The assessment of grief and loss in refugees: an exploration of culture, beliefs and migration experiences

‘Prolonged Grief Disorder’ (PGD) is a new mental health disorder that will be recognized by the World Health Organization’s disorder classification manual, the ICD-11 in 2018. A culturally appropriate mental health assessment tool has not yet been developed. Although this disorder has been validated and systematically examined in Europe, North America and China, it is undetermined if the proposed symptom criteria for prolonged grief disorder are relevant and appropriate for refugees and humanitarian migrants. Humanitarian migrants from countries of human/natural disasters or armed conflicts, are more likely to have experienced severe and repeated exposure to violence, traumatic loss, abuse of human rights and to witness the death of family and friends. Currently the nature of grief in refugees, and the prevalence or predictors of PGD are understudied in this group. Here we conduct an exploratory study with two main aims: 1) to identify symptoms of disordered, or abnormal grief in Syrian refugees 2) to develop an easy to use, efficient, online measurement tool for prolonged grief disorder that can be adapted for use in different cultures and has promise for international application. We aim to develop a new tool for the assessment of mental disorder, such as PGD, that is grounded in the cultural context of both refugees and health care workers so that there may be improved communication and shared understanding of mental health disorder. This will have implications for improving cultural understanding, psychological research, health policy, and for preserving the human rights and dignities of refugees.