Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024;15(1):2383525.
doi: 10.1080/20008066.2024.2383525. Epub 2024 Jul 31.

Cluster analysis of prolonged grief, posttraumatic stress, and depression symptoms in bereaved asylum seekers and refugees

Hannah Comtesse  1 , Hannah Edelhoff  2 , Rita Rosner  1 , Franziska Lechner-Meichsner  3
Affiliations

Cluster analysis of prolonged grief, posttraumatic stress, and depression symptoms in bereaved asylum seekers and refugees

Hannah Comtesse et al. Eur J Psychotraumatol. 2024.

Abstract
in English, Spanish

Background: Refugees and asylum seekers (ASRs) are frequently exposed to loss in addition to a variety of other stressors and often display high levels of various psychological symptoms.Objective: The study aimed to primarily determine clusters of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression symptoms in bereaved ASRs and secondly identify predictors of cluster membership. Sociodemographic - and flight-related variables were investigated in exploratory analyses.Method: ASRs in Germany (N = 92) with interpersonal loss exposure, i.e. at least one missing or deceased relative or friend, were assessed with interview-based questionnaires for PGD, PTSD, and depressive symptoms. We used k-means cluster analysis to distinguish symptom profiles and logistic regression analyses to identify predictors of cluster membership.Results: We found a three-cluster-solution. The PGD-cluster (30%) was characterised predominantly by PGD symptoms, while the PGD/PTSD-cluster (32%) had high PGD and PTSD and moderate depressive symptoms. The resilient cluster (38%) showed low symptoms overall. insecure residence status predicted membership in the PGD and PGD/PTSD clusters relative to the resilient cluster, whilst higher attachment anxiety predicted membership in the PGD/PTSD cluster relative to the other clusters. Explorative analysis revealed duration of stay as a significant predictor.Conclusion: Findings can extend the current knowledge about different symptom profiles among bereaved ASRs in Europe. Insights to attachment - and migration-related variables distinguishing between these profiles offer starting points for interventions.

Antecedentes: Los refugiados y solicitantes de asilo (ASRs) están frecuentemente expuestos a la pérdida, además de una variedad de otros factores estresantes, y a menudo muestran altos niveles de diversos síntomas psicológicos.

Objetivo: El estudio tiene como objetivo principal determinar los grupos de síntomas del trastorno de duelo prolongado (PGD por sus siglas en ingles), trastorno de estrés postraumático (TEPT) y depresión en ASRs en duelo, y secundariamente identificar los predictores de pertenencia a cada grupo. Las variables sociodemográficas y relacionadas con el vuelo fueron investigadas en análisis exploratorios.

Método: Se evaluaron a los ASRs en Alemania (N = 92) con exposición a la pérdida interpersonal, es decir, al menos un familiar o amigo desaparecido o fallecido, mediante cuestionarios basados en entrevistas para los síntomas de PGD, TEPT y depresión. Utilizamos análisis de agrupamiento k-media para distinguir perfiles de síntomas y análisis de regresión logística para identificar predictores de la pertenencia a los grupos.

Resultados: Encontramos una solución de tres grupos. El grupo de PGD (30%) se caracterizó predominantemente por síntomas de PGD, mientras que el grupo de PGD/TEPT (32%) tenía altos síntomas de PGD y TEPT y síntomas depresivos moderados. El grupo resiliente (38%) mostró bajos síntomas en general. El estado de residencia insegura predijo la pertenencia a los grupos de PGD y PGD/TEPT en comparación con el grupo resiliente, mientras que un mayor apego ansioso predijo la pertenencia al grupo de PGD/TEPT en comparación con los otros grupos. El análisis exploratorio reveló que la duración de la permanencia fue un predictor significativo.

Conclusión: Los hallazgos pueden ampliar el conocimiento actual sobre los diferentes perfiles de síntomas entre los ASRs en duelo en Europa. Los conocimientos sobre las variables relacionadas con el apego y la migración que se distinguen entre estos perfiles ofrecen puntos de partida para intervenciones.

Keywords: K-means cluster analysis; Refugees; Refugiados; análisis de agrupamiento k-media; apego; asylum seekers; attachment; bereavement; depresión; depression; duelo; posttraumatic stress disorder; prolonged grief disorder; solicitantes de asilo; trastorno de duelo prolongado; trastorno de estrés postraumático.

Plain language summary

Bereaved asylum seekers and refugees in Germany can be grouped into three symptom clusters: (1) predominantly prolonged grief, (2) high prolonged grief, high posttraumatic stress, and moderate depressive symptoms, and (3) low symptom load.Attachment – and migration-related variables (i.e. residence status, duration of stay, and attachment anxiety) distinguish between cluster membership.Results highlight the importance of attending to profiles and not only single categories of symptoms and attachment features in bereaved asylum seekers and refugees.

PubMed Disclaimer

Conflict of interest statement

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

Figures

The figure shows mean scores of PGD, PTSD and depressive symptoms for three clusters. The PGD-cluster is characterised by high scores on PGD symptoms, moderate scores on PTSD symptoms and low scores on depressive symptoms. The PGD/PTSD-cluster has high scores on both PGD and PTSD symptoms and moderate scores on depressive symptoms. The resilient cluster has low scores on all symptoms.
Figure 1.
Mean symptom scores per cluster.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. American Psychiatric Association . (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association. 10.1176/appi.books.9780890425787 - DOI
    1. Arnetz, J., Rofa, Y., Arnetz, B., Ventimiglia, M., & Jamil, H. (2013). Resilience as a protective factor against the development of psychopathology among refugees. Journal of Nervous & Mental Disease, 201(3), 167–172. 10.1097/NMD.0b013e3182848afe - DOI - PMC - PubMed
    1. Blackmore, R., Boyle, J. A., Fazel, M., Ranasinha, S., Gray, K. M., Fitzgerald, G., Misso, M., & Gibson-Helm, M. (2020). The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis. PLoS medicine, 17(9), e1003337. 10.1371/journal.pmed.1003337 - DOI - PMC - PubMed
    1. Boelen, P. A., Reijntjes, A., Djelantik, A. M. J., & Smid, G. E. (2016). Prolonged grief and depression after unnatural loss: Latent class analyses and cognitive correlates. Psychiatry Research, 240, 358–363. 10.1016/j.psychres.2016.04.012 - DOI - PubMed
    1. Boelen, P. A., & Smid, G. E. (2017). The traumatic grief inventory self-report version (TGI-SR): Introduction and preliminary psychometric evaluation. Journal of Loss and Trauma, 22(3), 196–212. 10.1080/15325024.2017.1284488 - DOI

LinkOut - more resources