Prolonged Grief in Cambodian Refugees Following Genocide: Rebirth Concerns and Avoidance of Reminders

Abstract

This study investigated whether prolonged grief (PG) forms a coherent syndrome that is discrete from posttraumatic stress disorder (PTSD) in a Cambodian refugee population and examined the relative centrality to PG of “avoidance of reminders of the deceased” as compared to “rebirth concerns” in the group. The Prolonged Grief 13 (PG-13) scale significantly explained variance over and beyond PTSD in regression analyses of severity of bereavement, as assessed by a culturally sensitive measure of grief (CSM-G) and by the presence of grief-related functional impairment. Rebirth concerns were significantly more correlated than avoidance of reminders to the PG-13 and CSM-G. In an item analysis of the PG-13 and its addendum item (rebirth concerns) to determine predictive power in respect to presence of grief-related functional impairment, the avoidance item performed very poorly and the rebirth item very well (as did the bitterness item). These findings point to the applicability of the prolonged grief disorder construct to the Cambodian experience of loss, yet indicate the poor performance of the avoidance item and the centrality of rebirth issues in this group.

KEYWORDS:

• Cambodian refugees
• culture
• functional impairment
• prolonged grief
• PTSD
• rebirth concerns

Notes

Note. R ²Δ = R ² change; FΔ = F change; B = unstandardized regression weight; β = standardized regression weight.

Note. B = unstandardized regression weight; OR = odds ratio; β = standardized regression weight.

#*p < .01, **p < .001.

Note. A symptom is only considered endorsed if rated as a 4 or 5 in severity on the 1–5 Likert-type scale. Sensitivity: probability of the presence of the symptom when grief-related functional impairment is present. Specificity: probability of the absence of the symptom when grief-related functional impairment is absent. Positive predictive power: probability of the presence of grief-related functional impairment when the symptom is present. Negative predictive power: probability of the absence of grief-related functional impairment when the symptom is absent.

Additional information

Notes on contributors

Devon E. Hinton

Devon E. Hinton is a psychiatrist and anthropologist and an associate professor of psychiatry at Harvard Medical School, Massachusetts General Hospital. He has written extensively on the presentation of trauma-related disorder and its treatment among Southeast Asian and Latino populations.

Angela Nickerson

Angela Nickerson is a National Health and Medical Research Council early career clinical research fellow at the University of New South Wales, Sydney, Australia. She conducts research into mechanisms underlying the relationship between refugee trauma and torture, as well as psychological disorders. She is also involved in the development of effective treatments to treat psychological responses to torture and trauma in refugee groups.

Richard A. Bryant

Richard A. Bryant is a scientia professor in the School of Psychology at the University of New South Wales and director of the Traumatic Stress Clinic, Sydney. He has conducted extensive research on trajectories, assessment, mechanisms, and treatment of PTSD and grief.