Andreas Maercker | University of Zurich, Switzerland (original) (raw)
Papers by Andreas Maercker
Journal of Traumatic Stress, 2023
Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) ... more Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) of psychotherapy exists for this population, with very few on older adults in general. This RCT aimed to compare the efficacy of Life Review Therapy for Holocaust survivors (LRT‐HS) relative to a supportive control group. Holocaust survivors with a probable diagnosis of full or subsyndromal posttraumatic stress disorder (PTSD) or depressive disorder were included. Exclusion criteria were probable dementia, acute psychotic disorder, and acute suicidality. The predefined primary endpoint was the course of PTSD symptom scores. In total, 49 of 79 consecutive individuals assessed for eligibility were randomized and included in the intent‐to‐treat analyses (LRT‐HS: n = 24, control: n = 25; Mage = 81.5 years, SD = 4.81, 77.6% female). Linear mixed models revealed no statistically significant superiority of LRT‐HS for PTSD symptoms at posttreatment, with moderate effect sizes, Time x Condition i...
Journal of Traumatic Stress
Historical trauma is a relatively new concept in the literature, and investigations are needed to... more Historical trauma is a relatively new concept in the literature, and investigations are needed to clarify its clinical aspects and develop instruments to measure its sequelae. The purpose of this study was to develop the Clinical Aspects of Historical Trauma Questionnaire (CAHTQ), which is meant to capture trauma sequelae in different contexts, and provide initial psychometric information. Participants were survivors of the genocide against the Tutsi in Rwanda (N = 261) aged 32–87 years (M = 46.30 years, SD = 11.95) who completed a preliminary version of the CAHTQ, constructed based on theoretical and content‐related consideration, as well as the International Trauma Questionnaire, Fatalism Scale, Public Health Depression Questionnaire, Brief Coping Inventory, Forgiveness Questionnaire, and Sentiment of Reconciliation Questionnaire to test the discriminant and convergent validity of the CAHTQ. Exploratory factor analysis was conducted to reduce the number of items and extract factor...
Journal of Traumatic Stress, 2023
Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) ... more Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) of psychotherapy exists for this population, with very few on older adults in general. This RCT aimed to compare the efficacy of Life Review Therapy for Holocaust survivors (LRT-HS) relative to a supportive control group. Holocaust survivors with a probable diagnosis of full or subsyndromal posttraumatic stress disorder (PTSD) or depressive disorder were included. Exclusion criteria were probable dementia, acute psychotic disorder, and acute suicidality. The predefined primary endpoint was the course of PTSD symptom scores. In total, 49 of 79 consecutive individuals assessed for eligibility were randomized and included in the intent-to-treat analyses (LRT-HS: n = 24, control: n = 25;Mage = 81.5 years, SD = 4.81, 77.6% female). Linear mixedmodels revealed no statistically significant superiority of LRT-HS for PTSD symptoms at posttreatment, with moderate effect sizes, Time x Condition interaction: t(75) = 1.46, p = .148, dwithin = 0.70, dbetween = 0.41, but analyses were significant at follow-up, with large effect sizes, t(79) = 2.89, p = .005, dwithin = 1.20, dbetween = 1.00. LRT-HS superiority for depression was observed at posttreatment, t(73) = 2.58, p = .012, but not follow-up, t(76) = 1.08, p = .282, with moderate effect sizes, d(within) = 0.46–0.60, d(between) = 0.53–0.70. The findings show that even in older age, PTSD and depression following exposure to multiple traumatic childhood events can be treated efficaciously using an age-appropriate treatment that includes structured life review and narrative exposure.
BMC Psychiatry, 2020
Background The Holocaust was one of the most traumatic catastrophes in recorded human history. Su... more Background The Holocaust was one of the most traumatic catastrophes in recorded human history. Survivors seeking psychotherapeutic help today, now in their seventies and older, often show symptoms of a posttraumatic stress disorder (PTSD), depression, or prolonged grief disorder. Established psychological treatments for PTSD (e.g. cognitive behaviour therapy, psychodynamic therapies) have been tested and assessed mainly with young and middle-aged adults; only very few studies examined them in old age. There is no therapy outcome study known to us for any treatment mode for Holocaust survivors. Moreover, there is a need for an age group-specific treatment of PTSD and other stress-related mental disorders. A narrative approach including life-review and narrative exposure seems to meet very well the natural need of older people to review their lives and is highly effective. However, most studies on the efficacy of life review therapy (LRT) focus on late-life depression. There is a lack...
