Individual and psychosocial mechanisms of adaptive functioning in parentally bereaved children

Intergenerational coping: Examining how caregiver and child coping relate to resilience in bereaved children

The death of a loved one can have harmful effects on children's mental health, yet some bereaved children exhibit resilience. Various caregiver and child coping strategies, including active and avoidant coping, may affect the psychosocial functioning of bereaved children. The current study recruited 78 bereaved children aged 8-17 and one of their caregivers to explore: 1) how caregivers' coping strategies affect their child's coping strategies and resilience, and 2) associations between children's coping and their resilience. Results from the active coping mediation model revealed that children's active coping was significantly associated with their resilience, and caregivers' active coping was indirectly associated with children's resilience through children's active coping. The avoidant coping model was not significant. These preliminary findings highlight the importance of promoting active coping strategies among bereaved children and caregivers.

Coping and grief symptoms after parental loss in adolescence - a nationwide follow-up study

Knowledge about effective coping strategies is important to support bereaved adolescents who have lost a parent. We used data on 104 bereaved adolescents (13-17 years) from the FALCON nationwide questionnaire study of parentally bereaved families. We examined associations between adolescents' control-oriented and escape-oriented coping strategies (KidCOPE scale) approximately two months after loss and grief symptoms (PG-13 scale) at six months follow-up. We also examined associations between the perceived efficacy of each coping strategy at baseline and grief symptoms at six months. The use of escape-oriented coping (e.g., distraction, self-criticism and social withdrawal) was associated with higher grief symptoms at six months follow-up (β = 0.4, 95% CI 0.1-0.9, p = 0.02), but no associations were found for control-oriented coping or perceived coping efficacy. Finding alternatives to the use of escape-oriented coping strategies may be an important part of grief interventions for bereaved adolescents.

Protective Factors in the Context of Childhood Bereavement: Youth Gratitude, Future Orientation, and Purpose in Life

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.

Identity-based bullying and mental health among Black and Latino youth: The moderating role of emotional suppression

The current study examined the prevalence of identity-based bullying, the unique links between identity-based bullying and mental health (i.e., depressive and posttraumatic stress symptoms [PTSS]), and emotional suppression as a potential moderator of these links. Participants were 899 clinic-referred Black and Latino youth aged 7-18 years (M = 13.37 years, SD = 2.75, 60.8% female). Regression analyses indicated youth who experienced identity-based bullying victimization reported worse depressive symptoms and PTSS, controlling for co-occurring trauma exposure and demographic characteristics. We did not find evidence that emotional suppression moderated these associations. The findings highlight the potentially traumatic nature of identity-based bullying victimization in treatment-seeking Black and Latino youth and speak to the need for identity-based bullying risk screening.

Ready to Meet God? Faithfulness and the Death of a Loved One

Religiosity often predicts better adjustment after the death of a loved one, but findings vary. One source of variability could be the perceived faithfulness of the deceased. In study 1, more religious college students found the death of a hypothetical faithful person to be less sad than the death of a hypothetical unfaithful person, whereas less religious college students did not. In study 2, MTurk participants and highly religious Christians reported that the death of a faithful loved one was less difficult than the death of an unfaithful loved one, but the difference was greater for the highly religious Christians.

Does Post-Traumatic Growth Follow Parental Death in Adulthood? An Empirical Investigation

This study looked at the loss of a parent in adulthood and whether this was followed by post-traumatic growth? Participants, 100 bereaved adults, from Pakistan and England, lost parents in the last 10 years. They completed three questionnaires. The study hypotheses were, first, that participants whose bereavement occurred more than five years ago would show significantly higher levels of post-traumatic growth. Second, participants with higher levels of post-traumatic growth would experience significantly higher grief scores. Thirdly, participants with higher levels of post-traumatic growth would show significantly higher levels of coping skills. Two hypotheses were rejected, only one received partial support. Yet, levels of post-traumatic growth were high in this sample. Post-traumatic growth does not follow every bereavement. The authors provide autoethnographic material to challenge this. Circumstances surrounding bereavement during the Covid-19 pandemic, are more likely to lead to increases in complicated grief reactions, rather than post-traumatic growth.

