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Falala A, Lannes A, Bui E, Revet A. Prevalence of prolonged grief disorder in bereaved children and adolescents: A systematic review. L'ENCEPHALE 2024; 50:557-565. [PMID: 38413249 DOI: 10.1016/j.encep.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 02/29/2024]
Abstract
PURPOSE Prolonged Grief Disorder (PGD) is a condition recently introduced in international classifications of mental disorders. Although PGD is associated with significant distress and impairment that may have developmental consequences, to date, little is known about its prevalence and associated factors in children and adolescents. The present systematic review registered in PROSPERO (CRD42021236026) aimed to: (i) review existing data on the prevalence of PGD in bereaved children and adolescents; and (ii) identify factors associated with PGD in this population. METHODS Six electronic databases, grey literature and a manually searched journal identified 1,716 articles with no backward limit to September 2021. Epidemiological studies were included if they reported the prevalence of PGD in bereaved children and adolescents. Study characteristics, diagnostic and assessment tools, population, loss-related characteristics and prevalence of PGD were reviewed. RESULTS Five studies met our inclusion criteria. The reported prevalences of PGD ranged from 10.4% to 32%. Female gender, cognitive avoidance, chronic stressors such as economic hardship, exposure to trauma or other losses appear to be associated with more severe symptoms or even a higher risk of PGD. Conversely, data suggest social support may be protective. CONCLUSION This first systematic review found a relatively high prevalence of PGD in bereaved children and adolescents. While further large epidemiological studies are needed, this review highlights the importance of evaluating PGD in current clinical practice and suggests that further research into diagnostic and therapeutic approaches targeting this disorder is warranted.
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Affiliation(s)
- Aude Falala
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpital Purpan, CHU de Toulouse, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
| | - Alice Lannes
- Unité d'hospitalisation pour adolescents, pôle de pédopsychiatrie, hôpitaux de Lannemezan, Lannemezan, France; Inserm, UPS, CERPOP, université de Toulouse, Toulouse, France
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Department of Psychiatry, University of Caen-Normandy & Caen University Hospital, Caen, France
| | - Alexis Revet
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpital Purpan, CHU de Toulouse, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France; Inserm, UPS, CERPOP, université de Toulouse, Toulouse, France
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2
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Linder L, Lunardini M, Zimmerman H. Supporting Childhood Bereavement Through School-Based Grief Group. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:741-758. [PMID: 35357962 DOI: 10.1177/00302228221082756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With 7.3% of children under the age of 18 experiencing the death of a parent and more who experience a loss of a loved one bereavement is a common experience in the lives of children and youth. The current study sought to evaluate the effectiveness of an 8-week, school-based grief group treatment program in reducing symptoms of grief, dysregulation, and improving social support. A total of 296 children and youth (age 11-18) participated in the grief programming provided by a local hospice agency. With a retention rate of 76% the researchers identified a significant reduction in grief symptomology, frequency of emotion dysregulation, and a significant increase in perceived social support from pre- to post-8-week school-based grief programming. A reduction in intensity of dysregulation was not significant. Implications for school personnel and parental support of children and youth experiencing loss are discussed.
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Affiliation(s)
- Lisa Linder
- San Diego State University, San Diego, CA, USA
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3
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Gunawan PK, Agustiani H, Qodariah L. Adaptation of PG-13 on Indonesian Adolescents. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:729-740. [PMID: 35350905 DOI: 10.1177/00302228221085187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Prolonged Grief (PG-13) Children Form was adapted, then went through basic validation to be applicable on Indonesian adolescents. The form was adapted based on the guidelines by Beaton et al. (2000). Pre-testing was done on 40 adolescents by online interviewing. PG-13 Indonesian Version and the Depression, Anxiety and Stress Scales (DASS) were then reconstructed into an online questionnaire for basic validation purposes. It was completed by 131 adolescents. Results prove a high internal consistency reliability and acceptable construct validity of the PG-13.
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Affiliation(s)
- Prudentia K Gunawan
- Department of Clinical Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Hendriati Agustiani
- Department of Clinical Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Laila Qodariah
- Department of Clinical Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
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4
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Hoppe R, Winter MA, Williams CD, Sandler I. When a parent dies: A scoping review of protective and risk processes for childhood bereavement. DEATH STUDIES 2024:1-11. [PMID: 38619445 DOI: 10.1080/07481187.2024.2340729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
The death of a parent can have profound effects on child development. Yet, little is known about the individual and environmental processes that contribute to heterogeneity in child bereavement outcomes. A scoping review was conducted in samples of parentally bereaved children to identify key processes, synthesize results, and determine research gaps. This scoping review identified 23 studies (mainly from the United States), published between 1990 and 2023, that reported child (ages 3-22 years) individual and/or environmental protective and/or risk processes that contributed to bereavement outcomes. Individual processes (i.e., how children manage stressors and think about themselves/their environment) included child coping and perception of themselves and/or their environment. Environmental processes (i.e., contextual resources) included family, mentorship, and stress exposure. Findings can be used to apprise clinicians, families, and policymakers of the unique nature of childhood bereavement and to identify malleable processes to target in interventions designed to prevent problematic outcomes in bereaved children.
