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Ong S, Loh T, Wong P, Teo I. The Healing through Arts (HeARTS) program for children bereaved by cancer: Pilot study findings from Singapore. Palliat Support Care 2024; 22:243-250. [PMID: 37016929 DOI: 10.1017/s1478951523000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVES The article aims to investigate the feasibility, acceptability, and initial efficacy of a short-term 3-day art therapy group for children who have experienced parental death to cancer. METHODS The study utilized a pretest-posttest design and included children (n = 20) aged 7-12 years. The feasibility of the intervention was measured by recruitment ability, study compliance, and intervention adherence, while acceptability was assessed using a child-reported satisfaction survey. Efficacy was examined using the child-reported Pediatric Quality of Life Inventory (PedsQL), while the emotional, social, and behavioral functioning of children was measured using the parent-reported Strengths and Difficulties Questionnaire. Paired sample t-tests were used for analyses. RESULTS The intervention was found to be feasible (80% recruitment rate and 100% session adherence). Acceptability was high, and all participants were satisfied and found the intervention to be helpful. While results did not reach statistical significance, improvements in psychosocial and physical quality of life were reported by all the children post-intervention and at the 3-month follow-up. Parent-reported a decrease in behavioral difficulties scores and an increase in prosocial behavior scores at post-intervention and at the 3-month follow-up. SIGNIFICANCE OF RESULTS The 3-day art therapy group intervention was shown to be feasible to conduct and acceptable to the recipients. The intervention shows promise in improving post-death adjustment and quality of life outcomes of children bereaved by parental death due to cancer that were maintained after 3 months. The use of art therapy groups to ameliorate difficulties associated with parental loss and to assist children in coping day-to-day difficulties should be further investigated.
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Affiliation(s)
- Saryna Ong
- Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Travis Loh
- Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Phyllis Wong
- Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Irene Teo
- Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School Singapore, Singapore, Singapore
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Aguirre LC, Jaramillo A, Saucedo Victoria T, Botero Carvajal A. Mental health consequences of parental death and its prevalence in children: A systematic literature review. Heliyon 2024; 10:e24999. [PMID: 38304821 PMCID: PMC10830864 DOI: 10.1016/j.heliyon.2024.e24999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
The death of a loved one can occur at any stage of life and can have a profound clinical impact on the patient. During childhood and adolescence, smoking has a functional impact on key aspects of family, school, and social life. The negative effects of parental death on children's mental health and its prevalence are unknown. Therefore, this systematic literature review aimed to describe the effects of parental death on children's mental health and its prevalence. The PubMed/Medline, WoS, and Cochrane Trials databases were searched for articles on patients aged 4-18 years. This review examines three articles. Anxiety and depression were identified as the predominant mental health outcomes, with a prevalence ranging from 7.5 % to 44.67 % of the mental health consequences associated with parental death.
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Affiliation(s)
| | - A.K. Jaramillo
- School of Health, Universidad Santiago de Cali, Cali, Colombia
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Liu C, Grotta A, Hiyoshi A, Berg L, Wall-Wieler E, Martikainen P, Kawachi I, Rostila M. Parental death and initiation of antidepressant treatment in surviving children and youth: a national register-based matched cohort study. EClinicalMedicine 2023; 60:102032. [PMID: 37396801 PMCID: PMC10314171 DOI: 10.1016/j.eclinm.2023.102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Background Population-based longitudinal studies on bereaved children and youth's mental health care use are scarce and few have assessed the role of surviving parents' mental health status. Methods Using register data of individuals born in Sweden in 1992-1999, we performed a matched cohort study (n = 117,518) on the association between parental death and subsequent initiation of antidepressant treatment among individuals bereaved at ages 7-24 years. We used flexible parametric survival models to estimate the hazard ratios (HRs) over time after bereavement, adjusting for individual and parental factors. We further examined if the association varied by age at loss, sex, parental sociodemographic factors, cause of death, and the surviving parents' psychiatric care. Findings The bereaved were more likely to initiate antidepressants treatment than the nonbereaved matched individuals during follow-up (incidence rate per 1000 person years 27.5 [26.5-28.5] vs. 18.2 [17.9-18.6]). The HRs peaked in the first year after bereavement and remained higher than the nonbereaved individuals until the end of the follow-up. The average HR over the 12 years of follow-up was 1.48 (95% confidence interval [1.39-1.58]) for father's death and 1.33 [1.22-1.46] for mother's death. The HRs were particularly high when the surviving parents received psychiatric care before bereavement (2.11 [1.89-2.56] for father's death; 2.14 [1.79-2.56] for mother's death) or treated for anxiety or depression after bereavement (1.80 [1.67-1.94]; 1.82 [1.59-2.07]). Interpretation The risk of initiating antidepressant treatment was the highest in the first year after parental death and remained elevated over the next decade. The risk was particularly high among individuals with surviving parents affected by psychiatric morbidity. Funding The Swedish Research Council.