Developmental Impact of Early Parental Death: Sustaining Posttraumatic Growth Throughout the Lifespan

Impacting millions of youth across the globe, early parental death is an important topic to investigate. This causal-comparative study (N = 256) examined a group of young adults who experienced a parental death during adolescence and a group of young adults who had not experienced an early parental death. The researchers examined the psychosocial developmental impact of early parental death and developed a predictive model of posttraumatic growth (PTG) for young adults who have experienced early parental death. When compared to non-bereaved peers, young adults who experienced an early parental death had lower psychosocial developmental strength. The findings of the study emphasized social support, spirituality, and psychosocial development as significant predictors of PTG in young adults who experienced an early parental death. The study also provided insight into sustaining PTG throughout the lifespan. Implications for the counseling profession are considered.

Acute and long-term grief reactions and experiences in parentally cancer-bereaved teenagers

Background

Previous research shows that many cancer-bereaved youths report unresolved grief several years after the death of a parent. Grief work hypothesis suggests that, in order to heal, the bereaved needs to process the pain of grief in some way. This study explored acute grief experiences and reactions in the first 6 months post-loss among cancer-bereaved teenagers. We further explored long-term grief resolution and potential predictors of having had “an okay way to grieve” in the first months post-loss.

Methods

We used a population-based nationwide, study-specific survey to investigate acute and long-term grief experiences in 622 (73% response rate) bereaved young adults (age > 18) who, 6–9 years earlier, at ages 13–16 years, had lost a parent to cancer. Associations were assessed using bivariable and multivariable logistic regression.

Results

Fifty-seven per cent of the participants reported that they did not have a way to grieve that felt okay during the first 6 months after the death of their parent. This was associated with increased risk for long-term unresolved grief (odds ratio (OR): 4.32, 95% confidence interval (CI): 2.99–6.28). An association with long-term unresolved grief was also found for those who reported to have been numbing and postponing (42%, OR: 1.73, 95% CI: 1.22–2.47), overwhelmed by grief (24%, OR: 2.02, 95% CI: 1.35–3.04) and discouraged from grieving (15%, OR: 2.68, 95% CI: 1.62–4.56) or to have concealed their grief to protect the other parent (24%, OR: 1.83, 95% CI: 1.23–2.73). Predictors of having had an okay way to grieve included being male, having had good family cohesion, and having talked about what was important with the dying parent.

Conclusion

More than half of the cancer-bereaved teenagers did not find a way to grieve that felt okay during the first 6 months after the death of their parent and the acute grief experiences and reaction were associated with their grief resolution long-term, i.e. 6–9 years post-loss. Facilitating a last conversation with their dying parent, good family cohesion, and providing teenagers with knowledge about common grief experiences may help to prevent long-term unresolved grief.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00758-7

Case Report: Parental Loss and Childhood Grief During COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedent public health crisis, transforming many aspects of our daily life. Protection measures, such as social distancing, nationwide lockdowns, and restrictions on hospital visits and funerals have a serious impact on how people mourn their loved ones. The grieving process during childhood and adolescence evolves along the developmental stages and is a dynamic, non-linear process that needs time. Parental death increases the risk for psychopathology in the short and long term. We present a case of an 11-year-old girl referred to child psychiatry-liaison service by her neurologist due to peer relationship problems and sadness. Fifteen days before her first psychiatric consultation, her father suffered a myocardial infarction complicated with hypoxic ischemic encephalopathy, and he was hospitalized in the intensive care unit. Positive coping mechanisms and adaptive emotional expression strategies were explored during her consultations. Her father died 2 weeks after emergency state and nationwide lockdown was declared in Portugal, during the first COVID-19 outbreak. The family did not have the opportunity for a proper farewell, the funeral obeyed strict rules, and the patient and her family were at home, due to social distancing and school closure policies. Consultations were maintained by telephone calls and, less frequently, by face-to-face appointments. Adaptive and helpful strategies to grieve were shared with the patient and her mother. Intervention with the mother alone was also helpful. Death circumstances related to COVID-19, confinement policies, and social-economical stressors can intensify the grief experience, increasing the risk for complicated grief. Although psychiatric teleconsultation is essential during COVID-19 pandemic, it poses various limitations. Non-verbal communication clues may not be totally apprehended; it may represent a problem in the therapeutic relationship, and access to technology can be difficult for psychiatric patients and clinicians. COVID-19 pandemic policies should include mental health protection measures, which should facilitate adjusted grief responses for those who lose a loved one during this pandemic.

