Due to the presumed high risk for prolonged grief disorder (PGD) in people bereaved during the COVID-19 pandemic, it is crucial to examine how grief develops over time in this population. This is the first study examining longitudinal symptom-profiles of PGD severity in people bereaved during the pandemic. We aimed to identify latent trajectories of DSM-5-TR PGD severity and predictors thereof in Dutch adults bereaved during the pandemic. Latent class growth modeling was employed to identify differential trajectories of PGD severity in 266 people bereaved on average 115 days prior when entering the study. Participants completed a PGD measure online (using the Traumatic Grief Inventory-Self Report-Plus) at three time-intervals six months apart. Associations between class-membership and socio-demographic, loss-related, health-related, and trauma-related characteristics were examined using multinomial logistic regression. Three trajectories were identified: Low/decreasing PGD symptoms (74%), Mild/stable PGD symptoms (18%), and High/decreasing PGD trajectory (8%). Closer kinship to the deceased, poorer self-rated health status, and having a mental disorder increased the likelihood of belonging to the Mild/stable PGD symptoms and High/decreasing PGD trajectories. This study provides insights in longitudinal PGD symptom-profiles in people bereaved during the pandemic. We found that PGD severity either remained low/mild or eventually decreased over time.
This study aimed to identify latent classes of adjustment in children confronted with parental cancer, based on profiles of traumatic stress symptoms, health-related quality of life (HRQoL), and satisfaction with life. In addition, correlates of classes were examined.Families were recruited through social media, health care providers, and cancer support centers. The sample consisted of 175 children (52% girls, aged M = 11.98, SD = 3.20, range = 6-20 years) from 92 families, including 90 parents with a current or past cancer diagnosis and 71 healthy parents. Children and parents completed self-report questionnaires at home. A latent profile analysis was conducted to identify classes based on child traumatic stress symptoms, HRQoL, and satisfaction with life.Four classes were identified, which were labeled (a) average functioning across domains (64%); (b) high stress, below-average HRQoL and life satisfaction (14%); (c) high stress, below-average HRQoL, and average satisfaction (11%); and (d) high functioning across domains (11%). Child age, parent traumatic stress symptoms, and perceived parental warmth were significantly associated with class membership. Child gender, which parent was diagnosed with cancer, and illness phase were unrelated to class membership.Meaningful subgroups of children can be distinguished based on positive and negative indicators of adjustment to parental cancer. Whereas the majority of children appear to adjust well, 25% of children display high levels of traumatic stress and impaired HRQoL, in some cases combined with low life satisfaction; these children may need specific attention to improve adjustment in the long term. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Objective: While exposure to morally transgressive events has been shown to lead to moral injury in combat veterans, research on moral injury in peacekeepers is limited. We aimed to determine patterns of exposure to potentially morally injurious events (PMIEs) and associated outcome and exposure-related factors among Dutch peacekeepers stationed in the former Yugoslavia during the Srebrenica massacre.Method: Data were collected among Dutchbat III veterans (N = 431). We used Latent Class Analysis to identify subgroups of PMIE exposure, as assessed by the Moral Injury Scale–Military version. It was investigated whether deployment location, posttraumatic stress symptoms, posttraumatic growth (PTG), resilience, and quality of life (QoL) differentiated between latent classes.Results: The analysis identified a three-class solution: a high exposure class, a moderate exposure class, and a betrayal and powerlessness-only class. More PMIE exposure was associated with deployment location and higher odds of having PTSD. PMIE exposure was not associated with PTG. Resilience and QoL were excluded from analyses due to high correlations with PTSD.Conclusion: Peacekeepers may experience varying levels of PMIE exposure, with more exposure being associated with worse outcomes 25 years later. The results emphasize the importance of better understanding PMIEs in the context of peacekeeping.
