Does Complicated/Prolonged Grief Predict Chronic PTSD Among Bosnian Refugees?
Methods:Survey packets (N = 500) with psychometrically validated measures of trauma exposure, PTSD, and complicated grief were randomly distributed by Bosnian research assistants to Bosnian Refugees who had been resettled in the United States for more than five years. The measures were translated into Bosnian using the translation-back translation method and consisted of the Trauma Life Events Questionnaire (TLEQ; Kubany, 2004), the PTSD Screening and Diagnostic Scale (PSDS; Kubany, 2004), and the Inventory of Complicated Grief (ICG; Prigerson, 1995). All translated measures were factor analyzed with alpha reliability coefficients above .70. All individuals who indicated at least one DSM-IV-TR (APA, 2000) criterion A trauma, who reported symptoms of PTSD for more than 3 months including the DSM-IV-TR criteria of one re-experiencing, three avoidance, and two hyper-arousal symptoms and who were above the clinical cut-off score on the PSDS (> 18) for PTSD were selected (N =80).
Results: The demographic variables of age, education, gender, complicated grief, trauma intensity (i.e., actual number of traumas) and PTSD were all significantly correlated. A three level hierarchical regression was conducted with age and gender entered onto step one and intensity of trauma exposure entered onto level two, and complicated grief as measured by the ICG was entered onto the third and final level. After step 1, with gender and age in the equation, R2 = .13, F (2, 77) = 4.79, p = .01. After step two, with trauma intensity entered into the equation, this did not add significantly to prediction of PTSD. At step three with complicated grief added to prediction of chronic PTSD by gender, education, and trauma intensity, R2 = .50 (adjusted R2 = .48), Finc(1, 75) = 55.74, p< .001. Addition of complicated grief to the equation resulted in a highly significant reliable improvement of the predictive variance of PTSD (37%).
Conclusions and Implications: Results indicate a need to focus on grief issues early in the treatment of PTSD in order to help prevent chronic PTSD reactions. Further implications indicate a need for implementing components on complicated/prolonged grief into evidence based practices for PTSD. Limitations of this study will be discussed.