Outcomes of the grief and communication family support intervention on parent and child psychological health and communication

Parents and children risk developing psychological health problems following the death of a partner/parent and may need professional support. This study used the reliable change criterion and clinically significant change to examine the outcomes of the Grief and Communication Family Support Intervention, comprising three family meetings with a family therapist, among 10 parents and 14 children, using pre-post outcome scores. The results provided preliminary evidence that the Grief and Communication Family Support Intervention may improve self-esteem and reduce anxiety in some parents and may improve communication and reduce internalizing and externalizing problems in some children.

Initial Validation and Measurement Invariance of the Active Inhibition Scale Among Traumatized and Grieving Youth

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.

The Mediating Effect of Coping Strategies on Religious/Spiritual Struggles and Life Satisfaction

A growing number of researchers are testing potential problematic forms of religiousness that denote anxieties regarding sacred matters. However, only a few studies have assessed how religious/spiritual struggle is associated with positive outcomes. Because people’s coping responses to stressors are key determinants of their well-being, we expected that different coping strategies could be potential mediators between religious problems/tensions and life satisfaction. The research was conducted on a group of 744 Roman Catholics. We used the Religious Comfort and Strain Scale, Satisfaction with Life Scale, and Brief Coping Orientation to Problems Experienced (COPE) questionnaire. The outcomes show that religious comfort correlated positively with life satisfaction, while fear/guilt, negative emotions toward God, and negative social interactions surrounding religion correlated negatively with life satisfaction. Our research amplifies the understanding of the religious/spiritual struggles and life satisfaction relationship, mediated by “secular” coping strategies. It confirms that both religious and secular methods of experiencing different strains seem to coexist with multiple other strategies in the context of broadly understood life satisfaction.

Posttraumatic growth in parentally bereaved children and adolescents: A systematic review

The systematic review aims to evaluate the posttraumatic growth in parentally bereaved children and adolescents. Six studies were obtained from the literature review. The total number of participants in the studies was 395. The age of the participants ranged from 6 to 25 years. When the studies were examined, it could be seen that the parentally bereaved children and adolescents showed post traumatic growth. Multiple circumstances surrounding loss including participants' age, cause of death, the closeness of the deceased person, and the time passed after the loss which can each affect the posttraumatic growth in parentally bereaved children and adolescents.

The Resilience Songwriting Program for Adolescent Bereavement: A Mixed Methods Exploratory Study

Music therapy research with youth who are grieving often reports on a combination of interventions, such as lyric analysis, improvisation, and/or songwriting. Unfortunately, the lack of theoretical transparency in how and why these interventions affect targeted outcomes limits interpretation and application of this important research. In this exploratory study, the authors evaluated the impact of an 8-session, theory-driven group songwriting program on protective factors in adolescent bereavement, and also sought to better understand adolescents' experiences of the program. Using a single-group, pretest-posttest convergent mixed methods design, participants were enrolled from three study sites and included 10 adolescents (five girls and five boys), ages 11-17 years, who self-identified as grieving a loss. Outcomes measured included grief, coping, emotional expression, self-esteem, and meaning making. Qualitative data were captured through in-session journaling and semi-structured interviews. There were no statistically significant improvements for grief, self-esteem, coping, and meaning making. Individual score trends suggested improvements in grief. The majority of the participants reported greater inhibition of emotional expression, and this was statistically significant. Thematic findings revealed that the program offered adolescents a sense of togetherness, a way to safely express grief-related emotions and experiences verbally and nonverbally, and opportunities for strengthening music and coping skills. These findings suggest that engaging in collaborative therapeutic songwriting with grieving peers may decrease levels of grief, enhance creative expression, and provide social support. More research is needed on measuring self-esteem, emotional expression, coping, and meaning making outcomes in ways that are meaningful to adolescents.

