The Assessment of Grief in Refugees and Post-conflict Survivors: A Narrative Review of Etic and Emic Research

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.

Psychological Antecedents of Refugee Integration (PARI)

“…Grief associated with counterfactual ruminations, or feelings of guilt about circumstances of death and one's own role therein may limit the sense of self-efficacy needed for active coping with current needs (Glickman, Shear, & Wall, 2017). Prolonged grief reactions might interfere with effective psychosocial functioning in new environment (Killikelly, Bauer, & Maercker, 2018).…”

Mental Health Services for Syrian Refugees in Lebanon: Perceptions and Experiences of Professionals and Refugees

“…These structural conditions in displacement settings contribute to heightened social and mental health problems (Jayawickreme et al, 2017;Killikelly, Bauer, & Maercker, 2018;Li, Liddell, & Nickerson, 2016;Miller & Rasmussen, 2010;Ryan, Dooley, & Benson, 2008;Silove, 2011). In Lebanon, the vast majority of information regarding the mental health of Syrian refugees come from epidemiological studies which report a high prevalence of mental health disorders (Karam et al, 2014;Kazour et al, 2017;Naja, Aoun, El Khoury, Abdallah, & Haddad, 2016;Souaiby, Kazour, Zoghbi & Richa, 2016).…”

Prevalence of Depression Symptoms and Associated Sociodemographic and Clinical Correlates Among Syrian Refugees in Lebanon

“…Participants who screened positive on the PHQ-2 and PHQ-9 were selected for further analysis. PHQ-9 score was categorized into no symptoms (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), and severe (20)(21)(22)(23)(24)(25)(26)(27). PHQ-9 categories and average scores, as well as individual PHQ-9 items were summarized by gender and tested for statistical difference using the Pearson's Chi-Square and the independent t-test.…”

“…As an example, Syrian refugees have restricted rights in Lebanon, which limit their access to proper healthcare, education, and employment opportunities, due to the lack of a clearly de ned legal and administrative framework under which they can operate (Blanchet, Fouad, & Pherali, 2016;Kerbage et al, 2020). Such systemic precariousness excludes potential opportunities for long-term integration, and places Syrian refugees in Lebanon at increased risk of developing mental health problems (Jayawickreme et al, 2017;Killikelly, Bauer, & Maercker, 2018). In addition to that, Syrian refugees lack basic needs such as food, water, and shelter.…”