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Howdle C, Wright WJA, Mant J, De Simoni A. Factors Influencing Recovery From Pediatric Stroke Based on Discussions From a UK-Based Online Stroke Community: Qualitative Thematic Study. J Med Internet Res 2024; 26:e49409. [PMID: 38625726 PMCID: PMC11061792 DOI: 10.2196/49409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 02/04/2024] [Accepted: 03/08/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The incidence of stroke in children is low, and pediatric stroke rehabilitation services are less developed than adult ones. Survivors of pediatric stroke have a long poststroke life expectancy and therefore have the potential to experience impairments from their stroke for many years. However, there are relatively few studies characterizing these impairments and what factors facilitate or counteract recovery. OBJECTIVE This study aims to characterize the main barriers to and facilitators of recovery from pediatric stroke. A secondary aim was to explore whether these factors last into adulthood, whether they change, or if new factors impacting recovery emerge in adulthood. METHODS We performed a qualitative thematic analysis based on posts from a population of participants from a UK-based online stroke community, active between 2004 and 2011. The analysis focused on users who talked about their experiences with pediatric stroke, as identified by a previous study. The posts were read by 3 authors, and factors influencing recovery from pediatric stroke were mapped into 4 areas: medical, physical, emotional, and social. Factors influencing recovery were divided into short-term and long-term factors. RESULTS There were 425 posts relating to 52 survivors of pediatric stroke. Some survivors of stroke posted for themselves, while others were talked about by a third party (mostly parents; 31/35, 89% mothers). In total, 79% (41/52) of survivors of stroke were aged ≤18 years and 21% (11/52) were aged >18 years at the time of posting. Medical factors included comorbidities as a barrier to recovery. Medical interventions, such as speech and language therapy and physiotherapy, were also deemed useful. Exercise, particularly swimming, was deemed a facilitator. Among physical factors, fatigue and chronic pain could persist decades after a stroke, with both reported as a barrier to feeling fully recovered. Tiredness could worsen existing stroke-related impairments. Other long-standing impairments were memory loss, confusion, and dizziness. Among emotional factors, fear and uncertainty were short-term barriers, while positivity was a major facilitator in both short- and long-term recovery. Anxiety, grief, and behavioral problems hindered recovery. The social barriers were loneliness, exclusion, and hidden disabilities not being acknowledged by third parties. A good support network and third-party support facilitated recovery. Educational services were important in reintegrating survivors into society. Participants reported that worrying about losing financial support, such as disability allowances, and difficulties in obtaining travel insurance and driving licenses impacted recovery. CONCLUSIONS The lived experience of survivors of pediatric stroke includes long-term hidden disabilities and barriers to rehabilitation. These are present in different settings, such as health care, schools, workplaces, and driving centers. Greater awareness of these issues by relevant professional groups may help ameliorate them.
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Affiliation(s)
- Charlotte Howdle
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Anna De Simoni
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Rubin SS, Manevich A, Yehene E. Continuing Bonds in Marriage, Death and Divorce: Conceptual and Clinical Considerations in the Relationship to Self and Spouse. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241226471. [PMID: 38226449 DOI: 10.1177/00302228241226471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
The shift from the detachment model of mourning to the continuing bonds paradigm in bereavement placed relationships to the deceased alongside relationships to the living. This emphasis on the continuation of the connection to the other person after death paradoxically narrowed the gap between relationships in life and after death. We explore and expand the concept of continuing bonds as it is now used in the field of loss and bereavement by comparing spousal relationships in the living, deceased and divorced. The Two-Track Model of Loss and Bereavement is a framework and clinical paradigm that clarifies similarities and differences in these three pair-bond relationships. The focus on continuing bonds adds and deepens theory, clinical and research aspects of assessing spousal relationship for the living as well as the bereaved and divorced.
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Affiliation(s)
- Simon Shimshon Rubin
- International Laboratory for the Study of Loss, Bereavement and Human Resilience, School of Psychological Sciences, University of Haifa, Haifa, Israel
- Department of Psychology, Max Stern Yezreel Valley College, Jezreel Valley, Israel
| | - Alexander Manevich
- Department of Psychology and Department of Behavioral Sciences, Kinneret Academic College and International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Einat Yehene
- School of Behavioral Sciences, The Academic College to Tel Aviv - Yaffo, Tel Aviv, Israel
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Sadeh Y, Graham L, Curtis M, Janson M, Kim J, Schwartz A, Undset A, Denejkina A. Posttraumatic stress and depression symptom classes in parents of trauma-exposed children: a transdiagnostic perspective using pooled individual participant data. Eur J Psychotraumatol 2024; 15:2299194. [PMID: 38197328 PMCID: PMC10783838 DOI: 10.1080/20008066.2023.2299194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024] Open
Abstract
Background: In the aftermath of child trauma, post-traumatic stress (PTS) and depression symptoms often co-occur among trauma exposed children and their parents. Studies have used latent class analysis (LCA) to examine PTS and depression symptoms and identify homogeneous subgroups among trauma exposed children. However, little is known about subgroups or classes of PTS and depression reactions of parents of traumatised children.Objectives: (1) Determine PTS and depression symptom classes at 2-9 months post-trauma, and (2) to examine sociodemographic covariates among parents of trauma exposed children.Methods: Using harmonised individual participant data (n = 702) from eight studies (Australia, UK, US) included in the Prospective studies of Acute Child Trauma and Recovery Data Archive (PACT/R), we modelled these phenomena at the symptom level using LCA.Results: Our LCA yielded three solutions: 'high internalizing symptom' class (11%); 'low PTS-high depression' class (17%); and 'low internalizing symptom' class (72%). Parents of children in the 'low PTS-high depression' class were more likely to have children of older age and be part of an ethnic minority, compared to the 'low internalizing symptoms' class. Mothers were more likely to be in the 'high internalizing symptom' class compared to the 'low internalizing symptoms' class.Conclusions: These findings reveal a qualitative structure and relationship between depression and PTS symptoms that highlights the importance of assessing and targeting a broad range of internalising symptoms in post-trauma psychological treatment.
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Affiliation(s)
- Yaara Sadeh
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Leila Graham
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael Curtis
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Melissa Janson
- Gevirtz Graduate School of Education, Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, CA, USA
| | - Jeeeun Kim
- Soro Orot Institute, Inc. (Soro Orot Institute – Counselor Group for Counseling and Education of Multicultural and Social Justice Issues), Seoul, Korea
| | - Ashlyn Schwartz
- Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
- Department of Public Health, University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Andrea Undset
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Anna Denejkina
- Translational Health Research Institute; YouthInsight, Sydney, Australia
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Phillips B. Caring for a Child With an Acquired Disability: Unveiling Light From Darkness. ANS Adv Nurs Sci 2024; 47:89-103. [PMID: 36745159 DOI: 10.1097/ans.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study explored how parents of children with acquired disabilities transform loss into meaning when faced with traumatic experiences. This type of loss is ambiguous and different from that of the bereaved. Directed content analysis was guided by the predetermined categories of unveiling, darkness, and light. Stories from 8 parents revealed the ability to decide how they perceived their experiences, discovering meaning in caring for their child despite the suffering associated with loss. These findings offer direction for nursing research, practice, and policy on how to assist parents in overcoming these challenges and shed light on the dynamic perspectives of loss.
