CoChat
Sign Up
Cited by 71Grief, Bereavement, and Mental HealthMigration, Health and TraumaPosttraumatic Stress Disorder Research

The assessment of grief in refugees and post-conflict survivors: a narrative review of etic and emic research

Open access
Killikelly, Clare, Bauer, Susanna, Maercker, Andreas·2018·Frontiers in Psychology
DOI 10.3389/fpsyg.2018.01957PMC PMC6204364
Open this paper in CoChat — free accountOpen PDF

Abstract

Background: Prolonged Grief Disorder (PGD) is a new mental health disorder that will be recognized by the World Health Organization’s disorder classification, the ICD-11, in 2018. Current assessment measures of PGD are largely based on North American and European conceptualizations of grief (etic i.e. from the perspective of the observer). However, research is emerging from communities outside of the Global North, in particular, conflict-exposed communities, exploring local models (emic i.e. from within the cultural group), assessment measures and symptoms of grief. Several reviews have found that refugees have higher rates of mental illness, defined by etic standards as depression, post-traumatic stress disorder (PTSD), anxiety disorders and psychotic symptoms. Yet, presently there are no reviews documenting the assessment of PGD in refugees and post conflict survivors. Method: This narrative review will provide an overview of studies that assess grief in refugees to 1) identify current assessment measures of grief in refugees (ie. type and frequency of questionnaires used, whether Global North-based, etic, or locally develop, emic, and the level of cultural adaptation) and 2) to document the variety and rate of grief symptoms identified with Global North standard measures and/or local measures (i.e. the endorsement of standard symptom items and the identification of culturally specific symptoms of grief). Results: This review revealed 24 studies that assessed disordered grief in refugee or post conflict samples. Studies where heterogeneous in their assessment methods; the majority (n=17) used an etic approach, four used a combined etic/emic approach, and three used a predominantly emic approach. The rate of disordered grief was high depending on cultural adaptation approach (31-76%) and when standard etic measures were used the disordered grief rate was 32%. Conclusion: These findings will help to guide future studies to provide accurate assessment of grief in refugee and post conflict populations and has implications for improving cultural knowledge in clinical practice.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review of 24 studies found that grief assessment in refugees and post-conflict survivors is methodologically heterogeneous and mostly etic, with high rates of disordered grief. Culturally adapted emic/etic measures reveal additional somatic, spiritual, and dream/re-experiencing symptoms not captured by standard Global North measures.

Key findings

  • Across 24 studies and 8,600 participants, 17 used a predominantly etic approach, 4 used combined etic/emic, and 3 used predominantly emic; all 24 measured traumatic or conflict-related loss.
  • When standard etic measures were used, the disordered grief rate averaged 32% (range 8–69); depending on cultural adaptation approach, rates ranged from 31% to 76%.
  • The yearning/distress item was endorsed by 68.4% of participants across studies examining single items acceptable in local communities.
  • Emic and deep structural adaptations identified culturally specific symptoms, including somatic symptoms, spiritual concerns, and dreams/re-experiencing the deceased; for example, in Cambodian refugees, 76% reported pained remembering, 72% had concerns over the spiritual status of the dead, and 70% attributed distress triggered by pained recall to a “khyal attack.”

Methods

  • Narrative review using PICOS inclusion criteria: adults (>18 years) who were refugees/migrants/asylum seekers or living in a (post-) conflict zone, peer-reviewed English articles, and a grief symptom measure.
  • Searched Web of Science and PsychINFO from 2000 to April 2018 using grief/bereavement/loss/mourning terms combined with refugee/migrant/asylum seeker terms; 24 studies were included after screening.
  • Data extraction covered study characteristics, grief measures, rates of disordered grief, cultural adaptation level, and culturally specific symptoms; adaptation was coded along four levels from no adaptation to culturally grounded adaptation.

Limitations

  • The paper states that including only English peer-reviewed articles may have excluded valuable emic literature, that few emic studies were found and findings are limited to specific groups such as West Papua and Cambodia, that not all articles provided exact time since loss, that relationship to the deceased was not assessed, and that only 14 of 24 articles indicated a disordered grief rate, making pooled PGD rates difficult to determine.
  • Evident from the text: as a narrative review, it does not report a systematic quality appraisal or meta-analytic pooling, and the heterogeneity of measures and adaptation approaches limits comparability across studies, which the authors also note.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3389/fpsyg.2018.01957

Cites

75 of 75 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 81 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The majority of included studies (n = 17) used an etic approach to grief assessment.

