Academic journal article European Journal of Psychotraumatology

Prolonged Grief, Depression, and Posttraumatic Stress in Disaster-Bereaved Individuals: Latent Class Analysis

Academic journal article European Journal of Psychotraumatology

Prolonged Grief, Depression, and Posttraumatic Stress in Disaster-Bereaved Individuals: Latent Class Analysis

Article excerpt

1.Background

On 17 July 2014 flight MH17 from Amsterdam to Kuala Lumpur crashed in Ukraine due to a missile impact. All 298 passengers, including 193 Dutch citizens, died (Dutch Safety Board, 2015). Worldwide, many individuals have lost their lives in disasters. For example, more than 227,000 people died due to the Indian Ocean tsunami in 2004 (Johannesson, Lundin, Hultman, Fröjd, Michel, 2011) and about 2800 people died in the 9/11 attacks in 2001 (Perlman et al., 2011). Explorations of psychopathology post-disasters have primarily focused on posttraumatic stress disorder (PTSD) in adults directly exposed to the disaster (e.g. as a survivor) and to a lesser extent on individuals who lost a significant other due to a disaster (Galea, Nandi, & Vlahov, 2005; Perlman et al., 2011).

The current study focuses on patterns and correlates of psychological symptoms in individuals who lost one or more significant others in the Ukrainian plane crash. This is important for a number of reasons. Firstly, the likelihood of developing psychopathology may be higher for manmade disasterbereaved individuals compared with individuals confronted with non-violent loss (e.g. due to illness). Specifically, the violent nature of the loss in the context of manmade disaster (Galea et al., 2005) and suffering multiple simultaneous losses seems to be linked to increased psychopathology levels (Kristensen, Weisaeth, & Heir, 2010). Gaining more knowledge about disaster-related risk factors may help to identify individuals at risk for development of psychopathology.

Secondly, different studies have explored the prevalence and correlates of psychopathology following disaster-related loss, including the 9/11 attacks (Bonanno, Galea, Bucciarelli, & Vlahov, 2006) and the Indian Ocean tsunami (Kristensen et al., 2010). However, to our knowledge, no studies have yet examined whether subgroups can be distinguished among disaster-bereaved individuals in terms of different forms of psychopathology, including prolonged grief disorder (PGD), major depressive disorder (MDD), and PTSD. PGD shows overlap with, yet is distinguishable from, MDD and PTSD (Boelen, van de Schoot, van den Hout, de Keijser, & van den Bout, 2010). The most prominent difference between these three syndromes is that PGD is dominated by yearning for the deceased, while MDD is characterized by anhedonia and dysphoria, and PTSD is dominated by intrusion and hyperarousal symptoms (Maercker & Znoj, 2010; Prigerson et al., 2009). Treatment effects may differ between subgroups of bereaved individuals that are characterized by different symptom-profiles (Smid et al., 2015). Identifying subgroups may provide valuable information for the development of diagnostic instruments and tailored interventions (Rosner, 2015).

The first aim of this study was to explore subgroups (i.e. latent classes) based on endorsement of PGD, MDD, and PTSD symptoms in manmade disaster-bereaved individuals, using latent class analysis (LCA). In recent years, there is growing interest in these person-centred analyses of responses to adverse life events (Armour et al., 2015; Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014; Contractor et al., 2015). LCA identifies unobserved subgroups of individuals based on predefined indicators (in the current study presence of PGD, MDD, and PTSD symptom clusters). Previous LCA studies in bereaved samples were either focused on PGD and PTSD symptoms (Nickerson et al., 2014) or PGD and MDD symptoms (Boelen, Reijntjes, Djelantik, & Smid, 2016). These studies indicated that three to four classes can be distinguished: (1) a Resilient class, (2) a PGD class, (3) a PGD combined with MDD or PTSD class, and (4) in the study of Nickerson et al. (2014) also a distinct PTSD class. To the best of our knowledge, the current study is the first to explore classes based on PGD, MDD, and PTSD assessed in a single study. Based on previous findings (Boelen et al., 2016; Nickerson et al. …

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