Variables associated with grief and personal growth following the death of a child from cancer: A mixed method analysis

This mixed method study explored parent and child characteristics that impact grief and personal growth in parents (n = 119) after a child dies from cancer in Australia. Medical components of a child's cancer care including radiation treatment, referral to palliative care, and location of death had a significant impact on levels of grief. Parents' gender, religious affiliation, and education level had a significant impact on levels of personal growth. This study further enhances our understanding of the impact of specific parent and child characteristics throughout a child's cancer treatment and end of life that may influence their families' experience of bereavement.

Perinatal Loss: Intensity and Duration of Emotional Recovery

This article seeks to expand our concept of the intense grief process that parents endure in suffering the loss of a baby. It is based on our experience of eighteen years in counseling bereaved parents in our perinatal support group program at Children's Medical Center, Dayton, Ohio. There are unique characteristics of parental grief that are not accounted for in our theories to date. Full emotional expression has been emphasized as helpful although it has been recognized in recent research findings that it may not be necessary for all individuals. Here we address how to conceptualize the continuous alternation of denial and acceptance as parents grieve and the lack of definitive resolution. We apply Berenson's Map of Emotions to this issue in developing a working clinical model of the mourning process.

Similarities and Differences in Spouses Coping with SIDS

Bereaved parents' marital relationships may be at high risk for problems after a SIDS death because of coping differences between spouses. Five coping patterns developed in prior studies of SIDS parents were used to study differences within thirty-four pairs of parents bereaved by SIDS, three to forty months after their loss. Individual items most frequently used by both genders were examined to explore similarities in coping behaviors. Findings reveal bereaved parents sought support from within the family most frequently and from outside resources the least. Bereaved mothers used these coping patterns significantly more often than her spouse. Almost all (33) couples had other living children at the time of their SIDS loss or a subsequent child or pregnancy since the death. A current pregnancy was related to coping for bereaved fathers. The presence of other living children was related to less support seeking for bereaved mothers. Couples remembered the child that died and anticipated emotional pain on the anniversary of the death. There were gender differences in frequencies for expressing feelings particularly crying behavior. The majority of the couples accepted the SIDS diagnosis and reported open communication with their spouse.

The Grief of Sids Parents and their Understanding of Each Other's Responses

This article reports on a survey of sixty-one parents (including 27 couples) who had recently experienced the loss of an infant to Sudden Infant Death Syndrome (SIDS). Data were collected on parents' reactions to the death, things which helped with grief, sources of solace, and attitudes to another pregnancy. Some sets of questions were presented twice: in the first instance the respondent reported his/her own situation and in the second instance the respondent estimated his/her partner's situation. In some areas, respondents tended to over- or under-estimate their partner's situation. Reported grief reactions and solace seeking were similar for both parents although women generally scored higher on these measures than men. More women than men wanted another pregnancy soon, while men worried more about another pregnancy than did women. It is suggested that an understanding of areas of difference may be important for SIDS parents and for practitioners who work to facilitate the grieving process.

Parental Bereavement: Levels of Grief as Affected By Gender Issues

This study examined differences between men's and women's levels of grief associated with the death of a child. Nineteen bereaved individuals were contacted through a local parental bereavement group. Gender and other variable data were gathered on a demographic data form. To measure levels of grief, the Grief Experience Inventory (GEI) was employed. Analyses of the results were performed using, t-tests, and eta-squared calculations. An alpha level of .05 was used for all parametric tests. Results supported only one hypothesis, that women experience higher levels of grief then men. The hypotheses that women who lost daughters would experience higher levels of grief then women who lost sons, and that men who lost sons would experience higher levels of grief then women who lost sons were not supported. The hypotheses that men who lost sons would experience higher levels of grief than men who lost daughters, and that women who lost daughters would experience higher levels of grief then men who lost daughters were also not supported.

Effects of a Child's Death on the Marital Relationship: A Review

A review of the clinical and empirical literature suggests that the grief of parents who have lost a child is especially intense, enduring, and taxing on numerous levels. Bereaved parents have been found to suffer multitudinous negative mental and physical health sequelae, as well as secondary losses, The deterioration of the marital relationship may be among these negative outcomes. This review focuses on the effects of a child's death on couple functioning in general, and on specific facets of the marital relationship. Research on variables that may affect the relationship between parental bereavement and marital outcome is explored. Various existing hypotheses for the potentially deleterious impact of a child's death on couples are also reviewed, and a new paradigm for understanding these effects is suggested.

