What are the long-term effects of child loss on parental health? Social integration as mediator

Decision-making regarding place of end-of-life care for children with life-limiting and life-threatening conditions: a systematic integrative review

BACKGROUND

Due to medical advancements the number of children living with life-limiting and life-threatening conditions is rising, meaning more children and their families will require palliative and end-of-life care in the future. While 'home' is often the preferred place of end-of-life care, the evidence around best practice for decision-making about place of end-of-life care remains inadequate.

AIM

To synthesise evidence on the factors influencing decision-making regarding place of end-of-life care for children with life-limiting and life-threatening conditions.

DESIGN

A systematic integrative literature review. The review protocol was registered in Prospero: CRD42023406800.

DATA SOURCES

CINAHL, MEDLINE, EMBASE, PsycINFO, and Maternal and Infant Health were searched for studies published between 2013 and 2024. Any empirical, peer-reviewed journal articles published in English that included data pertaining to decision-making about place of end-of-life care for children (≤ 18 years) with life-limiting or life-threatening conditions were considered. Quality appraisal was conducted using the Mixed Methods Appraisal Tool.

RESULTS

Eleven eligible studies were included. Using an iterative process of constant data comparison, four themes were identified, highlighting that (i) consideration of the child, (ii) availability and suitability of end-of-life care services, (iii) parents' capacity and control in providing care, and (iv) family and sibling well-being were factors influencing decision-making about place of end-of-life care.

CONCLUSION

There are a complex range of factors surrounding decision-making regarding place of end-of-life care for children with life-limiting and life-threatening conditions. Studies focused primarily on parents' perspectives. Further research is needed to identify how to best support decisions about place of end-of-life care for families of children with life-limiting and life-threatening conditions.

Coping With Child Loss: Its Impact on the Mental Health of Chinese Parents

Using data from the 2011-2018 China Health and Retirement Longitudinal Study, this research employs a two-way fixed effects model to investigate the impact of child loss on parental mental health. The findings indicate a significant decline in mental well-being among Chinese bereaved parents aged 45 to 65, as evidenced by elevated depression scores. Mechanism analysis reveals reduced emotional support from children and increased alcohol consumption, exacerbating mental health challenges. These effects persist regardless of the gender of the lost child and the gender of the parent, and such an adverse effect is found to exist for parents who lost biological children and those with a rural Hukou in China. Moreover, our study reveals that the pain of losing a child does not alleviate over time. These findings underscore the need for support for bereaved parents and call for societal and governmental attention to their challenges.

Implementation of a hospital-based end-of-life and bereavement care program in a latin American middle-income country. A source of light and compassion in the midst of cloudy times

BACKGROUND

The death of a child is one of the most devastating events a family can face, resulting in significant physical and psychosocial morbidity. Bereavement support programs have been developed in high-income contexts to address this need. However, little is known about implementing bereavement programs in low-and middle-income countries (LMICs). Here, we describe the implementation of a bereavement program for parents whose children died due to cancer or other catastrophic illnesses.

METHODS

We conducted a retrospective analysis to describe the implementation of a hospital-based End of Life (EoL) care and bereavement program. This program was developed in several stages, including an assessment of bereaved families, development program guidelines, staff training, piloting of the program, refinement, and standardization. The program was developed between 2019 and 2021 in a nonprofit, teaching hospital and referral center for southwestern Colombia.

RESULTS

Several tools were developed as key components of the bereavement program: a virtual bereavement course; guidance for EoL and bereavement communication and care, memory making, and follow-up calls; a condolence letter template, and group support workshops. A total of 956 healthcare professionals were trained, 258 follow-up calls to bereaved parents were made, 150 individual psychological follow-ups to parents with complicated grief occurred, 79 condolence letters were sent, and 10 support group workshops were carried out. Challenges were identified and overcome, such as limited resources and staff, and cultural perceptions of death. In 2021, this program received an award by the hospital as the Best Strategy to Humanize Healthcare.

CONCLUSIONS

This study highlights the feasibility of developing and implementing EoL and bereavement care programs for parents and families within hospitals in LMICs. Lack of resources, staff, and training are some of the identified challenges to implementation. Utilizing methodological tools allows us to identify facilitator factors and deliverable outcomes of our EoL and bereavement program. This model provides a valuable framework for resource-limited settings.

Does Interpersonal Vulnerability Mediate the Association Between Parental Bereavement and Mental Health?