    “the majority (n = 17) used an etic approach”
    Quote in the paperSubstantial claim
  • Findingown data

    The rate of disordered grief was high depending on cultural adaptation approach, ranging from 31% to 76%.

    “The rate of disordered grief was high depending on cultural adaptation approach (31–76%)”
    • Also stated in: § Discussion · plain
      “This revealed unique culturally specific symptoms of grief and higher rates of grief symptoms on these symptoms (ranging from 31 to 76%).”
    Quote in the paperSubstantial claim
  • Findingown data

    Three included studies used a predominantly emic approach to grief assessment.

    “three used a predominantly emic approach”
    • Also stated in: § Approach to Grief Measurement · plain
      “Few studies (n = 3) employed a predominantly emic approach.”
    Quote in the paperNot a substantial claim
  • Findingown data

    When standard etic measures were used, the average rate of disordered grief was 32%, with a range of 8% to 69%.

    “when standard etic measures were used the disordered grief rate was 32%.”
    • Also stated in: § Approach to Grief Measurement · plain
      “Where reported, the rates of disordered grief varied across these standard assessment measures with an average of 32% (range 8–69) of participants scoring in the disordered or severe range”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The rates of disordered grief obtained from different standard etic grief measures can be meaningfully averaged into a single rate.
  • Findingown data

    The included studies were heterogeneous in their assessment methods.

    “Studies were heterogeneous in their assessment methods;”
    Quote in the paperSubstantial claim
  • May combine two claims. 31
  • Classified as probably not a substantial claim. 20
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingcitation

    Hall et al. (2014) produced a 12-item traumatic grief scale with 11 items from the ITG and one Kurdish-specific symptom, 'Imitating behaviors of someone who had died'; mean scores were 8.89/36.

    “This method resulted in a 12-item traumatic grief scale with 11 items from the ITG and one symptom specific to the Kurdish local population, ‘Imitating behaviors of someone who had died.’ Mean scores on this measure were 8.89/36.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hall et al., 2014 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    68% of the refugee samples experienced intense yearning and distress.

    “The finding that 68% of the refugee samples experienced intense yearning and distress”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    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).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tay et al., 2017 source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Among included studies, 15 used a direct translation approach, two conducted surface adaptation, four conducted deep structural adaptation, and three conducted culturally grounded adaptation.

    “Fifteen studies used a direct translation approach, two studies conducted surface adaptation, four studies conducted deep structural adaptation and three studies conducted culturally grounded adaptation”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In Kokou-Kpolou et al. (2017), mean ICG-R scores were 31.33 for migrants versus 40.20 for refugees, and additional grief items were the most highly endorsed for both groups (means 2.85 and 2.15 out of 4).

    “Mean scores on the ICG-R were compared for migrants and refugees (31.33 vs 40.20 respectively). Scores on the additional grief items were the most highly endorsed items for both refugees and migrants (mean 2.85 and 2.15 out of 4 respectively).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kokou-Kpolou et al., 2017 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In Silove et al. (2017), among 677 couple-dyads (n = 1354 individuals), persistent yearning/longing was endorsed by 73.95%, bitterness about the death by 44.55%, feelings of emptiness by 40.65%, and functional impairment by 65.8%.

    “These were assessed in a sample of 677 couple-dyads (n = 1354 individuals): persistent yearning/longing (endorsed by 73.95% of participants), bitterness about the death (endorsed by 44.55%), feelings of emptiness (endorsed by 40.65%) and functional impairment (endorsed by 65.8%).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Silove et al., 2017 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In Hinton et al. (2013c), 76% of participants experienced pained remembering of the deceased; 72% had concerns over the spiritual status of the dead; 73% cried when recalling the dead; somatic symptoms ranged from 67% to 88%; 70% attributed distress triggered by pained recall to a khyal attack; and 78% did coining to treat these attacks.