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Affiliation(s)
- Brad Phillips
- West Virginia University School of Nursing, Morgantown
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5
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Manevich A, Yehene E, Rubin SS. A case for inclusion of disordered Non-Death Interpersonal Grief as an official diagnosis: rationale, challenges and opportunities. Front Psychiatry 2023; 14:1300565. [PMID: 38161721 PMCID: PMC10757611 DOI: 10.3389/fpsyt.2023.1300565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Alexander Manevich
- Department of Psychology, Kinneret Academic College, Tzemach, Israel
- Department of Behavioral Sciences, Kinneret Academic College, Tzemach, Israel
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Einat Yehene
- School of Behavioral Sciences, Academic College Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Simon Shimshon Rubin
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
- Department of Psychology, Max Stern Academic College of Emek Yezreel, Jezreel Valley, Israel
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6
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Sargénius HL, Andersson S, Haugen I, Hypher R, Brandt AE, Finnanger TG, Rø TB, Risnes K, Stubberud J. Cognitive rehabilitation in paediatric acquired brain injury-A 2-year follow-up of a randomised controlled trial. Front Neurol 2023; 14:1173480. [PMID: 37325227 PMCID: PMC10267836 DOI: 10.3389/fneur.2023.1173480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/26/2023] [Indexed: 06/17/2023] Open
Abstract
Background Goal management training (GMT), a metacognitive rehabilitation method that has been demonstrated to improve executive function (EF) in adults with acquired brain injury (ABI), could potentially be effective for children in the chronic phase of ABI. In a previously published randomised controlled trial (RCT), the efficacy of a paediatric adaptation of GMT (pGMT) compared to a psychoeducative control intervention (paediatric Brain Health Workshop, pBHW) was investigated. Comparable improvements in EF in both groups were found at 6-month follow-up. However, a specific effect of pGMT could not be conclusively proven. The present study reports 2-year follow-up data (T4; T1: baseline, T2: post-intervention, T3: 6-month follow-up, and T4: 2-year follow-up) from this original RCT. Methods A total of 38 children and adolescents and also their parents completed questionnaires tapping into daily life EF. Explorative analyses were conducted comparing the 2-year follow-up data (T4) with the baseline (T1) and 6-month follow-up data (T3) for T4-participants in the two intervention groups (pGMT; n = 21, pBHW; n = 17), and we also assessed T4-participants vs. non-responders (n = 38) in the RCT. Primary outcome measures were the Behavioural Regulation Index (BRI) and the Metacognition Index (MI) derived from the Behaviour Rating Inventory of Executive Function (BRIEF) parent report. Results No difference between intervention groups was found (BRI, F = 2.25, p = 0.143, MI, F = 1.6, p = 0.213), and no time*group interaction (BRI, F = 0.07, p = 0.976, MI, F = 0.137, p = 0.937) could be seen at the 2-year follow-up. Nevertheless, both pGMT and the pBHW groups improved daily EF as measured by parental reports over time from the baseline to T4 (p = 0.034). T4 participants and non-responders shared similar baseline characteristics. Conclusion Our results extend the findings from the 6-month follow-up previously published. Both pGMT and pBHW groups sustained their improvements in daily life EFs from the baseline, but additional effectiveness of pGMT relative to pBHW was not found.
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Affiliation(s)
| | - Stein Andersson
- Department of Psychology, University of Oslo, Oslo, Norway
- Psychosomatic Medicine and Clinical Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Ingvild Haugen
- Division of Mental Health Care, Innlandet Hospital Trust, Brumunddal, Norway
| | - Ruth Hypher
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Anne Elisabeth Brandt
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
- Children's Clinic, St. Olav University Hospital, Trondheim, Norway
| | | | - Torstein B. Rø
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
- Children's Clinic, St. Olav University Hospital, Trondheim, Norway
| | - Kari Risnes
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
- Children's Clinic, St. Olav University Hospital, Trondheim, Norway
| | - Jan Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
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Yehene E, Zukerman H, Goldzweig G, Gerner M, Brezner A, Landa J. Perfectionism, Big Five and biopsychosocial functioning among parents of children with and without acquired brain injury (ABI). Brain Inj 2022; 36:860-867. [PMID: 35727894 DOI: 10.1080/02699052.2022.2077443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Personality factors are often investigated in the context of parenting but are rarely studied in relation to coping with child disabilities like pediatric acquired brain injury (pABI). This study (1) compares Biopsychosocial functioning (BPSF), Big Five personality traits, and dimensions of perfectionism of parents of children with and without pABI, and (2) examines the role personality factors play in parental BPSF in each group. METHOD 57 parents of children who sustained a significant pABI and 50 parents of typically developing children participated in this cross-sectional study. Parents completed scales measuring Multidimensional Perfectionism, Big Five inventory, and BPSF. RESULTS Among the pABI group, multivariate analysis indicated significantly poorer BPSF, higher levels of neuroticism, socially prescribed perfectionism, and lower levels of openness, than controls. Regression analysis showed that personality explained 60.5% of the variance in parental BPSF post pABI. In both samples, neuroticism and socially prescribed perfectionism appeared as two prominent personality factors with a significant negative effect on parental BPSF, while self-perfectionism appeared prominent only in the pABI group, indicating a significant positive effect. IMPLICATIONS pABI may result in changes to parents` personality. Personality characteristics significantly contribute to parental BPSF post-injury and should be addressed in clinical practice.
