ABSTRACT
BACKGROUND: Resettled refugees exposed to trauma and loss are at risk to develop mental disorders such as posttraumatic stress disorder (PTSD) and persistent complex bereavement disorder (PCBD). Post-migration stressors have been linked to poor mental health and smaller treatment effects. AIM: Our aim was to evaluate reductions in PTSD and PCBD symptoms and to explore the presence of post-migration stressors and their associations with symptom change and non-completion in a traumatic grief focused treatment in a cohort of refugees. METHODS: Paired sample t-tests were used to test the significance of the symptom reductions in PTSD and PCBD symptoms during treatment. The presence of post-migration stressors was derived from a qualitative analysis of the patient files. Associations between post-migration stressors and symptom reductions as well as non-completion were calculated. RESULTS: In this uncontrolled study, 81 files of consecutive patients were included. Significant reductions in both PCBD and PTSD symptomatology with medium effect sizes were found. Patients experienced a mean of three different post-migration stressors during the treatment. Undocumented asylum seekers were more likely to be non-completers. Ongoing conflict in the country of origin was associated with smaller PTSD symptom reductions and the total number of post-migration stressors was associated with smaller PCBD symptom reductions. CONCLUSIONS: Treatment for resettled refugees for traumatic grief coincides with alleviations in both PCBD and PTSD symptomatology. Specific post-migration stressors were associated with reduced treatment effects and increased non-completion. This is a first step towards well-informed improvements of mental health interventions for resettled refugees.
ABSTRACT
Background: Bereaved individuals who have lost a loved one under traumatic circumstances can develop symptoms of Persistent Complex Bereavement Disorder (PCBD) and/or Posttraumatic Stress Disorder (PTSD). This is particularly common in refugees, as they frequently have been confronted with multiple traumatic losses. For patients with severe PTSD and traumatic grief a treatment programme was developed, embedding individual traumatic grief focused therapy in a group-based multidisciplinary day patient treatment programme. The day patient treatment comprised a weekly five-hour programme consisting of three phases with a duration of four months each. Objective: To evaluate the feasibility and potential effectiveness of the treatment programme. Method: Data were analyzed from 16 participants treated between October 2013 and March 2014. PTSD severity and PTSD/PCBD diagnoses were measured during the initial and final phases of treatment using the Clinician-Administered PTSD Scale for DSM-IV (CAPS) and the Traumatic Grief Inventory Self Report (TGI-SR). One clinical case is presented in more detail. Treatment attendance was also registered and therapist satisfaction was evaluated in a focus group. Results: Thirteen patients (81%) completed the treatment. Each day of the treatment programme was attended by a mean of 76% of the participants. In the focus group, therapists noted symptom reduction in their patients and they therefore regarded Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG) as an effective therapy for their patients. During treatment, significant decreases in PTSD severity as well as diagnosable PTSD and PCBD were observed. Conclusions: Results support the feasibility and potential effectiveness of the day patient treatment programme for traumatic grief. The programme appears to be particularly suitable for refugees with severe PTSD and PCBD psychopathology, who may not benefit enough from usual care.
Planteamiento: Las personas en duelo que han perdido a un ser querido en circunstancias traumáticas pueden desarrollar síntomas del trastorno por duelo complejo persistente (TDCP) y/o trastorno por estrés postraumático (TEPT). Esto es particularmente habitual en refugiados, ya que con frecuencia se han enfrentado a múltiples pérdidas traumáticas. Se desarrolló un programa de tratamiento para pacientes con TEPT grave y duelo traumático que incluía terapia individual centrada en el duelo traumático dentro de un programa grupal multidisciplinario de tratamiento de día. El tratamiento de día consistía en un programa semanal de cinco horas que constaba de tres fases, con una duración de cuatro meses cada una. Objetivo: Evaluar la viabilidad y la eficacia potencial del programa de tratamiento. Métodos: Se analizaron los datos de dieciséis participantes tratados entre octubre de 2013 y marzo de 2014. Se midió la gravedad del TEPT y los diagnósticos de TEPT / TDCP durante las fases inicial y final del tratamiento utilizando la Escala de TEPT administrada por el clínico para el DSM-IV (CAPS, siglas en inglés de Clinician-Administered PTSD Scale for DSM-IV) y el Autoinforme del inventario de duelo traumático (TGI-SR, siglas en inglés de Traumatic Grief Inventory Self Report). Se presenta con más detalle un caso clínico. También se registró la asistencia al tratamiento y se evaluó la satisfacción del terapeuta en un grupo focal. Resultados: Trece pacientes (81%) completaron el tratamiento. A cada día del programa de tratamiento asistió una media del 76% de los participantes. En el grupo focal, los terapeutas observaron reducción de síntomas en sus pacientes y, por lo tanto, consideraron la psicoterapia ecléctica breve para el duelo traumático (BEP-TG, siglas en inglés de Brief Eclectic Psychotherapy for Traumatic Grief) como una terapia eficaz para sus pacientes. Durante el tratamiento, se observaron reducciones significativas de la gravedad del TEPT, así como de los diagnósticos de TEPT y TDCP. Conclusión: Los resultados apoyan la viabilidad y la eficacia potencial del programa de tratamiento de día para duelo traumático. El programa parece ser particularmente adecuado para refugiados con una psicopatología grave de TEPT y TDCP, que pueden que no se beneficien lo suficiente de asistencia médica frecuente.
