Exposure to trauma and bereavement is common in conflict-affected regions. Previous research suggests considerable heterogeneity in responses to trauma and loss with varying symptom representations. The purpose of the current study was to (1) identify classes of prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD) symptom profiles among individuals who were exposed to both trauma and loss due to the Colombian armed conflict and (2) to examine whether sociodemographic, loss and trauma-related characteristics could predict class membership.
Three hundred eight victims of internal displacement who had experienced trauma and loss were assessed through measures of PGD (PG-13), PTSD (PCL-C), and social support (DUKE-UNC). Latent class analysis (LCA) was performed to analyze differential profiles by symptoms of PGD and PTSD and multinomial logistic regression was used to analyze predictors of class membership.
LCA revealed a four-class solution: a resilient class (23.6%), a PTSD-class (23.3%), a predominately PGD class (25.3%) and a high distress-class with overall high values of PGD and PTSD (27.8%). Relative to the resilient class, membership to the PGD class was predicted by the loss of a close family member and the exposure to a higher number of assaultive traumatic events, whereas membership to the PTSD class was predicted by the perception of less social support. Compared to the resilient class, participants in the high distress-class were more likely to be female, to have lost a close relative, experienced more accidental and assaultive traumatic events, and perceived less social support.
Specific symptom profiles emerged following exposure to trauma and loss within the context of the Colombian armed conflict. Profiles were associated with distinct types of traumatic experiences, the degree of closeness to the person lost, the amount of social support perceived, and gender. The results have implications for identifying distressed subgroups and informing interventions in accordance with the patient’s symptom profile.
Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009;302(5):537–49. doi: 10.1001/jama.2009.1132. CrossRefPubMed
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). Washington: American Psychiatric Publishing; 2013. CrossRef
Maercker A, Brewin CR, Bryant RA, Cloitre M, Ommeren M, Jones LM, Humayan A, Kagee A, Llosa AE, Rousseau C. Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11. World Psychiatry. 2013;12(3):198–206. doi: 10.1002/wps.20057. CrossRefPubMedPubMedCentral
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th edn, revised) (DSM-IV-TR). Washington, DC: APA; 2001.
Schaal S, Jacob N, Dusingizemungu JP, Elbert T. Rates and risks for prolonged grief disorder in a sample of orphaned and widowed genocide survivors. BMC Psychiatry. 2010;10(55). doi: 10.1186/1471-244x-10-55.
Boelen PA, Reijntjes A, J. Djelantik AAAM, Smid GE. Prolonged grief and depression after unnatural loss: Latent class analyses and cognitive correlates. Psychiatry Res. 2016;240:358–363. doi: 10.1016/j.psychres.2016.04.012.
Internal Displacement Monitoring Center. Global overview 2015: people internally displaced by conflict and violence. In: . Geneva: Internal Displacement Monitoring Center. p. 2015.
Centro Nacional de Memoria Histórica. Basta ya! Colombia: Memorias de guerra y dignidad. Bogotá: Imprenta Nacional; 2013.
Neria Y, Gross R, Litz B, Maguen S, Insel B, Seirmarco G, Rosenfeld H, Suh EJ, Kishon R, Cook J, et al. Prevalence and psychological correlates of complicated grief among bereaved adults 2.5-3.5 years after September 11th attacks. J Trauma Stress. 2007;20(3):251–62. doi: 10.1002/jts.20223. CrossRefPubMed
Lenferink LI, von Denderen M, de Keijser J, Wessel I, Boelen P. Prolonged grief and post-traumatic stress among relatives of missing persons and homicidally bereaved individuals: a comparative study. J Affect Disord. 2017;209(1-2). doi: 10.1016/j.jad.2016.11.012.
Stammel N, Heeke C, Díaz Gómez MT, Ziegler M, Knaevelsrud C. We don't want to be left behind: attitudes and experiences of internally displaced persons within the context of the armed conflict and the reparation process in Colombia. Berlin: Behandlungszentrum für Folteropfer; 2012.
