Killikelly Clare, Bauer Susanna, Maercker Andreas
Division Psychopathology and Clinical Intervention, Department of Psychology, University of Zürich, Zürich, Switzerland.
Front Psychol. 2018 Oct 22;9:1957. doi: 10.3389/fpsyg.2018.01957. eCollection 2018.
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. 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). This review revealed 24 studies that assessed disordered grief in refugee or post conflict samples. Studies were heterogeneous in their assessment methods; the majority ( = 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%. 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.
持续性悲伤障碍（PGD）是一种新的心理健康障碍，将于2018年被世界卫生组织的疾病分类《国际疾病分类第11版》（ICD - 11）认可。目前对PGD的评估措施很大程度上基于北美和欧洲对悲伤的概念化（etic，即从观察者的角度）。然而，来自全球北方以外社区，特别是经历冲突社区的研究正在兴起，探索当地模式（emic，即从文化群体内部）、悲伤的评估措施和症状。几项综述发现，按照etic标准定义，难民中精神疾病的发病率较高，如抑郁症、创伤后应激障碍（PTSD）、焦虑症和精神病症状。然而，目前尚无综述记录对难民和冲突后幸存者中PGD的评估情况。 本叙述性综述将概述评估难民悲伤情况的研究，以（1）确定目前难民悲伤的评估措施（即所使用问卷的类型和频率、是基于全球北方的etic问卷、还是当地开发的emic问卷以及文化适应程度），以及（2）记录用全球北方标准措施和/或当地措施确定的悲伤症状的种类和发生率（即标准症状项目的认可情况以及悲伤的文化特定症状的识别）。 本综述揭示了24项评估难民或冲突后样本中无序悲伤的研究。这些研究的评估方法各不相同；大多数（ = 17）采用etic方法，四项采用etic/emic相结合的方法，三项主要采用emic方法。根据文化适应方法，无序悲伤的发生率较高（31 - 76%），当使用标准etic措施时，无序悲伤发生率为32%。 这些发现将有助于指导未来的研究，以便对难民和冲突后人群的悲伤情况进行准确评估，并对提高临床实践中的文化知识具有启示意义。
