Skip to main content Accessibility help

A population study of prolonged grief in refugees

  • R. A. Bryant (a1), B. Edwards (a2), M. Creamer (a3), M. O'Donnell (a3), D. Forbes (a3), K. L. Felmingham (a4), D. Silove (a5), Z. Steel (a5), A. C. McFarlane (a6), M. van Hooff (a6), A. Nickerson (a1) and D. Hadzi-Pavlovic (a5)...



Despite the frequency that refugees suffer bereavement, there is a dearth of research into the prevalence and predictors of problematic grief reactions in refugees. To address this gap, this study reports a nationally representative population-based study of refugees to determine the prevalence of probable prolonged grief disorder (PGD) and its associated problems.


This study recruited participants from the Building a New Life in Australia (BNLA) prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015–2016, and comprised 1767 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, probable PGD, post-traumatic stress disorder (PTSD) and mental illness. Children were administered the Strengths and Difficulties Questionnaire.


In this cohort, 38.1% of refugees reported bereavement, of whom 15.8% reported probable PGD; this represents 6.0% of the entire cohort. Probable PGD was associated with a greater likelihood of mental illness, probable PTSD, severe mental illness, currently unemployed and reported disability. Children of refugees with probable PGD reported more psychological difficulties than those whose parents did not have probable PGD. Probable PGD was also associated with the history of imprisonment, torture and separation from family. Only 56.3% of refugees with probable PGD had received psychological assistance.


Bereavement and probable PGD appear highly prevalent in refugees, and PGD seems to be associated with disability in the refugees and psychological problems in their children. The low rate of access to mental health assistance for these refugees highlights that there is a need to address this issue in refugee populations.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      A population study of prolonged grief in refugees
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      A population study of prolonged grief in refugees
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      A population study of prolonged grief in refugees
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Richard Bryant, E-mail:


