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Peleg O, Shalev R, Cohen A, Hadar E. How is the loss of a parent in youth related to attachment and adult separation anxiety among women? Stress Health 2024; 40:e3356. [PMID: 38115802 DOI: 10.1002/smi.3356] [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: 05/01/2023] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Abstract
This study aimed to examine attachment and adult separation anxiety (ASA) among women who lost a parent in their youth. We hypothesized that insecure attachment and increased ASA from a romantic partner would be found among women who have lost a parent in youth, compared to women whose parents were both alive. Sixty women who lost one or both parents in their youth and 60 who had living parents participated in the study (mean age: 32.3, range: 18-62 years). Participants filled out the ASA and Short Attachment questionnaires. Women who lost a parent reported higher levels of anxious attachment and ASA from partner; the two groups did not differ, however, in terms of avoidant attachment. Additionally, similar effects on ASA and attachment were found among adult women who lost a father or a mother in their youth. In conclusion, the loss of a parent early in life may be associated with an insecure attachment style and increased ASA.
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Affiliation(s)
- Ora Peleg
- Departments of School Counseling and Education, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Ronit Shalev
- Departments of School Counseling and Education, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Adva Cohen
- Departments of School Counseling and Education, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Efrat Hadar
- Departments of School Counseling and Education, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
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Kobeissi E, Menassa M, Honein-AbouHaidar G, El Achi N, Abdul-Sater Z, Farhat T, Al Mohtar D, Hajjar M, Abdul-Khalek RA, Chaya BF, Elamine A, Hettiaratchy S, Abu-Sittah G. Long-term burden of war injuries among civilians in LMICs: case of the July 2006 war in Lebanon. Front Public Health 2023; 11:1305021. [PMID: 38145076 PMCID: PMC10748398 DOI: 10.3389/fpubh.2023.1305021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Lebanon, a country located on the eastern shore of the Mediterranean Sea, is one of the world's smaller sovereign states. In the past few decades, Lebanon endured a perpetual political turmoil and several armed conflicts. July 12, 2006, marked the start of a one-month war in Lebanon, which resulted in thousands of casualties. Little is known about the long-term consequences of war injuries inflicted on civilians during the July 2006 war. Methods The objectives of this paper were to identify and evaluate: 1- civilians' access to healthcare and medicine under conditions of war; 2- the long-term socioeconomic burden on injured civilians; and 3- their quality of life more than a decade post-war. We adopted a mixed-method research design with an emphasis on the qualitative component. We conducted interviews with patients, collected clinical and financial data from hospital medical records, and administered a self-rated health questionnaire, the EQ-5D-5L. Simple descriptive statistics were calculated using Excel. NVivo 12® was used for data management and thematic analysis. Results We conducted 25 interviews. Injured civilians were mostly males, average age of 27. The most common mechanism of injury was blast injury. Most patients underwent multiple surgeries as well as revision surgeries. The thematic analysis revealed three themes: 1- recall of the time of the incident, the thousand miles journey, and patients' access to services; 2- post-trauma sequelae and services; and 3- long-term impact. Patients described the long-term burden including chronic pain, poor mobility, anxiety or depression, and limited activities of daily living. Discussion Civilians injured during the July 2006 war described the traumatising events they endured during the war and the limited access to medical care during and post-war. Up until this study was conducted, affected civilians were still experiencing physical, psychological, and financial sequelae. Acknowledging the limitations of this study, which include a small sample size and recall bias, the findings underscore the necessity for the expansion of services catering to civilians injured during wartime.
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Affiliation(s)
- Elsa Kobeissi
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Marilyne Menassa
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Gladys Honein-AbouHaidar
- Refugee Health Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Nassim El Achi
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Zahi Abdul-Sater
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Theresa Farhat
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dalia Al Mohtar
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Marwan Hajjar
- Department of Surgery, Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
| | | | - Bachar F. Chaya
- Department of Surgery, Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Ahmad Elamine
- Department of Surgery, Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Shehan Hettiaratchy
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghassan Abu-Sittah
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
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Pacaol NF. Acceptance, Endurance, and Meaninglessness: A Qualitative Case Study on the Mourning Tasks of Parental Death From Childhood Experience to Adolescence. OMEGA-JOURNAL OF DEATH AND DYING 2023; 88:376-397. [PMID: 34121504 DOI: 10.1177/00302228211024465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bereavement and mourning are arguably one of the research interests of psychologists, psychoanalysts, and psychiatrists since Freud's publication of Mourning and Melancholia. This paper is a qualitative case study that sought to examine the mourning experience of the participant from childhood until his adolescence. For theoretical foundation, the four tasks of mourning primarily developed by James Worden was utilized for the proper direction of the research inquiry; namely: a.) accepting the reality of death; b.) experiencing the feeling of grief; c.) adjusting and creating new meanings in the post-loss world; and d.) reconfiguring the bond with the lost person. The paper finds that the participant's cognitive attitude, emotional experiences, and personal observations of the environment enable him to overcome actively (in an overlapping manner) the three tasks of mourning. However, the failure to find an enduring connection with his deceased parents is not a result of strong attachment but with the absence of personal belief about the meta-existence of God.
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Sheehan S, Hanna JR, Drury A, McCance T, Semple CJ, O'Neill C. A Systematic Review of Educational Interventions to Equip Health and Social Care Professionals to Promote End-of-Life Supportive Care when a Parent with Dependent Children is Dying with Cancer. Semin Oncol Nurs 2023; 39:151474. [PMID: 37481410 DOI: 10.1016/j.soncn.2023.151474] [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: 06/09/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES This systematic review aimed to determine the content, mode of delivery, assessment, and outcomes of educational interventions to equip health and social care professionals when delivering end of life supportive care for parents dying with cancer who have dependent children. DATA SOURCES A mixed-methods systematic review was undertaken. Six electronic database were searched from their inception until September 2023 (Medline OVID, CINAHL, EMBASE, PsycINFO, Web of Science, and ERIC), supplemented by citation chaining, grey literature searches using Google Advanced Search and relevant professional bodies. Quality assessment was conducted independently by two researchers on the included studies. A convergent integrated approach was utilised for data synthesis. CONCLUSION The review identified two educational interventions; highlighting a dearth of training opportunities to equip health and social care professionals to provide supportive care to families when a parent is at end of life with cancer. Despite health and social care professionals reported need and desire for upskilling in this area of clinical practice, there is a severe lack of evidence-based educational interventions. It is imperative that effective educational interventions are made accessible to professionals. IMPLICATIONS FOR NURSING PRACTICE There is an imminent need for robust educational interventions to be developed, as health and social care professionals often lack the knowledge, skills and confidence on how best to support families when a parent of dependent children is at end of life. Health and social care professionals engagement with high-quality, evidence-based and theory-driven educational interventions has the potential to impact professionals' provision of family-centred cancer care at end of life. This could lead to better mental and physical outcomes for the whole family at end of life and in bereavement.
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Affiliation(s)
- Sarah Sheehan
- Research Assistant, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Jeffrey R Hanna
- Research Associate, Institute of Nursing and Health Research, School of Nursing and Paramedic Science, Ulster University, Belfast, Northern Ireland
| | - Amanda Drury
- Associate Professor in General Nursing, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Tanya McCance
- The Mona Grey Professor of Nursing Research & Development, Institute of Nursing and Health Research, School of Nursing and Paramedic Science, Ulster University, Belfast, Northern Ireland
| | - Cherith J Semple
- Professor in Clinical Cancer Nursing, Institute of Nursing and Health Research, Ulster University / Cancer Services, South Eastern Health and Social Care Trust, Belfast, Northern Ireland
| | - Carla O'Neill
- Assistant Professor in Nursing, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
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Fugmann D, Richter P, Karger A, Ernstmann N, Hönig K, Bergelt C, Faller H, Maatouk I, Hornemann B, Stein B, Teufel M, Goerling U, Erim Y, Geiser F, Albus C, Senf B, Wickert M, Weis J. Caring for dependent children impacts practical and emotional problems and need for support, but not perceived distress among cancer patients. Psychooncology 2023; 32:1231-1239. [PMID: 37277899 DOI: 10.1002/pon.6173] [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: 02/15/2023] [Revised: 04/26/2023] [Accepted: 05/14/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE More than one in 10 cancer patients care for dependent children. It is unclear whether this status makes a difference in terms of the distress and associated problems they experience, or whether it is linked to differences in the need for or utilization of psychosocial support. METHODS Secondary analysis of a cross-sectional German study in National Comprehensive Cancer Centers using self-report standardized questionnaires administered to inpatients. Patients living with dependent children (n = 161) were matched by age and sex with a subsample of 161 cancer patients not living with dependent children. The resulting sample was tested for between-group differences in Distress Thermometer (DT) scores and the corresponding DT Problem List. Additionally, between-group differences in measures of the need for and utilization of psychosocial support were examined. RESULTS More than 50% of all patients suffered from clinically relevant distress. Patients living with dependent children reported significantly more practical (p < 0.001, η2 p = 0.04), family (p < 0.001, η2 p = 0.03), and emotional problems (p < 0.001, η2 p = 0.01). Although reporting a greater need for psychological support, parents with cancer were not found to more frequently utilize any type of psychosocial support. CONCLUSIONS The specific problems and needs of parents with cancer who care for dependent children are currently not sufficiently addressed in the clinical care pathways. All families should be helped to establish open and honest communication as well as understand the available support systems and what they can provide. Tailored interventions should be implemented for highly distressed families.