    “Results from the culturally grounded questionnaire indicated that 76% of participants experienced pained remembering of the deceased.”
    • Also stated in: § Approach to Grief Measurement · plain
      “72% had concerns over the spiritual status of the dead, 73% cried when recalling the dead, along with multiple somatic symptoms experienced to high degree ranging from 67–88%”
    • Also stated in: § Approach to Grief Measurement · plain
      “70% of participants attributed distress trigged by pained recall of the deceased to a khyal attack. 78% of participants did coining to treat these attacks.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hinton et al., 2013c

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Silove et al. (2017) field-tested a pool of ICD-11 PGD items in a community sample of Timor-Leste locals, and four items were determined to be most common and understandable in the community.

    “Silove et al. (2017) field-tested a pool of items from the ICD-11 PGD criteria (Maercker et al., 2013) in a community sample of Timor-Leste locals. Four items were determined to be most common and understandable in the community.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Silove et al., 2017 source

      Not checked in the free run.

    • cites Maercker et al., 2013 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Tay et al. (2016) resulted in an 18-item grief measure with endorsements ranging from 38.7% for strong feelings of yearning/longing to 5.2% for difficulty or reluctance to plan for the future.

    “This resulted in an 18 item grief measure with endorsements ranging from 38.7% for strong feelings of yearning/longing for the person who is dead, to 5.2% for difficulty or been reluctant to plan for the future.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tay et al., 2016 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In Hinton et al. (2013a), 52% of participants had dreamed of the deceased in the past month, and dream frequency was significantly correlated with PG-13 scores (r = 0.59).

    “52% of participants had dreamed of the deceased in the past month. The frequency of dreams was significantly correlated with scores on the PG-13 (r = 0.59).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hinton et al., 2013a

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Vromans et al. (2012) found that 98% of participants endorsed interpersonal grief (mean 2.97 on a 5-point scale) and 58% reported loss distress.

    “Vromans et al. (2012) found that 98% of participants endorsed interpersonal grief (mean of 2.97 measured on a 5 point scale) and 58% of participants reported loss distress.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Vromans et al., 2012 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In Powell et al. (2010b), the UCLA Expanded Grief Inventory found mean scores of 3.03 and 2.40 for existential and traumatic grief, respectively.

    “In Powell et al. (2010b), the UCLA Expanded Grief Inventory found mean scores of 3.03 and 2.40 for existential and traumatic grief respectively.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Powell et al., 2010b

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Data were collected using the PG-13 (n = 6), ICG/ICG-R (n = 7), ITG (n = 2), and CBI (n = 2).

    “Data was collected using the Prolonged Grief Disorder scale, PG-13 (Prigerson et al., 2009) (n = 6), the Inventory of Complicated Grief and the Inventory of Complicated Grief-Revised, (ICG/ICG-R) (Prigerson et al., 1995; Prigerson and Jacobs, 2001) (n = 7), the Inventory of Traumatic Grief (ITG) (HG. Prigerson et al., 1999) (n = 2), and the Core Bereavement Items (CBI) (n = 2) (Burnett et al., 199”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Prigerson et al., 2009 source

      Not checked in the free run.

    • cites Prigerson et al., 1995 source

      Not checked in the free run.

    • cites Burnett et al., 1997 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In Hinton et al. (2013b), 8% of Cambodian refugees met criteria for PGD based on the PG-13, while 31% scored in the severe range on the CSM-G.

    “8% of the refugees were found to meet criteria for PGD based on the PG-13, however 31% of the sample scored in the severe range (4/5) on the CSM-G.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hinton et al., 2013b

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Findingnone given

    This review benefits from an up-to-date overview of the most relevant and noteworthy papers in the field.

    “This review benefits from an up to date overview of the most relevant and noteworthy papers in the field.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The current study found very few emic studies, and the findings are limited to specific refugee groups such as West Papua and Cambodia.

    “The current study found very few emic studies and the findings are limited to specific refugee groups such as West Papua and Cambodia.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    The results indicate the assessment of PGD to be methodologically heterogeneous, which makes it difficult to compare results.

    “The results indicate the assessment of PGD to be methodically heterogeneous, which makes it difficult to compare results.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    The authors provide a framework for future assessment of cross-cultural research along the etic/emic continuum.