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Affiliation(s)
- Einat Yehene
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel.,Pediatric Rehabilitation Department Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Remat-Gan, Israel
| | - Hadas Zukerman
- Pediatric Rehabilitation Department Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Remat-Gan, Israel
| | - Gil Goldzweig
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Maya Gerner
- Pediatric Rehabilitation Department Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Remat-Gan, Israel
| | - Amichai Brezner
- Pediatric Rehabilitation Department Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Remat-Gan, Israel
| | - Jana Landa
- Pediatric Rehabilitation Department Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Remat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sadeh Y, Dekel R, Brezner A, Landa J, Silberg T. Families following pediatric traumatic medical events: identifying psychosocial risk profiles using latent profile analysis. Eur J Psychotraumatol 2022; 13:2116825. [PMID: 36186160 PMCID: PMC9518403 DOI: 10.1080/20008066.2022.2116825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) are often experienced by children and family members after pediatric traumatic medical events (PTMEs). Assessing families' psychosocial risk factors is a crucial part of trauma-informed practice as it helps identify risk for PTSS in the aftermath of PTME. OBJECTIVES Using the Psychosocial Assessment Tool 2.0 (PAT2.0), this study describes the psychosocial risk of families following PTMEs in two ways: 1. Describing the psychosocial risk defined by the PAT2.0 based on three-tiered risk levels; 2. Using latent profile analysis (LPA); identifying psychosocial risk profiles and examining how child- and injury-related factors can affect profile membership. METHODS Caregivers of 374 children following PTMEs admitted to a pediatric rehabilitation department in Israel completed the PAT2.0. Total PAT2.0 score and the seven PAT2.0 subscales (family structure/resources, social support, child problems, sibling problems, family problems, caregiver stress reactions, and family beliefs) were included in the first analysis. Mean PAT2.0 scores of three risk categories (universal, targeted, clinical) were calculated; LPA, which allows for cross-sectional latent variable mixture models to identify heterogeneity within a population, and multinomial logistic regressions using six out of the seven PAT2.0 subscales, were used to determine distinct profile differences and predictors of profile membership. RESULTS The three-tiered risk levels revealed were relatively high, as compared to levels in families of children with other clinical diagnoses. LPA yielded a three-profile solution: low family risk (63.53%); high caregiver stress, above-average levels of family risk (22.5%); and sibling problems, above-average levels of family risk (13.94%). Ethnicity and type of injury predicted group membership. CONCLUSION Families of children following PTMEs are at increased psychosocial risk. A clinically useful approach to identifying and preventing PTSS may be to evaluate specific domain patterns rather than just the total PAT2.0 risk level alone, based on the PAT2.0 subscales.