Frontiers in Psychiatry, 2023
Traumatic stress studies have recently addressed the issue of 'historical trauma' that well expla... more Traumatic stress studies have recently addressed the issue of 'historical trauma' that well explain the impact of collective or totalitarian trauma. The example of former communist Eastern Europe shows that there are many individual and sociopsychological consequences that still have effects today. This paper summarizes concepts and findings on 'historical traumas' that describe such long-lasting effects. The focus is on the side of the victims and their family descendants and thus also on the moral heirs of the dissidents, e.g., the Russian NGO Memorial. Analogous to developments in psychotraumatology, increasing knowledge in this area can explain psychosocial pathologies but also help develop effective remedies. This includes the development of a culture of remembrance, sociotherapeutic interventions and increased sensitivity towards those patients and clients who have such a personal legacy.
Figures of Pathos, 2023
In der Festschrift "Figures of Pathos" für Elisabeth Bronfen soll dem kleinen und ambivalenten Af... more In der Festschrift "Figures of Pathos" für Elisabeth Bronfen soll dem kleinen und ambivalenten Affekt der Rührung Raum zukommen (...). Auf welchem Feld kann man die Kulturwissenschaften und die Psychologie miteinander verbinden? Mein Vorschlag: auf dem der Affekte und Affekttheorien, zu denen solche „Großaffekte“ wie das Pathos gehören und auch kleinere Affekte wie jener der Rührung.
Rührung ist in der Psychologie und der Affekttheorie bedauerlicher- weise ein weitgehend unbearbeitetes Phänomen. Sie hat etwas mit Empa- thie und Mitgefühl zu tun, aber damit ist sie lange nicht erschöpfend er- klärt. Sie ist ein Medienphänomen und nicht zuletzt deshalb braucht sie auch eine kritische Rekonstruktion. Letzteres kann in diesem Beitrag nur ansatzweise geschehen.
As part of the trauma and stress-related disorders' category, adjustment disorder is a freque... more As part of the trauma and stress-related disorders' category, adjustment disorder is a frequently occurring mental disorder that develops after stressful life events. Preoccupation and failure to adapt are the core symptoms of adjustment disorder in ICD-11. As this is a new definition, we conducted a large-scale study to gain a deeper understanding of the validity and applicability of the revised diagnostic criteria. N=334 individuals who experienced involuntary job loss were interviewed three times one to nine months after the last day at work (immediately, six- and twelve-months follow-up). For measuring adjustment disorder symptoms, a newly developed structured diagnostic interview and a self-report questionnaire evidenced satisfying psychometric properties. Approximately six months after discharge, the prevalence of a tentative diagnosis of adjustment disorder was 27.3% and decreased to 10.5% over the course of 12 months. We identified several event- /person-related, intra- ...
Clinical Psychological Science, 2018
Adjustment disorders (AjDs) usually resolve after the precipitating life event and its consequenc... more Adjustment disorders (AjDs) usually resolve after the precipitating life event and its consequences are terminated. However, they bear the risk for the development of severe mental illness. The present study investigates the natural course of AjD as defined for International Classification of Diseases, 11th version (ICD-11). A total of 303 individuals who involuntarily lost their jobs were assessed initially after the job loss and 6 months later. Latent class latent change analysis and multinomial logistic regression were performed. Two groups showed low ( n = 149, 49.2%) and medium ( n = 108, 35.6%) symptom severity at initial assessment that declined over time. The third group ( n = 46, 15.2%) showed a high initial response and a small effect of worsening of symptoms. Female gender, higher age, first dismissal, impaired social functioning, dysfunctional disclosure, less social support, and less social acknowledgment were associated with belonging to the latter group. It might be b...