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Affiliation(s)
- Can Liu
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Alessandra Grotta
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
| | - Ayako Hiyoshi
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Lisa Berg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
| | | | - Pekka Martikainen
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Germany
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, United States
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
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4
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Quanjer B, van Dijk IK, Rosenbaum-Feldbrügge M. Short Lives: The Impact of Parental Death on Early-Life Mortality and Height in the Netherlands, 1850-1940. Demography 2023; 60:255-279. [PMID: 36656288 DOI: 10.1215/00703370-10421550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We investigate how experiencing parental death in infancy, childhood, or adolescence affected individuals' health using two distinct measures: mortality before age 20 and young adult height. Using two complementary indicators of health enables us to gain more insights into processes of selection and the scarring of health. Employing nationally representative data for the Netherlands for the 1850-1940 period, we analyze the survival of roughly 36,000 boys and girls using Cox proportional hazard models, and the stature of more than 4,000 young adult men using linear regression models. Results show that losing a parent-particularly a mother-at an early age (0-1 or 1-5) was related to a strongly increased risk of mortality. We find no evidence that losing a parent at these ages affected stature in young adulthood. For boys, experiencing maternal death between ages five and 12 was strongly associated with a shorter young adult height; however, we did not find evidence for an association between experiencing paternal death and shorter stature. We conclude that stature may not be a particularly good measure of the effects of early-life adversity if the health shock greatly increases mortality, as these effects create potential issues of health selection.
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Affiliation(s)
- Björn Quanjer
- Radboud Group for Family History and Historical Demography, Radboud University, Nijmegen, the Netherlands
| | - Ingrid K van Dijk
- Centre for Economic Demography, Department of Economic History, Lund University, Lund, Sweden.,Radboud Group for Family History and Historical Demography, Radboud University, Nijmegen, the Netherlands
| | - Matthias Rosenbaum-Feldbrügge
- Radboud Group for Family History and Historical Demography, Radboud University, Nijmegen, the Netherlands.,Federal Institute for Population Research, Migration and Mobility, Wiesbaden, Germany
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5
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Orri M, Macalli M, Galera C, Tzourio C. Association of parental death and illness with offspring suicidal ideation: cross-sectional study in a large cohort of university students. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2251-2260. [PMID: 35794467 DOI: 10.1007/s00127-022-02329-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this study was to (1) investigate the association of parental death and illness with suicidal ideation using a large sample of university students and (2) test whether associations were moderated by perceived family support. METHODS We used data from N = 15,008 French university students enrolled in the i-Share cohort (mean age, 20.5 years; 77% women). Students self-reported information on parental death, including the cause, parental illness (cardiovascular, stroke, cancer, depression/anxiety, alcohol abuse), and perceived family support during childhood/adolescence. Twelve-month suicidal ideation was self-reported and categorized into no, occasional, and frequent ideation. RESULTS Occasional and frequent suicidal ideation were, respectively, reported by 2692 (17.5%) and 699 (4.6%) students. After adjustment for age, gender, and parental education, we found associations between parental death and risk of occasional and frequent suicidal ideation (respectively, RR = 1.98 [1.81-2.17] and RR = 2.73 [2.30-3.24]). Parental deaths from illness, accidents, and suicides had the strongest associations. We also found associations for parental depression/anxiety (occasional, RR = 1.98 [1.81-2.17]; frequent, RR = 2.73 [2.30-3.24]), alcohol use problems (occasional, RR = 1.71 [1.5-1.94]; frequent, RR = 2.33 [1.89-2.87]), and cardiovascular diseases (occasional, RR = 1.22 [1.06-1.40]; frequent, RR = 1.83 [1.47-2.27]). For participants who experienced parental death and stroke, associations with occasional and frequent suicidal ideation (respectively) increased as perceived family support increased (Psinteraction ≤ 0.005). CONCLUSIONS Students who experienced parental death and common parental illnesses were at risk of reporting suicidal ideation, especially if their family were perceived as an important source of support. As information on parental death or illness can be routinely collected during health visits, attention should be paid to students reporting such experiences.
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Affiliation(s)
- Massimiliano Orri
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, 6875 Boulevard LaSalle, Montréal, QC, H4H 1R3, Canada. .,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, CHU Bordeaux, F-33000, U1219, Bordeaux, France.
