Grief reactions of parental couples: congenital handicap and cot death

Impact of a child with congenital anomalies on parents (ICCAP) questionnaire; a psychometric analysis

Background

The objective of this study was to validate the Impact of a Child with Congenital Anomalies on Parents (ICCAP) questionnaire. ICCAP was newly designed to assess the impact of giving birth to a child with severe anatomical congenital anomalies (CA) on parental quality of life as a result of early stress.

Methods

At 6 weeks and 6 months after birth, mothers and fathers of 100 children with severe CA were asked to complete the ICCAP questionnaire and the SF36. The ICCAP questionnaire measures six domains: contact with caregivers, social network, partner relationship, state of mind, child acceptance, and fears and anxiety. Reliability (i.e. internal consistency and test-retest) and validity were tested and the ICCAP was compared to the SF-36.

Results

Confirmatory factor analysis resulted in 6 six a priori constructed subscales covering different psychological and social domains of parental quality of life as a result of early stress. Reliability estimates (congeneric approach) ranged from .49 to .92. Positive correlations with SF-36 scales ranging from .34 to .77 confirmed congruent validity. Correlations between ICCAP subscales and children's biographic characteristics, primary CA, and medical care as well as parental biographic and demographic variables ranged from -.23 to .58 and thus indicated known-group validity of the instrument. Over time both mothers and fathers showed changes on subscales (Cohen's d varied from .07 to .49), while the test-retest reliability estimates varied from .42 to .91.

Conclusion

The ICCAP is a reliable and valid instrument for clinical practice. It enables early signaling of parental quality of life as a result of early stress, and thus early intervention.

Grief, parenting, and schizophrenia

It is argued that a child with schizophrenia represents an ongoing source of loss and grief for parents. The study aimed to (a) validate the presence of grief in mothers and fathers of children with schizophrenia, and (b)explore whether the hours of parental contact with the child influences the strength of grief reactions. The mean age (62 years) of the 16 mother-father dyads constituted an investigation of older parents, for 43% of whom the duration of diagnosed schizophrenia was over 10 years. Grief was conceptualised as a cognitive, behavioural, and emotional reaction to loss, and was operationalized by measuring current intrusive thoughts and avoidance behaviours, as well as emotional distress over reminders of time of diagnosis. As hypothesised, mothers and fathers were grieving in relation to their child's psychiatric illness. No differences between mothers and fathers in intrusive thinking, avoidance behaviours, and distress related to recall of diagnosis were detected. With the exception of intrusive thoughts, number of contact hours with the child was not an intervening variable of mothers' and fathers' grieving.

Family grief

As grief is both an individual and shared experience, adopting a systemic perspective is most appropriate for health-care professionals seeking to assist the bereaved. Within this framework, the family virtually always constitutes the most significant social group in which grief is experienced. In this paper we review the literature on family grief, covering clinical case reports, the observations of family therapists, systematic family bereavement research and family intervention studies. An understanding of patterns of family grief and vulnerability factors for morbid grief is pivotal to both preventive intervention and treatment of an established disorder.

Parental reactions to the loss of an infant child: a review

This article examines methodological problems, and describes and evaluates commonly explored variables regarding research on the effect of an infant's death on the family. The components of parents' and siblings' grief reactions, and the similarities and differences in parental grief are reviewed. The research shows marked differences between mothers' and fathers' reactions--the grief reactions in mothers being stronger and more prolonged. Different explanations for this are put forward. The effect of different types of loss as well as the effect of the child's life span before death are also reviewed and discussed. Further knowledge is needed to single out the influence of these factors' on the families' reactions. It is concluded that the death of an infant makes the family prone to develop short-term and/or long-term problems in their adaptation to the loss. An integrated effort by health professionals is needed to develop systematic ways of helping families to cope with the death of a child.

Adaptation following perinatal loss: a critical review

Parental adaptation following perinatal loss has received increasing attention in the past 20 years. From early anecdotal accounts to recent more rigorous investigations, it is clear that perinatal loss in the developed world is a significant psychological trauma for parents. Major immediate consequences are likely for virtually all affected families, and long-term sequelae are likely for some. Despite widespread attention to the experience of families who lose a stillborn or newborn infant, including major changes in hospital practices regarding management of these families, many important questions remain unanswered. We know little, for instance, about which parents are at greatest risk for disordered mourning or what additional measures might minimize their psychological morbidity. In fact, because of a tendency to focus exclusively on affective symptomatology following the loss, other important features of the process of mourning have been overlooked or examined unsystematically. Suggestions for specific and general directions for further research are discussed.