Prolonged grief disorder in refugees from Syria: qualitative analysis of culturally relevant symptoms and implications for ICD-11

ABSTRACT

Prolonged Grief Disorder (PGD) is a new mental disorder recognised by the ICD-11. However, the cultural norms for grief in refugees or humanitarian migrants from Syria have not yet been established. Here we conduct an exploratory qualitative study of 10 key informant interviews with refugees from Syria with two main aims: (1) to identify common symptoms of normal or abnormal grief in refugees from Syria (2) to identify barriers to the acceptability of the new prolonged grief disorder. Three levels of qualitative analysis informed a new model of grief in Syrian refugees. Important culturally relevant symptoms such as “emotional outburst” and “weariness” emerged. The theme of “refugee experience” including sub-themes such as loss of homeland, lack of social network and ambiguous loss, emerged as potential predictors of grief severity. Finally, the level of culture and society revealed key barriers to the acceptability of the PGD diagnosis including stigma.

KEYWORDS:

• Prolonged grief disorder
• ICD-11
• cultural acceptability
• culturally relevant symptoms
• humanitarian migrants

Acknowledgements

We would like to thank interns Lea Mozzini, Sarah Amardjia and Wasilah Sabadia who greatly assisted with the data collection, coding and translation of the interviews. Additionally, we would like to thank the participants who dedicated their time to this project. The results from this paper are partially based on the Master’s thesis of MR.

Disclosure statement

No potential conflict of interest was reported by the author(s).

The views expressed reflect the opinions of the authors and not necessarily the working group, and the content of this article does not represent WHO policy.

CK wrote the manuscript, conceptualised and managed the project. MR collected the data and conducted the data analysis. AM reviewed and edited the manuscript.