    “In addition we provide a framework for future assessment of cross-cultural research along the etic/emic continuum.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    This is the first review of the assessment methods and rates of disordered grief in refugee post-conflict survivor populations.

    “This is the first review of the assessment methods and rates of disordered grief in refugee post conflict survivor populations.”
    • Also stated in: § Future Research and Implications · plain
      “In summary, this is the first narrative review to evaluate grief measures and rates of disordered grief in the refugee population.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Only 14 out of 24 included articles indicated a disordered grief rate, which made it difficult to find accurate pooled PGD rates.

    “Only 14 out of 24 included articles indicated a disordered grief rate, which made it difficult to find accurate pooled PGD rates.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The level of cultural adaptation varied, with few studies using a combined emic-etic approach (n = 4) or a culturally grounded emic approach (n = 4).

    “The level of cultural adaptation varied with few studies using a combined emic-etic approach (n = 4) or a culturally grounded emic approach (n = 4).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    The review provides a comprehensive overview of published articles having used a valid grief measure on adult bereaved refugees.

    “It provides a comprehensive overview of published articles having used a valid grief measure on adult bereaved refugees.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    41% of West Papuan refugees experienced the traumatic loss of a beloved family member.

    “41% of West Papuan refugees experienced the traumatic loss of a beloved family member (Tay et al., 2015)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tay et al., 2015 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several reviews of refugee health have consistently found higher rates of distress and disorder across both physical and mental health conditions.

    “Several reviews of refugee health have consistently found higher rates of distress and disorder across both physical and mental health conditions (Fazel et al., 2005; Porter and Haslam, 2005).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Fazel et al., 2005 source

      Not checked in the free run.

    • cites Porter and Haslam, 2005

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Any culturally congruent psychiatric assessment should aim to blend an emic or insider perspective with an etic perspective on mental health.

    “Lewis-Fernandez and Kleinman (1995) assert that any culturally congruent psychiatric assessment should aim to blend emic or insider perspective with an etic perspective on mental health.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lewis-Fernandez and Kleinman, 1995

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The ICD-11 criteria for PGD have been refined to be clinically useful, valid, and reliable.

    “the ICD-11 criteria for PGD has been refined to be clinically useful, valid and reliable (Maercker et al., 2013; Maciejewski et al., 2016).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Maercker et al., 2013 source

      Not checked in the free run.

    • cites Maciejewski et al., 2016 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The high number of refugee samples experiencing intense yearning and distress more likely reflects multiple traumas in a specific post-conflict context and should not be considered a cultural norm.

    “however, when considering the context violence and trauma and the implications it is more likely that this high number reflects the multiple traumas experienced by these individuals within this specific post-conflict context and should not be considered a ‘norm.’”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The strongest predictors of disorder were the number of traumatic events experienced and exposure to torture.

    “The strongest predictors of disorder were the number of traumatic events experienced and exposure to torture.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Steel et al., 2009 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A typology of dreams was developed because the type of dream may indicate the severity of grief distress.

    “A typology of dreams was developed as the type of dream (i.e., trauma reliving or visitation dream) may indicate the severity of grief distress.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hinton et al., 2013a

      Not checked in the free run.

    • cites Hinton et al., 2013b

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Dreaming of the deceased was found to be an important indicator of grief symptoms in a Cambodian refugee population and is strongly connected to spiritual beliefs about rebirth and reincarnation after death.

    “Furthermore, dreaming of the deceased was found to be an important indicator of grief symptoms in a Cambodian refugee population; it is strongly connected to spiritual beliefs about rebirth and reincarnation after death (Hinton et al., 2013a,b).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hinton et al., 2013a

      Not checked in the free run.

    • cites Hinton et al., 2013b

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    By only including English articles from peer-reviewed journals, valuable emic literature might have been excluded.

    “By only including English articles from peer-reviewed journals, valuable emic literature might have been excluded.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Dreaming of the deceased seems to be a universal part of the grieving process, and dreaming of the loved person in a positive state can be comforting for the bereaved.

    “Dreaming of the deceased seems to be a universal part of the grieving process and dreaming of the loved person in a positive state can be comforting for the bereaved (Kübler-Ross and Kessler, 2005).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kübler-Ross and Kessler, 2005

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The one-item scale CSM-G and the "khyal attack"-item measured physical discomfort associated with grief.

