Prolonged grief disorder among asylum seekers in Germany: the influence of losses and residence status

Figures & data

Table 1. Sociodemographic characteristics.

Characteristic	Total (N = 99)	Group 1 (n = 29)	Group 2 (n = 32)	Group 3 (n = 38)	Group differences
Female, % (n)	32.3 (32)	31.0 (9)	31.3 (10)	34.2 (13)	χ^2 = 0.10, p = .951
Age in years, M (SD)	30.12 (9.43)	28.62 (6.72)	28.21 (6.94)	32.86 (11.98)	F = 2.78, p = .066
Education in years, M (SD)	9.91 (4.79)	8.52 (5.38)	10.15 (4.15)	10.76 (4.69)	F = 1.90, p = .154
Ethnicity, % (n)					χ^2 = 23.76, p = .003
Arabic	45.4 (45)	24.1 (7)	37.5 (12)	68.4 (26)
Kurdish	32.3 (32)	55.2 (16)	31.2 (10)	15.8 (6)
Yazidi	2.0 (2)	6.9 (2)	0.0 (0)	0.0 (0)
Afghan	15.2 (15)	10.3 (3)	21.9 (7)	13.1 (5)
Persian	5.1 (5)	3.4 (1)	9.4 (3)	2.6 (1)
Time in Germany in months, M (SD)	16.56 (12.92)	5.53 (11.20)	15.70 (11.97)	25.71 (6.75)	F = 33.48, p = .001
Accommodation, % (n)					χ^2 = 55.12, p = .001
Initial reception centre	40.4 (40)	89.6 (26)	43.7 (14)	0.0 (0)
Collective accommodation	59.6 (59)	10.3 (3)	56.2 (18)	100 (38)
Language proficiency, M (SD)^a	6.00 (7.02)	1.24 (3.47)	4.80 (5.81)	10.65 (7.21)	F = 22.13, p = .001
Employment/further training, % (n)	48.5 (48)	17.2 (5)	46.8 (15)	73.6 (18)	χ^2 = 21.03, p = .001

Note: Group 1 = asylum request in process, Group 2 = appeal against rejected asylum request, Group 3 = temporary residence permit. X² test with df = 2, F-test with df = 96/2. ^a Participants were asked for how many months they have been studying German.

Table 2. Loss and trauma characteristics.

Characteristic	Total (N = 99)	Group 1 (n = 29)	Group 2 (n = 32)	Group 3 (n = 38)
Number of losses, M (SD)	5.67 (6.47)	2.65 (2.34)	3.68 (4.13)	9.65 (8.10)
Type of loss, % (n)
Nuclear family members	64.6 (64)	72.4 (21)	62.5 (20)	60.5 (23)
Extended family members	89.9 (89)	89.6 (26)	84.3 (27)	94.7 (36)
Friends	88.9 (88)	96.5 (28)	78.1 (25)	92.1 (35)
Number of traumatic events, M (SD)	7.11 (3.53)	6.65 (4.1)	7.40 (3.4)	7.21 (3.2)
Type of traumatic event, % (n)
Natural disaster	34.3 (34)	51.7 (15)	50.0 (16)	7.9 (3)
Fire or explosion	64.6 (64)	58.6 (17)	65.6 (21)	68.4 (26)
Transportation accident	73.7 (73)	65.5 (19)	78.13 (25)	76.3 (29)
Serious accident	38.4 (38)	27.6 (8)	50.0 (16)	36.8 (14)
Exposure to toxic substance	5.0 (5)	3.4 (1)	3.1 (1)	7.9 (3)
Physical assault	51.5 (51)	41.3 (12)	53.1 (17)	57.8 (22)
Assault with a weapon	46.4 (46)	44.8 (13)	43.7 (14)	50.0 (19)
Sexual assault	6.1 (6)	0.0 (0)	9.4 (3)	7.9 (3)
Other unwanted sexual experience	12.1 (12)	13.8 (4)	15.6 (5)	7.9 (3)
Combat or exposure to war-zone	69.7 (69)	65.5 (19)	37.5 (12)	78.9 (30)
Captivity	45.4 (45)	44.8 (13)	31.2 (10)	57.8 (22)
Life-threatening illness or injury	55.5 (55)	51.7 (15)	50.0 (16)	63.1 (24)
Severe human suffering	74.7 (74)	89.6 (26)	75.0 (24)	63.1 (24)
Sudden violent death	51.5 (51)	44.8 (13)	56.2 (18)	52.6 (20)
Sudden accidental death	51.5 (51)	31.0 (9)	62.5 (20)	50.0 (19)
Serious injury inflicted on someone else	8.1 (8)	6.9 (2)	6.2 (2)	10.5 (4)
Other	25.2 (25)	24.1 (7)	28.1 (9)	23.6 (9)

Note: Group 1 = asylum request in process, Group 2 = appeal against rejected asylum request, Group 3 = temporary residence permit. Traumatic events (personally experienced and/or witnessed) were assessed with the LEC-5 (Weathers et al., 2013).

Table 3. Prevalence of probable psychiatric diagnoses.

	Total sample (N = 99)	Group 1 (n = 29)	Group 2 (n = 32)	Group 3 (n = 38)	Group differences
Diagnostic status, % (n)
PGD	20.2 (20)	20.7 (6)	37.5 (12)	5.2 (2)	χ^2 = 15.56, p = .001
PCBD	16.1 (16)	20.7 (6)	25.0 (8)	5.2 (2)	χ^2 = 8.95, p = .012
PTSD	45.4 (45)	55.1 (16)	59.3 (19)	26.3 (10)	χ^2 = 9.21, p = .010
Depression	42.4 (42)	31.0 (9)	34.3 (11)	57.8 (22)	χ^2 = 6.11, p = .047

Note: Group 1 = asylum request in process, Group 2 = appeal against rejected asylum request, Group 3 = temporary residence permit. PGD = prolonged grief disorder according to the Prigerson et al. (2009) criteria, PCBD = persistent complex bereavement disorder, PTSD = post-traumatic stress disorder. X² test with df = 2. Percentage of positive cases was defined as participants fulfilling the diagnoses based on the TGI-SR or PCL-5 or participants with a symptom score above the PHQ-9 cutoff.

Table 4. Hierarchical regression analysis to predict prolonged grief disorder symptoms (TGI-SR).

Predictor	B(SE)	β	p value
Age	–0.24 (0.23)	–.11	.315
Gender^a	–1.90 (4.43)	–.04	.669
Education	0.65 (0.38)	.16	.094
Traumatic events	–1.14 (0.63)	–.19	.076
Losses of nuclear family members	3.16 (1.44)	.23	.032
Losses of extended family members	0.33 (0.47)	.08	.485
Losses of friends	0.54 (0.88)	.06	.467
Residence status^b
Appeal against rejected asylum request	–4.52 (4.63)	–.10	.322
Temporary residence permit	–13.19 (5.03)	–.33	.010
PTSD	0.39 (0.11)	.36	.001
Depression	0.28 (0.30)	.09	.350

Note: N = 95. PTSD = post-traumatic stress disorder. ^a Coded as ‘0’ male, ‘1’ female. ^b Dummy coded variables, ‘asylum request in process’ served as the reference category.

Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM–5 (PCL-5). Instrument available from the National Center for PTSD. Retrieved from www.ptsd.va.gov.

 Google Scholar

Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., … Bonanno, G. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine, 6, e1000121.

 PubMed Web of Science ®Google Scholar