Scholar 

  21. Silove D, Ivancic L, Rees S, Bateman-Steel C, Steel Z (2014) Clustering of symptoms of mental disorder in the medium-term following conflict: An epidemiological study in Timor-Leste. Psychiatry Res 219:341–346

    Article  PubMed  Google Scholar 

  22. Elsmslie J (2010) West Papuan demographic transition and the 2010 Indonesian Census: “Slow motion genocide” or not?. The West Papua project at the Centre for Peace and Conflict Studies. Centre for Peace and Conflict Studies Working Paper 11/1, The University of Sydney

  23. Tay K, Rees S, Silove D, Chen J, Kareth M, et al (2015) Exposure to conflict-related trauma and current stressors on the mental health and functioning of West Papuan refugees in Port Moresby, Papua New Guinea (PNG). PLos One (in press)

  24. Tay AK, Rees S, Chen J, Kareth M, Silove D (2015) Examining the broader psychosocial effects of mass conflict on PTSD symptoms and functional impairment amongst West Papuan refugees resettled in Papua New Guinea (PNG). Soc Sci Med 132:70–78

    Article  PubMed  Google Scholar 

  25. Van Ommeren M, Sharma B, Thapa S, Makaju R, Prasain D et al (1999) Preparing instruments for transcultural research: use of the translation monitoring form with Nepali-speaking Bhutanese refugees. Transcult Psychiatry 36:285–301

    Article  Google Scholar 

  26. Flaherty JA, Gaviria FM, Pathak D, Mitchell T, Wintrob R et al (1988) Developing instruments for cross-cultural psychiatric research. J Nerv Mental Dis 176:257–263

    CAS  Google Scholar 

  27. Muthen B (1978) Contributions to factor analysis of dichotomous variables. Psychometrika 43:551–560

    Article  Google Scholar 

  28. Muthen B, Kaplan AS (1985) A comparison of some methodologies for the factor analysis of non-normal Likert variables. Br J Math Stat Psychol 38:171–189

    Article  Google Scholar 

  29. Joreskog K, Goldberger A (1975) Estimation of a model with multiple indicators and multiple causes of a single latent variable. J Am Stat Assoc 70:631–639

    Google Scholar 

  30. Barrett P (2007) Structural equation modelling: adjudging model fit. Personality Individ Differ 42:815–824

    Article  Google Scholar 

  31. Hu LT, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 6:1–55

    Article  Google Scholar 

  32. Kline RB (1998) Principles and practice of structural equation modeling. The Guilford Press, New York

    Google Scholar 

  33. StataCorp (2013) Stata statistical software: release 13. StataCorp LP, College station

    Google Scholar 

  34. Muthen L, Muthen B (2014) Mplus user’s guide, 7th ed. Muthen & Muthen, Los Angeles

  35. Rees Silove D (2011) Sakit Hati: a state of chronic mental distress related to resentment and anger amongst West Papuan refugees exposed to persecution. Soc Sci Med 73:103–110

    Article  PubMed  Google Scholar 

  36. Markowitz JC, Milrod B, Bleiberg K, Marshall RD (2009) Interpersonal factors in understanding and treating posttraumatic stress disorder. J Psychiatr Pract 15:133–140

    Article  PubMed  PubMed Central  Google Scholar 

  37. Vromans L, Schweitzer RD, Brough M (2012) The multidimensional loss scale: validating a cross-cultural instrument for measuring loss. J Nerv Mental Dis 200:349–357

    Article  Google Scholar 

  38. Schreiber S (1995) Migration, traumatic bereavement and transcultural aspects of psychological healing: loss and grief of a refugee woman from Begameder County in Ethiopia. Br J Med Psychol 68:135–142

    Article  PubMed  Google Scholar 

  39. Prigerson HG, Shear MK, Frank E, Beery LC, Silberman R et al (1997) Traumatic grief: a case of loss-induced trauma. Am J Psychiatry 154:1003–1009

    Article  CAS  PubMed  Google Scholar 

  40. Brooks R, Silove D, Steel Z, Steel CB, Rees S (2011) Explosive anger in postconflict Timor Leste: interaction of socio-economic disadvantage and past human rights-related trauma. J Affect Disord 131:268–276

    Article  PubMed  Google Scholar 

  41. Silove D, Bryant R (2006) Rapid assessments of mental health needs after disasters. JAMA 296:576–578

    Article  CAS  PubMed  Google Scholar 

  42. Murray LK, Cohen JA, Ellis BH, Mannarino A (2008) Cognitive behavioral therapy for symptoms of trauma and traumatic grief in refugee youth. Child Adolesc Psychiatr Clin N Am 17:585-604, ix

  43. Shear Frank E, Houck PR, Reynolds CF (2005) Treatment of complicated grief: a randomized controlled trial. J Am Med Assoc 293:2601–2608

    Article  CAS  Google Scholar 

  44. Cruz M, Scott J, Houck P, Reynolds Iii CF, Frank E et al (2007) Clinical presentation and treatment outcome of African Americans with complicated grief. Psychiatric Services 58:700–702

    Article  PubMed  PubMed Central  Google Scholar 

  45. Rosner R, Pfoh G, Kotoucova M, Hagl M (2014) Efficacy of an outpatient treatment for prolonged grief disorder: a randomized controlled clinical trial. J Affect Disord 167:56–63

    Article  PubMed  Google Scholar 

  46. Papa A, Sewell MT, Garrison-Diehn C, Rummel C (2013) A randomized open trial assessing the feasibility of behavioral activation for pathological grief responding. Behav Ther 44:639–650

    Article  PubMed  Google Scholar 

  47. Shear, Wang Y, Skritskaya N, Duan N, Mauro C, et al. (2014) Treatment of complicated grief in elderly persons: a randomized clinical trial. JAMA Psychiatry

  48. Barbosa V, Sa M, Carlos Rocha J (2014) Randomised controlled trial of a cognitive narrative intervention for complicated grief in widowhood. Aging Ment Health 18:354–362

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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).

Author information

Authors and Affiliations

  1. Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia

    Alvin Kuowei Tay, Susan Rees, Moses Kareth & Derrick Silove

  2. Simpson Centre for Health Services Research, University of New South Wales, Sydney, Australia

    Jack Chen

  3. Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia

    Alvin Kuowei Tay, Susan Rees, Moses Kareth & Derrick Silove

  4. The Ingham Institute, Applied Medical Research Centre, Liverpool, NSW, Australia

    Susan Rees, Jack Chen & Derrick Silove

Authors
  1. Alvin Kuowei Tay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan Rees
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jack Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Moses Kareth
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Derrick Silove
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alvin Kuowei Tay.

Ethics declarations

Funding support

NHMRC program number: RM08333.

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tay, A.K., Rees, S., Chen, J. et al. Factorial structure of complicated grief: associations with loss-related traumatic events and psychosocial impacts of mass conflict amongst West Papuan refugees. Soc Psychiatry Psychiatr Epidemiol 51, 395–406 (2016). https://doi.org/10.1007/s00127-015-1099-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-015-1099-x

Keywords

Search

Navigation