| | - Melissa Macalli
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, CHU Bordeaux, F-33000, U1219, Bordeaux, France
| | - Cedric Galera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, CHU Bordeaux, F-33000, U1219, Bordeaux, France.,Department of Child and Adolescent Psychiatry, Charles Perrens Hospital, Bordeaux, France.,Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, CHU Bordeaux, F-33000, U1219, Bordeaux, France
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Pastore A, de Girolamo G, Tafuri S, Tomasicchio A, Margari F. Traumatic experiences in childhood and adolescence: a meta-analysis of prospective studies assessing risk for psychosis. Eur Child Adolesc Psychiatry 2022; 31:215-228. [PMID: 32577908 DOI: 10.1007/s00787-020-01574-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
Evidence of the association between traumatic experiences and psychosis are uncertain with respect to temporal order, clinical outcomes and the role of the age and genetic liability. The aim of the present meta-analysis was to explore the temporal relationship between the development of psychosis and traumatic exposure using prospective studies and to examine the role of moderation factors on overall effect sizes. Studies were identified by searching Embase-Ovid, PsycINFO (EBSCO), Pubmed, Scopus, Web of Science databases, and yielded an initial total of 9016 papers, leaving finally 23 after the screening process. Three sets of meta-analyses estimated the risk of developing psychotic experiences or full clinical psychosis by having experienced maltreatment by an adult or bullying by peers or parental death, using the random-effects model. Bullying by peers (OR = 2.28 [1.64, 4.34]), maltreatment by an adult (OR = 2.20 [1.72, 2.81]) and parental death (OR = 1.24 [1.06, 1.44]) all increased the risk of psychosis. Moderator analysis showed that negative effects of bullying were detected especially in those with genetic liability for psychosis and exposure to multiple trauma types; studies with higher prevalence of males showed a stronger risk for those exposed to parental death. No significant meta-regression was found between the risk of developing a full clinical psychosis or a psychotic experience. Lack of studies hampered the results about the age of trauma occurrence. The cumulative effect of being bullied from peers and experiencing other adversities during childhood and/or adolescence, together with genetic liability for psychosis, appears to confer the highest risk for developing psychotic symptoms later in life.
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Affiliation(s)
- Adriana Pastore
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Giulio Cesare Square, 11, Bari, Italy.
| | | | - Silvio Tafuri
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Aldo Tomasicchio
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Giulio Cesare Square, 11, Bari, Italy
| | - Francesco Margari
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Giulio Cesare Square, 11, Bari, Italy
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Li DJ, Tsai SJ, Chen TJ, Liang CS, Chen MH. Risks of major mental disorders after parental death in children, adolescents, and young adults and the role of premorbid mental comorbidities: a population-based cohort study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2393-2400. [PMID: 35869371 PMCID: PMC9307433 DOI: 10.1007/s00127-022-02334-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/20/2022] [Indexed: 12/03/2022]
Abstract
Previous studies have shown an association between early parental death and the risk of subsequent major mental disorders (MMDs) among the bereaved children and adolescents; however, it is unclear whether this risk exists in young adults and in individuals with premorbid mental comorbidities. We aimed to explore differences between children, adolescents, and young adults in the risk of MMDs after parental death. We analyzed data from the Taiwan National Health Research Database. The index cohort was offspring (divided into four groups: aged < 6, 6-11, 12-17, and 18-29 years) whose parents had died. The control cohort was demographically matched offspring whose parents were still alive. Cox regression with adjustments for demographics was used to estimate the risk of subsequent MMDs between the index and control cohorts, including schizophrenia, bipolar disorder, and depressive disorder. We included 202,837 cases and 2,028,370 matched controls. As with the bereaved children and adolescents, the bereaved young adults had a significantly higher risk of schizophrenia (hazard ratio with 95% confidence interval: 5.63; 5.01-6.33), bipolar disorder (3.37; 2.96-3.84), and depressive disorder (2.78; 2.68-2.90) than the control cohort. The risk of MMDs was similar for maternal death and paternal death. Among premorbid mental comorbidities, bereaved individuals with premorbid substance use disorder were associated with the highest risk of schizophrenia (10.43; 8.57-12.71), bipolar disorder (12.93; 10.59-15.79), and depressive disorder (10.97; 10.22-11.78). Healthcare workers should be aware that young adults and individuals with premorbid mental comorbidities are at a higher risk of subsequent MMDs than those without premorbid mental comorbidities after parental death.
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Affiliation(s)
- Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan ,Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec. 2, Shihpai Road, Beitou District, Taipei, 11217 Taiwan ,Department of Psychiatry, College of Medicine, National-Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ,Institute of Hospital and Health Care Administration, National Yang-Ming Chiao Tung University, Taipei, Taiwan ,Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, 31064 Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, No. 60, Xinmin Road, Beitou District, Taipei, 11243, Taiwan. .,Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec. 2, Shihpai Road, Beitou District, Taipei, 11217, Taiwan. .,Department of Psychiatry, College of Medicine, National-Yang Ming Chiao Tung University, Taipei, Taiwan.