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Affiliation(s)
- Dominik Fugmann
- Medical Faculty, Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Peter Richter
- Medical Faculty, Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - André Karger
- Medical Faculty, Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Nicole Ernstmann
- Department of Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany
| | - Klaus Hönig
- Ulm University Clinic Department of Psychosomatic Medicine and Psychotherapy, Comprehensive Cancer Center Ulm (CCCU), Ulm, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, Greifswald Medical School, Greifswald, Germany
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Imad Maatouk
- Department of Medical Psychology and Psychotherapy, Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Beate Hornemann
- Comprehensive Cancer Center, University Clinic Center Dresden, Dresden, Germany
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, Comprehensive Cancer Center Essen (WTZ) and LVR Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ute Goerling
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität and Berlin Institute of Health, Berlin, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine, University Clinic Center Erlangen, Erlangen, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine, University Clinic Center Bonn, Bonn, Germany
| | - Christian Albus
- Department of Psychosomatic Medicine & Center Psychooncology (CePO), University Clinic Center Cologne, Cologne, Germany
| | - Bianca Senf
- University Clinic Center Frankfurt University Cancer Center, Frankfurt, Germany
| | - Martin Wickert
- Comprehensive Cancer Center, University Clinic Center Tübingen, Tübingen, Germany
| | - Joachim Weis
- Department of Self-Help Research, Faculty of Medicine and Medical Center, Comprehensive Cancer Center, University of Freiburg, Freiburg, Germany
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Malmström N, Jakobsson Larsson B, Nilsson S, Öhlén J, Nygren I, Andersen PM, Ozanne A. Living with a parent with ALS - adolescents' need for professional support from the adolescents' and the parents' perspectives. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-9. [PMID: 37486108 DOI: 10.1080/21678421.2023.2228348] [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: 02/22/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 07/25/2023]
Abstract
AIM The aim of the study was to qualitatively investigate the adolescents' need for professional support when a parent has amyotrophic lateral sclerosis (ALS) - from the adolescents' and the parents' perspectives. METHODS A total of 37 individual semi-structured single interviews with 18 families were conducted, including 11 adolescents aged 8-25 and 26 parents, 13 with ALS and 13 co-parents. Data was analysed using qualitative content analysis. RESULTS Both adolescents and parents described the adolescents as needing professional support but found it difficult to articulate this need. However, the results indicate that the adolescents needed help in bringing manageability into their lives due to the uncertainty of living with the illness in the family. It was therefore essential to ensure that the adolescents were not forgotten in the disease context and that their needs for being involved as well as for obtaining information and understanding, was addressed. The importance of offering the adolescents support early was emphasized, but also of actively helping the families to master challenges in their everyday life. Support adapted to each family's unique situation and preferences was desired, as the adolescents' need for support seemed to be individual, disease-dependent and varied during different phases. CONCLUSION Given the adolescents' need for information and understanding, healthcare professionals must actively work to reach the adolescents as early as possible. It is crucial to ensure that the adolescents are given the opportunity to be involved based on their own conditions, as well as to support the families to strengthen their communication.
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Affiliation(s)
- Nina Malmström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birgitta Jakobsson Larsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden
| | - Stefan Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
- Palliative Centre at the Sahlgrenska University Hospital Region Västra Götaland, Gothenburg, Sweden
| | - Ingela Nygren
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter M Andersen
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden, and
| | - Anneli Ozanne
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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7
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Woodward KP, Yu Z, Chen W, Chen T, Jackson DB, Powell TW, Wang L. Childhood Bereavement, Adverse and Positive Childhood Experiences, and Flourishing among Chinese Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4631. [PMID: 36901641 PMCID: PMC10001697 DOI: 10.3390/ijerph20054631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Childhood bereavement (CB) resulting from a parent or primary caregiver death is associated with a range of adverse outcomes. Little is known about the association between CB and adult flourishing in the context of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs). In a cross-sectional observational study, we examined how ACEs, PCEs, and adult flourishing differs by self-reported CB history among 9468 Chinese young adults (18-35 years), of which 4.3% experienced CB (n = 409). Data collection included convenience sampling among university students in Mainland China. Respondents voluntarily completed an online survey between August and November 2020. Descriptive statistics, chi-square tests, and logistic regressions examined frequencies and differences in ACEs, PCEs, and flourishing by the history of CB controlling for a few demographic covariates. Bereaved individuals reported significantly higher ACEs and lower PCEs. The odds of experiencing emotional, physical, and sexual abuse as well as household substance abuse, parental mental illness, and parental incarceration ranged from 2.0-5.2 times higher for bereaved individuals. Bereaved participants also reported significant negative relationships with Flourishing Index (β = -0.35, t = -4.19, p < 0.001) and Secure Flourishing Index (β = -0.40, t = -4.96, p < 0.001). Consistent with previous research, our findings demonstrate the lasting effects of CB on well-being. We discuss study implications for ACEs and PCEs screening and surveillance as well as grief counseling to promote flourishing among bereaved youth in China and beyond.
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Affiliation(s)
- Krista P. Woodward
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Zhiyuan Yu
- Johns Hopkins School of Nursing, 525N Wolfe Street, Baltimore, MD 21205, USA
| | - Wenyi Chen
- Johns Hopkins School of Nursing, 525N Wolfe Street, Baltimore, MD 21205, USA
| | - Tingting Chen
- Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Dylan B. Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Terrinieka W. Powell
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Lin Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200240, China
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Levkovich I, Elyoseph Z. "I Don't Know What to Say": Teachers' Perspectives on Supporting Bereaved Students After the Death of a Parent. OMEGA-JOURNAL OF DEATH AND DYING 2023; 86:945-965. [PMID: 33583258 DOI: 10.1177/0030222821993624] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This qualitative study examined teachers' experiences dealing with bereaved students following the death of a parent. The researchers conducted in-depth, semi-structured, face-to-face interviews with 25 teachers in Israeli schools who had counseled one of their students after the death of a parent. The interviews were recorded and transcribed and underwent content analysis. Analysis of the findings revealed that the teachers felt helpless, confused, overloaded emotionally and anxious when counseling students who had lost a parent. In addition, the teachers discussed the complex nature of their relationship with the remaining parent, ranging from a desire to support the family through avoidance for fear of hurting the parent to fears of being overwhelmed by the child's problems. Many teachers mentioned their need for support from school officials.
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Affiliation(s)
- Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College of Education, Kiryat Tiv'on, Israel
| | - Zohar Elyoseph
- Faculty of Graduate Studies, Oranim Academic College of Education, Kiryat Tiv'on, Israel
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Manandhar Shrestha R, Mizoue T, Pham TTP, Fukunaga A, Hoang DV, Nguyen CQ, Phan DC, Hachiya M, Huynh DV, Le HX, Do HT, Inoue Y. Association between parental absence during childhood and metabolic syndrome during adulthood: A cross-sectional study in rural Khanh Hoa, Vietnam. PLoS One 2023; 18:e0282731. [PMID: 36893153 PMCID: PMC9997891 DOI: 10.1371/journal.pone.0282731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND This study aimed to determine the association between parental absence during childhood and metabolic syndrome (MetS) in adulthood among middle-aged adults in rural Khanh Hoa province, Vietnam. Given that broader literature on adverse childhood experiences (ACEs) suggests a strong positive association between ACEs and cardiometabolic risk or diseases, we hypothesized that parental absence during childhood, which is a major component of ACEs, is more likely to cause MetS in adulthood. METHODS Data were obtained from the baseline survey of the Khanh Hoa Cardiovascular Study, in which 3000 residents aged between 40 to 60 years participated. MetS was assessed using the modified Adult Treatment Panel III (ATP III) criteria. It was considered parental absence if the participants had experienced parental absence due to death, divorce, or out-migration before three or between three to 15 years. We used multiple logistic regression analyses to examine the association between parental absence during childhood and metabolic syndrome during adulthood. RESULTS There was no significant association between parental absence and MetS; adjusted odds ratio [AOR] was 0.97 (95% confidence interval [CI] = 0.76-1.22) for those who experienced parental absence between three to 15 years and the corresponding figure for those who experienced it before three years was 0.93 (95% CI = 0.72-1.20). No significant associations were observed when these were examined for the causes of parental absence. CONCLUSION This study did not support our hypothesis of an association between parental absence during childhood and metabolic syndrome during adulthood. Parental absence may not be a predictor of MetS among Vietnamese people in rural communities.
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Affiliation(s)
- Rachana Manandhar Shrestha
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- * E-mail:
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Thuy Thi Phuong Pham
- Department of Non-communicable Disease Control and Nutrition, Pasteur Institute in Nha Trang, Khanh Hoa, Vietnam
| | - Ami Fukunaga
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Dong Van Hoang
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Chau Que Nguyen
- Department of Non-communicable Disease Control and Nutrition, Pasteur Institute in Nha Trang, Khanh Hoa, Vietnam
| | - Danh Cong Phan
- Department of Non-communicable Disease Control and Nutrition, Pasteur Institute in Nha Trang, Khanh Hoa, Vietnam
| | - Masahiko Hachiya
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Dong Van Huynh
- Khanh Hoa Center for Disease Control, Khanh Hoa, Vietnam
| | - Huy Xuan Le
- Pasteur Institute in Nha Trang, Khanh Hoa, Vietnam
| | - Hung Thai Do
- Pasteur Institute in Nha Trang, Khanh Hoa, Vietnam
| | - Yosuke Inoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
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McGill G, Mann E, Moreland M, Osborne A, Kiernan MD, Wilson-Menzfeld G. Bereaved Military Families: Relationships and Identity. JOURNAL OF LOSS & TRAUMA 2022. [DOI: 10.1080/15325024.2022.2127678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Gill McGill
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Emily Mann
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Mary Moreland
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Alison Osborne
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Matthew Donal Kiernan
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Gemma Wilson-Menzfeld
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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Dalton LJ, McNiven A, Hanna JR, Rapa E. Exploring healthcare professionals' beliefs, experiences and opinions of family-centred conversations when a parent has a serious illness: A qualitative study. PLoS One 2022; 17:e0278124. [PMID: 36441706 PMCID: PMC9704560 DOI: 10.1371/journal.pone.0278124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
This study explored healthcare professionals' perceived role in talking to adult patients about sharing their diagnosis with children. Semi-structured interviews were conducted to explore healthcare professionals' beliefs about how families could and should be supported when a parent has a serious illness. Participants were 24 healthcare professionals working in primary, secondary and tertiary NHS services in the UK with adult patients diagnosed with a serious illness. Data were analysed thematically. Many healthcare professionals reported systems to identify patients' family relationships, but this information was rarely used to initiate conversations on what and how to talk to children. It was frequently assumed that someone else in the healthcare system was supporting patients with family communication. Others reported there were more urgent priorities for the consultation or considered that talking to children was a private family matter. However, several professionals did undertake these conversations, viewing this as a central part of their role. Some healthcare professionals felt they had inadequate skills or confidence to raise talking to children with their patients and indicated a need for specific training to address this. The results highlight the importance of systematically documenting patients' relationships with children so that this information can be used to inform ongoing discussions with the healthcare team about what children have been told. Patients consistently report wanting support about how to talk to children and the benefits of effective communication are well documented. Dissemination of this evidence could encourage professionals across all specialities to include family-centred communication in routine patient care. Training resources are needed so that staff feel empowered and equipped to raise these sensitive subjects with their patients.
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Affiliation(s)
- Louise J. Dalton
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Abigail McNiven
- Medical Sciences Division, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jeffrey R. Hanna
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Elizabeth Rapa
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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12
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Wray A, Pickwell-Smith B, Greenley S, Pask S, Bamidele O, Wright B, Murtagh F, Boland JW. Parental death: a systematic review of support experiences and needs of children and parent survivors. BMJ Support Palliat Care 2022:bmjspcare-2022-003793. [PMID: 36384696 DOI: 10.1136/spcare-2022-003793] [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: 06/04/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bereaved people need a supportive response from those around them. Knowing children's and surviving parents' needs following parental death is the first step to ensuring a supportive response. However, no systematic review has reported on this phenomenon. AIM To systematically identify and synthesise qualitative literature exploring support experiences of parentally bereaved children and surviving parents. METHODS Systematic review with thematic synthesis, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. MEDLINE, Embase, PsycINFO, CINAHL and the British Nursing Database were searched for relevant papers to September 2021. Included studies were appraised for quality and thematically synthesised using Thomas and Harden's thematic synthesis framework. RESULTS Fifteen qualitative studies from nine countries were included. There were four analytical themes from the children's perspectives (1) Openness of communication with children about death and dying, (2) Children's challenges of managing change, (3) Navigating emotions, and (4) Children's acceptability, access and engagement with support. There were three analytical themes from the parents' perspectives: (1) Adjusting as a parent, (2) Supporting their children, and (3) Parent's acceptability, access and engagement with support. CONCLUSIONS Following a parental death, open and honest communication and involvement in what is happening within the family will help children cope. Both children and parents suppress emotions and avoid conversations to protect each other and those around them. A taboo around death exists and constrains the support some families receive. Childhood bereavement is a public health issue, with a need for professionals and communities to better understand and respond to the needs of bereaved families.CRD42020166179.
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Affiliation(s)
- Alexandra Wray
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Benjamin Pickwell-Smith
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, Kingston upon Hull, UK
| | - Sarah Greenley
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, Kingston upon Hull, UK
| | - Sophie Pask
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Olufikayo Bamidele
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, Kingston upon Hull, UK
| | - Barry Wright
- Child Orientated Mental Health Innovation Collaborative, Hull York Medical School, York, UK
| | - Fliss Murtagh
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Jason W Boland
- Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine, Hull York Medical School, Hull, UK
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13
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Harrop E, Goss S, Longo M, Seddon K, Torrens-Burton A, Sutton E, Farnell DJ, Penny A, Nelson A, Byrne A, Selman LE. Parental perspectives on the grief and support needs of children and young people bereaved during the COVID-19 pandemic: qualitative findings from a national survey. BMC Palliat Care 2022; 21:177. [PMID: 36210432 PMCID: PMC9548427 DOI: 10.1186/s12904-022-01066-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/30/2022] [Accepted: 09/28/2022] [Indexed: 11/15/2022] Open
Abstract
Background During the COVID-19 pandemic, many children and young people have experienced the death of close family members, whilst also facing unprecedented disruption to their lives. This study aimed to investigate the experiences and support needs of bereaved children and young people from the perspective of their parents and guardians. Methods We analysed cross-sectional qualitative free-text data from a survey of adults bereaved in the UK during the pandemic. Participants were recruited via media, social media, national associations and community/charitable organisations. Thematic analysis was conducted on free text data collected from parent/guardian participants in response to a survey question on the bereavement experiences and support needs of their children. Results Free-text data from 104 parent/guardian participants was included. Three main themes were identified: the pandemic-related challenges and struggles experienced by children and young people; family support and coping; and support from schools and services. Pandemic-challenges include the impacts of being separated from the relative prior to their death, isolation from peers and other family members, and disruption to daily routines and wider support networks. Examples were given of effective family coping and communication, but also of difficulties relating to parental grief and children’s existing mental health problems. Schools and bereavement organisations’ provision of specialist support was valued, but there was evidence of unmet need, with some participants reporting a lack of access to specialist grief or mental health support. Conclusion Children and young people have faced additional strains and challenges associated with pandemic bereavement. We recommend resources and initiatives that facilitate supportive communication within family and school settings, adequate resourcing of school and community-based specialist bereavement/mental health services, and increased information and signposting to the support that is available. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01066-4.
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Affiliation(s)
- Emily Harrop
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, CF14 4YS, Cardiff, UK.
| | - Silvia Goss
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, CF14 4YS, Cardiff, UK
| | - Mirella Longo
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, CF14 4YS, Cardiff, UK
| | - Kathy Seddon
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, CF14 4YS, Cardiff, UK
| | - Anna Torrens-Burton
- PRIME Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Eileen Sutton
- Palliative and End of Life Care Research Group, Population Health Sciences, University of Bristol, Bristol Medical School, Bristol, UK
| | | | - Alison Penny
- National Bereavement Alliance/Childhood Bereavement Network, London, UK
| | - Annmarie Nelson
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, CF14 4YS, Cardiff, UK
| | - Anthony Byrne
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, CF14 4YS, Cardiff, UK
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, University of Bristol, Bristol Medical School, Bristol, UK
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14
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Rice T. Children Who Lose a Parent in the COVID-19 Era: Considerations on Grief and Mourning. PSYCHOANALYTIC STUDY OF THE CHILD 2022. [DOI: 10.1080/00797308.2022.2120336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Marshall S, Fearnley R, Bristowe K, Harding R. 'It's not just all about the fancy words and the adults': Recommendations for practice from a qualitative interview study with children and young people with a parent with a life-limiting illness. Palliat Med 2022; 36:1263-1272. [PMID: 35766527 PMCID: PMC9446426 DOI: 10.1177/02692163221105564] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Healthcare professionals report challenges in supporting dying patients who have dependent children. These parents are often uncertain how to meet the needs of their children and require appropriate support from professionals. There is limited evidence based guidance for professionals around this issue, which is informed by the views and experiences of children themselves. AIM To develop an understanding of the perspective of children on living with parental life-limiting illness and inform recommendations for healthcare professionals. DESIGN Qualitative semi-structured interviews were conducted, with thematic analysis of the data. SETTING/PARTICIPANTS A diverse sample of 32 children aged 6-17, whose parent was living with life-limiting illness, were recruited from across the United Kingdom. RESULTS Despite the challenges of living with a parent with a life-limiting illness, the children display agency in their response. The children: feel a responsibility to look after their family; negotiate a relationship with healthcare; employ strategies to maintain some normality; and ensure that the inevitable sadness does not become overwhelming. CONCLUSIONS Five recommendations for healthcare professionals were developed from the findings. Clinicians should encourage dying parents to: (1) acknowledge the agency of children; (2) recognise children's caregiving roles; (3) engender children's trust in healthcare; (4) maintain some normality; and (5) discuss emotions with their children. Implementing these recommendations will assist parents with a life-limiting illness to provide evidence-based support to their dependent children.
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Affiliation(s)
- Steve Marshall
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Rachel Fearnley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Katherine Bristowe
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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16
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Association between parental absence during childhood and depressive symptoms in adulthood in rural Vietnam. J Affect Disord 2022; 311:479-485. [PMID: 35598745 DOI: 10.1016/j.jad.2022.05.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND While parental absence during childhood has been linked to depression/depressive symptoms in adulthood, no research has been conducted on this association in Vietnam, where many children were separated from their parents during and after the Vietnam War (1955-1975). We examined the association between parental absence in childhood and depressive symptoms among rural community dwellers in Khanh Hoa Province, Vietnam. METHODS Data came from 3000 individuals aged 40-60 years old who participated in the baseline survey of the Khanh Hoa Cardiovascular Study. Depressive symptoms were assessed with the 11-item Center for Epidemiologic Studies Depression Scale. Self-reported information on parental absence due to death, divorce, or outmigration to other locations before the age of 15 was also obtained. A Poisson regression analysis with a robust variance estimator was used to examine associations. RESULTS Experiencing parental absence at 3 - < 15 years old and before 3 years old was associated with a 1.21 times (95% confidence interval [CI] = 1.02-1.43) and 1.41 times (95% CI = 1.15-1.73) higher prevalence of depressive symptoms, respectively (p trend <0.001). When examining the associations by the different reasons for the parental absence, the strongest association was found for parental absence due to outmigration to other locations. LIMITATIONS We had no information on who respondents lived with after they experienced parental absence. In addition, self-reported information on childhood experiences was subject to recall bias. CONCLUSIONS In rural Vietnam, parental absence during childhood was associated with a significantly increased prevalence of depressive symptoms in middle adulthood.
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17
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COVID-19 and Cardiometabolic Health: Lessons Gleaned from the Pandemic and Insights for the Next Wave. Curr Atheroscler Rep 2022; 24:607-617. [PMID: 35773565 PMCID: PMC9247906 DOI: 10.1007/s11883-022-01033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/24/2022]
Abstract
Purpose of Review
To review the current evidence regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on cardiometabolic health, with a focus on strategies to help mitigate adverse effects on population health. Recent Findings Individuals with cardiometabolic disease are particularly vulnerable to worse outcomes with COVID-19 infection. In addition, the pandemic itself has had significant deleterious impact on the cardiometabolic health of the population, including declines in physical activity, increases in smoking and alcohol use, worsening blood pressure and glycemic control, and detrimental effects on mental health. Targeted interventions at the patient and community level will be needed to mitigate the long-term consequences of the COVID-19 pandemic on population cardiometabolic health. Summary The COVID-19 pandemic has worsened cardiometabolic health, but there are several opportunities and enhanced tools available to counteract these changes.
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18
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Fadeeva A, Mann E, McGill G, Wilson Menzfeld G, Moreland M, Melling A, Kiernan MD. Bereaved UK military families: A mixed methods study on the provision of practical and emotional support. DEATH STUDIES 2022; 47:450-460. [PMID: 35762408 DOI: 10.1080/07481187.2022.2089777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Traumatic deaths of military personnel can have tragic consequences for the lives and health of bereaved significant others. To mitigate the effects, the UK Armed Forces enhanced the support for bereaved military families. However, little is known about whether the support has been satisfactory. The present research applied mixed methods to explore the experiences of bereaved UK military families (N = 264) with different types of support and how it historically changed over time. The findings suggest that although support has improved, further improvements are required in the provision of financial information, administrative support, and access to psychological support for all bereaved family members.
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Affiliation(s)
- Anastasia Fadeeva
- Violence and Society Centre, University of London, London, United Kingdom
| | - Emily Mann
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Gill McGill
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Gemma Wilson Menzfeld
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Mary Moreland
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Andrew Melling
- School of Nursing, University of Central Lancashire, Preston, United Kingdom
| | - Matthew D Kiernan
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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19
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Wray A, Seymour J, Greenley S, Boland JW. Parental terminal cancer and dependent children: a systematic review. BMJ Support Palliat Care 2022:bmjspcare-2021-003094. [PMID: 35091436 DOI: 10.1136/bmjspcare-2021-003094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/28/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND When a parent has terminal cancer, their children are part of that experience. Parents often want to protect their children from their disease and prognosis. Knowledge of dependent children's experience will help ensure they receive appropriate support. To date, there is lack of synthesis of this evidence examining children's perspectives. OBJECTIVES To systematically search and synthesise the qualitative literature exploring the experiences of dependent children when their parent has terminal cancer. METHODS Databases of MEDLINE, Embase, PsycINFO, CINAHL, Assia and the Cochrane library were searched systematically from inception to July 2020 to determine eligible studies. Included studies were appraised for quality and thematically synthesised using Thomas and Harden's thematic synthesis framework. RESULTS Fourteen studies were included, which interviewed children about their experiences (n=654 children aged 4-18 years at the time of parental death), from six countries. Five descriptive themes were identified, further categorised into two broad themes: (1) finding out about parental cancer and its impact on the family and (2) coping with life with parental cancer, death and beyond. CONCLUSION Children want to be involved in their parent's cancer experience and to help support the family. Healthcare professionals are ideally placed to support and encourage parents to include their children. They should reassure parents that children can cope well and that maintaining normality will help, and explain the benefits of honest and open communication and how they can include dependent children from diagnosis and beyond.
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Affiliation(s)
- Alexandra Wray
- Wolfson Palliative Care Research Centre, Hull York Medical School, Univeristy of Hull, Hull, UK
| | - Julie Seymour
- Institiute of Clinical Applied Health Research, Hull York Medical School, Univeristy of Hull, Hull, UK
| | - Sarah Greenley
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Palliative Medicine, Care Plus Group and St Andrew's Hospice, NE Lincolnshire, UK
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20
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Azuike P, Anjoyeb M, King L. Bereavement and children's mental health: recognising the effects of early parental loss. Nurs Child Young People 2022; 34:26-32. [PMID: 34278749 DOI: 10.7748/ncyp.2021.e1387] [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] [Accepted: 02/02/2021] [Indexed: 11/09/2022]
Abstract
Parental death in childhood is a traumatic event and, as a consequence, bereaved children can be at an increased risk of developing mental health issues in adulthood. This article details an extended literature review that was undertaken to explore the effects of early parental death on bereaved children's mental health and identifies implications for healthcare practice. Several electronic databases were searched and eight articles were selected for inclusion in this review. Four themes were identified from the literature: child's age at parental death; cause of parental death; type of parental death; and cascading circumstances. Increased exposure to other adverse circumstances after a parent's death can also predispose an individual to psychopathology in adulthood, so such circumstances can serve as indicators of the potential effects on children's future mental health outcomes.
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Affiliation(s)
- Priscilla Azuike
- School of Nursing and Allied Health, Buckinghamshire New University, Uxbridge, England
| | - Mahmood Anjoyeb
- School of Nursing and Allied Health, Buckinghamshire New University, Uxbridge, England
| | - Liz King
- Department of Nursing and Midwifery, Institute of Health and Social Care, London South Bank University, London, England
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21
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Peng A, Lai W, He S, Li W, Song T, Ji S, Zhao X, Chen L. Association Between Early Parental Death and Loneliness in Adulthood: A Community-Based Study in Southwest China. Front Psychiatry 2022; 13:784000. [PMID: 35432037 PMCID: PMC9008135 DOI: 10.3389/fpsyt.2022.784000] [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] [Received: 09/27/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Loneliness is a growing public health problem that threatens physical and mental health to a large extent. Compelling evidence has shown that premature parental death is strongly associated with many mental health disorders in adulthood, but whether it increases the risk of loneliness remains unclear. In this large community-based study, we included 32,682 adult participants (20-93 years old) from Southwest China and used the three-item short version of University of California, Los Angeles, Loneliness Scale to identify participants with loneliness. A total of 1,975 participants reported loneliness, which resulted in a loneliness prevalence of 6.0% in Southwest China. Logistic regression was used to evaluate the association between early parental death and loneliness after adjusting for age, gender, education level, marital status, smoking and drinking status, living status, and chronic diseases. We found that early parental death was significantly associated with loneliness [odds ratio (OR) = 1.21, 95% confidence interval (CI), 1.03-1.42]. A Sensitivity analysis excluding those with mental health disorders (796 participants) yielded similar results (OR = 1.26, 95% CI = 1.06-1.49). We also found that being younger, single, divorced, or widowed, and more educated; living alone; and having chronic disorders were associated with loneliness. We conclude that childhood parental death is associated with loneliness in adulthood, suggesting the need for early intervention in affected children to prevent long-term adverse neuropsychiatric effects.
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Affiliation(s)
- Anjiao Peng
- Department of Neurology, Joint Research Institute of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
| | - Wanlin Lai
- Department of Neurology, Joint Research Institute of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
| | - Shixu He
- Department of Neurology, Joint Research Institute of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
| | - Wanling Li
- Department of Neurology, Joint Research Institute of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
| | - Tingting Song
- Department of Neurology, Joint Research Institute of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
| | - Shuming Ji
- Department of Project Design and Statistics, West China Hospital, Sichuan University, Chengdu, China
| | - Xia Zhao
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Chen
- Department of Neurology, Joint Research Institute of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
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22
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Lee JS, Jaini PA, Papa F. An Epigenetic Perspective on Lifestyle Medicine for Depression: Implications for Primary Care Practice. Am J Lifestyle Med 2022; 16:76-88. [PMID: 35185430 PMCID: PMC8848122 DOI: 10.1177/1559827620954779] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/17/2020] [Accepted: 08/13/2020] [Indexed: 06/16/2024] Open
Abstract
Depression is the most common presenting mental health disorder in primary care. It is also a major contributor to somatic complaints, worsening of chronic medical conditions, poor quality of life, and suicide. Current pharmacologic and psychotherapeutic approaches avert less than half of depression's cumulative burden on society. However, there is a growing body of research describing both how maladaptive lifestyle choices contribute to the development and worsening of depression and how lifestyle-oriented medical interventions can reduce the incidence and severity of depression. This research, largely derived from an emerging field called epigenetics, elucidates the interactions between our lifestyle choices and those epigenetic factors which mediate our tendencies toward either health, or the onset, if not worsening of disease. The present review highlights how lifestyle choices involving diet, physical activity, sleep, social relationships, and stress influence epigenetic processes positively or negatively, and thereby play a significant role in determining whether one does or does not suffer from depression. The authors propose that medical training programs consider and adopt lifestyle medicine oriented instructional initiatives that will enable tomorrow's primary care providers to more effectively identify and therapeutically intervene in the maladaptive choices contributing to their patients' depression.
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Affiliation(s)
- Jenny Sunghyun Lee
- Jenny Sunghyun Lee, Department of Preventive Medicine, Loma Linda University Medical School, 24785 Stewart Street, Loma Linda, CA 92350; e-mail:
| | - Paresh Atu Jaini
- Department of Preventive Medicine, Loma Linda University Medical School, Loma Linda, California (JSL)
- Department of Psychiatry, John Peter Smith Hospital, Fort Worth, Texas (PAJ)
- Department of Medical Education, University of North Texas Health Science Center, Fort Worth, Texas (FP)
| | - Frank Papa
- Department of Preventive Medicine, Loma Linda University Medical School, Loma Linda, California (JSL)
- Department of Psychiatry, John Peter Smith Hospital, Fort Worth, Texas (PAJ)
- Department of Medical Education, University of North Texas Health Science Center, Fort Worth, Texas (FP)
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Chantaratin S, Trimetha K, Werarak P, Lapphra K, Maleesatharn A, Rungmaitree S, Wittawatmongkol O, Phongsamart W, Kongstan N, Khumcha B, Chokephaibulkit K. Depression and Anxiety in Youth and Young Adults Living with HIV: Frequency and Associated Factors in Thai Setting. J Int Assoc Provid AIDS Care 2022; 21:23259582221101811. [PMID: 35581716 PMCID: PMC9121500 DOI: 10.1177/23259582221101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Integrative mental health care in HIV patients is an important contributor to
successful therapy. This is a cross-sectional study in youth and young adults
who attend routine HIV clinic at a tertiary care centre in Bangkok. We recruited
100 youth and 130 young adults living with HIV to evaluate the frequency of
depression and anxiety and associated sociodemographic including sexual
orientation and health-related behaviours. Overall, about a fifth of the
participants had significant depression or anxiety. Interestingly, we found
different factors associated with depression in youth and young adults living
with HIV. Loss of their father, loss of close relatives or friends, and being
unemployed or school exclusion were the factors associate with depression in
youth; while dangerous alcohol use, feeling discriminated against and having
lipodystrophy were factors in young adults. The understanding of the frequency
and different associated factors can inform more effective prevention and
treatment strategies.
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Affiliation(s)
- Sasitorn Chantaratin
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 26685Mahidol University, Bangkok, Thailand
| | - Kawita Trimetha
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 26685Mahidol University, Bangkok, Thailand
| | - Peerawong Werarak
- Department of Preventive Medicine, Faculty of Medicine Siriraj Hospital, 26685Mahidol University, Bangkok, Thailand
| | - Keswadee Lapphra
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 26685Mahidol University, Bangkok, Thailand
| | - Alan Maleesatharn
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 26685Mahidol University, Bangkok, Thailand.,Department of Preventive Medicine, Faculty of Medicine Siriraj Hospital, 26685Mahidol University, Bangkok, Thailand
| | - Supattra Rungmaitree
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 26685Mahidol University, Bangkok, Thailand
| | - Orasri Wittawatmongkol
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 26685Mahidol University, Bangkok, Thailand
| | - Wanatpreeya Phongsamart
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 26685Mahidol University, Bangkok, Thailand
| | - Nantaka Kongstan
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 26685Mahidol University, Bangkok, Thailand
| | - Benjawan Khumcha
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 26685Mahidol University, Bangkok, Thailand
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 26685Mahidol University, Bangkok, Thailand.,Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, 26685Mahidol University, Bangkok, Thailand
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24
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Ng C. Meaning-oriented narrative reconstruction: navigating the complexities of bereaved families. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2021. [DOI: 10.1080/03069885.2021.1983157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Carolyn Ng
- Portland Institute for Loss and Transition, Singapore, Singapore
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25
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Cockle-Hearne J, Aldiss S, Gibson F, Milne S, Todd J, Ream E. Support interventions provided during palliative care to families with dependent children when a parent has terminal illness: a scoping review protocol. JBI Evid Synth 2021; 19:3163-3173. [PMID: 34100829 DOI: 10.11124/jbies-20-00472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this scoping review is to identify and map support interventions provided during palliative care to families with dependent children when a parent has a terminal illness. INTRODUCTION For dependent children, losing a parent through terminal illness can be one of the most traumatic experiences they will face. Without age-appropriate information and support, parental death can lead to unresolved grief, post-traumatic stress, and longer-term negative social, emotional, educational, and behavioral consequences. Support from health care professionals is provided, but challenges within hospice and community palliative care mean the needs of dependent children may not be addressed. Greater emphasis is often placed on children's and families' bereavement needs as opposed to their pre-bereavement needs. The status of pre-bereavement support in palliative care for these families has not been documented. INCLUSION CRITERIA We will include studies of support interventions provided to families with dependent children when a parent has a terminal illness that are delivered during palliative care and in settings including, but not limited to, hospices, hospitals, and the community (including family and care homes). Empirical, peer-reviewed studies based on qualitative, quantitative, or mixed methods data, and gray literature, reporting any stage of intervention development will be included. METHODS This review will follow the JBI approach for scoping reviews. Multiple database searches will be conducted. Two authors will independently review full-text articles and extract data. Interventions will be mapped in terms of characteristics, evaluation methods, and implementation challenges. Data will be presented in tables, diagrammatic form, and narrative summary.
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Affiliation(s)
| | - Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK.,Centre for Outcomes and Experience Research in Children's Health Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Shannon Milne
- Research Department, Princess Alice Hospice, Esher, UK
| | - Jennifer Todd
- Research Department, Princess Alice Hospice, Esher, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, UK
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Hanna JR, Rapa E, Miller M, Turner M, Dalton LJ. Conversations About Children When an Important Adult Is at End of Life: An Audit. Am J Hosp Palliat Care 2021; 39:806-811. [PMID: 34538106 PMCID: PMC9210112 DOI: 10.1177/10499091211046241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Health and social care professionals report it challenging to have conversations with families when an important adult in the life of a child is at end of life, often feeling this aspect of care is the responsibility of other colleagues. This study aimed to understand professionals' perceived role in family-centered conversations as part of routine care at end of life, and how to promote this element of care in clinical practice. METHODS An audit was completed with 116 professionals who work in palliative care including doctors and nurses that attended a 2-day virtual congress. RESULTS Professionals (73.2%) felt confident about starting a conversation with adult patients at end of life about important children. However, enquiring about relationships with children was largely dependent on the age of the patient. 64.7% of respondents reported signposting families to websites and services that provide family support. Most professionals (76.7%) wanted training to equip them with the skills and confidence to having family-centered conversations at end of life, with videos demonstrating how to provide these elements of care the most preferred option. CONCLUSIONS Short training resources should be developed to equip professionals with the necessary skills toward having conversations about children with patients and relatives in clinical appointments. There is a need for professionals to ask every patient about important relationships with children.
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Affiliation(s)
- Jeffrey R Hanna
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Mary Miller
- Department of Palliative Care, Sir Michael Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Madeleine Turner
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Louise J Dalton
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
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Rapa E, Hanna JR, Mayland CR, Mason S, Moltrecht B, Dalton LJ. Experiences of preparing children for a death of an important adult during the COVID-19 pandemic: a mixed methods study. BMJ Open 2021; 11:e053099. [PMID: 34400462 PMCID: PMC8370837 DOI: 10.1136/bmjopen-2021-053099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objectives of this study were to investigate how families prepared children for the death of a significant adult, and how health and social care professionals provided psychosocial support to families about a relative's death during the COVID-19 pandemic. DESIGN/SETTING A mixed methods design; an observational survey with health and social care professionals and relatives bereaved during the COVID-19 pandemic in the UK, and in-depth interviews with bereaved relatives and professionals were conducted. Data were analysed thematically. PARTICIPANTS A total of 623 participants completed the survey and interviews were conducted with 19 bereaved relatives and 16 professionals. RESULTS Many children were not prepared for a death of an important adult during the pandemic. Obstacles to preparing children included families' lack of understanding about their relative's declining health; parental belief that not telling children was protecting them from becoming upset; and parents' uncertainty about how best to prepare their children for the death. Only 10.2% (n=11) of relatives reported professionals asked them about their deceased relative's relationships with children. This contrasts with 68.5% (n=72) of professionals who reported that the healthcare team asked about patient's relationships with children. Professionals did not provide families with psychosocial support to facilitate preparation, and resources were less available or inappropriate for families during the pandemic. Three themes were identified: (1) obstacles to telling children a significant adult is going to die, (2) professionals' role in helping families to prepare children for the death of a significant adult during the pandemic, and (3) how families prepare children for the death of a significant adult. CONCLUSIONS Professionals need to: provide clear and honest communication about a poor prognosis; start a conversation with families about the dying patient's significant relationships with children; and reassure families that telling children someone close to them is dying is beneficial for their longer term psychological adjustment.
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Affiliation(s)
| | | | - Catriona R Mayland
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - Stephen Mason
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
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28
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Schacht R, Meeks H, Fraser A, Smith KR. Was Cinderella just a fairy tale? Survival differences between stepchildren and their half-siblings. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200032. [PMID: 33938278 PMCID: PMC8090814 DOI: 10.1098/rstb.2020.0032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 11/12/2022] Open
Abstract
The death of a parent, particularly the mother, is linked to a suite of negative outcomes across the life-course. Compounding concerns for child outcomes are expectations of poor treatment by step-parents after parental remarriage. Indeed, folk tales of step-parental abuse abound cross-culturally and are embedded into stories taught to children. To understand why child outcomes might be sensitive to levels of relatedness within the household, evolutionary-oriented research targets patterning in parental expenditure in ways predicted to maximize inclusive fitness. In particular, parents are expected to prioritize investments in their biological children. However, stepfamilies are only formed after children experience multiple unfortunate events (e.g. parental loss, poverty), blurring causal interpretations between step-parental presence and stepchild outcomes. Moreover, stepchildren have been shown to be integral to household functioning, caring for their half-siblings and stabilizing relationships. These results challenge narrow views of adaptive behaviour; specifically, that step-parents, unlike biological parents, do no stand to reap fitness benefits from the care that they provide to their stepchildren. To evaluate these critiques, we analyse the survival outcomes of stepchildren. We include over 400 000 individuals from across a natural fertility period (1847-1940) in the United States state of Utah and examine the consequences of parental loss and step-parental introduction. Our analyses yield three key results: (i) exposure to maternal loss in childhood is associated with elevated mortality risk, (ii) parental remarriage does not increase the risk of mortality among stepchildren compared to non-stepchildren who too had lost a parent, and (iii) stepchildren enjoy higher survival than their half-siblings within the same family. Ultimately, this work contributes to the increasingly recognized importance of cooperative relationships among non-kin for childcare and household functioning. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
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Affiliation(s)
- Ryan Schacht
- Department of Anthropology, East Carolina University, Greenville 27858, USA
| | - Huong Meeks
- Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City 20270, USA
| | - Alison Fraser
- Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City 20270, USA
| | - Ken R. Smith
- Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City 20270, USA
- Department of Family and Consumer Studies, University of Utah, Salt Lake City 20270, USA
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29
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McCaughan E, Semple CJ, Hanna JR. 'Don't forget the children': a qualitative study when a parent is at end of life from cancer. Support Care Cancer 2021; 29:7695-7702. [PMID: 34143326 PMCID: PMC8550711 DOI: 10.1007/s00520-021-06341-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/06/2021] [Indexed: 01/04/2023]
Abstract
Purpose Preparation for end of life is one of the greatest challenges faced by parents with cancer who have dependent children (< 18 years old), with requirement for support from professionals. The aim of this study is to explore how parents can be best supported in relation to their children, when a parent is at end of life from cancer. Methods This is an interpretive qualitative study, using 79 semi-structured interviews with parents at end of life (n3), bereaved parents (n21), health and social care professionals (HSCPs) (n32) and funeral directors (n23). Data were analysed thematically and triangulated. Results Parents are central to preparing their children for the death of a parent. Striving for everyday ordinariness, maximising social networks, maintaining hope and making preparations for the future are helpful for families when a parent is at end of life. Most HSCPs were unaware of the challenges faced by parents at end of life, and psychosocial support was often left outside the caring realm. As a result, funeral directors noted complexities faced by the families after the death. Results are discussed under four themes: (1) communication with the children as a process, (2) coping throughout the unfolding end of life experience, (3) tension and complexities at end of life and (4) preparing for the future. Conclusions Parents should be reassured that by involving the children early in the end of life experience when the ill-parent is ‘well enough’ to parent enables them to be actively involved in supporting their child through one of the greatest life changing event. A number of recommendations are discussed for professionals. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06341-3.
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Affiliation(s)
- Eilís McCaughan
- School of Nursing, Ulster University, Cromore Road, Coleraine, BT52 1SA, Co. L'Derry, UK
| | - Cherith J Semple
- School of Nursing, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Co, Antrim, UK.,South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Upper Newtownards Road, Belfast, BT16 1RH, UK
| | - Jeffrey R Hanna
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK.
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30
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Semple CJ, McCaughan E, Beck ER, Hanna JR. 'Living in parallel worlds' - bereaved parents' experience of family life when a parent with dependent children is at end of life from cancer: A qualitative study. Palliat Med 2021; 35:933-942. [PMID: 33765868 PMCID: PMC8114437 DOI: 10.1177/02692163211001719] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND When a parent of dependent children (<18 years old) is at end of life from cancer, this has a profound impact on the family. Children less prepared for the death of a parent are more susceptive to poorer psychosocial adjustment in later life. There is a lack of understanding from the literature surrounding what support parents require, and how they navigate this end of life experience. AIM To explore bereaved parents' experience and needs for families when a parent is at end of life from cancer with dependent children. DESIGN In-depth, semi-structured qualitative interviews were conducted with 21 bereaved mothers and fathers, identified from the general public, a family support service and hospice. Data were analysed thematically. RESULTS Parents often live in 'parallel worlds' throughout the end of life period. In one world, 'living in the moment', cherishing the ordinariness of family life, remaining hopeful treatment will prolong life, whilst adapting as the illness unfolds. The other world presents as 'intermitted glimpses that death is approaching', shadowed with painful emotional concerns surrounding their children and the future. At the end, death rapidly approaches, characterised as suddenly 'falling off the cliff'; placing significant demands on the well-parent. CONCLUSIONS Amidst challenges, clinicians should provide parents with clear information surrounding a poor prognosis, so families can plan and prepare for parental death. There is a need for healthcare professionals to engage, encourage and equip parents, as they prepare their children throughout the end of life experience for the inevitable death of a parent.
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Affiliation(s)
- Cherith J Semple
- School of Nursing, Ulster University, Newtownabbey, Co. Antrim, UK
- South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Belfast, UK
| | - Eilís McCaughan
- School of Nursing, Ulster University, Coleraine, Co. L’Derry, UK
| | - Esther R Beck
- School of Nursing, Ulster University, Newtownabbey, Co. Antrim, UK
| | - Jeffrey R Hanna
- School of Nursing, Ulster University, Newtownabbey, Co. Antrim, UK
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31
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Hanna JR, Rapa E, Dalton LJ, Hughes R, McGlinchey T, Bennett KM, Donnellan WJ, Mason SR, Mayland CR. A qualitative study of bereaved relatives' end of life experiences during the COVID-19 pandemic. Palliat Med 2021; 35:843-851. [PMID: 33784908 PMCID: PMC8114449 DOI: 10.1177/02692163211004210] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Meeting the needs of relatives when a family member is dying can help facilitate better psychological adjustment in their grief. However, end of life experiences for families are likely to have been deleteriously impacted by the COVID-19 crisis. Understanding how families' needs can be met during a global pandemic will have current/future relevance for clinical practice and policy. AIM To explore relatives' experiences and needs when a family member was dying during the COVID-19 pandemic. DESIGN Interpretative qualitative study using semi-structured interviews. Data were analysed thematically. SETTING/PARTICIPANTS A total of 19 relatives whose family member died during the COVID-19 pandemic in the United Kingdom. RESULTS In the absence of direct physical contact, it was important for families to have a clear understanding of their family member's condition and declining health, stay connected with them in the final weeks/days of life and have the opportunity for a final contact before they died. Health and social care professionals were instrumental to providing these aspects of care, but faced practical challenges in achieving these. Results are presented within three themes: (1) entering into the final weeks and days of life during a pandemic, (2) navigating the final weeks of life during a pandemic and (3) the importance of 'saying goodbye' in a pandemic. CONCLUSIONS Health and social care professionals can have an important role in mitigating the absence of relatives' visits at end of life during a pandemic. Strategies include prioritising virtual connectedness and creating alternative opportunities for relatives to 'say goodbye'.
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Affiliation(s)
- Jeffrey R Hanna
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Louise J Dalton
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Rosemary Hughes
- Palliative Care Institute Liverpool, North West Cancer Research Centre, University of Liverpool, Liverpool, UK
| | - Tamsin McGlinchey
- Palliative Care Institute Liverpool, North West Cancer Research Centre, University of Liverpool, Liverpool, UK
| | - Kate M Bennett
- Department of Psychology, University of Liverpool, Liverpool, UK
| | | | - Stephen R Mason
- Palliative Care Institute Liverpool, North West Cancer Research Centre, University of Liverpool, Liverpool, UK
| | - Catriona R Mayland
- Palliative Care Institute Liverpool, North West Cancer Research Centre, University of Liverpool, Liverpool, UK.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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32
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McGachy B. Dealing with bereaved children: a case study. Br Paramed J 2021; 5:54-58. [PMID: 34421376 PMCID: PMC8341062 DOI: 10.29045/14784726.2021.3.5.4.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: A personal reflection on managing bereaved children (BC) following unexpected death of a parent. Questions: What evidence is available to assist ambulance clinicians when supporting BC? Methods: A literature search on BC in pre-hospital environments was undertaken. Results: Paucity of literature necessitated search expansion beyond pre-hospital/ambulance focus, and use of supplementary sources of credible information from registered bereavement charities and help groups. Conclusion: More research is needed to better support this vulnerable, unique demographic. It is hoped that this article will encourage further discussion and research into this topic.