The current study examined the role of interpersonal vulnerability, that is, self-perceived threats to one's interpersonal domain, in the mental health of bereaved parents. Israeli bereaved parents in older adulthood (N = 105, aged 48-88, M = 64.06, SD = 9.93) were pair-matched with equivalent 105 non-bereaved parents. Participants completed questionnaires assessing interpersonal vulnerability, satisfaction with life, and depressive symptoms. The results showed higher levels of interpersonal vulnerability among bereaved parents compared to their non-bereaved counterparts. Additionally, parental bereavement and interpersonal vulnerability were associated with worse mental health. Finally, interpersonal vulnerability mediated the association of parental bereavement with worse mental health. This study reveals interpersonal vulnerability as an important vulnerability factor among a significant minority in older adulthood.

Grief and Bereavement Support for Parents in Low- or Middle-Income Countries: A Systematic Review

INTRODUCTION

The death of a child may be the most traumatic event a family can experience. Bereavement care for parents is essential for their physical and mental well-being and is a psychosocial standard of care. Childhood mortality is higher in low- or middle-income countries (LMICs); however, little is known regarding bereavement support or interventions for parents in LMICs.

AIM

To identify programs, services, initiatives, or interventions offered to bereaved parents in LMICs in hospital settings.

METHODS

A systematic search was executed following the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles from LMICs describing interventions, programs, or resources provided to parents after the death of a child (0-18 years old) from any cause were included. Extracted data was categorized by demographics, study design, outcomes, and quality assessment using the McGill Mixed Methods Appraisal Tool (MMAT).

RESULTS

We retrieved 4428 papers and screened their titles and abstracts, 36 articles were selected for full-text assessment, resulting in nine articles included in the final analysis. Most interventions described support for parents whose child died during the prenatal or neonatal period. The primary interventions included psychological counseling, creating mementos (such as photographs or footprints), and bereavement workshops. Only one paper described a fully established bereavement program for parents. Eight of the papers met high-quality criteria.

DISCUSSION

Although bereavement care is crucial for parents whose child has died, only a few studies have documented bereavement interventions in LMICs. More research may help with bereavement program implementation and improved care for bereaved parents in LMICs.

Child loss and depressive symptoms among Chinese older adults: The moderating role of community care service

Child loss is recognized as a risk factor for Chinese older adults' mental health, yet the differential impact and protective factors related to this association are not fully understood. This study examines potential differences in the effects of the deceased child's gender and only-child status, as well as the moderating role of community care service. Data is collected from a sample of 9686 Chinese older adults through the 2018 China Longitudinal Aging Social Survey. The results indicate that the loss of a son has a more significant impact on depressive symptoms among Chinese older adults than the loss of a daughter. The effect of child loss on depressive symptoms is not related to being an only child. Furthermore, community care service can buffer the negative impact of child loss on depressive symptoms. This study holds significant practical implications for enhancing the mental health of bereaved older adults.

Association of social integration with cognitive function trajectories among Chinese older adults: evidence from the China health and retirement longitudinal study (CHARLS)

Background

The prevalence of cognitive impairment among older adults remains high. It has been proven that social integration is related to cognitive function. However, limited research has examined the association of social integration and its different dimensions with cognitive function trajectories of older adults.

Methods

The data were from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2013 (T1) to 2018 (T3). A total of 3,977 older adults were included in the final analysis. Cognitive function was measured with items from an adapted Chinese version of the Mini-Mini-Mental Mental State Examination (MMSE), while the measurement of social integration included three dimensions: economic integration, relational integration and community integration. A group-based trajectory model (GBTM) was used to identify cognitive trajectory groups among participants and an unordered multinomial logistic regression was employed to explore the association of baseline social integration and its three dimensions with cognitive function trajectories.

Result

Three cognitive function trajectory groups were identified: low-decline group (24.1%), medium-decline group (44.2%) and high-stable group (31.7%). Comparing to the medium-decline trajectory group, older adults with higher social integration scores were more likely to be in the high-stable trajectory group (OR = 1.087, 95%CI: 1.007 ~ 1.174), while less likely to be in the low-decline group (OR = 0.806, 95%CI: 0.736 ~ 0.882). Among the different dimensions of social integration, older adults with higher community integration scores were more likely to be in the high-stable trajectory group (OR = 1.222, 95%CI: 1.026 ~ 1.456); Older adults with higher relational integration scores were less likely to be in the low-decline trajectory group (OR = 0.816, 95%CI: 0.734 ~ 0.906). The economic integration was not found to correlate with the cognitive function trajectories. Stratified analyses revealed that the association between community integration and cognitive trajectories was only significant among older adults aged 60 to 69, and the association between relational integration and cognitive trajectories was only significant among older adults who was agricultural household registration.