Adolescent Parent Mourning Reactions Associated with Stillbirth or Neonatal Death

Case studies of the mourning reactions observed in six adolescent mothers who lost their infants to stillbirth or neonatal death are reported. The adolescent mothers were interviewed in a semi-structured format during their pregnancy, at the loss of the pregnancy or neonate, and two, four, six, and twelve months after the death of the infant. Bereaved adolescent mothers experienced extreme fluctuations in emotions following their loss. Additionally, they experienced losses associated with development and their successful transition to adulthood: identity losses, separation from family of origin losses, and friendship losses. No bereavement support or educational programs currently exist for bereaved adolescent mothers; they thus face potential deleterious impacts on their physiological, interpersonal, familial, and social well-being.

Factors influencing the uptake of neonatal bereavement support services - Findings from two tertiary neonatal centres in the UK

BACKGROUND

Research on perinatal bereavement services is limited. The aim of the study was to compare the uptake of bereavement support services between two tertiary neonatal units (NNU), and to investigate influencing factors.

METHOD

The medical and bereavement records of all neonatal deaths were studied from January 2006 to December 2011. Data collected included parent and baby characteristics, mode of death, consent for autopsy and bereavement follow-up. The categorical data were compared by chi-square or Fisher's exact test and continuous data by Wilcoxon signed-rank test; a multivariable regression analysis was performed using STATA 12.0.

RESULTS

The neonatal deaths of 297 babies (182 in NNU1 and 115 in NNU2) with full datasets were analysed. Baby characteristics were similar between units except for lower median gestational age in NNU1 (p = 0.03). Significantly more NNU1 parents were non-Caucasian (p < 0.01), from lower socio-economic status (p = 0.01) and had previous stillbirth/miscarriage (p = 0.03). More babies had care withdrawn in NNU2 (p < 0.01). A significantly higher proportion of parents from NNU1 (61 %) attended bereavement follow-up compared to NNU2 (34 %; p < 0.01). On multivariable analysis, significantly more parents who were married or co-habiting (p = 0.02) and consented for an autopsy (p = 0.01) attended bereavement services.

CONCLUSION

Uptake of bereavement services varied between the two NNUs, which could be due to differences in the ethnic and socio-economic mix of the population. Significantly more parents who were married or co-habiting, or consented for autopsy, attended bereavement follow up services.

Marriage and cohabitation outcomes after pregnancy loss

OBJECTIVE

The goal was to evaluate marriage and cohabitation outcomes for couples who experienced a live birth or fetal death at any gestational age.

METHODS

For married and cohabitating women who experienced live births, miscarriages, or stillbirths, we conducted a survival analysis (median follow-up period: 7.8 years), by using data from the National Survey of Family Growth, to examine the association between birth outcomes and subsequent relationship survival. The Cox proportional-hazards models controlled for multiple independent risk factors known to affect relationship outcomes. The main outcome measure was the proportion of intact marriages or cohabitations over time.

RESULTS

Of 7770 eligible pregnancies, 82% ended in live births, 16% in miscarriages, and 2% in stillbirths. With controlling for known risk factors, women who experienced miscarriages (hazard ratio: 1.22 [95% confidence interval: 1.08-1.38]; P = .001) or stillbirths (hazard ratio: 1.40 [95% confidence interval: 1.10-1.79]; P = .007) had a significantly greater hazard of their relationship ending, compared with women whose pregnancies ended in live births.

CONCLUSIONS

This is the first national study to establish that parental relationships have a higher risk of dissolving after miscarriage or stillbirth, compared with live birth. Given the frequency of pregnancy loss, these findings might have significant societal implications if causally related.

Psychological aspects of perinatal loss

After perinatal loss, parents experience painful grief. Fathers and mothers show the same pattern of symptoms, but generally mothers' distress is more intense. Grief should be sympathetically acknowledged by health professionals, and parents should be reassured that their feelings are normal and that recovery may take many months. Intense depression lasting more than 6 months may require psychological treatment. There is some evidence that delaying conception for a year may allow an easier pregnancy psychologically. The common practice of encouraging parents to have contact with a dead infant is not evidence-based and may have adverse effects, including inducing symptoms of post-traumatic stress disorder. A protocol of postnatal follow-up allows parents to get appropriate information about the loss, including possible problems and timing of another pregnancy. The subsequent pregnancy is stressful, and health professionals should recognize that parents may suffer significant anxiety.