    “The one-item scale CSM-G (Hinton et al., 2013b) and the “khyal attack”-item (Hinton et al., 2013c) measured physical discomfort associated with grief.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hinton et al., 2013b

      Not checked in the free run.

    • cites Hinton et al., 2013c

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Harper Shehadeh et al. (2016) conducted a systematic review and meta-analysis to evaluate the extent of cultural adaptation and the effectiveness of interventions for common mental health disorders.

    “For example, Harper Shehadeh et al. (2016) conducted a systematic review and meta-analysis to evaluate the extent of cultural adaptation and the effectiveness of interventions for common mental health disorders.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Harper Shehadeh et al., 2016 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Global North samples, dreaming of the deceased was originally one of the 30 symptoms proposed as a key intrusive symptom of complicated grief but is not used in the more recent Inventory of Complicated Grief.

    “In Global North samples, dreaming of the deceased was originally one of the 30 symptoms proposed as a key intrusive symptom of complicated grief (Horowitz et al., 1997), but is not used in the more recent Inventory of Complicated Grief (Prigerson et al., 1995).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Horowitz et al., 1997 source

      Not checked in the free run.

    • cites Prigerson et al., 1995 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    This review did not assess the relationship to the deceased, which could have provided valuable information about predictors of severity of grief response.

    “Thirdly, this review did not assess the relationship to the deceased, which could have provided valuable information about predictors of severity of grief response.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Migrants experience multiple stressors and this can lead to debilitating somatic complaints such as irritability, headache, migraine, nervousness, insomnia, fear and general discomfort.

    “The authors describe how migrants experience multiple stressors and this can lead to debilitating somatic complaints such as irritability, headache, migraine, nervousness, insomnia, fear and general discomfort.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Bianucci et al., 2017 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    They found that the level of adaptation had a positive effect on the effectiveness of the intervention.

    “They found that the level of adaptation had a positive effect on the effectiveness of the intervention.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Harper Shehadeh et al., 2016 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Religious beliefs can foster resilience during bereavement by providing a stable, shared belief system and by providing affiliation and social support from the religious community.

    “For instance, religious beliefs can foster resilience during bereavement both by providing a stable, shared belief system and by providing affiliation and social support from the religious community (Bonanno et al., 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bonanno et al., 2002 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    Implementation of the suggested criteria for PGD for the new ICD-11, particularly the new socio-cultural caveats, could aid in cross-cultural knowledge sharing and alignment.

    “The implementation of the suggested criteria for PGD for the new ICD-11, particularly in terms of the new socio-cultural caveats (Maercker et al., 2013), could aid in this process of cross cultural knowledge sharing and alignment.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Maercker et al., 2013 source

      Not checked in the free run.

  • The quote only partly states this claim.

    Interpretationreasoning

    The underrepresentation of spiritual concerns in standard grief measures is similar to that of somatic symptoms.

    “This underrepresentation is similar for spiritual concerns.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    They developed a questionnaire to assess the level of adaptation for each study.

    “They developed a questionnaire to assess the level of adaptation for each study.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Harper Shehadeh et al., 2016 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Conflict-related loss and trauma are not the only events that can precipitate a mental health disorder.

    “They assert that conflict-related loss and trauma are not the only events that can precipitate a mental health disorder.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Miller and Rasmussen, 2017

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Not all selected articles provided an exact time since loss, but this was counterbalanced by the time criterion that was, in most cases, inherent in the grief instruments applied.

    “Not all selected articles provided an exact time since loss, but this was counterbalanced by the time criterion that was, in most cases, inherent in grief instruments applied.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    There is increasing recognition of the importance of including cultural concepts of distress or idioms of distress within the format of North American and European mental health assessments.

    “There is increasing recognition for the importance of including cultural concepts of distress or idioms of distress within the format of North American and European mental health assessments (Rasmussen et al., 2014).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Rasmussen et al., 2014 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The ICG has other intrusive items, such as hearing the voice or seeing the person who died, which attests to the importance of assessing some form of re-experience of the deceased, whether in dreams, voices or hallucinations.