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Affiliation(s)
- Yaara Sadeh
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel.,Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel
| | - Jana Landa
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-aviv, Israel
| | - Tamar Silberg
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Department of Psychology, Bar Ilan University, Ramat Gan, Israel
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Yehene E, Steinberg P, Gerner M, Brezner A, Landa J. "Concurrent Ropes and Ladders": Mapping and Conceptualizing the Emotional Loss Experience of Parents Following Pediatric Acquired Brain Injury. QUALITATIVE HEALTH RESEARCH 2021; 31:1518-1533. [PMID: 34024215 PMCID: PMC8278457 DOI: 10.1177/10497323211012384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This grounded theory study aims to map, conceptualize, and theorize the emotional loss experienced by parents following their child's pediatric acquired brain injury (pABI). Data were obtained from 47 semi-structured interviews conducted with parents (72% mothers) at least 1 year following pABI. The study's theory of "concurrent ropes and ladders" emerged from a process of initial in vivo coding followed by focused and thematic coding. Codes were consolidated into five thematic categories capturing parents' emotional continuous loss experience: (a) comparing life before and after, (b) struggling to construct new realities, (c) recognizing instability and permanency, (d) adjusting and readjusting, and (e) grieving as an emotional shadow. These categories are at work simultaneously in parents' accounts, thus supporting a model of dynamic concurrency within and across their lived experiences. Recommendations for practitioners were derived from the theory to support parents' emotional coping with living loss throughout the chronic stage.
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Affiliation(s)
- Einat Yehene
- The Academic College of Tel Aviv–Yaffo, Tel Aviv, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | | | | | | | - Jana Landa
- Sheba Medical Center, Ramat Gan, Israel
- Tel Aviv University, Tel Aviv, Israel
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10
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Yehene E, Manevich A, Rubin SS. Caregivers' Grief in Acquired Non-death Interpersonal Loss (NoDIL): A Process Based Model With Implications for Theory, Research, and Intervention. Front Psychol 2021; 12:676536. [PMID: 33995234 PMCID: PMC8119762 DOI: 10.3389/fpsyg.2021.676536] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/07/2021] [Indexed: 12/31/2022] Open
Abstract
The number of family members caring and caregiving for a loved one undergoing physical and mental changes continues to increase dramatically. For many, this ongoing experience not only involves the “burden of caregiving” but also the “burden of grief” as their loved-one’s newfound medical condition can result in the loss of the person they previously knew. Dramatic cognitive, behavioral, and personality changes, often leave caregivers bereft of the significant relationship they shared with the affected person prior to the illness or injury. This results in what we term conditions of acquired “non-death interpersonal loss” (NoDIL). Current approaches to these losses use an amalgam of models drawn from both death and non-death loss. Despite their utility, these frameworks have not adequately addressed the unique processes occurring in the interpersonal sphere where the grieving caregiver needs to reach some modus vivendi regarding the triad of “who the person was,” “who they are now,” and “who they will yet become.” In this paper we propose a process-based model which addresses cognitive-emotional-behavioral challenges caregivers meet in the face of their new reality. These require a revision of the interpersonal schemas and the relationships that takes into account the ongoing interactions with the affected family member. The model and its utility to identify adaptive and maladaptive responses to NoDIL is elaborated upon with clinical material obtained from caregivers of people diagnosed with major neuro-cognitive disorder and pediatric traumatic brain injury. The article concludes with implications for theory, research and clinical intervention.