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Affiliation(s)
- Rebecca Hoppe
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcia A Winter
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Chelsea D Williams
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Irwin Sandler
- Department of Psychology, Arizona State University, Arizona, Phoenix, USA
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5
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O’Hara KL, Wolchik SA, Rhodes CA, Uhlman RN, Sandler IN, Tein JY. Preventing Adverse Outcomes for Bereaved Youth: Indirect Effects From a Randomized Trial of the Family Bereavement Program on Fear of Abandonment, Grief, and Mental Health. J Pediatr Psychol 2024; 49:247-258. [PMID: 37654097 PMCID: PMC11019585 DOI: 10.1093/jpepsy/jsad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/23/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES We investigated whether the self-system belief of fear of abandonment mediated the effects of intervention-induced change in 2 protective factors-positive parenting and adaptive coping-and one risk factor-stressful events-on youth mental health problems and maladaptive grief. This study extends prior research on fear of abandonment in youth who experience parental death by examining pathways through which a program reduced fear of abandonment and, in turn, affected subsequent pathways to child mental health problems in the context of a randomized experiment. METHODS This is a secondary data analysis study. We used data from the 4-wave longitudinal 2-arm parallel randomized controlled trial of the Family Bereavement Program conducted between 1996 and 1999 in a large city in the Southwestern United States. The sample consisted of 244 offspring between 8 and 16 at the pretest. They were assessed again at posttest, 11-month follow-up, and 6-year follow-up. Offspring, caregivers, and teachers provided data. RESULTS Mediation analyses indicated that intervention-induced reductions in stressful events were prospectively associated with a lower fear of abandonment. For girls, fear of abandonment was related to self-reported maladaptive grief and teacher-reported internalizing problems 6 years later. CONCLUSIONS This study extends prior research on the relation between intervention-induced changes in risk and protective factors and improvements in outcomes of bereaved youth. The findings support the reduction of stressful events as a key proximal target of prevention programs for bereaved children.
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Giang C, Alvis L, Oosterhoff B, Kaplow JB. Protective Factors in the Context of Childhood Bereavement: Youth Gratitude, Future Orientation, and Purpose in Life. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241246919. [PMID: 38621174 DOI: 10.1177/00302228241246919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
The objective of the study was to examine potential associations between positive youth development constructs (gratitude, future orientation, purpose in life) and psychological functioning (posttraumatic stress symptoms, depressive symptoms, maladaptive grief reactions) among bereaved youth and test whether these associations vary by age. A diverse sample of 197 clinic-referred bereaved youth (56.2% female; M = 12.36, SD = 3.18; 36.1% Hispanic, 23.7% White, 20.1% Black, 11.9% Multiracial, and 8.2% another race/ethnicity) completed self-report measures of psychological functioning and positive youth development constructs. Linear regression models indicated that gratitude and purpose were associated with lower posttraumatic stress and depressive symptoms among bereaved youth. Future orientation was associated with higher posttraumatic stress symptoms. Results were consistent across age. If replicated longitudinally, gratitude and purpose may be important protective factors against negative mental health outcomes in the aftermath of losing a loved one.
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Affiliation(s)
- Christopher Giang
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Lauren Alvis
- The Trauma and Grief Center, Meadows Mental Health Policy Institute, Houston, TX, USA
| | - Benjamin Oosterhoff
- The Trauma and Grief Center, Meadows Mental Health Policy Institute, Houston, TX, USA
| | - Julie B Kaplow
- The Trauma and Grief Center, Meadows Mental Health Policy Institute, Houston, TX, USA
- Department of Psychiatry, Tulane University School of Medicine, New Orleans, LA, USA
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7
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Hanauer C, Telaar B, Rosner R, Doering BK. The efficacy of psychosocial interventions for grief symptoms in bereaved children and adolescents: A systematic review and meta-analysis. J Affect Disord 2024; 350:164-173. [PMID: 38218256 DOI: 10.1016/j.jad.2024.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The present meta-analysis investigates the efficacy of psychosocial interventions in bereaved children and adolescents. METHOD We conducted a systematic review searching PsycINFO, PsycARTICLES, PubMed, MEDLINE, PSYNDEX, Web of Science, CINAHL and ERIC. Random-effects meta-analyses examined the effect of interventions on symptoms of grief, posttraumatic stress disorder (PTSD) and depression in controlled and uncontrolled studies. RESULTS We included 39 studies (n = 5.578). Post-treatment, preventive interventions demonstrated a significant effect on grief (uncontrolled studies: g = 0.29, 95%CI [0.09;0.48]; controlled studies: g = 0.18, 95%CI [0.03;0.32]). For symptoms of PTSD and depression, only uncontrolled preventive studies yielded significant effects (PTSD: g = 0.24, 95%CI [0.11;0.36]; depression: g = 0.28, 95%CI [0.10;0.45]). Interventions targeting youth with increased grief-related distress demonstrated a significant effect in uncontrolled studies on grief (g = 1.25, 95%CI [0.94;1.57]), PTSD (g = 1.33, 95%CI [0.85;1.82]) and depression (g = 0.61, 95%CI [0.45;0.77]). A controlled effect size could only be calculated for PTSD symptoms (g = 0.71, 95%CI [0.15;1.27]). LIMITATIONS Interventions varied widely, contributing to high heterogeneity. Only a small number of studies with mostly limited quality could be analysed. CONCLUSIONS Psychosocial interventions may ameliorate grief symptoms in bereaved youth, especially when targeting youth with elevated grief distress. However, the effects observed in uncontrolled studies are substantially reduced when controlling for the natural course of bereavement. Given the increasing number of children worldwide bereaved through ongoing crises, research on interventions is surprisingly sparse.
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Affiliation(s)
- Christina Hanauer
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Germany
| | - Berit Telaar
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Germany
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Blackburn J, Waring G, Turner M, Currell K, Caress AL. Exploring the Impact of Bereavement During the COVID-19 Pandemic on Children and Young People: A Scoping Review. Compr Child Adolesc Nurs 2024; 47:55-67. [PMID: 38127065 DOI: 10.1080/24694193.2023.2292503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Experiencing bereavement as a child or young person (CYP) can have long-lasting effects. The societal and environmental burdens of the SARS-CoV-2 pandemic exacerbated the experience of loss and grief for many CYP, who were unable to access their usual the support networks. However, it is still unclear what is currently known and not known about the experiences of CYP bereaved during the SARS-CoV-2 pandemic. This review used the framework of Arksey and O'Malley and included five stages: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results. The methodological quality of the included studies was also assessed using the Critical Appraisal Skills Programme tool. The PRISMA framework was used for reporting the results. The electronic databases Medline, PsychINFO, CINAHL, and PubMed were searched for relevant articles. A total of three papers meeting the inclusion criteria were included in this review and two main themes identified: (1) support (which included sub-themes; social isolation and the impact on support; support from family and friends; wider support networks); (2) Emotional impact of bereavement during a pandemic. Access to support networks is crucial for CYP to understand and process their emotions relating to their bereavement experience. The pandemic meant that many usual support networks such as family and friends were inaccessible to CYP, who struggled to deal with their experience of grief during this time. Schools are a valuable support mechanism and can help CYP understand their emotions through open discussions about their bereavement. The limited empirical evidence currently available in this area of research demonstrates an important need to further understanding of the long-term impacts of dealing with pandemic-related loss in childhood.