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8
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Syer S, Clarke M, Healy C, O'Donnell L, Cole J, Cannon M, McKay M. The association between familial death in childhood or adolescence and subsequent substance use disorder: A systematic review and meta-analysis. Addict Behav 2021; 120:106936. [PMID: 33975176 DOI: 10.1016/j.addbeh.2021.106936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Exposure to childhood adversity has been linked to long-term negative mental health consequences in adulthood. PURPOSE This review examined the association between exposure to the death of a family member (i.e., parent or sibling) during childhood or adolescence and the subsequent diagnosis of a substance use disorder. METHODS Electronic databases (Scopus, Medline (for Ovid), EMBASE, and PsychINFO) were searched for cohort and case-control studies in the English language. Studies were retained if it was demonstrable that exposure to death occurred before age 18, and that disorder was diagnosed subsequently. Sensitivity analyses were performed for the meta-analysis, and study quality assessed using the Newcastle-Ottawa Scale. RESULTS Nine studies, seven cohort and two case-control, were retained. Due to differential metrics (hazard ratios [HRs] versus odds/risk ratios [ORs/RRs]), only one meta-analysis was possible. Individuals experiencing familial death had 1.42 (95% CI = 0.96, 2.09) times the odds of developing a substance use disorder compared to those non-exposed. Where there was a statistically significant effect in other studies, these were mostly studies using National Registers (1.4 ≤ HR ≤ 2.51). LIMITATIONS Meta-analysis options were limited by the variety of study designs. CONCLUSIONS Evidence for a significant association between familial death and subsequent disorder appears to be an artefact of the study design. Implications of key findings. Further studies are required to better understand and estimate the association between familial death and substance use disorders. Registration and funding. The review was pre-registered (PROSPERO Reg No: CRD42020192892) and funded by the Irish Research Council (COALESCE/2019/61).
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Bylund-Grenklo T, Birgisdóttir D, Beernaert K, Nyberg T, Skokic V, Kristensson J, Steineck G, Fürst CJ, Kreicbergs U. Acute and long-term grief reactions and experiences in parentally cancer-bereaved teenagers. BMC Palliat Care 2021; 20:75. [PMID: 34044835 PMCID: PMC8161967 DOI: 10.1186/s12904-021-00758-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
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
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Affiliation(s)
- Tove Bylund-Grenklo
- Department of Caring Science, Faculty of Health and Occupational Studies, University of Gävle, SE-801 76, Gävle, Sweden.
| | - Dröfn Birgisdóttir
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University and Region Skåne, Medicon Village, Hus 404B, 223 81, Lund, Sweden.
| | - Kim Beernaert
- Ghent University & Vrije Universiteit Brussel (VUB), End-of-Life Care Research Group, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Tommy Nyberg
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK.,Department of Oncology-Pathology, Karolinska Institute, Division of Clinical Cancer Epidemiology, Stockholm, Sweden
| | - Viktor Skokic
- Department of Oncology-Pathology, Karolinska Institute, Division of Clinical Cancer Epidemiology, Stockholm, Sweden
| | - Jimmie Kristensson
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University and Region Skåne, Medicon Village, Hus 404B, 223 81, Lund, Sweden.,Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
| | - Gunnar Steineck
- Department of Oncology-Pathology, Karolinska Institute, Division of Clinical Cancer Epidemiology, Stockholm, Sweden.,Department of Oncology, Sahlgrenska Academy at the University of Gothenburg, Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Gothenburg, Sweden
| | - Carl Johan Fürst
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University and Region Skåne, Medicon Village, Hus 404B, 223 81, Lund, Sweden
| | - Ulrika Kreicbergs
- Department of Caring Sciences, Ersta Sköndal Bräcke University College, Palliative Research Center, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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10
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Kailaheimo-Lönnqvist S, Kotimäki S. Cause of parental death and child's health and education: The role of parental resources. SSM Popul Health 2020; 11:100632. [PMID: 32817879 DOI: 10.1016/j.ssmph.2020.100632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/23/2022] Open
Abstract
Early parental death has been linked to problems in health and educational path. We added to the literature by examining disability pension and various educational outcomes after external (accident, violence, suicide) or natural parental death during childhood or adolescence, taking into account possible heterogeneous associations by parental resources. Using Finnish register data and linear random-effects models, we analysed outcomes of 90,620 and 88,859 children (paternal and maternal death samples, respectively) born between 1982 and 1990. Results indicated lower educational performance and attainment, and a higher probability of disability pension in the bereaved offspring, especially after external parental death. Half of these connections were explained after adjusting for childhood family characteristics. Having a highly educated surviving parent might protect from negative educational and health outcomes. The findings were partly similar for father's and mother's deaths. We demonstrated that the negative associations between parental death and child wellbeing differ by cause of death and parental resources. Cause of death and overall family circumstances should both be considered when analysing child outcomes after parental loss.
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11
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Simbi CMC, Zhang Y, Wang Z. Early parental loss in childhood and depression in adults: A systematic review and meta-analysis of case-controlled studies. J Affect Disord 2020; 260:272-80. [PMID: 31521863 DOI: 10.1016/j.jad.2019.07.087] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/13/2019] [Accepted: 07/29/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Many researchers have concluded that early parental loss during childhood is a risk factor for depression in late life of adults; however others didn't find any association. The objective of this systematic review is to assess whether this association exists or not by conducting a meta-analysis of published studies. METHODS Nine published case-controlled studies were chosen through literature searches in PUBMED, and LIBRARY GENESIS. Newcastle-Ottawa Scale (NOS) have been used to assess the quality of studies included. Thereafter, data were extracted from each study and analysed using ProMeta. RESULTS Nine case-controlled studies (representing n = 2784, cases=716 and controls=2068) were included in meta-analysis. The overall random effects model results of parental loss [OR = 2.18, 95% CI, 1.63-2.90, p < 0.00; I2 = 15.79%, df = 8, p = 0.302], parental death [OR = 1.76, 95% CI, 1.13-2.73, p = 0.012; I2 = 0.00%, df = 3, p = 0.600] and parental separation [OR = 3.14, 95% CI, 1.92-5.15, p < 0.001; I2 = 0.00%, df = 2, p = 0.675] showed a strong positive effect on developing depression in adults. Egger's linear regression test [t = 0.14, p = 0.895] and Begg and Mazumdar's rank correlation test [z = 0.63, p = 0.532] confirmed absence of publication bias of studies included in this meta-analysis. LIMITATIONS This systematic review was limited by a small number of case-controlled studies included in meta-analysis due to the differences in methodological designs of studies. CONCLUSION The study concluded that parental loss, parental death, and parental separation before age 18 are risk factors of depression in adulthood.
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Abstract
Previous research on the impact of parental loss on labor market outcomes in adulthood has often suffered from low sample sizes. To generate further insights into the long-term consequences of parental death, I use the Historical Sample of the Netherlands (HSN). The HSN contains occupational information on life courses of a sample of more than 8,000 males and almost 7,000 females born between 1850 and 1922, a period of important labor market transformations. Roughly 20 % of the sample population experienced parental death before age 16. Linear regression models show that maternal loss is significantly associated with lower occupational position in adulthood for both men and women, which points to the crucial importance of maternal care in childhood for socioeconomic outcomes in later life. This interpretation is supported by the finding that a stepmother's entry into the family is positively related with sons' occupational position later in life. In contrast to expectations, the loss of economic resources related to the father's death is generally not associated with lower status attainment in adulthood for men or for women. The results indicate, however, that the negative consequences of paternal death on men's socioeconomic outcomes decreased over time, illustrating the complex interaction between individual life courses and surrounding labor market transformations.
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Affiliation(s)
- Matthias Rosenbaum-Feldbrügge
- Radboud Group for Historical Demography and Family History, Department of History, Radboud University, Erasmusplein 1, 6525HT, Nijmegen, The Netherlands.
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Lundberg T, Forinder U, Olsson M, Fürst CJ, Årestedt K, Alvariza A. Bereavement stressors and psychosocial well-being of young adults following the loss of a parent - A cross-sectional survey. Eur J Oncol Nurs 2018; 35:33-38. [PMID: 30057081 DOI: 10.1016/j.ejon.2018.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/07/2018] [Accepted: 05/11/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE The knowledge about young adults who have lost a parent to cancer is limited, and to reach a broader understanding about this group, this study used the Dual Process Model of Coping with Bereavement (Stroebe and Schut, 1999) as a theoretical framework. The purpose of this study was to describe loss- and restoration-oriented bereavement stressors and psychosocial wellbeing of young adults following the loss of a parent to cancer. METHOD This survey used baseline data from a longitudinal study. Young adults, aged 16-28 years, who lost a parent to cancer more than two months earlier and agreed to participate in support groups held at three palliative care services in Sweden, responded to a comprehensive theory-based study-specific questionnaire. RESULTS Altogether, 77 young adults (64 women and 13 men) answered the questionnaire an average of five-to-eight months after the loss. Twenty percent (n = 15) had not been aware of their parent's impending death at all or only knew a few hours before the death, and 65% (n = 50) did not expect the death when it occurred. The young adults reported low self-esteem (n = 58, 76%), mild to severe anxiety (n = 55, 74%), mild to severe depression (n = 23, 31%) and low life satisfaction. CONCLUSION Young adults reported overall poor psychosocial wellbeing following bereavement. The unexpectedness and unawareness of the parent's imminent death, i.e., loss-oriented bereavement stressors, might influence psychosocial wellbeing. Despite these reports, restoration-oriented stressors, such as support from family and friends, helped them to cope with the loss.
