When a parent dies suddenly, most children and teens experience grief that fades over time, but some have increased or prolonged grief reactions that may increase the risk of depression and inability to function normally, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
According to background information in the article, 4 percent of children and adolescents in Western countries experience a parental death, including 5 percent of U.S. individuals under 18 years old. The authors report that a parent's death can be one of the most stressful life events for a young person. While research has enhanced the understanding of the nature and course of adult grief, the authors write, "Relatively little is known about the course of grief in children and adolescents." (The authors define "grief" as "the subjective experience of loss," and "bereavement" as referring to "status with respect to loss, regardless of subjective experience.") The investigators examined the grief reactions of children and adolescents after a parent's sudden death to determine how those reactions affected bereaved participants' mental well-being and ability to function.
Nadine M. Melhem, Ph.D., from the Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, and colleagues studied children, adolescents and families experiencing a parental death from July 2002 to January 2007. The researchers used coroners' reports and a newspaper advertisement to recruit participants ages 7 through 18 years whose parent died by suicide, unintentional injury or sudden natural causes. A modified version of the adult Inventory of Complicated Grief was used to assess the state of grief in child and adolescent participants; the original version of this instrument was completed by surviving parents. Other assessment tools were used to determine whether children and adolescents experienced other psychiatric disorders and functional impairment and to evaluate the severity of their grief symptoms. Assessments occurred at baseline, a mean (average) of 8.5 months after the parent died; approximately one year later; and approximately two years after the parental death. Of the 182 initial child and adolescent participants, 165 and 141 completed the one- and two-year follow-ups, respectively.
For most participants (58.8 percent), grief scores decreased significantly between nine and 21 months after the parent's death and then stayed low. In a second group (30.8 percent), grief reactions increased at about nine months but then steadily declined through the 33rd month after the parent died. Grief scores were high at the ninth month and remained high through the 33rd month for 10.4 percent of participants.
Parental death due to unintentional injury and higher self-reported depression at nine months were associated with higher grief scores. The 10.4 percent of participants with high grief scores that did not decline much were more likely to have functional impairment at nine months post-parental death, a previous history of depression and new-onset posttraumatic stress disorder. Children and adolescents were more likely to experience depression during follow-up if their surviving parent had complicated or prolonged grief, if they felt others were accountable for the death or if they experienced other life events since the death.
The authors summarize that prolonged grief appears to contribute to functional impairment and psychiatric problems in children and adolescents after the sudden death of a parent. They suggest that interventions which focus on prolonged grief be developed for these young people, as well as for those with increased grief reactions at nine months after the parent's death. Lastly, the authors point out that the surviving parent's grief reaction was associated with the risk that children and teens with complicated grief would develop depression. "These findings have important clinical implications regarding intervention and prevention efforts," they write. "It is imperative to assess the surviving parent and to intervene, when appropriate, to improve the outcomes for parentally bereaved children and adolescents."
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