Nothing is more devastating for a parent than the death of a child. The overwhelming and painful experience of enduring a child's admission to a neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU) and their eventual death throws them into a crisis. Many also are faced with the difficult decision to limit treatment or withdraw life support. Yet, few studies have examined parents' mental health and personal growth, especially in black and Hispanic parents, following their child's death in the NICU or PICU.
Researchers from the Christine E. Lynn College of Nursing at Florida Atlantic University and collaborators conducted a longitudinal study with a racially and ethnically diverse sample to look at the relationships between spiritual and religious coping strategies, and grief, mental health, including depression and post-traumatic stress disorder (PTSD), and personal growth for parents at one and three months following the death of their child in a NICU or PICU.
"Losing a child and the resulting stress disrupts parents' mental and physical health, and can occur during the early phase of grieving and continue for years afterward," said Dawn M. Hawthorne, Ph.D., R.N., first author of the study and an assistant professor in FAU's College of Nursing. "We wanted to better understand if spiritual coping strategies would be helpful to parents at this time of very high stress."
For the study, the researchers measured variables of grief including hopelessness, sadness and loneliness as well as depression and PTSD. They also measured spiritual coping, which included religious activities and spiritual activities such as self-reflection and confiding in family and friends.
Results of the study, which are published in the Journal of Pediatric Nursing, suggest that mothers' and fathers' spiritual activities at one month post-death resulted in less severe symptoms of grief at both one and three months. Use of religious activities was helpful in reducing fathers' grief at one month, but not at three months; yet these activities were not related to mothers' grief at either time point. This suggests that spiritual activities may assist bereaved mothers to reduce their symptoms of grief, depression, PTSD and increase personal growth over a longer period of time than religious activities.
"Our findings suggest that fathers may find more solace in religious activities than mothers," said Hawthorne. "If so, then use of both religious and spiritual activities may help fathers move through their grieving process faster, allowing them to return to their previous routines such as getting back to work earlier than bereaved mothers."
The findings also showed that mothers' use of spiritual activities, but not religious activities, was related to less severe symptoms of depression and PTSD at one and three months. Bereaved mothers valued the social support from family and friends and used non-religious activities to relieve feelings of hopelessness, sadness and loneliness. Non-religious activities helped mothers to connect with their inner self, to acknowledge their strengths, and to ultimately find peace.
"Bereaved mothers need to talk more about the death of their child than bereaved fathers, whereas bereaved fathers were found to cope with their grief by isolating themselves from family and friends," said Hawthorne. "While religious activities might be helpful in the first month after a child's death, maybe religious activities come into play later when their anger with God has diminished. The use of spiritual activities such as self-reflection, confiding in others, and cultivating friendships may be more helpful to parents over time."
The study provides evidence for health care professionals about the importance of spiritual coping activities for bereaved mothers and fathers. Hawthorne expects that dissemination of this information in the clinical areas to nurses and other health care team members will enable bereaved parents to receive relevant and appropriate support following the death of their child.
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