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Affiliation(s)
- Tina Lundberg
- Department of Neurobiology, Care Sciences and Society/Division of Social Work, Karolinska Institutet, 141 83, Huddinge, Sweden; Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden; Function Area in Social Work and Health, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Ulla Forinder
- Department of Neurobiology, Care Sciences and Society/Division of Social Work, Karolinska Institutet, 141 83, Huddinge, Sweden; Function Area in Social Work and Health, Karolinska University Hospital, 171 76, Stockholm, Sweden; Department of Social Work and Psychology, Gävle University, 801 76, Gävle, Sweden
| | - Mariann Olsson
- Department of Neurobiology, Care Sciences and Society/Division of Social Work, Karolinska Institutet, 141 83, Huddinge, Sweden; Function Area in Social Work and Health, Karolinska University Hospital, 171 76, Stockholm, Sweden; Stockholms Sjukhem Foundation, Box 12230, 102 26, Stockholm, Sweden
| | - Carl Johan Fürst
- The Institute for Palliative Care at Lund University and Region Skåne, Department of Clinical Sciences, Oncology, Lund University, Box 117, 221 00, Lund, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Science, Linnaeus University, 391 82 Kalmar, Sweden; Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden; Kalmar County Council, Box 601, 391 26, Kalmar, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden; Capio Palliative Care Unit, Dalen Hospital, Åstorpsringen 6, Enskededalen, 121 87, Stockholm, Sweden
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Bergman AS, Axberg U, Hanson E. When a parent dies - a systematic review of the effects of support programs for parentally bereaved children and their caregivers. BMC Palliat Care 2017; 16:39. [PMID: 28797262 PMCID: PMC5553589 DOI: 10.1186/s12904-017-0223-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 07/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The death of a parent is a highly stressful life event for bereaved children. Several studies have shown an increased risk of mental ill-health and psychosocial problems among affected children. The aims of this study were to systematically review studies about effective support interventions for parentally bereaved children and to identify gaps in the research. METHODS The review's inclusion criteria were comparative studies with samples of parentally bereaved children. The focus of these studies were assessments of the effects on children of a bereavement support intervention. The intervention was directed towards children 0-18 years; but it could also target the children's remaining parent/caregiver. The study included an outcome measure that dealt with effects of the intervention on children. The following electronic databases were searched up to and including November 2015: PubMed, PsycINFO, Cinahl, PILOTS, ProQuest Sociology (Sociological Abstracts and Social Services Abstracts). The included studies were analysed and summarized based on the following categories: type of intervention, reference and grade of evidence, study population, evaluation design, measure, outcome variable and findings as effect size within and between groups. RESULTS One thousand, seven hundred and-six abstracts were examined. Following the selection process, 17 studies were included. The included studies consisted of 15 randomized controlled studies, while one study employed a quasi-experimental and one study a pre-post-test design. Thirteen studies provided strong evidence with regards to the quality of the studies due to the grade criteria; three studies provided fairly strong evidence and one study provided weaker evidence. The included studies were published between 1985 and 2015, with the majority published 2000 onwards. The studies were published within several disciplines such as psychology, social work, medicine and psychiatry, which illustrates that support for bereaved children is relevant for different professions. The interventions were based on various forms of support: group interventions for the children, family interventions, guidance for parents and camp activities for children. In fourteen studies, the interventions were directed at both children and their remaining parents. These studies revealed that when parents are supported, they can demonstrate an enhanced capacity to support their children. In three studies, the interventions were primarily directed at the bereaved children. The results showed positive between group effects both for children and caregivers in several areas, namely large effects for children's traumatic grief and parent's feelings of being supported; medium effects for parental warmth, positive parenting, parent's mental health, grief discussions in the family, and children's health. There were small effects on several outcomes, for example children's post-traumatic stress disorder (PTSD) symptoms, anxiety, depression, self-esteem and behaviour problems. There were studies that did not show effects on some measures, namely depression, present grief, and for the subgroup boys on anxiety, depression, internalizing and externalizing. CONCLUSIONS The results indicate that relatively brief interventions can prevent children from developing more severe problems after the loss of a parent, such as traumatic grief and mental health problems. Studies have shown positive effects for both children's and remaining caregiver's health. Further research is required including how best to support younger bereaved children. There is also a need for more empirically rigorous effect studies in this area.
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Affiliation(s)
- Ann-Sofie Bergman
- Department of Social Work, Swedish Family Care Competence Centre, Linnaeus University, SE-351 95 Vaxjo, Sweden
| | - Ulf Axberg
- Department of psychology, University of Gothenburg, SE-40530 Gothenburg, Sweden
| | - Elizabeth Hanson
- Swedish Family Care Competence Centre, Linnaeus University, SE-391 82 Kalmar, Sweden
- University of Sheffield, Sheffield, UK
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Kravdal Ø, Grundy E. Health effects of parental deaths among adults in Norway: Purchases of prescription medicine before and after bereavement. SSM Popul Health 2017; 2:868-875. [PMID: 28470035 PMCID: PMC5404113 DOI: 10.1016/j.ssmph.2016.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 01/23/2023] Open
Abstract
We analyse effects of parental deaths on the health of women and men aged 18–59 in 2004–2008, indicated by purchases of prescription medicines. Register data covering the entire Norwegian population were used, and fixed-effects models were estimated to control for unobserved time-invariant individual factors. A parent's death seemed to have immediate adverse consequences in both main age groups considered (18–39, 40–59), although effects were lower in the older group. Some results suggested that this health disadvantage widened with increasing time since the parent's death. However, effects were weak: the annual number of different medicines purchased was only increased by 1–7% as a result of losing a parent. Death of a parent was associated with an immediate increase in purchases of medication for mental diseases, and there were indications of a physical response as well. As time since the parental death increased, there was a decline in the purchase of medication for mental diseases, but an opposite trend with respect to medication for other diseases. On the whole, maternal and paternal deaths had the same impact, and effects on daughters and sons were of the same magnitude. A parent’s death seemed to have immediate weakly adverse health consequences. Some results suggested that this health disadvantage widened with time since death. The effects on physical and mental health seemed to be different. Purchases of prescription medicine were used as indicators of health. Unobserved time-invariant individual factors were controlled for.