Cause of Caregiver Death and Surviving Caregiver Coping Style Predict Thwarted Belongingness in Bereaved Youth

Both bereavement and thwarted belongingness serve as risk markers for youth suicide-related behaviors. This study examined candidate predictors of thwarted belongingness among bereaved youth, including caregiver cause of death and surviving caregiver coping style. A group of 43 caregiver-bereaved families (58 children aged 7-13-years-old) participated in a longitudinal study investigating associations between hypothesized bereavement-related contextual factors and youth thwarted belongingness. Cause of caregiver deaths included anticipated deaths preceded by illness (37%; n = 16), sudden natural deaths (25.6%; n = 11), accidental deaths (20.9%; n = 9), death by suicide (9.3%; n = 4), and death from drug overdose (7.0%; n = 3). Children's thwarted belongingness was significantly higher among youth bereaved by suicide compared to youth bereaved by sudden natural death, accident, and anticipated death by illness. Surviving caregivers' use of behavioral disengagement and positive reinterpretation and growth as coping strategies at Time 1 predicted lower thwarted belongingness in children at Time 2. Implications for risk screening and assessment of suicide risk among bereaved youth are discussed.

Family Communication and Psychological Health in Children and Adolescents Following a Parent’s Death From Cancer

Parentally bereaved children and adolescents are at risk of developing psychological health problems. Evidence for a correlation between communication and broad measures of psychological health exists in other populations. The aim of this study was to examine associations between family communication and specific aspects of psychological health for children and adolescents following a parent’s death from cancer using parent-proxy and adolescent self-reports. Parent-proxy reports for children and adolescents, and adolescent self-reports for Parent–Adolescent Communication, Strengths and Difficulties Questionnaire, and Prolonged Grief-13 child were analyzed using descriptive statistics and Spearman’s correlation. Parents rated communication as moderate in quality and reported good psychological health for children and adolescents. Adolescent self-reports indicated low-quality communication with their parent and poor psychological health. Significant associations between Parent–Adolescent Communication subscales and Strengths and Difficulties Questionnaire subscales were found for each group. Prolonged grief was associated with emotional problems but not communication for all three groups.

Associations between dimensions of religiousness and psychosocial functioning among bereaved youth

Using a sample of recently bereaved youth (N = 2,425; M_age = 15.31, SD = 1.50), this study examined associations between dimensions of religiousness and current functioning. Youth reported on their religious service attendance, religious coping, and the importance of religious beliefs and substance use, academic achievement, depressive symptoms, and self-esteem. Greater religious service attendance was associated with lower substance use and the greater importance of religious beliefs was associated with lower substance use and greater self-esteem. Greater religious coping was associated with greater academic achievement. Findings suggest distinct dimensions of religiousness may have differential implications for adolescent functioning after experiencing loss.

Out of the Mouths of Babes: Links Between Linguistic Structure of Loss Narratives and Psychosocial Functioning in Parentally Bereaved Children

This study examined links between the language bereaved children use to describe the death of their caregiver and children's psychological/behavioral functioning and coping strategies. Participants included 44 children (54.5% male) aged 7 to 12 (M = 9.05) years who were bereaved by the death of a caregiver. Children were assessed via self- and caregiver-report measures and an in-person interview regarding the loss of their caregiver. Children's loss narratives gathered through in-person interviews were transcribed and subjected to textual analysis. Linguistic categories included pronouns and verb tense. Drawing from linguistic and self-distancing theories, we hypothesized that children's use of language reflecting self-distancing (third-person pronouns and past tense) or social connectedness (first-person plural pronouns) would be negatively associated with psychological/behavioral distress and avoidant coping. Similarly, we expected that children's use of self-focused language (first-person singular pronouns and present tense) would be positively associated with psychological/behavioral distress and avoidant coping. As hypothesized, preliminary findings suggest that children who employed more self-distancing language and used more social connectedness words reported less avoidant coping, rs = .40-.42. Also as hypothesized, children who employed more self-focused language had higher levels of self-reported posttraumatic stress symptoms, r = .54, and avoidant coping, r = .54, and higher parent-reported psychological/behavioral distress, r = .43. Implications for theory-building, risk screening, and directions for future research with bereaved youth are discussed.