Explanatory model of health in bereaved parents post-fetal/infant death

In order to identify which features contribute to attenuating or intensifying the deleterious consequences of a perinatal loss such that some family systems endure and sometimes even thrive when faced with such a situational stressor, while other family units seem to deteriorate and disintegrate under similar circumstances, an explanatory model of health was tested. The purpose of this longitudinal study was to examine how the relationships between the elements in the model namely: resources both internal (hardiness) and external (marital and social supports), as well as appraisal of the situation, predicted the health of 110 bereaved couples (husbands and wives).

Posttraumatic growth in child survivors of a road traffic accident

Although the negative consequences of trauma have been well researched and described, posttraumatic growth has only recently come to the attention of researchers. This paper considers whether children (aged 7-18 years) who have been involved in a road traffic accident can experience posttraumatic growth outcomes. From 158 children who took part in an interview, qualitative analysis of interview notes found that 67 (42%) reported some aspect of posttraumatic growth, most notably in terms of their philosophy of life. Of these, 25 (37%) were also assessed as experiencing posttraumatic stress disorder.

Psychological aspects of perinatal loss

PURPOSE OF REVIEW

Parents are attached to their unborn children, and loss around the time of birth is a serious trauma. Parental grief is a normal response, and may last for many months. Clinicians have always sought to implement practices that will help recovery, and for a generation, have advocated that parents have contact with the body of their dead infant, believing that this will facilitate mourning. Review of the literature shows that no previous systematic evidence has ever been offered to support this practice.

RECENT FINDINGS

Recent research throws doubt on the therapeutic value of the practice of encouraging contact with the dead infant. These findings are outlined and discussed.

SUMMARY

Following an outline of what is already known about the psychological effects of perinatal loss, the paper focuses on the evidence that aspects of psychosocial management are associated with better outcomes. It goes on to describe the cultural context in which psychosocial management changed and parents were first encouraged to see and handle their dead infant, and explores the distinction between the medical and cultural models which may frame this behaviour in very different ways. Finally, it briefly discusses the ethical position of staff who advise parents about their choice to see or not see their infant's body.

A waste of life: fathers' experience of losing a child before birth

BACKGROUND

The prenatal loss of an expected child entails parental despair and grief. The grief after a stillborn child is sometimes described as a "forgotten form of grief" and the fathers as the "forgotten mourners." Our aim was to describe how fathers experienced losing a child as a result of intrauterine death.

METHOD

Eleven men were interviewed 5 to 27 months after the intrauterine death of their child during weeks 32 to 42 of pregnancy. The interviews were analyzed using a phenomenological methodology.

RESULTS

After being informed of the infant's death, most fathers first wanted their partners to have a cesarean section, but all later thought that it would be right for the child to be delivered vaginally. A strong feeling of frustration and helplessness came over them during and after the delivery. Several men found meaning and relief in their grief by supporting their partner. Tokens of remembrance from the child were invaluable, and fathers appreciated that the staff collected these items, even if the parents declined them. The perceived prerequisite for resuming their everyday lives consisted of the support they received from the hospital staff and precious memories of the child. The most important comfort in their grief was a good relationship with their partner. Some fathers missed having a man to talk to both at the time of the stillbirth and subsequently.

CONCLUSION

The fathers' general trust in life and the natural order was suddenly and unexpectedly severely tested by the death of their child, which they perceived as a terrible waste of life. They sought understanding as grieving men and fathers from both the hospital personnel and their partners, as well as from relatives. Being able to protect their partner and to grieve in their own way was important to the fathers.

Effects of a program of intervention on parental distress following infant death

A longitudinal study of 144 parents (65 fathers, 79 mothers) was conducted to evaluate the effectiveness of a program of intervention in relieving the psychological distress of parents affected by infant death. Participants were assessed in terms of their psychiatric disturbance, depression, anxiety, physical symptoms, dyadic adjustment, and coping strategies. The experimental group (n = 84) was offered an intervention program comprising the use of specially designed resources and contact with a trained grief worker. A control group (n = 60) was given routine community care. Parental reactions were assessed at four to six weeks postloss (prior to the implementation of the intervention program), at six months postloss, and at 15 months postloss. A series of multivariate analyses of variance revealed that the intervention was effective in reducing the distress of parents, particularly those assessed prior to the intervention as being at high-risk of developing mourning difficulties. Effects of the intervention were noted in terms of parents' overall psychiatric disturbance, marital quality, and paternal coping strategies.