Prigerson HG, Vanderwerker LC, Maciejewski PK. A case for inclusion of prolonged grief disorder in DSM-V. In: Stroebe MS, Hansson RO, Schut H, Stroebe W, Van den Blink E, editors. Handbook of bereavement research and practice: advances in theory and intervention. Washington, DC: American Psychological Association; 2008. p. 165–86. CrossRef
Weathers FW, Litz BT, Huska JA, Keane TM. PTSD checklist - civilian version. Boston: National Center for PTSD; 1994.
Mollica RF, Caspiyavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard trauma questionnaire: validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic-stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992;180(2):111–6. doi: 10.1097/00005053-199202000-00008. CrossRefPubMed
Foa EB, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Psychol Assess. 1997;9(4):445–51. CrossRef
Nickerson A, Bryant RA, Schnyder U, Schick M, Mueller J, Morina N. Emotion dysregulation mediates the relationship between trauma exposure, post-migration living difficulties and psychological outcomes in traumatized refugees. J Affect Disord. 2015;173:185–92. doi: 10.1016/j.jad.2014.10.043. CrossRefPubMed
Broadhead W, Gehlbach SH, De Gruy FV, Kaplan BH. The Duke-UNC functional social support questionnaire: measurement of social support in family medicine patients. Med Care. 1988;26(7):709–723. doi: 10.1097/00005650-198807000-00006.
Bellón Saameño J, Delgado Sánchez A, Luna del Castillo J, Lardelli Claret P. Validez y fiabilidad del cuestionario de apoyo social funcional Duke-UNC-11. Aten Primaria. 1996;18(4):153–63. PubMed
Geiser C. Datenanalyse mit Mplus. Wiesbaden: VS Verlag für Sozialwissenschaften; 2011. CrossRef
Muthén L, Muthén B. Mplus User's Guide (Version 7). Muthén & Muthén: Los Angeles; 2015.
Asparouhov T, Muthén B: Auxiliary variables in mixture modeling: Using the BCH method in Mplus to estimate a distal outcome model and an arbitrary secondary model. Mplus Web Notes. 2014; 21(2).
Masyn KE. Latent class analysis and finite mixture modeling. In: Little TD, Little TD, editors. The Oxford handbook of quantitative methods (Vol 2): statistical analysis. New York, NY, US: Oxford University Press; 2013. p. 551–611.
Burke LA, Neimeyer RA. Prospective risk factors for complicated grief. In: Stroebe MS, Schut H, van den Bout J, editors. Complicated grief: scientific foundations for health care professionals. New York: Routledge; 2013. p. 145–61.
Boelen PA, Reijntjes A, Smid GE. Concurrent and prospective associations of intolerance of uncertainty with symptoms of prolonged grief, posttraumatic stress, and depression after bereavement. J Anxiety Disord. 2016. doi: 10.1016/j.janxdis.2016.03.004.
Neuner F, Schauer M, Klaschik C, Karunakara U, Elbert T. A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an african refugee settlement. J Consult Clin Psychol. 2004;72(4):579. doi: 10.1037/0022-006X.72.4.579. CrossRefPubMed
Kersting A, Dölemeyer R, Steinig J, Walter F, Kroker K, Baust K, Wagner B. Brief internet-based intervention reduces posttraumatic stress and prolonged grief in parents after the loss of a child during pregnancy: a randomized controlled trial. Psychother Psychosom. 2013;82(6):372–81. doi: 10.1159/000348713. CrossRefPubMed
Layne CM, Saltzman WR, Poppleton L, Burlingame GM, Pašalić A, Duraković E, Mušić M, Ćampara N, Ðapo N, Arslanagić B, et al. Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2008;47(9):1048–62. doi: 10.1097/CHI.0b013e31817eecae. CrossRefPubMed
- Conflict-related trauma and bereavement: exploring differential symptom profiles of prolonged grief and posttraumatic stress disorder
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