Abstract
Background: Prolonged grief disorder (PGD) is a new mental health disorder that will be recognized by the World Health Organization’s disorder classification, the ICD-11, in 2018. Current assessment measures of PGD are largely based on North American and European conceptualizations of grief (etic i.e., from the perspective of the observer). However, research is emerging from communities outside of the Global North, in particular, conflict-exposed communities, exploring local models (emic i.e., from within the cultural group), assessment measures and symptoms of grief. Several reviews have found that refugees have higher rates of mental illness, defined by etic standards as depression, post-traumatic stress disorder (PTSD), anxiety disorders and psychotic symptoms. Yet, presently there are no reviews documenting the assessment of PGD in refugees and post conflict survivors.Method: This narrative review will provide an overview of studies that assess grief in refugees to (1) identify current assessment measures of grief in refugees (i.e., type and frequency of questionnaires used, whether Global North-based, etic, or locally developed, emic, and the level of cultural adaptation) and (2) to document the variety and rate of grief symptoms identified with Global North standard measures and/or local measures (i.e., the endorsement of standard symptom items and the identification of culturally specific symptoms of grief).Results: This review revealed 24 studies that assessed disordered grief in refugee or post conflict samples. Studies were heterogeneous in their assessment methods; the majority (n = 17) used an etic approach, four used a combined etic/emic approach, and three used a predominantly emic approach. The rate of disordered grief was high depending on cultural adaptation approach (31–76%) and when standard etic measures were used the disordered grief rate was 32%.Conclusion: These findings will help to guide future studies to provide accurate assessment of grief in refugee and post conflict populations and has implications for improving cultural knowledge in clinical practice.
Highlights
As the number of displaced people increases above 60 million (United Nations High Commissioner for Refugees UNHCR, 2017), researchers have mobilized to provide up to date and extensive knowledge on the physical and mental health of refugees, asylum seekers, displaced persons and forced migrants as well as post-conflict survivors
Several reviews have found that refugees have higher rates of mental disorders such as depression, post-traumatic stress disorder (PTSD), anxiety disorders (Fazel et al, 2005; Porter and Haslam, 2005) and psychotic symptoms compared to non-refugee migrants (Heeren et al, 2014; Hollander et al, 2016)
Despite the knowledge that refugees are highly likely to experience severe and repeated exposure to violence, traumatic loss, abuse of human rights and to witness the death of family and friends (Chen et al, 2017; Miller and Rasmussen, 2017), presently there are no reviews documenting the assessment of prolonged grief disorder (PGD) or disordered grief in refugees or post conflict survivor samples
Summary
As the number of displaced people increases above 60 million (United Nations High Commissioner for Refugees UNHCR, 2017), researchers have mobilized to provide up to date and extensive knowledge on the physical and mental health of refugees, asylum seekers, displaced persons and forced migrants as well as post-conflict survivors. The criteria state that symptoms should be present for at least 6 months, this will defer to clinical opinion and cultural norms i.e., within the German context 1 year of mourning or ‘Trauerjahr’ is considered normal and this should be considered when assessing patients in the German context (Hays and Hendrix, 2008) These criteria were developed within the North American and European psychiatric context, the simplified structure and cultural caveats that aim to assess PGD across different populations, in particular refugees and post conflict samples, are essential for mobilizing support and providing effective treatment (Killikelly and Maercker, 2018). Presently there are no reviews documenting the assessment of PGD in refugees and post conflict survivors
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