A baby has died: the impact of perinatal loss on family social networks

OBJECTIVES

To describe the impact of a baby's death on the family's social network and to design nursing interventions to support families and their networks.

DESIGN

Descriptive, with a qualitative approach.

SETTING

An urban area of western Quebec.

PARTICIPANTS

Twenty parents (mothers and fathers) who had experienced a perinatal loss (abortion, miscarriage, in-utero death, stillbirth, or death of a newborn within the 1st week of life) within the last 6 years.

MAIN OUTCOME MEASURES

Self-administered questionnaires developed by the authors were completed by each parent.

RESULTS

Family members' quality and quantity of ties with their network were profoundly affected by the perinatal loss. Some families experienced reinforcement of their bonds with their social network, but most suffered permanent losses of relationships with friends, colleagues, or extended family members.

CONCLUSIONS

The quality and quantity of ties with one's network are associated with improved health status and life satisfaction. Considering the changes participants noted in their relationships within their network, further studies of the impact of these changes on family members' grieving process would be useful to guide nursing interventions.

Long-term impact of perinatal bereavement. Comparison of grief reactions after intrauterine versus neonatal death

OBJECTIVE

To investigate possible differences in emotional impact on parents following either a deliberate intrauterine death or a neonatal death in extremely preterm growth retarded infants.

DESIGN

Retrospectively matched study by audiotaped semi-structured interview, 3-9 years after the perinatal loss.

RESULTS

Nineteen couples (ten in the intrauterine death group and nine in the neonatal death group) consented to participate. More than 50% of the intrauterine death group couples could not share or discuss their emotions. Most partners in this group did not feel the loss of their own child. Discongruent grieving between partners was more pronounced in the intrauterine death group and could be identified as a risk factor for prolonged and abnormal grief reactions. Four couples (three in the intrauterine death group and one in the neonatal death group) developed long-term emotional disturbance and psychosocial problems. Long-term follow-up in both groups was failing remarkably.

CONCLUSION

Assimilating a non-intervention policy followed by fetal death requires different skills and is more complicated than grief support around an early neonatal death. Follow-up is essential to identify the couple 'at risk' and to mobilize extra support.

Facilitating perinatal grieving between the mother and the father

Society often expects mothers and fathers to share equally in the perinatal grief process because the child was a common bond between them. Unfortunately, in perinatal grief, this is not always the case. The mother and the father can experience incongruent grieving and use discordant coping mechanisms. It is important to evaluate these differences to facilitate communication between the distraught parents. Improved communication can in turn facilitate the grieving process.

Similarities and differences in couples' grief reactions following a miscarriage: results from a longitudinal study

Recent studies have documented grief and depressive reactions in women after a miscarriage. However, the men's reactions to their partner's experience have been neglected. In a controlled follow-up study, 56 couples were studied shortly after the miscarriage, and 6 (N = 47) and 12 months later (N = 45). The participants completed standardized questionnaires for depression, physical complaints, anxiety, and grief. Contrary to commonly held beliefs, men do grieve, but less intensely and enduringly than their partners. The manner in which they experience their grief is similar to that of the women, except that the men cry less and feel less need to talk about it. Unlike the women they do not react with an increased depressive reaction (compared to age- and sex-matched community control groups). Giving up their personal expectations, hopes for, and fantasies about the unborn child is a major source of grieving for both. Some men feel burdened by their wives' grief or depressive reactions. Conflicting reactions may affect the couples' interactions and promote depressive reactions in the women.

Predictors of husbands' and wives' grief reactions following infant death: the role of marital intimacy

This follow-up study examined how bereaved couples' grief reactions change over time and how the quality of the marriage can predict these reactions for men and women. A group of 31 bereaved couples who 2 to 4 years earlier had lost an infant ( greater than 20 weeks gestation and less than 1 year of age) were revisited in their home 24 months after the initial home visit. With the exception of somatization, couples' grief reactions were less intense at follow-up than at the initial visit. Overall, husbands experienced less guilt, meaninglessness, yearning, and morbid fear than wives. Both husbands and wives who reported lower levels of marital intimacy soon after the loss experienced more intense grief at follow-up. Finally, couples continued to be vulnerable to a resurgence of grief even years later.