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Affiliation(s)
- Joanna Blackburn
- Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Gill Waring
- Department of Nursing, School of Human and Health Sciences, Huddersfield, Huddersfield, UK
| | - Mary Turner
- Department of Nursing, School of Human and Health Sciences, Huddersfield, Huddersfield, UK
| | - Karen Currell
- Department of Nursing, School of Human and Health Sciences, Huddersfield, Huddersfield, UK
| | - Ann-Louise Caress
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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9
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Hoppe R, Alvis L, Oosterhoff B, Kaplow J. Caregiver behaviors associated with positive youth development among bereaved children. DEATH STUDIES 2024:1-11. [PMID: 38288688 DOI: 10.1080/07481187.2024.2309475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Grounded in Multidimensional Grief Theory, this study examined the cross-sectional associations between child-reported caregiver grief facilitation behaviors (ongoing connection, grief expression, existential continuity and support, grief inhibition/avoidance) and positive youth development outcomes (future orientation, gratitude, social responsibility) in treatment-seeking bereaved children ages 7 to 18 (N = 170; 54.1% girls; 35.9% Hispanic/Latinx, 24.9% White, 17.8% Black) from the United States. Results indicate that higher levels of perceived caregiver existential continuity and support (behaviors theorized to promote the continuity of child routines and reassurance of a positive future after experiencing a death) were associated with greater future orientation and social responsibility values among participants. Findings suggest that in the wake of a death, structured and supportive caregiver responses may be related to children's positive outlook on their future and commitment to others.
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Affiliation(s)
- Rebecca Hoppe
- Trauma and Grief (TAG) Center at the Meadows Mental Health Policy Institute (MMHPI), Dallas, Texas, USA
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lauren Alvis
- Trauma and Grief (TAG) Center at the Meadows Mental Health Policy Institute (MMHPI), Dallas, Texas, USA
| | - Benjamin Oosterhoff
- Trauma and Grief (TAG) Center at the Meadows Mental Health Policy Institute (MMHPI), Dallas, Texas, USA
| | - Julie Kaplow
- Trauma and Grief (TAG) Center at the Meadows Mental Health Policy Institute (MMHPI), Dallas, Texas, USA
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Ennis N, Pastrana FA, Moreland AD, Davies F, delMas S, Rheingold A. Assessment Tools for Children who Experience Traumatic Loss: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:3205-3219. [PMID: 36314510 DOI: 10.1177/15248380221127256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Children who experience the traumatic (i.e., violent and/or unexpected) death of a loved one are at risk for a range of adverse developmental and mental health problems, including pathological processes of grief. Over the last decades, conceptualizations of maladaptive grief have varied, resulting in a range of assessment tools and no "gold standard" measure to assess symptoms of prolonged grief in children. The current paper is a systematic review of studies that measured grief in children who experienced traumatic loss in order to determine the measures currently used in the literature with children who experience traumatic loss. Searches were conducted according to the preferred reporting items for systematic reviews and meta-analyses in PUBMED, PsycINFO, and OVID and through hand searches of relevant reference lists. Two authors reviewed each study yielded by searches and conducted data extraction on included studies. Studies were included if they were peer-reviewed, included a measure of grief, and consisted of samples of children (age 18 and younger) whereby at least a portion experienced traumatic loss. Thirty-nine studies met inclusion criteria, from which 17 measures were identified. The most commonly used measure was the Inventory of Complicated Grief (n = 10 studies) followed by the Extended Grief Inventory (n = 6). Most studies used different measures and variations of the same measures to assess similar constructs. All but one measure relied on child self-report. More standardization of measurement across studies is needed, along with parent and/or teacher reported measures.
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11
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Alvis L, Zhang N, Sandler IN, Kaplow JB. Developmental Manifestations of Grief in Children and Adolescents: Caregivers as Key Grief Facilitators. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:447-457. [PMID: 35106114 PMCID: PMC8794619 DOI: 10.1007/s40653-021-00435-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 05/26/2023]
Abstract
The death of a loved one represents one of the most distressing and potentially traumatic life events in childhood and adolescence. Grief reactions in youth are influenced by ongoing developmental processes and manifest differently depending on the child's age and developmental stage. These grief-related processes unfold within youths' caregiving context, as children and adolescents rely heavily on the adults in their environment to navigate and cope with the death of a loved one. Despite the field's increasing recognition of the potential for maladaptive grief reactions to impede functioning over time, few longitudinal research studies on childhood grief currently exist. In this article, we will (a) provide a brief overview of the childhood bereavement literature; (b) review the new DSM-5 and ICD-11 Prolonged Grief Disorder diagnostic criteria through a developmentally-informed lens; (c) describe how grief reactions manifest in children and adolescents of different ages through the lenses of multidimensional grief theory and relational developmental systems theory; (d) highlight key moderating factors that may influence grief in youth, and (e) discuss a primary moderating factor, the caregiving environment, and the potential mechanisms through which caregivers influence children's grief.