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Affiliation(s)
- Ben McGachy
- South Western Ambulance Service NHS Foundation Trust
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33
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Weinstock L, Dunda D, Harrington H, Nelson H. It's Complicated-Adolescent Grief in the Time of Covid-19. Front Psychiatry 2021; 12:638940. [PMID: 33708148 PMCID: PMC7940762 DOI: 10.3389/fpsyt.2021.638940] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/01/2021] [Indexed: 01/04/2023] Open
Abstract
Presently, there is a real possibility of a second pandemic occurring: a grief pandemic. There are estimated to be over 1 million children and young people experiencing bereavement because of Covid-19. Adolescent grief is unique due to bio-psycho-social factors such as increased risk-taking, identity-formation, and limited capacity for emotional regulation. In this article, we will argue that adolescents are at increased risk of developing complicated grief during the Covid-19 pandemic, and that it is vital that services are improved to recognize and address this need before secondary problems emerge, including anxiety, depression, and substance abuse. Complicated grief in adolescents is widely underrecognized and often misdiagnosed as a range of mental health problems, addictions, and offending behavior. For example, 25% of <20 year olds who commit suicide have experienced childhood bereavement, whilst 41% of youth offenders have experienced childhood bereavement; this is in comparison with only 4% of the general population. Many of the broader risk factors for complicated grief were already increasing prior to the Covid-19 pandemic, including increased loneliness amongst young people, and the collapse of collective structures to help people manage grief. We propose that this pandemic could be a catalyst for mental health professionals to support and nurture the caring communities emerging in this time as an essential resource to prevent the onset of a grief pandemic.
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Affiliation(s)
| | | | | | - Hannah Nelson
- Psychology Department, University of Loughborough, Loughborough, United Kingdom
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34
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Paul S, Vaswani N. The prevalence of childhood bereavement in Scotland and its relationship with disadvantage: the significance of a public health approach to death, dying and bereavement. Palliat Care Soc Pract 2020; 14:2632352420975043. [PMID: 33313505 PMCID: PMC7716073 DOI: 10.1177/2632352420975043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background and Method There is an absence of research on the prevalence of bereavement during early childhood and the relationship between childhood bereavement and socioeconomic status (SES) and this poses a challenge in both understanding and supporting children's bereavement experiences. Using longitudinal data from the Growing Up in Scotland study, which tracks the lives of three nationally representative cohorts of children, this paper aimed to address these gaps in research. It specifically drew on data from Birth Cohort 1 to document the recorded bereavements of 2,815 children who completed all 8 sweeps of data collection, from age 10 months to 10 years. Findings The study found that 50.8% of all children are bereaved of a parent, sibling, grandparent or other close family member by age 8 and this rises to 62% by age 10. The most common death experienced was that of a grandparent or other close relative. The study also found that children born into the lowest income households are at greater risk of being bereaved of a parent or sibling than those born into the highest income households. Discussion and Conclusion Given the prevalence of childhood bereavement and its relationship with disadvantage, this paper argues that there is an important need to understand bereavement as a universal issue that is affected by the social conditions in which a child becomes bereaved, as well as an individual experience potentially requiring specialist support. This paper thus seeks to position childhood bereavement more firmly within the public health approach to palliative and bereavement care discourse and contends that doing so provides a unique and comprehensive opportunity to better understand and holistically respond to the experience of bereavement during childhood.
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Affiliation(s)
- Sally Paul
- University of Strathclyde, Lord Hope Building, 141 St James Road, Glasgow G4 0LT, UK
| | - Nina Vaswani
- Children and Young People's Centre for Justice, University of Strathclyde, Glasgow, UK
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35
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Hanna JR, McCaughan E, Beck ER, Semple CJ. Providing care to parents dying from cancer with dependent children: Health and social care professionals' experience. Psychooncology 2020; 30:331-339. [DOI: 10.1002/pon.5581] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - Cherith J. Semple
- School of Nursing Ulster University Newtownabbey UK
- South Eastern Health and Social Care Trust Cancer Services Ulster Hospital Belfast UK
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36
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Verdery AM, Smith-Greenaway E, Margolis R, Daw J. Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States. Proc Natl Acad Sci U S A 2020; 117:17695-17701. [PMID: 32651279 PMCID: PMC7395491 DOI: 10.1073/pnas.2007476117] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to a large increase in mortality in the United States and around the world, leaving many grieving the sudden loss of family members. We created an indicator-the COVID-19 bereavement multiplier-that estimates the average number of individuals who will experience the death of a close relative (defined as a grandparent, parent, sibling, spouse, or child) for each COVID-19 death. Using demographic microsimulation-based estimates of kinship networks in the United States, the clear age gradient in COVID-19 mortality seen across contexts, and several hypothetical infection prevalence scenarios, we estimate COVID-19 bereavement multipliers for White and Black individuals in the United States. Our analysis shows that for every COVID-19 death, approximately nine surviving Americans will lose a grandparent, parent, sibling, spouse, or child. These estimates imply, for example, that if 190,000 Americans die from COVID-19, as some models project, then ∼1.7 million will experience the death of a close relative. We demonstrate that our estimates of the bereavement multiplier are stable across epidemiological realities, including infection scenarios, total number of deaths, and the distribution of deaths, which means researchers can estimate the bereavement burden over the course of the epidemic in lockstep with rising death tolls. In addition, we provide estimates of bereavement multipliers by age group, types of kin loss, and race to illuminate prospective disparities. The bereavement multiplier is a useful indicator for tracking COVID-19's multiplicative impact as it reverberates across American families and can be tailored to other causes of death.
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Affiliation(s)
- Ashton M Verdery
- Department of Sociology and Criminology, Pennsylvania State University, University Park, PA 16802;
| | | | - Rachel Margolis
- Department of Sociology, University of Western Ontario, London, ON N6A 5C2, Canada
| | - Jonathan Daw
- Department of Sociology and Criminology, Pennsylvania State University, University Park, PA 16802
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37
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Holm M, Weber Falk M, Lövgren M, Kreicbergs U, Alvariza A, Sveen J. Sources of social support and its importance for cancer-bereaved spouses and their minor children: A cross-sectional study. DEATH STUDIES 2020; 46:996-1002. [PMID: 32552419 DOI: 10.1080/07481187.2020.1780344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to evaluate the sources from which bereaved families with minor children reported receiving social support after the death of a parent/partner and which sources they perceived as important. Using an online platform, 23 adolescents, 42 parents, and 27 parent proxies for children aged 4-11 years, completed questionnaires. Family and friends were valued as the most important sources of social support, while social support from societal institutions, such as health care and school, was considered less important, and insufficient.
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Affiliation(s)
- Maja Holm
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
| | - Megan Weber Falk
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care Unit, Dalen Hospital, Stockholm, Sweden
| | - Josefin Sveen
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Neuroscience, National Center for Disaster Psychiatry, Uppsala University, Uppsala, Sweden
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Abstract
The aim of this study was to explicate ways in which parents tell their adolescents about a parent's death. This study used a descriptive, qualitative design. From a large hospice in northeastern Ohio, nine adolescent children and six surviving spouses of recently deceased hospice patients were recruited. Participants completed a demographic questionnaire and a semistructured individual interview. Thematic content analysis techniques were used to analyze the data. Surviving parents tell adolescents about the parent's death in ways that are intended to inform and ease the adolescents' distress. They engage in the process of disclosure in one of three ways: measured telling, matter-of-fact telling, and inconsistent telling. Findings from the current study are consistent with the ways parents told their children about an ill parent's life-threatening illness and imminent death. The findings support a framework that describes the processes of disclosure of a parent's illness, imminent death, and death to their adolescent children. Predeath findings about telling foreshadowed the postdeath findings. These results can be used to inform the development of interventions in which nurses and other health care professionals assist families with disclosure before and after death by tailoring strategies according to the family's communication style.
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39
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Weber Falk M, Alvariza A, Kreicbergs U, Sveen J. The grief and communication family support intervention: Intervention fidelity, participant experiences, and potential outcomes. DEATH STUDIES 2020; 46:233-244. [PMID: 32072870 DOI: 10.1080/07481187.2020.1728429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study aimed to evaluate intervention fidelity and explore participants' experiences and potential outcomes after participating in the intervention. Using a pretest post-test pilot study, 10 parentally bereaved families completed the three-session manual-based intervention with a family therapist. Sessions were audio-recorded. Therapists completed an adherence checklist to assess fidelity. Assessments via questionnaires and interviews occurred at one month post-intervention and via questionnaires at baseline and six months post-intervention. This study showed a high level of fidelity. The study shows preliminary evidence of the intervention's capacity to improve communication and relationships in parentally bereaved families.
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Affiliation(s)
- Megan Weber Falk
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Anette Alvariza
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women and Child's Health, Karolinska Institute, Stockholm, Sweden
| | - Josefin Sveen
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Menendez D, Hernandez IG, Rosengren KS. Children’s Emerging Understanding of Death. CHILD DEVELOPMENT PERSPECTIVES 2020. [DOI: 10.1111/cdep.12357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Çokuğraş FÇ, Ferrara P, Pop TL, Nigri L, Giardino I, Pettoello-Mantovani M. The role of paediatricians in implementing adequate social programs to assist children suffering parental loss. TURK PEDIATRI ARSIVI 2019; 54:203-206. [PMID: 31949410 PMCID: PMC6952474 DOI: 10.14744/turkpediatriars.2018.33341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Fügen Çullu Çokuğraş
- European Paediatric Association-Union of National European Paediatric Societies and Associations (EPA-UNEPSA), Berlin, Germany
- Division of Gastroenterology, Department of Pediatrics, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Pietro Ferrara
- European Paediatric Association-Union of National European Paediatric Societies and Associations (EPA-UNEPSA), Berlin, Germany
- Italian Society of Pediatrics (SIP), Rome, Italy
- Institute of Pediatrics, Catholic University Medical School, Rome, Italy
- Campus Bio-Medico University Medical School, Rome, Italy
| | - Tudor Lucian Pop
- European Paediatric Association-Union of National European Paediatric Societies and Associations (EPA-UNEPSA), Berlin, Germany
- Second Pediatric Clinic, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Romanian Social Pediatrics Society, Cluj-Napoca, Romania
| | - Luigi Nigri
- European Paediatric Association-Union of National European Paediatric Societies and Associations (EPA-UNEPSA), Berlin, Germany
- Italian Federation of Pediatricians, Rome, Italy
| | - Ida Giardino
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Massimo Pettoello-Mantovani
- European Paediatric Association-Union of National European Paediatric Societies and Associations (EPA-UNEPSA), Berlin, Germany
- Department of Pediatrics, Scientific Institute “Casa Sollievo della Sofferenza”, University of Foggia, Foggia, Italy
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Griffiths N, Mazzucchelli TG, Skinner S, Kane RT, Breen LJ. A pilot study of a new bereavement program for children: Lionheart Camp for Kids. DEATH STUDIES 2019; 46:780-790. [PMID: 31858883 DOI: 10.1080/07481187.2019.1702121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We assessed the acceptability and effectiveness of a new childhood bereavement service known as Lionheart Camp for Kids. Using a pre-post-follow-up design, data pertaining to 12 bereaved children (aged 5-12 years) and their primary caregivers were obtained. Results showed that caregivers reported decreases in children's peer relationship problems, improvements in parental consistency, and reductions in coercive parenting, and there was a trend toward lower self-reported grief by the children. Caregivers were highly satisfied with the program. There is a need for a wait-list or randomized controlled trial over a longer time period to determine the full benefits of the camp.