The World Journal of Biological Psychiatry, 2018
Acta Psychiatrica Scandinavica, 2018
BMC research notes, Jan 19, 2017
Complex posttraumatic stress disorder (CPTSD) is a newly proposed diagnosis in the International ... more Complex posttraumatic stress disorder (CPTSD) is a newly proposed diagnosis in the International Classification of Diseases-version 11, which is currently intensively investigated. Childhood trauma is regarded as main source of CPTSD symptoms, even in later life. Induction of DNA methylation changes by childhood trauma may contribute to its long-lasting adverse health consequences. The current study analyzed the correlation of genome-wide DNA methylation profiles with complex posttraumatic sequelae in buccal epithelial cells from 31 elderly former indentured child laborers (Verdingkinder) using the Infinium Illumina 450k Human DNA methylation chip. DNA methylation modifications indicated experiment-wide significant associations with the following complex posttraumatic symptom domains: dissociation, tension reduction behavior and dysfunctional sexual behavior. Differentially methylated CpG sites were mapped to the genes huntington associated protein 1 (HAP1), RAN binding protein 2 (R...
Journal of anxiety disorders, 2018
A new diagnostic concept of Adjustment Disorder (AjD) was proposed for inclusion in the Internati... more A new diagnostic concept of Adjustment Disorder (AjD) was proposed for inclusion in the International Classification of Diseases, 11th version (ICD-11). However, the symptom structure of AjD is poorly understood. The aim of the present study was to investigate the dimensionality of AjD as a stress-response syndrome. A general population sample of the Israeli population (N = 1003) completed the Adjustment Disorder - New Module 20 and the WHO-5 Wellbeing Scale. We compared seven alternative models of AjD using confirmatory factor analysis (CFA). A latent profile analysis (LPA) was performed to determine if subtypes of AjD were present. The performance of the unidimensional and multidimensional models of AjD were evaluated using regression analyses. CFA results supported a unidimensional model of AjD. The LPA identified three quantitatively distinct classes (low, medium, and high) with no evidence of any subtypes of AjD. The criterion validity of AjD was superior when treated as unidim...
International Journal of Clinical and Health Psychology, 2016
European journal of psychotraumatology, 2015
Complex posttraumatic stress disorder (PTSD) presents with clinical features of full or partial P... more Complex posttraumatic stress disorder (PTSD) presents with clinical features of full or partial PTSD (re-experiencing a traumatic event, avoiding reminders of the event, and a state of hyperarousal) together with symptoms from three additional clusters (problems in emotional regulation, negative self-concept, and problems in interpersonal relations). Complex PTSD is proposed as a new diagnostic entity in ICD-11 and typically occurs after prolonged and complex trauma. Here we shortly review current knowledge regarding the biological correlates of complex PTSD and compare it to the relevant findings in PTSD. Recent studies provide support to the validity of complex PTSD as a separate diagnostic entity; however, data regarding the biological basis of the disorder are still very limited at this time. Further studies focused on complex PTSD biological correlates and replication of the initial findings are needed, including neuroimaging, neurobiochemical, genetic, and epigenetic investiga...
Psychologica Belgica, 2010
Sleep and vigilance, Mar 18, 2022
Sleep and vigilance, Mar 18, 2022
The current Russian war against Ukraine is of global concern. It builds on the annexation of Crim... more The current Russian war against Ukraine is of global concern. It builds on the annexation of Crimea in 2014 and subsequently the war in the Donbas region of Ukraine, and has become a large-scale Russian invasion of Ukraine from three directions, Crimea in the south, Russia in the east, and Belarus in the north. Despite the geopolitical background that, in the eyes of Russia, justifies its annexation of regions in and around Ukraine, we cannot turn a blind eye towards the untold miseries of the citizens of the invaded country. Although it is unclear as to how the situation will unfold, what is clear is that lives are being lost, many civilians are being injured, traumatized, and valuable assets destroyed. Taking into consideration that the population of the countries involved in this conflict totals nearly 200 million citizens, many lives on both sides will be sacrificed, millions of people displaced, Europe will be overrun with new refugees, and global world economics will be disrupted by the war itself and by the sanctions imposed on Russia. The current global governance mechanisms are likely to be forever changed, with other players with malevolent intentions becoming emboldened to embark on expansionist ventures.
Journal of Traumatic Stress, 2023
Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) ... more Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) of psychotherapy exists for this population, with very few on older adults in general. This RCT aimed to compare the efficacy of Life Review Therapy for Holocaust survivors (LRT‐HS) relative to a supportive control group. Holocaust survivors with a probable diagnosis of full or subsyndromal posttraumatic stress disorder (PTSD) or depressive disorder were included. Exclusion criteria were probable dementia, acute psychotic disorder, and acute suicidality. The predefined primary endpoint was the course of PTSD symptom scores. In total, 49 of 79 consecutive individuals assessed for eligibility were randomized and included in the intent‐to‐treat analyses (LRT‐HS: n = 24, control: n = 25; Mage = 81.5 years, SD = 4.81, 77.6% female). Linear mixed models revealed no statistically significant superiority of LRT‐HS for PTSD symptoms at posttreatment, with moderate effect sizes, Time x Condition i...
Journal of Traumatic Stress
Historical trauma is a relatively new concept in the literature, and investigations are needed to... more Historical trauma is a relatively new concept in the literature, and investigations are needed to clarify its clinical aspects and develop instruments to measure its sequelae. The purpose of this study was to develop the Clinical Aspects of Historical Trauma Questionnaire (CAHTQ), which is meant to capture trauma sequelae in different contexts, and provide initial psychometric information. Participants were survivors of the genocide against the Tutsi in Rwanda (N = 261) aged 32–87 years (M = 46.30 years, SD = 11.95) who completed a preliminary version of the CAHTQ, constructed based on theoretical and content‐related consideration, as well as the International Trauma Questionnaire, Fatalism Scale, Public Health Depression Questionnaire, Brief Coping Inventory, Forgiveness Questionnaire, and Sentiment of Reconciliation Questionnaire to test the discriminant and convergent validity of the CAHTQ. Exploratory factor analysis was conducted to reduce the number of items and extract factor...
Journal of Traumatic Stress, 2023
Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) ... more Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) of psychotherapy exists for this population, with very few on older adults in general. This RCT aimed to compare the efficacy of Life Review Therapy for Holocaust survivors (LRT-HS) relative to a supportive control group. Holocaust survivors with a probable diagnosis of full or subsyndromal posttraumatic stress disorder (PTSD) or depressive disorder were included. Exclusion criteria were probable dementia, acute psychotic disorder, and acute suicidality. The predefined primary endpoint was the course of PTSD symptom scores. In total, 49 of 79 consecutive individuals assessed for eligibility were randomized and included in the intent-to-treat analyses (LRT-HS: n = 24, control: n = 25;Mage = 81.5 years, SD = 4.81, 77.6% female). Linear mixedmodels revealed no statistically significant superiority of LRT-HS for PTSD symptoms at posttreatment, with moderate effect sizes, Time x Condition interaction: t(75) = 1.46, p = .148, dwithin = 0.70, dbetween = 0.41, but analyses were significant at follow-up, with large effect sizes, t(79) = 2.89, p = .005, dwithin = 1.20, dbetween = 1.00. LRT-HS superiority for depression was observed at posttreatment, t(73) = 2.58, p = .012, but not follow-up, t(76) = 1.08, p = .282, with moderate effect sizes, d(within) = 0.46–0.60, d(between) = 0.53–0.70. The findings show that even in older age, PTSD and depression following exposure to multiple traumatic childhood events can be treated efficaciously using an age-appropriate treatment that includes structured life review and narrative exposure.
BMC Psychiatry, 2020
Background The Holocaust was one of the most traumatic catastrophes in recorded human history. Su... more Background The Holocaust was one of the most traumatic catastrophes in recorded human history. Survivors seeking psychotherapeutic help today, now in their seventies and older, often show symptoms of a posttraumatic stress disorder (PTSD), depression, or prolonged grief disorder. Established psychological treatments for PTSD (e.g. cognitive behaviour therapy, psychodynamic therapies) have been tested and assessed mainly with young and middle-aged adults; only very few studies examined them in old age. There is no therapy outcome study known to us for any treatment mode for Holocaust survivors. Moreover, there is a need for an age group-specific treatment of PTSD and other stress-related mental disorders. A narrative approach including life-review and narrative exposure seems to meet very well the natural need of older people to review their lives and is highly effective. However, most studies on the efficacy of life review therapy (LRT) focus on late-life depression. There is a lack...
