Prolonged Grief in Refugees Seeking Treatment for PTSD: Comorbidity with Post-Traumatic Stress Symptoms and Network Structure

Refugees often experience traumatic events and the loss of loved ones, leading to post-traumatic stress disorder (PTSD), complex PTSD (cPTSD) and prolonged grief disorder (PGD). It has been repeatedly shown that comorbidity between PGD and PTSD is frequent especially after violent losses, but only few studies have investigated the relationship between PGD and cPTSD. The network approach to psychopathology is well suited to investigate associations between different symptoms. We therefore combined a traditional investigation of the probable prevalence of PGD and its comorbidity with PTSD and cPTSD in refugees and used network analysis to identify central symptoms and bridge symptoms. A total N of 92 treatment-seeking refugees who had experienced both loss and traumatic events completed a self-report measure of PGD and clinical interviews for PTSD and cPTSD. We determined the probable prevalence of PGDICD-11 and rates of comorbidity. Network centrality and associations between symptoms of PGD and cPTSD were examined using network analysis. The probable prevalence of PGDICD-11 was 28.04%. Of those with probable PGDICD-11, 65.38% also met criteria for comorbid PTSDICD-11 and 19.23% for comorbid cPTSD. The most central PGD symptom in the network was difficulties engaging in social or other activities, and the most central cPTSD symptom was negative self-concept. The most important PGD bridge symptom was emotional numbness. Results underscore the importance of screening for PGD in treatment-seeking traumatized refugees in order to consider it in treatment planning. The relatively small sample size and the stability indices call for cautious interpretation of the results. TRIAL REGISTRATION: DRKS-ID: DRKS00019876. SUMMARY: This is the first prolonged grief and post-traumatic stress symptom network analysis in refugees. Prolonged grief disorder is an important mental health problem in refugees. Emotional numbness and avoidance were the most important bridge symptoms. Screening for PGD is important in traumatized treatment-seeking refugees. Culturally sensitive grief-focused interventions should be offered to refugees.