Paternal Bereavement in Older Men

Styles of coping with the death of an adult child were explored in a study that examined the behavioral and affective aftermath of loss in older men. Twenty-five fathers aged sixty to eighty-eight who had lost an adult child were studied through ethnographic interviews based on life history review. Three general styles of adjustment to loss were identified. Men who described themselves and their careers in superlative terms appeared most likely to adjust well to the loss. These men tended to “conquer” the loss by intellectualizing it, psychologically relegating the loss to the periphery of daily life, or capitalizing on their self-esteem to reestablish control over life. A second group of men used avoidance, denial, or a dependence on others as primary agents of adjustment. While this latter group presented as only slightly less self-complacent than the above, they were less able to diffuse or appease accompanying feelings of helplessness through self-aggrandizement. For them, recovery from the death of a child seemed more tied to external than to self-affirming mechanisms. Immersion in second marriages, bereavement support groups, or religion became outlets for relief and sources of regeneration. Two men who candidly described their lives with regret and disappointment, constituted a third group. Lacking the conviction of self-worth that lead other men in the sample to triumph over the loss, they displayed no determination to rescue themselves or be rescued from grief. For both men, mourning was a continuing process that seemed to relate to the futility of unrealized self-potential as well as the loss of a child. Results suggest that, for men, narcissism may be a potent antidote for loss that can buffer, neutralize, and even erase the pain of losing a child.

The Long-Term Effects of Grief on Marital Intimacy following an Infant's Death

This follow-up study examined how marital intimacy changes over time in bereaved couples and how their marriages are affected by the death of their infant. A group of thirty-one bereaved couples who two to four years earlier had lost an infant (> 20 weeks gestation and < 1 year of age) were revisited in their home twenty-four months after the initial home visit. Couples did report a significant drop in sexual intimacy at follow-up compared to before the loss and at the initial home visit. Moreover, wives reported less emotional intimacy overall, than did their husbands. In contrast to wives whose own initial grief responses predicted their feelings about their marriages two years later, intensity of husband's initial grief response did not affect their relationship with their wives but, rather a more powerful predictor was their wives' initial reactions, the early state of their marriage (whether they had considered separating), and whether or not they had warning of the impending death. Finally, there is some evidence that women are affected in part, by their husbands' grief.

Effects of sudden infant death on bereaved siblings: a comparative study

This study investigated behavioural problems (as rated by mothers) in 38 children who had been suddenly bereaved of an infant sibling between 3 and 27 months previously. These children were compared with 40 children matched on age, gender, family composition and social background. Bereaved siblings were reported to have a prolonged and significantly elevated rate of non-specific behavioural problems. It is argued that, either the bereaved children's problems were real, or bereaved mothers' perceptions of their surviving children were significantly distorted. In either case, there is serious cause for concern about the welfare of children in families bereaved by Sudden Infant Death Syndrome.

The psychologic effects of sudden infant death syndrome on parents

Sudden infant death syndrome is the sudden, unexpected death of an apparently healthy infant, accounting for 7,000 to 10,000 deaths per year. For the parents, the unexpectedness and guilt can be overwhelming. The long, difficult grief process has a great effect on marital relationships, surviving siblings, and subsequent children. Increasing the nurse's understanding of the effects of sudden infant death syndrome can enhance the support the parents receive. A caring attitude and follow-up throughout the grief process are necessary.

Evolution of bereavement counselling in sudden infant death syndrome, neonatal death and stillbirth

There have been changing attitudes to death and grief in Western society in recent centuries. During the twentieth century complex medical and social changes have resulted in changing attitudes to and experiences with death. Specifically, the impact of death in childhood is reviewed. In recent decades sudden and unexpected death associated with stillbirth, the newborn and infants appears to have a more profound affect on the bereaved parents than in the past when the overall death rates in childhood were higher. The evolution of parent support groups developed since the 1960s to alleviate the psychological trauma of unexpected and sudden death in childhood has been traced. These groups were founded initially for support with sudden infant death syndrome and later extended to include families with stillbirth and neonatal death.