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Cited by 26Posttraumatic Stress Disorder ResearchGrief, Bereavement, and Mental HealthMigration, Health and Trauma

The role of grief symptoms and a sense of injustice in the pathways to post-traumatic stress symptoms in post-conflict timor-leste.

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Tay, A. K., Rees, S., Steel, Z., Liddell, B., Nickerson, A., Tam, N., Silove, D.·2017·Epidemiology and Psychiatric Sciences
DOI 10.1017/s2045796016000317PMC PMC6998498
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Abstract

Aims.: Grief symptoms and a sense of injustice may be interrelated responses amongst persons exposed to mass conflict and both reactions may contribute to post-traumatic stress disorder (PTSD) symptoms. As yet, however, there is a dearth of data examining these relationships. Our study examined the contributions of grief and a sense of injustice to a model of PTSD symptoms that included the established determinants of trauma events, ongoing adversity and severe psychological distress. The study involved a large population sample (n = 2964, response rate: 82.4%) surveyed in post-conflict Timor-Leste. Methods.: The survey sites included an urban administrative area (suco) in Dili, the capital of Timor-Leste and a rural village located an hour's drive away. Culturally adapted measures were applied to assess conflict related traumatic events (TEs), ongoing adversity, persisting preoccupations with injustice, symptoms of grief, psychological distress (including depressive symptoms) and PTSD symptoms. Results.: We tested a series of structural equation models, the final comprehensive model, which included indices of grief symptoms and injustice, producing a good fit. Locating grief symptoms as the endpoint of the model produced a non-converging model. In the final model, strong associations were evident between grief and injustice (β = 0.34, s.e. = 0.02, p < 0.01) and grief and PTSD symptoms (β = 0.14, s.e. = 0.02, p < 0.01). The sense of injustice exerted a considerable effect on PTSD symptoms (β = 0.13, s.e. = 0.03, p < 0.01). In addition, multiple indirect paths were evident, most involving grief and a sense of injustice, attesting to the complex inter-relationship of these factors in contributing to PTSD symptoms. Conclusions.: Our findings support an expanded model of PTSD symptoms relevant to post-conflict populations, in which grief symptoms and a sense of injustice play pivotal roles. The model supports the importance of a focus on loss, grief and a sense of injustice in conducting trauma-focused psychotherapies for PTSD amongst populations exposed to mass conflict and violence. Further research is needed to identify the precise mechanisms whereby grief symptoms and the sense of injustice impact on PTSD symptoms.

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  • In Tay et al. (2017), among n = 2964 individuals, persistent yearning/longing was endorsed by 73.5%, bitterness by 43.6%, emptiness by 38.9%, and functional impairment by 32.3%.

    “A follow up study (Tay et al., 2017) followed the same surface cultural adaptation procedure and found similar rates for n = 2964 individuals: persistent yearnings or longing for the deceased (endorsed by 73.5%), feelings of bitterness about the death (43.6%), and feelings of emptiness (38.9%), functional impairment associated with grief symptoms (32.3).”

    From The assessment of grief in refugees and post-conflict survivors: a narrative review of etic and emic research (2018) · cites this paper as Tay et al., 2017

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Authors
Tay, A. K., Rees, S., Steel, Z., Liddell, B., Nickerson, A., Tam, N., & Silove, D.
Affiliations
  • UNSW Sydney (AU)
  • Black Dog Institute (AU)
Corresponding author
Tay, A. K.
ORCID
Venue
Epidemiology and Psychiatric Sciences
Publisher
Cambridge University Press (CUP)
Published
2016-08-30
Volume
26
Issue
4
Pages
403-413
ISSN
  • 2045-7960 (ISSN-L)
  • 2045-7979
DOI
10.1017/s2045796016000317
PMC
PMC6998498
OpenAlex
W2513202147
Cited by
26
References
45
Citations by year
2026: 4 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 3 · 2019: 5 · 2018: 3 · 2017: 1
FWCI
4.02
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified)
Locations
  • Epidemiology and Psychiatric Sciences (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Health and Medical Research Council
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords
grief symptoms, sense of injustice, post-traumatic stress disorder, post-conflict trauma, psychological distress, depressive symptoms, loss, trauma-focused psychotherapy, Timor-Leste
MeSH terms
Adolescent, Adult, Aged, Anger, Bereavement, Female, Grief, Humans, Male, Middle Aged, Rural Population, Social Justice, Stress Disorders, Post-Traumatic, Stress, Psychological, Violence, Warfare, Survivors, Timor-Leste, Young Adult

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