    “However the ICG has other intrusive items such as “I hear the voice of the person who died speak to me” or “I see the person who died stand before me” and attests to the importance of assessing some form of re-experience of the deceased, whether in dreams, voices or hallucinations.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A study in a German sample found that dreaming of the deceased had poor ability to identify people with complicated grief, and the authors suggested it should be dropped from the criteria.

    “A study in a German sample found that dreaming of the deceased had poor ability to identify people with complicated grief and the authors suggested it should be dropped from the criteria (Langner and Maercker, 2005).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Langner and Maercker, 2005

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Somatic symptoms are not overtly part of, or are at least underrepresented in, most standard grief measures.

    “These findings and the culturally specific somatic items identified in this review point to the fact that somatic symptoms are not overtly part of –or are at least underrepresented– in the most standard grief measures.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent study presented a phenomenon identified as 'Ulysses syndrome' or the psychosomatic disorder of modern migrants.

    “Interestingly, a recent study presented a phenomenon identified as ‘Ulysses syndrome’ or the psychosomatic disorder of modern migrants (Bianucci et al., 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bianucci et al., 2017 source

      Not checked in the free run.

49 of 49

  • The paper relies on this without support.

    The rates of disordered grief obtained from different standard etic grief measures can be meaningfully averaged into a single rate.

    “Where reported, the rates of disordered grief varied across these standard assessment measures with an average of 32% (range 8–69) of participants scoring in the disordered or severe range”

  • The paper relies on this without support.

    Refugees experience many losses beyond the loss of a loved one, including loss of homeland, cultural group, employment, housing, and security.

    “Refugees experience many losses, not only the loss of a loved one, but also the loss of homeland, cultural group, employment, housing, and security.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Studies of depression across history and cultures suggest that while several core features of depression are clearly identified across geographies and cultures, there remain significant variations.

    “Studies of depression across history and cultures (see Figures 1 and 2) suggest that while several core features of depression are clearly identified across geographies and cultures, there remain significant variations. For instance, the prominence of sadness might not be universal, emotions are expressed in differing ways, and there is overlap between the concepts of social suffering and”

    From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [101]

  • Attitudes may be less negative in cultural contexts where the symptoms of depression are attributed predominantly to problems of the heart, or to loss of the soul or other spiritual beliefs, rather than to a brain dysfunction.

    “Conversely, attitudes may be less negative in cultural contexts where the symptoms of depression are attributed predominantly to problems of the heart, or to loss of the soul or other spiritual beliefs, rather than to a brain dysfunction. 101,351”

    From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [101]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting counts of culturally grounded studies

    Minor

    The Results section counts three culturally grounded studies, while the Discussion counts four.

  • Five of 24 studies is not 22%

    Minor

    Table 1 reports sickness/health loss in five studies as 22%, but five of the 24 included studies is approximately 20.8%, or 21% rounded to a whole percent.

    Reported 22 · recomputed 20.833333

2 of 2

Cites

Flagged first, then by citations

4 of the 79 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. 2013, Diagnostic and Statistical Manual of Mental Disorders
  2. Bolton, 2008, Design, Implementation, Monitoring, and Evaluation of Cross-Cultural Hiv-Related Mental Health and Psychosocial Assistance Programs: A User’s Manual for Researchers and Program Implementers.
  3. Kast, 1982, Trauern
  4. Nunnally, 1994, The assessment of reliability., Psychom. Theory, 3, 248
  5. 2017, UNHCR - Figures at a Glance. Unhcr.Org.

Cited by

Sorted by citations

Related

Authors
Killikelly, C., Bauer, S., & Maercker, A.
Affiliations
University of Zurich (CH)
Corresponding author
Killikelly, Clare
ORCID
Killikelly, Clare
Venue
Frontiers in Psychology
Publisher
Frontiers Media SA
Published
2018-10-22
Volume
9
Pages
1957-1957
ISSN
1664-1078 (ISSN-L)
DOI
10.3389/fpsyg.2018.01957
PMC
PMC6204364
OpenAlex
W2897870866
Cited by
71
References
79
Citations by year
2026: 6 · 2025: 6 · 2024: 11 · 2023: 12 · 2022: 10 · 2021: 12 · 2020: 11 · 2019: 3
FWCI
1.10
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
prolonged grief disorder, grief assessment, refugees, emic and etic approaches, ICD-11, cross-cultural mental health

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review