Conclusion

The developmental trajectories of cognitive function among Chinese older adults are heterogeneous. Social integration is significantly related to the trajectories of cognitive function in Chinese older adults. Measures should be taken to promote social integration of Chinese older adults to reduce the decline of cognitive function.

"We were made to mourn": A meta-ethnographic synthesis of living through the loss of a child to cancer for Latinx families in the United States

Latinx children with cancer in the United States (US) are more than 50% more likely to die of their cancer compared to non-Latinx White children. Despite this disproportionate likelihood, little is known about the grief experiences of Latinx populations in the US related to the loss of a child including the sociocultural context of this loss experience. We used a meta-ethnographic approach to analyze and synthesize qualitative data across 9 studies related to bereavement and grief in US-based Latinx families following the death of a child. Four key concepts emerged that shape the environment of loss, influence the experience of grief, and affect the related resiliency capacities of Latinx families in the US: (1) immigration context, (2) Latinx cultural influences, (3) social support/familismo, and (4) healthcare inequities. These findings can inform future research and the development of culturally responsive interventions.

"They were here, and they still matter": A qualitative study of bereaved parents legacy experiences and perceptions

BACKGROUND

Legacy building interventions are used in pediatric healthcare settings to help families cope with difficult healthcare experiences and typically reserved for intentional use at or near the end of a child's life. However, little is known about how bereaved families perceive the concept of legacy that these practices are meant to address. Emerging research challenges the view of legacy as a standardized, handheld keepsake item but rather as a summation of qualities and experiences that affect those left behind. Therefore, more research is needed.

AIM

To explore the legacy perceptions and experiences of bereaved parents/caregivers in an effort to inform legacy-oriented interventions in pediatric palliative care.

DESIGN

In this qualitative, phenomenological study grounded in social constructionist epistemology, bereaved parent/caregivers completed a semi-structured interview about their legacy perceptions and experiences. The interviews were audio-recorded, transcribed, and analyzed using an inductive, open coding approach grounded in psychological phenomenology.

SETTING/PARTICIPANTS

Participants were parents/caregivers and one adult sibling of children (ages 6 months-18 years) that died between 2000 and 2018 at a children's hospital in the Southeastern United States and spoke English as their primary language.

RESULTS

Sixteen parents/caregivers and one adult sibling were interviewed. Participants' responses converged across three themes: (1) definitions of legacy, including traits and characteristics, impacts on others, and the child's enduring presence; (2) manifestations of legacy, such as tangible items, experiences, traditions, and rituals, and altruism; and (3) factors perceived to affect legacy experiences, including characteristics of the child's death and one's personal grief process.

CONCLUSION

Bereaved parents/caregivers define and experience their child's legacy in ways and manifestations that conflict with current legacy building interventions used in pediatric healthcare settings. Thus, an immediate shift from standardized legacy-oriented care to individualized assessment and intervention is needed to provide high-quality patient- and family-centered pediatric palliative care.

Disparities in unmet health service needs among people with disabilities in China

BACKGROUND

Extensive research has explored disparities in access to health care between people with and without disabilities, but much less is understood about disparities and associated factors within the disabled population.

OBJECTIVE

The aim of this study was to examine differences in the prevalence of unmet health-care needs by residential status (hukou status) and disability type among people with disabilities.

METHODS

Our data were from the National Survey on Basic Public Service Delivery of Persons with Disabilities. The analysis sample included a nationally representative sample of 9 642 112 adults (aged 16+ years) with disabilities. Associated factors were obtained at both individual level and community level. Cross-sectional multivariable logistic regression analyses were conducted to compare unmet medical, care, rehabilitation and accessibility needs among people with different residential statuses and different types of disabilities.

RESULTS

The estimated prevalence of unmet medical, care, rehabilitation and accessibility needs is 15.4%, 10.2%, 45.6% and 13.7%, respectively. Rural hukou was associated with an important 13-40% increase in unmet health-care needs for people with disabilities in China. These rural-urban disparities in unmet health service needs can be partly explained by community-level factors, including access to facilities, social participation and health professionals. Disparities across the type of disability were smaller, but on average, people with multiple disabilities appeared to have the highest rates of unmet care, medical and accessibility needs, whereas those with physical disability had the highest unmet rehabilitation need.

CONCLUSIONS

Differences by residential status and impairment type were evident in all types of unmet health service needs. Targeted policy designs that meet the needs for justice and equality of people with disabilities are advisable. Public health and policy efforts are required to improve access to health service and meet the needs of people with disabilities, especially in rural practices and for particular disability groups.