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Affiliation(s)
- Lauren Alvis
- The Hackett Center for Mental Health, Meadows Mental Health Policy Institute, Houston, TX USA
| | - Na Zhang
- Human Development and Family Sciences, University of Connecticut, Storrs, CT 06269 USA
| | - Irwin N. Sandler
- Department of Psychology, Arizona State University, Tempe, AZ 85281 USA
| | - Julie B. Kaplow
- The Hackett Center for Mental Health, Meadows Mental Health Policy Institute, Houston, TX USA
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12
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Zhang T, Krysinska K, Alisic E, Andriessen K. Grief Instruments in Children and Adolescents: A Systematic Review. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231171188. [PMID: 37078181 DOI: 10.1177/00302228231171188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Many children and adolescents experience the death of a close person, such as a family member or a friend. However, there is a scarcity of literature on the assessment of grief in bereaved youth. The use of validated instruments is essential to advance our knowledge of grief in children and adolescents. We conducted a systematic review, adhering to PRISMA guidelines, to identify instruments that measure grief in this population and explore their characteristics. Searches in six databases (Medline, PsycINFO, Embase, Emcare, Scopus, and Web of Science) identified 24 instruments, encompassing three categories: general-purpose grief scales, maladaptive grief scales, and specialized grief scales. We extracted data using a predetermined list of descriptive and psychometric properties. Findings indicate a need to direct research towards more stringent validation of existing instruments and the design of new instruments in line with developments in the understanding of grief in this population.
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Affiliation(s)
- Toni Zhang
- Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Karolina Krysinska
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Eva Alisic
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Karl Andriessen
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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13
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Zhang N, Sandler I, Tein JY, Wolchik S. Reducing suicide risk in parentally bereaved youth through promoting effective parenting: testing a developmental cascade model. Dev Psychopathol 2023; 35:433-446. [PMID: 34872628 PMCID: PMC9170840 DOI: 10.1017/s0954579421001474] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Children who experience parental death are at increased risk for suicide. The Family Bereavement Program (FBP) is an upstream preventive intervention for parentally bereaved families that was found to reduce suicide risk in parentally bereaved youth up to 6 and 15 years later. We tested whether FBP-induced improvements in effective parenting led to changes in multiple proximal factors that prior theory and research implicated in the cascading pathway to suicide risk, namely, aversive self-views, caregiver connectedness, peer connectedness, complicated grief, depressive symptoms, and emotion suppression. The sample was 244 bereaved youth and their surviving caregiver from 156 families. Families were randomized into the FBP (12 group-based sessions for parents, youth, and two joint sessions) or a literature control condition. Multimethod and multiinformant data were collected at baseline, posttest, 6-year and 15-year follow-up assessments. Results showed that program-induced improvements in effective parenting at posttest were associated with reduced aversive self-views and increased caregiver connectedness at the 6-year follow-up, and each mediator was in turn associated with reduced suicide risk at the 6- and 15-year follow-up. The mediated pathways via aversive self-views remained significant while controlling for caregiver connectedness. Self-related concepts may be important targets in upstream suicide prevention for at-risk youth.
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Affiliation(s)
- Na Zhang
- Department of Human Development and Family Sciences, University of Connecticut, Stamford, CT, USA
| | - Irwin Sandler
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Jenn-Yun Tein
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Sharlene Wolchik
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ, USA
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Burns M, Landry L, Mills D, Carlson N, Blueford JM, Talmi A. COVID-19 pandemic's disproportionate impact on childhood bereavement for youth of color: Reflections and recommendations. Front Pediatr 2023; 11:1063449. [PMID: 37063655 PMCID: PMC10098329 DOI: 10.3389/fped.2023.1063449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023] Open
Abstract
The COVID-19 pandemic devastated public welfare worldwide, bringing excess deaths connected to causes such as homicide, substance abuse, and heart disease. In the U.S., these mortality increases disproportionally impacted communities of color and contributed to a rise in bereavement among adults and children. The death of an important person is one of the most frequently reported disruptive childhood experiences. According to 2023 Childhood Bereavement Estimation Model (CBEM) results, one in 14 U.S. children will experience the death of a parent by age 18. The current study analyzes the impact of the pandemic on childhood bereavement due to parent death by comparing CBEM results for 2021 and 2020 to the average of annual results for 2016 through 2019 for combined U.S. Census race and Hispanic origin categories. Analyses demonstrate that more than 700,000 U.S. children were newly bereaved due to a parent's death in 2020 and 2021. 2020 increases were observed for each race and Hispanic origin population, ranging from 14.9% to 72.4% compared to the 2016-2019 annual average. Hispanic Asian Pacific Islander and Hispanic Black youth experienced the largest percentage increases, while non-Hispanic white youth experienced the smallest. The results contribute to the growing evidence documenting longstanding and enduring disparities in critical U.S. health outcomes based on race and Hispanic origin. Recommendations for the scale and focus of efforts to understand and address bereavement in a way that accommodates the rising need for support in diverse populations to help all bereaved children find hope and healing are offered.
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Affiliation(s)
- Michaeleen Burns
- Evaluation and Research, Judi’s House/JAG Institute for Grieving Children and Families, Aurora, CO, United States
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Correspondence: Michaeleen Burns
| | - Laura Landry
- Evaluation and Research, Judi’s House/JAG Institute for Grieving Children and Families, Aurora, CO, United States
| | - David Mills
- Evaluation and Research, Judi’s House/JAG Institute for Grieving Children and Families, Aurora, CO, United States
| | - Nichole Carlson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Jillian M. Blueford
- Department of Counseling Psychology, University of Denver, Denver, CO, United States
| | - Ayelet Talmi
- Departments of Psychiatry and Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
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15
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Douglas RD, Alvis LM, Rooney EE, Busby DR, Kaplow JB. Racial, ethnic, and neighborhood income disparities in childhood posttraumatic stress and grief: Exploring indirect effects through trauma exposure and bereavement. J Trauma Stress 2021; 34:929-942. [PMID: 34643296 DOI: 10.1002/jts.22732] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 11/09/2022]
Abstract
Previous findings suggest that experiences with systems of oppression that disproportionately affect individuals based on race and neighborhood residency (e.g., systemic racism, neighborhood income disadvantage [NID]) can be associated with higher odds of developing psychological problems following traumatic events. Although race/ethnicity and NID residency are often associated, they are separate concepts that play unique roles in mental health outcomes among youth. Residents of Black, Latinx, and income-disadvantaged communities also have an increased risk of exposure to polyvictimization and the loss of multiple loved ones. Studies have not carefully delineated the potential relations between race/ethnicity and NID residency, polyvictimization, accumulated losses, and trauma and grief outcomes in youth. We examined mediation models to investigate whether polyvictimization, the loss of multiple loved ones, and exposure to violent death were potential mechanisms through which race/ethnicity and NID would predict trauma and grief outcomes in youth. Participants (N = 429) included Black (19.9%), Latinx (36.0%), and White (27.3%) children and adolescents who were assessed through a routine baseline assessment at a trauma and grief outpatient clinic. Black youth reported significantly elevated posttraumatic stress and maladaptive grief symptoms through higher polyvictimization and violent death exposure relative to White youth, βs = .06-.12, ps <.001. Latinx identity and NID were positively and directly associated with specific domains of maladaptive grief reactions, βs = .10-.17, ps < .001. If replicated longitudinally, these findings suggest that polyvictimization and violent death exposure may be mechanisms through which Black youth develop more severe traumatic stress and grief reactions.
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Affiliation(s)
- Robyn D Douglas
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Lauren M Alvis
- The Trauma and Grief Center at The Hackett Center for Mental Health, Meadows Mental Health Policy Institute, Houston, Texas
| | - Evan E Rooney
- Department of Psychology, University of Mississippi, Oxford, MS
| | - Danielle R Busby
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Julie B Kaplow
- The Trauma and Grief Center at The Hackett Center for Mental Health, Meadows Mental Health Policy Institute, Houston, Texas
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16
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Dierkhising CB, Sanchez JA, Gutierrez L. "It Changed My Life": Traumatic Loss, Behavioral Health, and Turning Points Among Gang-Involved and Justice-Involved Youth. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:8027-8049. [PMID: 31079521 DOI: 10.1177/0886260519847779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An especially vulnerable population to traumatic loss, violence exposure, and posttraumatic stress symptoms are those involved in the juvenile justice system. However, justice-involved youth are not a homogeneous group. Research looking at subpopulations within juvenile justice systems highlight the diverse backgrounds and treatment needs of justice-involved youth such as those who are also gang-involved. The current study seeks to address the interrelated issues of behavioral health, traumatic grief, loss, and self-reported turning points among a sample of formerly incarcerated youth who report extensive juvenile justice histories (N = 62). All youth participated in an extensive survey interview. Just over half (56.5%) of the youth reported being gang-involved. Chi-square analyses revealed that gang- and justice-involved youth were significantly more likely to have experienced traumatic loss compared with their justice-only peers (χ2 = 4.265, p < .05). Gang involvement approximately doubled youth's exposure to community violence, both direct and witnessed, and there were significant differences in the levels of posttraumatic stress symptoms and substance use, between the gang- and justice-involved youth compared with the justice-only youth. When asked to describe a turning point in their lives, 15% of the sample described significant loss and how it affected their lives, for better or worse. Findings lend support for a focus on supporting posttraumatic growth and increasing access to trauma-focused treatment, with an emphasis on grief and loss, for those who are both gang- and justice-involved.
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17
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Djelantik AAAMJ, Bui E, O'Connor M, Rosner R, Robinaugh DJ, Simon NM, Boelen PA. Traumatic grief research and care in the aftermath of the COVID-19 pandemic. Eur J Psychotraumatol 2021; 12:1957272. [PMID: 34567440 PMCID: PMC8462871 DOI: 10.1080/20008198.2021.1957272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A significant increase in the number of individuals suffering from prolonged grief disorder is expected in the aftermath of the COVID-19 pandemic for two main reasons. First, the number of excess deaths has contributed to an immense number of bereaved individuals. Second, recent literature has shown that circumstances associated with COVID-19 deaths may be contributing to increased risk for the development of prolonged grief disorder. OBJECTIVE To best support those affected by loss during the COVID-19 pandemic, it is important to inform clinicians and researchers about the development, the nature and the treatment of prolonged grief disorder and employ sound research. METHOD In this editorial, we discuss important themes regarding prolonged grief disorder in the aftermath of the COVID-19 pandemic, to gather and present useful information for clinicians and researchers. RESULTS The following themes were addressed: 1. Harmonization in the diagnosis of prolonged grief disorder. 2. Screening tools and interventions. 3. Pharmacotherapy. 4. Special attention for the elderly. 5. Special attention for children and adolescents. 6. A causal system perspective for understanding grief and prolonged grief disorder. CONCLUSIONS If those involved in bereavement research and care manage to collaborate, the tragic consequences of COVID-19 might catalyse improvement of care for those most impaired following the loss of a loved one.
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Affiliation(s)
- A A A Manik J Djelantik
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department Youth - KOOS, Altrecht GGZ, Utrecht, The Netherlands
| | - Eric Bui
- Department Psychiatry, University of Caen Normandy, Caen, France
| | - Maja O'Connor
- Department of Psychology, Unit for Bereavement Research, Aarhus University/The Danish National Center for Grief, Aarhus, Denmark
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Naomi M Simon
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Paul A Boelen
- ARQ National Psychotrauma Centre, Diemen, The Netherlands.,ARQ Centrum'45, Diemen, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherland
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18
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Alvis LM, Dodd CG, Oosterhoff B, Hill RM, Rolon-Arroyo B, Logsdon T, Layne CM, Kaplow JB. Caregiver behaviors and childhood maladaptive grief: Initial validation of the Grief Facilitation Inventory. DEATH STUDIES 2020; 46:1307-1315. [PMID: 33180687 DOI: 10.1080/07481187.2020.1841849] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Grief Facilitation Inventory (GFI) is a newly-developed measure of caregiver behaviors theorized to facilitate or hinder children's adaptive grief reactions. We examine its factor structure, reliability, and validity. An exploratory factor analysis identified four factors: Ongoing Connection, Existential Continuity/Support, Caregiver Grief Expression, and Grief Inhibition/Avoidance. Both child- and caregiver-report versions had adequate-to-good internal consistency. The child-report GFI showed evidence of criterion-referenced validity via significant correlations with measures of child maladaptive grief and other psychological symptoms. Results provide preliminary evidence of the reliability, validity, and clinical utility of the GFI as a measure of caregiver grief-facilitation behaviors.
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Affiliation(s)
- Lauren M Alvis
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Cody G Dodd
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Benjamin Rolon-Arroyo
- Graduate School of Psychology, California Lutheran University, Oxnard, California, USA
| | - Tami Logsdon
- Children's Bereavement Center of South Texas, San Antonio, Texas, USA
| | - Christopher M Layne
- UCLA/Duke University National Center for Child Traumatic Stress, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Julie B Kaplow
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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19
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Hill RM, Dodd C, Oosterhoff B, Layne CM, Pynoos RS, Staine MB, Kaplow JB. Measurement Invariance of the Persistent Complex Bereavement Disorder Checklist With Respect to Youth Gender, Race, Ethnicity, and Age. J Trauma Stress 2020; 33:850-856. [PMID: 32686226 DOI: 10.1002/jts.22560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 11/09/2022]
Abstract
The Persistent Complex Bereavement Disorder (PCBD) Checklist was constructed to facilitate the developmentally sensitive assessment of proposed PCBD criteria in bereaved children and adolescents 8-18 years of age. Initial analyses of the PCBD Checklist provided support for the hypothesized two-factor model. The purpose of the present study was to evaluate the measurement invariance of the PCBD Checklist with respect to gender (boys and girls), race/ethnicity (White, Black, and Hispanic youth), and age (school age, preadolescent, and adolescent youth). Participants were 594 youth (50.4% female) aged 7-18 years (M = 11.91, SD = 2.80) who were evaluated as part of standard care at a community-based grief support center. Youth self-identified as Hispanic (n = 184, 30.8%), non-Hispanic white (n = 179, 30.0%), and African American/Black (n = 136, 22.8%). A series of stepwise, multigroup confirmatory factor analyses provided evidence in support of the PCBD Checklist's measurement invariance for all three groups concerning configural invariance, metric invariance, and scalar invariance. These results suggest that PCBD Checklist Criterion B and C scores are measuring similar latent variables, to a similar degree, across gender, race/ethnicity, and age. Establishing the cross-group equivalence of the PCBD Checklist is an important endorsement of its generalizability and clinical utility in that it can be administered to diverse populations with confidence that it is measuring proposed PCBC diagnostic criteria similarly across subgroups.
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Affiliation(s)
- Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Cody Dodd
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Christopher M Layne
- UCLA/Duke University National Center for Child Traumatic Stress, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Robert S Pynoos
- UCLA/Duke University National Center for Child Traumatic Stress, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | | | - Julie B Kaplow
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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20
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Dodd CG, Hill RM, Alvis LM, Rooney EE, Layne CM, Logsdon T, Sandler IN, Kaplow JB. Initial Validation and Measurement Invariance of the Active Inhibition Scale Among Traumatized and Grieving Youth. J Trauma Stress 2020; 33:843-849. [PMID: 32516471 DOI: 10.1002/jts.22529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/16/2019] [Accepted: 01/07/2020] [Indexed: 01/08/2023]
Abstract
The Active Inhibition Scale (AIS; Ayers, Sandler, & Twohey, 1998) is an 11-item, self-report measure of emotional suppression among children and adolescents. Previous research with the AIS has linked emotional suppression to several clinically significant outcomes, such as posttraumatic stress symptoms (PTSS) and suicide, among trauma-exposed and bereaved youth; however, there are no published evaluations of its psychometric properties. We examined the factor structure and criterion validity of the AIS in two samples. Sample 1 included youth (M = 12.22 years, SD = 2.96, range: 6-18 years; 55.4% female) referred to an outpatient psychology clinic specializing in childhood trauma and grief. Sample 2 included youth (M = 13.18 years, SD = 2.58, range: 8-18 years; 61.8% female) referred to a community grief counseling center. Confirmatory factor analytic results supported a one-factor solution, Cronbach's α = .94. Additionally, AIS scores correlated positively with PTSS, depression, and maladaptive grief, rs = .43-.64. Evidence of factorial invariance was found across gender, race/ethnicity, and age group. Emotional suppression scores were higher among girls compared to boys, Black and Hispanic youth compared to White youth, and older compared to younger age groups. The magnitude of correlations between AIS and symptom measure scores was comparable across groups. These results support the reliability and criterion validity of the AIS with diverse youth populations and underscore the role that emotional suppression may play in explaining group differences in mental health symptoms.
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Affiliation(s)
- Cody G Dodd
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Lauren M Alvis
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Evan E Rooney
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Christopher M Layne
- UCLA-Duke University National Center for Child Traumatic Stress, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Tami Logsdon
- Children's Bereavement Center of South Texas, San Antonio, Texas, USA
| | - Irwin N Sandler
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Julie B Kaplow
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
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21
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Pastrana FA, Moreland AD, Milman EJ, Williams JL, delMas S, Rheingold AA. Interventions for child and adolescent survivors of intrafamilial homicide: A review of the literature. DEATH STUDIES 2020; 46:1206-1218. [PMID: 32807043 DOI: 10.1080/07481187.2020.1805819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The nature of intrafamilial homicide is complex and traumatic. Child survivors are at significant risk for maladjustment, including negative psychological sequela, grief complications, and contextual challenges associated with the homicide. Thus, children may benefit from services addressing specific psychosocial challenges following intrafamilial homicide. In this paper, we review the literature to identify trauma- and grief-informed interventions implemented for youth following violent bereavement. Given limited research on this vulnerable population, we discuss interventions that show promise for child survivors, exploring specific needs, challenges, and potential implications of these interventions for treating children and families experiencing intrafamilial homicide bereavement.
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Affiliation(s)
- Freddie A Pastrana
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Angela D Moreland
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Joah L Williams
- Department of Psychology, University of Missouri, Kansas City, Missouri, USA
| | - Sara delMas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alyssa A Rheingold
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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22
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Unterhitzenberger J, Sachser C, Rosner R. Posttraumatic Stress Disorder and Childhood Traumatic Loss: A Secondary Analysis of Symptom Severity and Treatment Outcome. J Trauma Stress 2020; 33:208-217. [PMID: 32216150 DOI: 10.1002/jts.22499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 11/08/2022]
Abstract
Loss is a commonly experienced traumatic event among children. Although the experience of loss can potentially lead to posttraumatic stress symptoms (PTSS), little is known about PTSS levels after traumatic loss versus other traumatic events. We investigated data from a randomized controlled trial (RCT) on trauma-focused cognitive behavioral therapy (TF-CBT) versus a waitlist condition for children with PTSS. In a secondary analysis, we compared participants who reported traumatic loss as their index event (n = 23) to those who reported the two most frequently reported index events in the RCT: sexual abuse (SA; n = 59) and physical violence (PV; n = 55). The index event was rated according to the participants' most distressing traumatic event reported on the Clinician-Administered PTSD Scale for Children and Adolescents. Participants who experienced traumatic loss reported fewer PTSS and better general functioning than those who reported SA. A subgroup RCT (n = 19) revealed TF-CBT to be highly effective in reducing PTSS in cases of traumatic loss, d = 1.69. The effect sizes for PTSS indicated that all three trauma groups benefited from TF-CBT. In the waitlist group, PTSS symptoms improved for SA and PV, ds = 0.76 and 0.98, respectively, but not for traumatic loss, d = 0.23. These findings suggest that TF-CBT is a feasible and promising treatment for children who experience PTSS after traumatic loss. The results are limited by the post hoc quality of the analyses and lack of a measure of grief in the RCT.
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Affiliation(s)
| | - Cedric Sachser
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
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23
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Lee SA, Jobe MC, Mathis AA, Gibbons JA. Persistent Complex Bereavement Disorder Symptoms Predict Grief Interview Emotions. OMEGA-JOURNAL OF DEATH AND DYING 2020; 84:856-869. [PMID: 32295480 DOI: 10.1177/0030222820919013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined persistent complex bereavement disorder (PCBD) symptoms' ability to predict emotional reactions of 69 bereaved adults who participated in grief interviews. The results supported the predictive validity of PCBD symptoms for both self-report and behavioral observation measures of sadness but with only one behavioral measure of happiness. Furthermore, PCBD symptoms uniquely predicted sadness in all but one measure of that emotion while accounting for symptoms of depression, posttraumatic stress, and separation anxiety. Because interviews are the primary method of psychological evaluation for clinicians, these findings collectively support the validity of the PCBD construct.
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Affiliation(s)
- Sherman A Lee
- Department of Psychology, Christopher Newport University, Newport News, Virginia, United States
| | - Mary C Jobe
- Department of Psychology, Christopher Newport University, Newport News, Virginia, United States
| | - Amanda A Mathis
- Department of Psychology, Christopher Newport University, Newport News, Virginia, United States
| | - Jeffrey A Gibbons
- Department of Psychology, Christopher Newport University, Newport News, Virginia, United States
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24
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Kaplow JB, Rolon-Arroyo B, Layne CM, Rooney E, Oosterhoff B, Hill R, Steinberg AM, Lotterman J, Gallagher KAS, Pynoos RS. Validation of the UCLA PTSD Reaction Index for DSM-5: A Developmentally Informed Assessment Tool for Youth. J Am Acad Child Adolesc Psychiatry 2020; 59:186-194. [PMID: 30953734 DOI: 10.1016/j.jaac.2018.10.019] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/16/2018] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the test construction procedure and evaluate the internal consistency, criterion-referenced validity, and diagnostic accuracy of the Child/Adolescent Self-Report Version of the UCLA PTSD Reaction Index for DSM-5 (RI-5) across 2 independent samples. METHOD Study 1 examined the clarity, developmental appropriateness, acceptability of individual RI-5 items, and internal consistency and criterion-referenced validity of the full test. The study 1 sample included 486 youth recruited from 2 major US cities who completed the RI-5 and a measure of depression. Study 2 evaluated the reliability and diagnostic accuracy of the RI-5 in 41 treatment-seeking youth who completed the RI-5 and a "gold standard" structured diagnostic interview, the Clinician-Administered PTSD Scale for DSM-5-Child/Adolescent Version. RESULTS RI-5 total scale scores showed excellent internal consistency in the 2 samples. Study 1 provided evidence of criterion-referenced validity, in that total scale scores correlated positively with depressive symptoms. Study 2 provided evidence of diagnostic accuracy (including discriminant-groups validity). RI-5 total scores discriminated youth with from youth without PTSD as benchmarked against the structured diagnostic interview. Further, receiver operating characteristic analyses using a total score of 35 provided excellent diagnostic classification accuracy (area under the curve 0.94). CONCLUSION The developmental appropriateness and diagnostic accuracy of the RI-5 support its utility for clinical assessment, case conceptualization, and treatment planning in different child-serving systems, including schools, juvenile justice, child welfare, and mental health.
