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Refugees are at risk of experiencing a combined constellation of complicated bereavement and posttraumatic stress disorder (PTSD) symptoms following exposure to complex traumas associated with personal threat and loss. Features of identity confusion are central to both complicated bereavement and PTSD and these characteristics may be particularly prominent amongst refugees from traditional cultures displaced from their homelands, families, and kinship groups. We investigate whether a combined pattern of complicated bereavement and PTSD can be identified amongst West Papuan refugees participating in an epidemiological survey (n = 486, response rate: 85.8%) in a remote town in Papua New Guinea.
Latent class analysis was applied to derive subpopulations of refugees based on symptoms of complicated bereavement and PTSD. Associations were examined between classes and traumatic loss events, post-migration living difficulties (PMLDs), and psychosocial support systems.
The four classes identified comprised a complicated bereavement class (11%), a combined posttraumatic bereavement class (10%), a PTSD class (11%), and a low symptom class (67%). Symptoms of identity confusion were prominent in the posttraumatic bereavement class. Compared with the low symptom class, the combined posttraumatic bereavement class reported greater exposure to traumatic loss events (OR 2.43, 95% CI 1.11–5.34), PMLDs (OR 2.24, 95% CI 1.01–4.6), disruptions to interpersonal bonds and networks (OR 3.3, 95% CI 1.47–7.38), and erosion of roles and identities (OR 2.18, 95% CI 1.11–4.27).
Refugees appear to manifest a combined pattern of complicated bereavement and PTSD symptoms in which identity confusion is a prominent feature. This response appears to reflect the combined impact of high levels of exposure to traumatic losses, PMLDs, and disruption of relevant psychosocial systems.
Following years of controversy, a category of complex post-traumatic stress disorder (CPTSD) will be included in the forthcoming ICD-11.
To test whether refugees with CPTSD differ from those with other common mental disorders (CMDs) in the degree of exposure to childhood adversities, adult interpersonal trauma and post-traumatic hardship.
Survey of 487 West Papuan refugees (response rate 85.5%) in Papua New Guinea.
Refugees with CPTSD had higher exposure to childhood adversities (CPTSD: mean 2.6, 95% CI 2.5–2.7 versus CMD: mean 1.15, 95% CI 1.10–1.20), interpersonal trauma (CPTSD: mean 9, 95% CI 8.6–9.4 versus CMD: mean 5.4, 95% CI 5.4–5.5) and postmigration living difficulties (CPTSD: mean 2.3, 95% CI 2–2.5 versus CMD mean 1.85, 95% CI 1.84–1.86), compared with those with CMDs who in turn exceeded those with no mental disorder on all these indices.
The findings support the cross-cultural validity of CPTSD as a reaction to high levels of exposure to recurrent interpersonal trauma and associated adversities.
Declaration of interest
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