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Affiliation(s)
- Øystein Kravdal
- Department of Economics, University of Oslo, Norway.,Norwegian Institute of Public Health, Norway
| | - Emily Grundy
- Department of Social Policy, London School of Economics and Political Science, London, UK
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Sheehan DK, Mayo MM, Christ GH, Heim K, Parish S, Shahrour G, Draucker CB. Two worlds: Adolescents' strategies for managing life with a parent in hospice. Palliat Support Care 2016; 14:177-86. [PMID: 26126748 DOI: 10.1017/S1478951515000735] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study aimed to generate an explanatory model of the coping strategies that adolescents employ to manage the stressors they experience in the final months of their ill parent's life and shortly after their death. METHOD The sample included 26 families of adolescents with a parent receiving care in a large hospice program in northeastern Ohio. A semistructured interview was conducted with 14 ill parents, 17 well parents/guardians, and 30 of their adolescent children before the parent's death and, additionally, with 6 of these families after the death. The interviews were audiotaped, transcribed verbatim, and analyzed using a grounded-theory approach. RESULTS The participants described two worlds that constituted the lives of the adolescents: the well world of normal adolescence and the ill world of having a parent near the end of life. The adolescents experienced a common challenge of living in two worlds and responded to the challenge with a process we labeled "managing two worlds." Five stages through which adolescents manage their worlds were identified: keeping the ill world and the well world separate; having the ill world intrude into the well world; moving between the ill world and the well world; being immersed in the ill world; and returning to the well world having been changed by the ill world. SIGNIFICANCE OF RESULTS The explanatory model of "managing two worlds" outlines a complex and nuanced process that changes over time. The model can be used by health professionals who seek to help adolescents navigate this critical time when their parents are dying or have recently died. These results can also be used to inform the development of interventions that assist families with strategies tailored to an adolescent's specific needs. Future research should investigate associations among the process of "managing two worlds" and outcomes related to adolescent bereavement.
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Mueller SC, Baudoncq R, De Schryver M. The effect of parental loss on cognitive and affective interference in adolescent boys from a post-conflict region. J Adolesc 2015; 42:11-9. [PMID: 25899130 DOI: 10.1016/j.adolescence.2015.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/22/2015] [Accepted: 03/29/2015] [Indexed: 02/05/2023]
Abstract
Little is known about the impact of early-life stressors such as parental loss on cognitive-affective processing during adolescence, especially in regions chronically affected by war and armed conflict. Here, we tested 72 male adolescents living in Northern Uganda (ages 14-19), 52 of whom still had both of their parents and 20 participants who had experienced parental loss. Participants completed a classic color-naming Stroop task as well as an affective interference task, the opposite emotions test (OET). Adolescents with parental loss showed a decrease in performance over time, especially on the Stroop task. Critically, this decrement in performance was positively associated with reported symptoms of trauma, but only in the parental loss group. The current data suggest a difficulty in maintaining cognitive control performance in youths with experience of parental loss. The findings are discussed in relation to traumatic stress and mental health in post-conflict regions.
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Affiliation(s)
- S C Mueller
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium.
| | - R Baudoncq
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - M De Schryver
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
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Shaw TV, Bright CL, Sharpe TL. Child welfare outcomes for youth in care as a result of parental death or parental incarceration. Child Abuse Negl 2015; 42:112-120. [PMID: 25641050 DOI: 10.1016/j.chiabu.2015.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/30/2014] [Accepted: 01/01/2015] [Indexed: 06/04/2023]
Abstract
Every day, in the United States, children are removed from their homes and placed into state supervised out-of-home care because of concerns around their safety. These children enter care as a result of child abuse, child neglect, abandonment or some other reasons. Lost in most discussions of out-of-home care is the role that parental incarceration and parental death have on the trajectory of children through the child welfare system. In order to address this gap in the literature, the present study aims to compare youth in foster care as a result of parental death or youth in foster care as a result of parental incarceration with youth in care because of child maltreatment in terms of the length of time to achieve permanency. Holding all other variables constant, entering care as a result of parental death more than doubled the average time to exit (HR=2.32, SE=0.22), and these youth were significantly less likely to exit to permanency when compared to children entering care for other maltreatment reasons (OR=0.35, SE=0.24). Entering care as a result of parental incarceration led to a 24% longer time to exit (HR=1.24, SE=0.09) compared to children entering care for other maltreatment reasons. Findings suggest that a one-size-fits-all approach to policy and practice may not be useful to identifying permanent placements for children entering care as a result of parental death or incarceration.