Hide All
Australian Bureau of Statistics (2012) 4817.0.55.001 – Information Paper: use of the Kessler Psychological Distress Scale in ABS Health Surveys, Australia, 2007–08. Available at (Accessed 30 April 2019).
Australian Government (2017) Building a new life in Australia: the longitudinal study of humanitarian migrants. Data user's guide, release 3.0. Available at Canberra
Bartolomei, J, Baeriswyl-Cottin, R, Framorando, D, Kasina, F, Premand, N, Eytan, A and Khazaal, Y (2016) What are the barriers to access to mental healthcare and the primary needs of asylum seekers? A survey of mental health caregivers and primary care workers. BMC Psychiatry 16, 336.
Bonanno, GA, Neria, Y, Mancini, A, Coifman, KG, Litz, B and Insel, B (2007) Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity. Journal of Abnormal Psychology 116, 342351.
Bryant, RA, Kenny, L, Joscelyne, A, Rawson, N, Maccallum, F, Cahill, C, Hopwood, S, Aderka, I and Nickerson, A (2014) Treating prolonged grief disorder: a randomized controlled trial. JAMA: Psychiatry 71, 13321339.
Craig, CD, Sossou, M-A, Schnak, M and Essex, H (2008) Complicated grief and its relationship to mental health and well-being among Bosnian refugees after resettlement in the United States: implications for practice, policy, and research. Traumatology 14, 103115.
Edwards, B, Smart, D, De Maio, J, Silbert, M and Jenkinson, R (2018) Cohort profile: Building a New Life in Australia (BNLA): the longitudinal study of humanitarian migrants. International Journal of Epidemiology 47, 20–20h.
Goodman, R (2001) Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry 40, 13371345.
Hansen, M, Andersen, TE, Armour, C, Elklit, A, Palic, S and Mackrill, T (2010) PTSD-8: a short PTSD inventory. Clinical Practice Epidemiology and Mental Health 6.
Hollifield, M, Warner, TD, Lian, N, Krakow, B, Jenkins, JH, Kesler, J and Westermeyer, J (2002) Measuring trauma and health status in refugees – a critical review. JAMA 288, 611621.
Kersting, A, Brähler, E, Glaesmer, H and Wagner, B (2011) Prevalence of complicated grief in a representative population-based sample. Journal of Affective Disorders 131, 339343.
Kessler, RC, Green, JG, Gruber, MJ, Sampson, NA, Bromet, E, Cuitan, M, Furukawa, TA, Gureje, O, Hinkov, H, Hu, CY, Lara, C, Lee, S, Mneimneh, Z, Myer, L, Oakley-Browne, M, Posada-Villa, J, Sagar, R, Viana, MC and Zaslavsky, AM (2010) Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative. International Journal of Methods in Psychiatric Research 19(suppl. 1), 422.
Kinzie, JD (2006) Immigrants and refugees: the psychiatric perspective. Transcultural Psychiatry 43, 577591.
Lambert, JE, Holzer, J and Hasbun, A (2014) Association between parents’ PTSD severity and children's psychological distress: a meta-analysis. Journal of Traumatic Stress 27, 917.
Li, SS, Liddell, BJ and Nickerson, A (2016) The relationship between post-migration stress and psychological disorders in refugees and asylum seekers. Current Psychiatry Reports 18, 82.
Lichtenthal, WG, Nilsson, M, Kissane, DW, Breitbart, W, Kacel, E, Jones, EC and Prigerson, HG (2011) Underutilization of mental health services among bereaved caregivers with prolonged grief disorder. Psychiatric Services 62, 12251229.
Maciejewski, PK, Maercker, A, Boelen, PA and Prigerson, HG (2016) ‘Prolonged grief disorder’ and ‘persistent complex bereavement disorder’, but not ‘complicated grief’, are one and the same diagnostic entity: an analysis of data from the Yale Bereavement Study. World Psychiatry 15, 266275.
McLeod, BD, Weisz, JR and Wood, JJ (2007) Examining the association between parenting and childhood depression: a meta-analysis. Clinical Psychology Review 27, 9861003.
Melhem, NM, Rosales, C, Karageorge, J, Reynolds, CF III, Frank, E and Shear, MK (2001) Comorbidity of axis I disorders in patients with traumatic grief. Journal of Clinical Psychiatry 62, 884887.
Mollica, RF, Caspi Yavin, Y, Bollini, P, Truong, T, et al. (1992) The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous and Mental Disease 180, 111116.
Neria, Y, Gross, R, Litz, B, Maguen, S, Insel, B, Seirmarco, G and Marshall, RD (2007) Prevalence and psychological correlates of complicated grief among bereaved adults 2.5–3.5 years after September 11th attacks. Journal of Traumatic Stress 20, 251262.
Papadopoulos, R, Lay, M, Lees, S and Gebrehiwot, A (2003) The impact of migration on health beliefs and behaviours: the case of Ethiopian refugees in the UK. Contemporary Nurse 15, 210221.
Prigerson, HG, Bierhals, AJ, Kasl, SV, Reynolds, CF III, Shear, MK, Day, N and Jacobs, S (1997) Traumatic grief as a risk factor for mental and physical morbidity. American Journal of Psychiatry 154, 616623.
Richter, J, Sagatun, A, Heyerdahl, S, Oppedal, B and Roysamb, E (2011) The Strengths and Difficulties Questionnaire (SDQ) – self-report. An analysis of its structure in a multiethnic urban adolescent sample. Journal of Child Psychology and Psychiatry 52, 10021011.
Schaal, S, Jacob, N, Dusingizemungu, JP and Elbert, T (2010) Rates and risks for prolonged grief disorder in a sample of orphaned and widowed genocide survivors. BMC Psychiatry 10, 55.
Shear, MK (2015) Clinical practice. Complicated grief. New England Journal of Medicine 372, 153160.
Shear, MK, McLaughlin, KA, Ghesquiere, A, Gruber, MJ, Sampson, NA and Kessler, RC (2011) Complicated grief associated with hurricane Katrina. Depression and Anxiety 28, 648657.
Shear, MK, Reynolds, CF III, Simon, NM, Zisook, S, Wang, Y, Mauro, C and Skritskaya, N (2016) Optimizing treatment of complicated grief: a randomized clinical trial. JAMA Psychiatry 73, 685694.
Simon, NM, Shear, KM, Thompson, EH, Zalta, AK, Perlman, C, Reynolds, CF and Silowash, R (2007) The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief. Comprehensive Psychiatry 48, 395399.
Steel, Z, Chey, T, Silove, D, Marnane, C, Bryant, RA and van Ommeren, M (2009) 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 302, 537549.
Tay, AK, Rees, S, Chen, J, Kareth, M and Silove, D (2016) Factorial structure of complicated grief: associations with loss-related traumatic events and psychosocial impacts of mass conflict amongst West Papuan refugees. Social Psychiatry and Psychiatric Epidemiology 51, 395406.
United Nations High Commissioner for Refugees (2017) Available at (Accessed 14 April 2017).
van Ijzendoorn, MH, Bakermans-Kranenburg, MJ and Sagi-Schwartz, A (2003) Are children of Holocaust survivors less well-adapted? A meta-analytic investigation of secondary traumatization. Journal of Traumatic Stress 16, 459469.
World Health Organization (2018) ICD-11: International Classification of Diseases 11th revision. Available at



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed