Open Access Highly Accessed Research article

Posttraumatic stress disorder and prolonged grief in refugees exposed to trauma and loss

Angela Nickerson1*, Belinda J Liddell1, Fiona Maccallum1, Zachary Steel2, Derrick Silove2 and Richard A Bryant1

Author Affiliations

1 School of Psychology, University of New South Wales, Sydney NSW 2052, Australia

2 Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney NSW, 2052, Australia

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BMC Psychiatry 2014, 14:106  doi:10.1186/1471-244X-14-106

Published: 9 April 2014



While a large proportion of conflict-affected populations have been dually exposed to trauma and loss, there is inadequate research identifying differential symptom profiles related to bereavement and trauma exposure in these groups. The objective of this study were to (1) determine whether there are distinct classes of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) symptoms in bereaved trauma survivors exposed to conflict and persecution, and (2) examine whether particular types of refugee experiences and stressors differentially predict symptom profiles.


Participants were 248 Mandaean adult refugees who were assessed at an average of 4.3 years since entering Australia following persecution in Iraq. PTSD, PGD, trauma exposure, adjustment difficulties since relocation, and English proficiency were measured. Latent class analysis was used to elucidate symptom profiles of PTSD and PGD in this sample.


Latent class analysis revealed four classes of participants: a combined PTSD/PGD class (16%), a predominantly PTSD class (25%), a predominantly PGD class (16%), and a resilient class (43%). Whereas membership in the PTSD/PGD class was predicted by exposure to traumatic loss, those in the PGD class were more likely to have experienced adaptation difficulties since relocation, and individuals in the PTSD class were more likely to have experienced difficulties related to loss of culture and support.


This study provides evidence that specific symptom patterns emerge following exposure to mass trauma and loss. These profiles are associated with distinct types of traumatic experiences and post-migration living difficulties. These results have substantial public health implications for assessment and intervention following mass trauma.

Trauma; Bereavement; Posttraumatic stress disorder; Grief; Refugees; War