Abstract Background A growing body of literature shows profound effects of the COVID-19 pandemic on mental health, among which increased rates of posttraumatic stress disorder (PTSD) and adjustment disorder (AD). However, current research efforts have largely been unilateral, focusing on psychopathology and not including well-being, and are dominated by examining average psychopathology levels or on disorder absence/presence, thereby ignoring individual differences in mental health. Knowledge on individual differences, as depicted by latent subgroups, in the full spectrum of mental health may provide valuable insights in how individuals transition between health states and factors that predict transitioning from resilient to symptomatic classes. Our aim is to (1) identify longitudinal classes (i.e., subgroups of individuals) based on indicators of PTSD, AD, and well-being in response to the pandemic and (2) examine predictors of transitioning between these subgroups. Methods and analysis We will conduct a three-wave longitudinal online survey-study of n ≥ 2000 adults from the general Dutch population. The first measurement occasion takes place six months after the start of the pandemic, followed by two follow-up measurements with six months intervals. Latent transition analysis will be used for data-analysis. Ethics and dissemination Ethical approval has been obtained from four Dutch universities. Longitudinal study designs are vital to monitor mental health (and predictors thereof) in the pandemic to develop preventive and curative mental health interventions. This study is carried out by researchers who are board members of the Dutch Society for Traumatic Stress Studies and is part of a pan-European study (initiated by the European Society for Traumatic Stress Studies) examining the impact of the pandemic in eleven countries. Results will be published in peer-reviewed journals and disseminated at conferences, via newsletters, and media-appearance among (psychotrauma-)professionals and the general public. Strengths and limitations of this study This is one of the first studies examining the mental health impact of the COVID-19 pandemic by focusing on negative and positive mental health in the general population. A longitudinal research design is used, which enable us to examine predictors of transitioning between mental health classes over three time points. A limitation of this study is that we used self-report measures, instead of clinical interviews, to assess mental health.
Abstract Objectives In the present study, we examined relations between premigration, perimigration, and postmigration risk factors (i.e., potentially traumatic events [PTEs], postmigration living problems [PMLPs], stressful life events) and psychological symptoms (i.e., anxiety/depression, posttraumatic stress) in Syrian emerging adults with refugee backgrounds; we also tested cultural identity conflict as a possible mediator of these relations. We expected that greater exposure to migration risk factors was associated with more psychological symptoms and that higher cultural identity conflict would contribute to these associations. Methods We used data from the first wave of Karakter, a longitudinal study of 158 Syrians with refugee backgrounds (69.0% men, age range 18–35). Participants completed a questionnaire assessing PTEs, PMLPs, stressful life events, cultural identity conflict, and symptoms of anxiety/depression and posttraumatic stress. Results Correlational analyses indicated that more PTEs and stressful life events were related to higher levels of cultural identity conflict and more psychological symptoms. Furthermore, greater cultural identity conflict was associated with more psychological symptoms. We did not observe indirect effects of cultural identity conflict in the mediation analyses. Conclusions Results suggest that postmigration stressors and cultural identity conflict are associated with psychological symptoms among Syrian emerging adults who have resettled in the Netherlands.
In contrast with traumatic experiences, there is a dearth of studies on the link between trauma symptoms, disconnected (frightened, threatening and dissociative) parenting behavior, extremely insensitive parenting behavior and child attachment. This study extends previous work on the impact of posttraumatic stress disorder (PTSD) on families by studying the unique contribution of disconnected and extremely insensitive parenting behavior on child attachment in a highly traumatized sample of 68 asylum seekers and refugees and their children (18–42 months). The results show that parental symptoms of PTSD are directly related to children's insecure attachment and disorganized attachment. The greatest proportion of the risk could be attributed to factors related to the dyad and not the family. A mediation effect of adverse parenting behavior was not confirmed. On the one hand the results indicate the need for an effective treatment of PTSD symptomatology while on the other hand the results indicate the need for clinical attention to insecure attachment relationships.
Background While treatment of posttraumatic stress disorder (PTSD) in refugees is generally effective, many refugees remain symptomatic after treatment. Coping styles could be relevant to PTSD treatment response and as such may be a potential focus of PTSD treatment. Aims The study aims to examine 1) if baseline coping styles are related to treatment response after EMDR therapy or stabilization, and 2) if coping styles change during these treatments. Method Seventy-two refugees with PTSD were randomly allocated to 12 hours of EMDR therapy or stabilization. A coping questionnaire (COPE-easy) and clinical interview for PTSD (CAPS-IV) were administered before and after treatment and at three-month follow-up. The association between baseline coping styles and PTSD symptom change was examined using regression analysis and a t-test. Changes in coping styles were analyzed using mixed design ANOVA. Results No significant relations between baseline coping style levels and PTSD symptom changes were found. Additionally, coping style levels did not change significantly after either treatment. Conclusion Contrary to the hypothesis, we did not find any evidence that treatment was related to (changes in) coping style. Addressing pre-treatment coping styles among refugees receiving short-term therapy, may not be required for reducing PTSD. Changing coping styles may need a longer or different type of treatment.