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Affiliation(s)
| | | | - Christopher M Layne
- University of California, Los Angeles (UCLA); UCLA and the Duke University National Center for Child Traumatic Stress, Durham, NC
| | | | | | - Ryan Hill
- Baylor College of Medicine, Houston, TX
| | - Alan M Steinberg
- University of California, Los Angeles (UCLA); UCLA and the Duke University National Center for Child Traumatic Stress, Durham, NC
| | | | | | - Robert S Pynoos
- University of California, Los Angeles (UCLA); UCLA and the Duke University National Center for Child Traumatic Stress, Durham, NC
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25
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Geronazzo-Alman L, Fan B, Duarte CS, Layne CM, Wicks J, Guffanti G, Musa GJ, Hoven CW. The Distinctiveness of Grief, Depression, and Posttraumatic Stress: Lessons From Children After 9/11. J Am Acad Child Adolesc Psychiatry 2019; 58:971-982. [PMID: 30877043 DOI: 10.1016/j.jaac.2018.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 10/30/2018] [Accepted: 11/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The clinical and nosological significance of grief reactions in youth exposed to a shared trauma (9/11, the September 11, 2001 terrorist attacks on the United States) was tested by examining whether the predictors (ie, non-loss-related trauma versus traumatic bereavement), clinical correlates, factorial structure, and phenomenology of grief reactions are distinct from those of major depressive disorder (MDD) and 9/11-related posttraumatic stress disorder (PTSD). METHOD In a representative sample of New York City schoolchildren (N = 8,236; grades 4-12; n = 1,696 bereaved), assessed 6 months post-9/11, multivariate regressions examined predictors of grief, PTSD, and MDD, as well as the incremental validity of grief in predicting health problems and functional impairment. Factor analysis and latent class analysis determined, respectively, the factorial and the syndromic distinctiveness of grief, PTSD, and MDD. RESULTS Four types of evidence supporting the distinctiveness of grief emerged. (1) Bereavement was associated with grief independently of PTSD and MDD, but not with PTSD and MDD after adjusting for grief; conversely, non-loss related trauma was associated primarily with PTSD. (2) Grief contributed uniquely to functional impairment. (3) Grief reactions loaded on a separate factor. (4) Youth with elevated grief reactions fell into two classes characterized by only moderate and negligible probability of co-occurring PTSD and MDD symptoms, respectively. CONCLUSION A multifaceted approach provided convergent evidence that grief reactions are independent of other common types of postdisaster child and adolescent psychopathology, and capture a unique aspect of bereavement-related distress. These findings suggest that grief reactions in traumatically bereaved youth merit separate clinical attention, informing tailored interventions.
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Affiliation(s)
- Lupo Geronazzo-Alman
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY.
| | - Bin Fan
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Cristiane S Duarte
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Christopher M Layne
- UCLA-Duke University National Center for Child Traumatic Stress, Los Angeles, CA
| | - Judith Wicks
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | | | - George J Musa
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Christina W Hoven
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
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26
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Smith Lee JR, Robinson MA. “That’s My Number One Fear in Life. It’s the Police”: Examining Young Black Men’s Exposures to Trauma and Loss Resulting From Police Violence and Police Killings. JOURNAL OF BLACK PSYCHOLOGY 2019. [DOI: 10.1177/0095798419865152] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Black males are disproportionately the victims of police killings in the United States, yet few studies have examined their personal narratives of trauma and bereavement resulting from police violence. Informed by critical race theory and stress and coping theory, we used a modified grounded theory approach to conduct and analyze in-depth, semistructured life history interviews with 40 young Black men (aged 18-24 years) in Baltimore, Maryland. Study participants were recruited from a GED and job readiness center serving Baltimore youth. Study results offer a nuanced understanding of the patterning and mental health consequences of police violence for young Black men. Participant disclosures of witnessing and experiencing police violence began in childhood and spanned through emerging adulthood, met Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition criteria for trauma exposure, and embodied theoretical conceptualizations of racial trauma. Exposures to police violence fostered distrust of police and informed participants’ appraisals of their vulnerability to police violence across the life course. Six study participants disclosed losing loved ones to police killings. Injustice and hypervigilance accompanied grief. Implications for research, policy, and practice are discussed.
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27
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Boelen PA, Spuij M, Lenferink LIM. Comparison of DSM-5 criteria for persistent complex bereavement disorder and ICD-11 criteria for prolonged grief disorder in help-seeking bereaved children. J Affect Disord 2019; 250:71-78. [PMID: 30836282 DOI: 10.1016/j.jad.2019.02.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/25/2019] [Accepted: 02/16/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Persistent complex bereavement disorder (PCBD) is a disorder of grief that newly entered DSM-5. Prolonged grief disorder (PGD) is a disorder of grief included in ICD-11. No prior studies examined and compared the dimensionality, prevalence, and concurrent validity of both conditions among bereaved children. METHODS With data from 291 help-seeking bereaved 8-18 year old children, we used confirmatory factor analysis to evaluate the fit of different factor models for PCBD and PGD. In addition, we determined diagnostic rates for probable PCBD and PGD and calculated associations of PCBD and PGD caseness with concurrently assessed symptoms of overall disturbed grief, depression, posttraumatic stress, and parent-rated problem behavior. RESULTS For PCBD and PGD, one-factor models-with all symptoms forming a unidimensional factor of disturbed grief-fit the data best. The prevalence of probable DSM-5 PCBD (3.4%) was significantly lower than ICD-11 PGD (12.4%). Both PCBD and PGD were significantly associated with concurrently assessed overall disturbed grief, depression, and posttraumatic stress; associations with parent-rated problems were moderate. LIMITATIONS Findings were based on self-reported ratings of symptoms, obtained from three different scales not specifically designed to assess PCBD and PGD. The use of a help-seeking sample limits the generalization of findings to bereaved children generally. CONCLUSIONS Findings support the validity of DSM-5 PCBD and ICD-11 PGD. Prevalence rates of both constructs differ. This needs further scrutiny.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands; Arq Psychotrauma Expert Group, Diemen, the Netherlands.
| | - Mariken Spuij
- Department of Child and Adolescent Studies, Utrecht University, the Netherlands
| | - Lonneke I M Lenferink
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
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Hill RM, Kaplow JB, Oosterhoff B, Layne CM. Understanding grief reactions, thwarted belongingness, and suicide ideation in bereaved adolescents: Toward a unifying theory. J Clin Psychol 2019; 75:780-793. [DOI: 10.1002/jclp.22731] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/23/2018] [Accepted: 11/04/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Ryan M. Hill
- Section of Psychology, Department of Pediatrics; Baylor College of Medicine and Texas Children's Hospital; Houston Texas
| | - Julie B. Kaplow
- Section of Psychology, Department of Pediatrics; Baylor College of Medicine and Texas Children's Hospital; Houston Texas
| | | | - Christopher M. Layne
- UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences; University of California; Los Angeles California
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