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Affiliation(s)
- Einat Yehene
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Alexander Manevich
- The School of Psychological Sciences and the International Laboratory for the Study of Loss, Bereavement and Human Resilience, University of Haifa, Haifa, Israel
| | - Simon Shimshon Rubin
- The School of Psychological Sciences and the International Laboratory for the Study of Loss, Bereavement and Human Resilience, University of Haifa, Haifa, Israel.,Department of Psychology, Max Stern Academic College of Emek Yezreel, Jezreel Valley, Israel
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11
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Palmor Haspel S, Benyamini Y, Ginzburg K. Transactional Model of Parental Adjustment and Caregiving Burden Following a Children's Acquired Disability. J Pediatr Psychol 2020; 45:1177-1187. [PMID: 33094315 DOI: 10.1093/jpepsy/jsaa075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pediatric-acquired disability is often a crossroads in the lives of children and their parents, as they set out to adjust to a new physical impairment. This longitudinal study examined associations between the severity of children's-acquired disability, their parents' caregiver burden and adjustment, and parents' perception of the children's adjustment over time. METHODS Participants were parents and medical staff of 140 children with acquired disability, aged 1-18, hospitalized in pediatric or rehabilitation departments. Data were collected about 1 month after diagnosis (T1) and about 4 months later (T2). Parents completed background information, caregiver burden, child, and parental adjustment questionnaires. Medical staff contributed the disability severity indices. RESULTS The severity of the child's disability was negatively associated with parents' adjustment and perception of the child's adjustment. Caregiver burden was positively associated with the severity of the disability, and negatively with parents' adjustment and perception of their child's adjustment, at both time points. Over time, the severity of the disability and caregiver burden decreased, and parents' adjustment and perception of the child's adjustment improved. At T2, parents' and children's adjustment were strongly associated. CONCLUSIONS The findings revealed the relationship between objective severity indices and caregiver burden. They suggest that parents' adjustment may affect their perception of the child's adjustment to disability, and emphasize the role of parental perceptions over time. Therefore, parents who are less likely to adjust effectively should be identified early on to facilitate professional intervention.
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Affiliation(s)
- Shoshi Palmor Haspel
- Shaare Zedek University Medical Center, Jerusalem.,Department of Special Education in the Herzog Academic College, Jerusalem.,Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv
| | - Karni Ginzburg
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv
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12
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Rubin SS, Malkinson R, Witztum E. Traumatic Bereavements: Rebalancing the Relationship to the Deceased and the Death Story Using the Two-Track Model of Bereavement. Front Psychiatry 2020; 11:537596. [PMID: 33093833 PMCID: PMC7523537 DOI: 10.3389/fpsyt.2020.537596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/17/2020] [Indexed: 11/13/2022] Open
Abstract
Bereavements that occur under external traumatic circumstances increase the risk for dysfunction, trauma symptomatology, as well as disordered and prolonged grief. While the majority of individuals who have experienced traumatic bereavements do not meet formal criteria for posttraumatic stress disorder (PTSD), persistent complex bereavement disorder (PCBD), or prolonged grief disorder (PGD), the degree of distress and dysfunction for these bereaved can be quite significant. The assessment and intervention paradigms in use with traumatic bereavements often prioritize the trauma and bypass the centrality of the interpersonal loss. By using a bifocal approach in conceptualizing bereavement, the Two-Track Model of Bereavement (TTMB) rebalances the approach to the class of traumatic bereavements. Track I examines biopsychosocial functioning and symptoms of trauma, and track II focuses on the nature of the ongoing relationship with the deceased and the death story that may also have elements of traumatic response. The model and its application serve to identify both adaptive and maladaptive responses to loss along both axes to optimally focus interventions where needed. The story of the death, the psychological relationship with the deceased, and the presence of biopsychosocial difficulties each have a part to play in assessment and intervention. A case study of assessment and intervention following traumatic bereavement due to suicide illustrates how attention to each of these factors in the TTMB can facilitate change. Ultimately, the relational bond with the deceased is a major vector in grief and mourning. Assessment and intervention with traumatic bereavements require attention to dysfunction and symptoms of trauma as well as to the death story and the state of the relationship to the deceased.
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Affiliation(s)
- Simon Shimshon Rubin
- International Laboratory for the Study of Loss, Bereavement and Human Resilience, University of Haifa, Haifa, Israel.,School of Psychological Sciences, University of Haifa, Haifa, Israel.,Zramim, Postgraduate Psychotherapy Program, University of Haifa, Haifa, Israel.,Department of Psychology, Max Stern Emek Jezreel College, Emek, Israel
| | - Ruth Malkinson
- International Laboratory for the Study of Loss, Bereavement and Human Resilience, University of Haifa, Haifa, Israel.,Mitra-Israel Center for REBT, Rehovot, Israel
| | - Eliezer Witztum
- International Laboratory for the Study of Loss, Bereavement and Human Resilience, University of Haifa, Haifa, Israel
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