Prolonged Grief in African Contexts: Scale Validation, Prevalence Rates and Risk Factors Among Young Adults in Kenya, Namibia, and South Africa

Abstract

Although grief is a universal part of the human experience, for some it may become a debilitating mental health disorder. Prolonged grief disorder (PGD) has recently been included in diagnostic guidelines worldwide, but there is little research on global applicability. This is the first study to examine PGD rates, risk factors and psychometric validity of the international prolonged grief disorder scale (IPGDS) concurrently across multiple African countries. It is also the first study to examine probable PGD in young adults anywhere, and importantly, in a context where bereavement is often experienced earlier and more often. Psychometric validity and reliability of the IPGDS was confirmed and exploratory factor analysis supported a one factor structure. Despite significantly higher exposure to loss and death than in the Western samples, prevalence rates for probable PGD were similar (Kenya 9.63%, South Africa 6.85%, and Namibia, 5.34%, vs. global average of 9.8%). Risk factors identified in all three samples include a close relationship to the deceased and a violent death. Gender differences were seen in Kenya and Namibia, with higher rates of probable PGD for women. Financial difficulties increased disorder-level risk in Kenya and South Africa. Overall, results suggest the presence of protective factors, perhaps related to high religiosity and traditional practices.

Funding: Data collection and work on the manuscript by the second and last authors was supported by Swiss National Science Foundation Eccellenza Fellowship 10001C_179458/1 “Universal and Culturally specific aspects of personality and mental health”, awarded to Amber Gayle Thalmayer. Data collection was supervised in Namibia by Elizabeth Shino and Annelisa Murangi of the University of Namibia; in Kenya by Stephen Asatsa and John Makunda of the Catholic University of Eastern Africa; and in South Africa by Luzelle Naudé and Catherine Shirma of the University of the Free State, Sumaya Laher and Tasneem Hassem of the University of the Witwatersrand, Maria Florence, Tracy-Ann Adonis, and Casey Botha of the University of the Western Cape. Work on this manuscript by the first author was supported by the Swiss National Science Foundation Starting Grant fellowship TMSGI1_218018 / 1

Declaration of Interest: The authors declare no conflict of interest.

Ethical Approval: Ethical approval was obtained as a whole by the partner universities, specifically, the Catholic University of Eastern Africa, the University of Namibia, the University of the Free State, the University of the Witwatersrand, and the University of the Western Cape, as well as at the national level in Namibia and at the national and county levels in Kenya. Annual ethical review is mandatory in Kenya, requiring inperson visits to offices in each county.

Keywords: prolonged grief disorder, psychometric validation, prevalence rates, risk factors, Africa