Gender Views and Relationships in Families of Children With Craniofacial Differences

OBJECTIVE

Gender values and beliefs are known to influence family functioning. The aim of the current study was to describe the association between views about gender and family functioning within families with a child with a craniofacial difference (CFD).

DESIGN

Participants included 74 dyads composed of children (8-18 years old) with CFD (n = 36 female), including cleft lip/palate, and a parent (n = 56 female). Children and caregivers both completed the activities subscale of the Occupations, Activities, and Traits-Attitudes Measure (C/OAT-AM). Children completed selected items from the Parent Perception Inventory (PPI). Caregivers completed the nurturance subscale of the Parenting Dimensions Inventory-Short Form (PDI-S) and the Parenting Stress Scale (PSS).

SETTING

Participants were recruited from an outpatient program at an academic medical center.

RESULTS

There were no significant relationships among the participant demographics and the study variables, with the exception that more complex CFD diagnoses were correlated with increased parenting stress. General linear modeling showed that parents with more flexible gender attitudes reported more nurturing parenting behaviors. There was also a positive association between parental flexibility in gender views and child-reported parent-child relationship quality. An interaction showed that the relationship between parental flexibility in gender views and child-reported relationship quality was stronger for females and nonsignificant for males.

CONCLUSIONS

Caregivers with more flexible gender attitudes perceived themselves as more nurturing and were seen more positively by their daughters with a CFD. This pattern may inform parenting interventions for CFD populations.

Caregivers' positive emotional expression and children's psychological functioning after parental loss

The death of a loved one, particularly a parent, has been identified as not only the most common, but also the most distressing form of adversity youth may experience in their lifetime. Surviving caregivers' communication with their children may play a critical role in shaping bereaved children's psychological functioning. However, few studies have examined the specific content (e.g., word usage) of caregivers' verbal communication as a predictor of psychological functioning in bereaved youth. In a sample of 39 parentally-bereaved children and their surviving caregivers, we investigated whether the frequency of caregivers' use of positive emotion words (e.g., "love", "happy", "hope") during a reminiscing task about the deceased was associated with children's psychological functioning and coping. In a cross-sectional analysis, we specifically examined whether these associations were moderated by the amount of time passed since children lost their parents. The Linguistic Inquiry and Word Count Program (LIWC) was used to code and evaluate the percentage of positive emotion words caregivers used during the discussion. When caregivers used more positive emotion words, children were less likely to experience depression, anxiety, and avoidant coping. Those associations were present for children who had experienced parental loss at least 105 days prior to the study. Our findings have implications for how caregivers can support their children and help to alleviate psychological distress in the aftermath of parental loss.

Parental relationships beyond the grave: Adolescents' descriptions of continued bonds

OBJECTIVE

Many people experience an ongoing relationship with a deceased loved one. This is called a "continued bond." However, little is known about the adolescent experience with continued bonds once a parent has died. This study describes three ways that adolescents continue their relationship with a parent after that parent's death.

METHOD

Individual semistructured interviews were conducted with nine adolescent children of deceased hospice patients from a large hospice in northeastern Ohio as part of a larger grounded-theory study. The interviews were audiotaped, transcribed verbatim, and analyzed using a conventional content analysis approach.

RESULTS

Adolescents continued their bonds with deceased parents in one of three ways: experiencing encounters with the deceased parent, listening to the inner guide of the parent, and keeping mementos to remind them of the parent.

SIGNIFICANCE OF RESULTS

The ways that the adolescents continued their bond with a deceased parent assisted them in creating meaning out of their loss and adjusting to life without that parent. Our results can be used by health professionals and parents to help adolescents after a parent has died.