Frontiers in Psychiatry, 2023
Traumatic stress studies have recently addressed the issue of 'historical trauma' that well expla... more Traumatic stress studies have recently addressed the issue of 'historical trauma' that well explain the impact of collective or totalitarian trauma. The example of former communist Eastern Europe shows that there are many individual and sociopsychological consequences that still have effects today. This paper summarizes concepts and findings on 'historical traumas' that describe such long-lasting effects. The focus is on the side of the victims and their family descendants and thus also on the moral heirs of the dissidents, e.g., the Russian NGO Memorial. Analogous to developments in psychotraumatology, increasing knowledge in this area can explain psychosocial pathologies but also help develop effective remedies. This includes the development of a culture of remembrance, sociotherapeutic interventions and increased sensitivity towards those patients and clients who have such a personal legacy.
Figures of Pathos, 2023
In der Festschrift "Figures of Pathos" für Elisabeth Bronfen soll dem kleinen und ambivalenten Af... more In der Festschrift "Figures of Pathos" für Elisabeth Bronfen soll dem kleinen und ambivalenten Affekt der Rührung Raum zukommen (...). Auf welchem Feld kann man die Kulturwissenschaften und die Psychologie miteinander verbinden? Mein Vorschlag: auf dem der Affekte und Affekttheorien, zu denen solche „Großaffekte“ wie das Pathos gehören und auch kleinere Affekte wie jener der Rührung.
Rührung ist in der Psychologie und der Affekttheorie bedauerlicher- weise ein weitgehend unbearbeitetes Phänomen. Sie hat etwas mit Empa- thie und Mitgefühl zu tun, aber damit ist sie lange nicht erschöpfend er- klärt. Sie ist ein Medienphänomen und nicht zuletzt deshalb braucht sie auch eine kritische Rekonstruktion. Letzteres kann in diesem Beitrag nur ansatzweise geschehen.
As part of the trauma and stress-related disorders' category, adjustment disorder is a freque... more As part of the trauma and stress-related disorders' category, adjustment disorder is a frequently occurring mental disorder that develops after stressful life events. Preoccupation and failure to adapt are the core symptoms of adjustment disorder in ICD-11. As this is a new definition, we conducted a large-scale study to gain a deeper understanding of the validity and applicability of the revised diagnostic criteria. N=334 individuals who experienced involuntary job loss were interviewed three times one to nine months after the last day at work (immediately, six- and twelve-months follow-up). For measuring adjustment disorder symptoms, a newly developed structured diagnostic interview and a self-report questionnaire evidenced satisfying psychometric properties. Approximately six months after discharge, the prevalence of a tentative diagnosis of adjustment disorder was 27.3% and decreased to 10.5% over the course of 12 months. We identified several event- /person-related, intra- ...
Clinical Psychological Science, 2018
Adjustment disorders (AjDs) usually resolve after the precipitating life event and its consequenc... more Adjustment disorders (AjDs) usually resolve after the precipitating life event and its consequences are terminated. However, they bear the risk for the development of severe mental illness. The present study investigates the natural course of AjD as defined for International Classification of Diseases, 11th version (ICD-11). A total of 303 individuals who involuntarily lost their jobs were assessed initially after the job loss and 6 months later. Latent class latent change analysis and multinomial logistic regression were performed. Two groups showed low ( n = 149, 49.2%) and medium ( n = 108, 35.6%) symptom severity at initial assessment that declined over time. The third group ( n = 46, 15.2%) showed a high initial response and a small effect of worsening of symptoms. Female gender, higher age, first dismissal, impaired social functioning, dysfunctional disclosure, less social support, and less social acknowledgment were associated with belonging to the latter group. It might be b...
The World Journal of Biological Psychiatry, 2018
Acta Psychiatrica Scandinavica, 2018
BMC research notes, Jan 19, 2017
Complex posttraumatic stress disorder (CPTSD) is a newly proposed diagnosis in the International ... more Complex posttraumatic stress disorder (CPTSD) is a newly proposed diagnosis in the International Classification of Diseases-version 11, which is currently intensively investigated. Childhood trauma is regarded as main source of CPTSD symptoms, even in later life. Induction of DNA methylation changes by childhood trauma may contribute to its long-lasting adverse health consequences. The current study analyzed the correlation of genome-wide DNA methylation profiles with complex posttraumatic sequelae in buccal epithelial cells from 31 elderly former indentured child laborers (Verdingkinder) using the Infinium Illumina 450k Human DNA methylation chip. DNA methylation modifications indicated experiment-wide significant associations with the following complex posttraumatic symptom domains: dissociation, tension reduction behavior and dysfunctional sexual behavior. Differentially methylated CpG sites were mapped to the genes huntington associated protein 1 (HAP1), RAN binding protein 2 (R...