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Affiliation(s)
- Terry V Shaw
- University of Maryland School of Social Work, 525 W. Redwood Street, Baltimore, MD 21201, USA
| | - Charlotte Lyn Bright
- University of Maryland School of Social Work, 525 W. Redwood Street, Baltimore, MD 21201, USA
| | - Tanya L Sharpe
- University of Maryland School of Social Work, 525 W. Redwood Street, Baltimore, MD 21201, USA
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Mentec M, Flahault C. [ Parental death in childhood: the state of theoretical knowledge and clinical challenges in the future]. Bull Cancer 2015; 102:287-94. [PMID: 25732046 DOI: 10.1016/j.bulcan.2015.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 01/15/2015] [Indexed: 11/23/2022]
Abstract
Although children's psychological adaptation to parental cancer is a wide field for psycho-oncological research, few empirical studies target children bereavement specifically following parental cancer. In this paper, our purpose is to make a state of art about literature concerning parental death. Literature dealing with grief concerns psychopathological consequences of parental loss and most recently post-traumatic growth. Although references about support programs have emerged, few of these programs have been scientifically evaluated. This review underlines that more studies are needed with prospective quantitative and qualitative studies, in order to describe more precisely children bereavement process and long term effects of bereavement. Psychological support for other family members and evaluation of support programs seem to be critical to improve children adaptation to parental death.
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Abstract
Early-life parental death (PD) may increase suicide and other mortality risk in adulthood. The potential implications of subsequent remarriage of the widowed parent (RWP) for suicide have not been well examined. Data came from the Utah Population Database for birth cohorts between 1886 and 1960, yielding a sample of N = 663,729 individuals, including 4533 suicides. Cox models showed PD was associated with increased adult suicide risk before age 50, and with increased risk of cardiovascular disease deaths (CVD) for adults of all ages. For females, RWP attenuated the suicide relationship before age 50 (though not statistically significant), but significantly exacerbated it after age 50. RWP had no significant impact for males. Further, for females, PD's positive association with suicide was stronger than with CVD before age 50. These findings reinforce the importance of biological and social mechanisms in linking early-life stressors to adult mental and physical health.
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Affiliation(s)
- Michael S Hollingshaus
- Department of Sociology, University of Utah, 380 S 1530 E Rm 301, Salt Lake City, UT 84112, United States.
| | - Ken R Smith
- Department of Family and Consumer Studies and Population Sciences, Huntsman Cancer Institute, University of Utah, United States
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Myrskylä M, Elo IT, Kohler IV, Martikainen P. The association between advanced maternal and paternal ages and increased adult mortality is explained by early parental loss. Soc Sci Med 2014; 119:215-23. [PMID: 24997641 DOI: 10.1016/j.socscimed.2014.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/30/2014] [Accepted: 06/09/2014] [Indexed: 01/23/2023]
Abstract
The association between advanced maternal and paternal ages at birth and increased mortality among adult offspring is often attributed to parental reproductive aging, e.g., declining oocyte or sperm quality. Less attention has been paid to alternative mechanisms, including parental socio-demographic characteristics or the timing of parental death. Moreover, it is not known if the parental age-adult mortality association is mediated by socioeconomic attainment of the children, or if it varies over the lifecourse of the adult children. We used register-based data drawn from the Finnish 1950 census (sample size 89,737; mortality follow-up 1971-2008) and discrete-time survival regression with logit link to analyze these alternative mechanisms in the parental age-offspring mortality association when the children were aged 35-49 and 50-72. Consistent with prior literature, we found that adult children of older parents had increased mortality relative to adults whose parents were aged 25-29 at the time of birth. For example, maternal and paternal ages 40-49 were associated with mortality odds ratios (ORs) of 1.31 (p<.001) and 1.22 (p<.01), respectively, for offspring mortality at ages 35-49. At ages 50-72 advanced parental age also predicted higher mortality, though not as strongly. Adjustment for parental socio-demographic characteristics (education, occupation, family size, household crowding, language) weakened the associations only slightly. Adjustment for parental survival, measured by whether the parents were alive when the child reached age 35, reduced the advanced parental age coefficients substantially and to statistically insignificant levels. These results indicate that the mechanism behind the advanced parental age-adult offspring mortality association is mainly social, reflecting early parental loss and parental characteristics, rather than physiological mechanisms reflecting reproductive aging.
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Affiliation(s)
- Mikko Myrskylä
- Department of Social Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK; Population Research Unit, Department of Social Research, University of Helsinki, P.O. Box 18, 00014, Finland.
| | - Irma T Elo
- Population Studies Center, University of Pennsylvania, 3718 Locust Walk, McNeil Building, Philadelphia, PA 19104-6299, USA; Department of Sociology, University of Pennsylvania, 3718 Locust Walk, McNeil Building, Ste. 113, Philadelphia, PA 19104-6299, USA.
| | - Iliana V Kohler
- Population Studies Center, University of Pennsylvania, 3718 Locust Walk, McNeil Building, Philadelphia, PA 19104-6299, USA; Population Aging Research Center (PARC), University of Pennsylvania, 3718 Locust Walk, McNeil Building, Ste. 113, Philadelphia, PA 19104-6299, USA.
| | - Pekka Martikainen
- Population Research Unit, Department of Social Research, University of Helsinki, P.O. Box 18, 00014, Finland.
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