Journal of anxiety disorders, 2018
A new diagnostic concept of Adjustment Disorder (AjD) was proposed for inclusion in the Internati... more A new diagnostic concept of Adjustment Disorder (AjD) was proposed for inclusion in the International Classification of Diseases, 11th version (ICD-11). However, the symptom structure of AjD is poorly understood. The aim of the present study was to investigate the dimensionality of AjD as a stress-response syndrome. A general population sample of the Israeli population (N = 1003) completed the Adjustment Disorder - New Module 20 and the WHO-5 Wellbeing Scale. We compared seven alternative models of AjD using confirmatory factor analysis (CFA). A latent profile analysis (LPA) was performed to determine if subtypes of AjD were present. The performance of the unidimensional and multidimensional models of AjD were evaluated using regression analyses. CFA results supported a unidimensional model of AjD. The LPA identified three quantitatively distinct classes (low, medium, and high) with no evidence of any subtypes of AjD. The criterion validity of AjD was superior when treated as unidim...
International Journal of Clinical and Health Psychology, 2016
European journal of psychotraumatology, 2015
Complex posttraumatic stress disorder (PTSD) presents with clinical features of full or partial P... more Complex posttraumatic stress disorder (PTSD) presents with clinical features of full or partial PTSD (re-experiencing a traumatic event, avoiding reminders of the event, and a state of hyperarousal) together with symptoms from three additional clusters (problems in emotional regulation, negative self-concept, and problems in interpersonal relations). Complex PTSD is proposed as a new diagnostic entity in ICD-11 and typically occurs after prolonged and complex trauma. Here we shortly review current knowledge regarding the biological correlates of complex PTSD and compare it to the relevant findings in PTSD. Recent studies provide support to the validity of complex PTSD as a separate diagnostic entity; however, data regarding the biological basis of the disorder are still very limited at this time. Further studies focused on complex PTSD biological correlates and replication of the initial findings are needed, including neuroimaging, neurobiochemical, genetic, and epigenetic investiga...
Psychologica Belgica, 2010
Sleep and vigilance, Mar 18, 2022
Sleep and vigilance, Mar 18, 2022
The current Russian war against Ukraine is of global concern. It builds on the annexation of Crim... more The current Russian war against Ukraine is of global concern. It builds on the annexation of Crimea in 2014 and subsequently the war in the Donbas region of Ukraine, and has become a large-scale Russian invasion of Ukraine from three directions, Crimea in the south, Russia in the east, and Belarus in the north. Despite the geopolitical background that, in the eyes of Russia, justifies its annexation of regions in and around Ukraine, we cannot turn a blind eye towards the untold miseries of the citizens of the invaded country. Although it is unclear as to how the situation will unfold, what is clear is that lives are being lost, many civilians are being injured, traumatized, and valuable assets destroyed. Taking into consideration that the population of the countries involved in this conflict totals nearly 200 million citizens, many lives on both sides will be sacrificed, millions of people displaced, Europe will be overrun with new refugees, and global world economics will be disrupted by the war itself and by the sanctions imposed on Russia. The current global governance mechanisms are likely to be forever changed, with other players with malevolent intentions becoming emboldened to embark on expansionist ventures.
Cultural clinical psychology and PTSD, 2019
This chapter considers cultural dimensions to be a theory-guided framework within which to approa... more This chapter considers cultural dimensions to be a theory-guided framework within which to approach the wealth of psychological differences across diverse cultural groups. First, a few reflective statements will provide some background to the topic. This is followed by an overview of the current state of research on these dimensions in general, as well as in the area of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD). The goal of this chapter is to encourage research which takes more of the so-called contextual factors into account when describing or analyzing posttrauma or postbereavement individuals, groups, or communities.