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Affiliation(s)
| | | | - Shelly Skinner
- Lionheart Camps for Kids, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Robert T Kane
- School of Psychology, Curtin University, Perth, Australia
| | - Lauren J Breen
- School of Psychology, Curtin University, Perth, Australia
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Weber M, Alvariza A, Kreicbergs U, Sveen J. Adaptation of a Grief and Communication Family Support Intervention for Parentally Bereaved Families in Sweden. DEATH STUDIES 2019; 45:528-537. [PMID: 31584356 DOI: 10.1080/07481187.2019.1661883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article aims to describe the adaptation of the evidence-based Family Bereavement Program to a Swedish context. Empirical support indicating that family communication is a protective factor for parentally bereaved children was used to motivate the focus of the intervention. Modules from the Family Bereavement Program manual were translated, culturally adapted, and modified to fit a family format. The manual for the Grief and Communication Family Support Intervention was pilot-tested with two families, which resulted in minor modifications being made to the manual. Therapists reported that they could follow the manual and adapt it to children's varying ages.
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Affiliation(s)
- Megan Weber
- Ersta Sköndal Bräcke University College, Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Anette Alvariza
- Ersta Sköndal Bräcke University College, Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Ersta Sköndal Bräcke University College, Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Dept of Women and Child's Health, Karolinska Institute, Stockholm, Sweden
| | - Josefin Sveen
- Ersta Sköndal Bräcke University College, Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Hanna JR, McCaughan E, Semple CJ. Challenges and support needs of parents and children when a parent is at end of life: A systematic review. Palliat Med 2019; 33:1017-1044. [PMID: 31244381 DOI: 10.1177/0269216319857622] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Preparing children for the death of a parent is challenging. Parents are often uncertain if and how to communicate and support their children. Many parents feel it is protecting their children by not telling them about the prognosis. Children less prepared for parental death from a terminal illness are more susceptive to later adversities. To facilitate coping and moderate for such adversities, there is a need to gain insight and understand the experience and challenges confronted by families. AIM This review synthesised evidence on the experiences of parents and children when a parent is at end of life to discern their challenges, support needs and factors that facilitated good practice. DESIGN Mixed-methods systematic review. DATA SOURCES Four electronic databases (CINAHL, PubMed, PsycINFO and Ovid MEDLINE) using MeSH terms and word searches in October 2018. Studies were not limited by year of publication, language or country. Grey literature searches were also completed on Google Scholar and OpenGrey. RESULTS In all, 7829 records were identified; 27 qualitative and 0 quantitative studies met the inclusion criteria. Eight descriptive themes were identified, further categorised into two broad themes: (1) barriers and facilitators in sharing the news that a parent is dying and (2) strategies to manage the changing situation. CONCLUSION Lack of understanding in relation to the parent's prognosis, denial and feeling ill-equipped were suggested as barriers for parents to share the news with their children. Engagement with social networks, including extended family relatives and peers, and maintaining routines such as attending school were suggested supportive by parents and children. Findings are limited primarily to White, middle-class two-parent families. A number of areas for future research are identified.
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Affiliation(s)
| | | | - Cherith J Semple
- 1 School of Nursing, Ulster University, Newtownabbey, UK.,3 Cancer Services and Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK
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Winstanley EL, Stover AN. The Impact of the Opioid Epidemic on Children and Adolescents. Clin Ther 2019; 41:1655-1662. [PMID: 31303278 PMCID: PMC7017799 DOI: 10.1016/j.clinthera.2019.06.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 11/21/2022]
Abstract
Although an epidemic of opioid-related overdose deaths has continued to increase in the United States for 2 decades, the impact of opioid use disorders (OUDs) on children and families receives minimal attention. The purpose of this commentary was to provide an overview of the impact of the opioid epidemic on children and adolescents, as well as to summarize challenges to improving outcomes for children. Children and adolescents who grow up in households with opioid misuse and OUDs may experience a myriad of adverse consequences, including: increased risk of mental health problems and drug use; accidental opioid poisoning; increased risk of developing a substance use disorder; and family dissolution that results from parents' incarceration, foster care placement, or loss of parent to an opioid overdose. Parental drug use may result in child neglect or deficits in parent-child attachment, and parents with an OUD may be less likely to be reunified with their children. OUD treatment is effective at reducing parental opioid use and improving child outcomes; however, stigma and cross-system collaboration may limit access to treatment and timely reunification of families. Children are the most vulnerable witnesses of the opioid epidemic, and further research is urgently needed to expand prevention interventions.
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Affiliation(s)
- Erin L Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States.
| | - Amanda N Stover
- School of Pharmacy, West Virginia University, Morgantown, WV, United States
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Weber M, Alvariza A, Kreicbergs U, Sveen J. Family Communication and Psychological Health in Children and Adolescents Following a Parent’s Death From Cancer. OMEGA-JOURNAL OF DEATH AND DYING 2019; 83:630-648. [DOI: 10.1177/0030222819859965] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Parentally bereaved children and adolescents are at risk of developing psychological health problems. Evidence for a correlation between communication and broad measures of psychological health exists in other populations. The aim of this study was to examine associations between family communication and specific aspects of psychological health for children and adolescents following a parent’s death from cancer using parent-proxy and adolescent self-reports. Parent-proxy reports for children and adolescents, and adolescent self-reports for Parent–Adolescent Communication, Strengths and Difficulties Questionnaire, and Prolonged Grief-13 child were analyzed using descriptive statistics and Spearman’s correlation. Parents rated communication as moderate in quality and reported good psychological health for children and adolescents. Adolescent self-reports indicated low-quality communication with their parent and poor psychological health. Significant associations between Parent–Adolescent Communication subscales and Strengths and Difficulties Questionnaire subscales were found for each group. Prolonged grief was associated with emotional problems but not communication for all three groups.
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Affiliation(s)
- Megan Weber
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Anette Alvariza
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women and Child's Health, Karolinska Institute, Stockholm, Sweden
| | - Josefin Sveen
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Sweden
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Weber M, Alvariza A, Kreicbergs U, Sveen J. Communication in families with minor children following the loss of a parent to cancer. Eur J Oncol Nurs 2019; 39:41-46. [DOI: 10.1016/j.ejon.2019.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/12/2018] [Accepted: 01/19/2019] [Indexed: 11/16/2022]
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Dalton L, Rapa E, Ziebland S, Rochat T, Kelly B, Hanington L, Bland R, Yousafzai A, Stein A. Communication with children and adolescents about the diagnosis of a life-threatening condition in their parent. Lancet 2019; 393:1164-1176. [PMID: 30894272 DOI: 10.1016/s0140-6736(18)33202-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 11/27/2022]
Abstract
Many adults diagnosed with a life-threatening condition have children living at home; they and their partners face the dual challenge of coping with the diagnosis while trying to maintain a parenting role. Parents are often uncertain about how, when, and what to tell their children about the condition, and are fearful of the effect on their family. There is evidence that children are often aware that something is seriously wrong and want honest information. Health-care professionals have a key role in supporting and guiding parents and caregivers to communicate with their children about the diagnosis. However, the practical and emotional challenges of communicating with families are compounded by a scarcity of evidence-based guidelines. This Review considers children's awareness and understanding of their parents' condition, the effect of communication around parental life-threatening condition on their wellbeing, factors that influence communication, and the challenges to achieving effective communication. Children's and parents' preferences about communication are outlined. An expert workshop was convened to generate principles for health-care professionals, intended as practical guidance in the current absence of empirically derived guidelines.
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Affiliation(s)
- Louise Dalton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tamsen Rochat
- Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Human Sciences Research Council, Johannesburg, South Africa
| | - Brenda Kelly
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lucy Hanington
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ruth Bland
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Institute of Health and Wellbeing, Glasgow, UK; University of Glasgow and Royal Hospital for Children, Glasgow, UK
| | | | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
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Muriel AC, Moore CW, Beiser M, Park ER, Lim CT, Rauch P. What do surviving children wish for from a dying parent? A qualitative exploration. DEATH STUDIES 2019; 44:319-327. [PMID: 30623743 DOI: 10.1080/07481187.2018.1554608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Legacy may play an important role in how children integrate the loss of a parent. Sixteen adults (19-40 years old, 69% women) who experienced the death of a parent from an illness before age 12 were interviewed, exploring legacies from their deceased parent. Transcribed interviews were iteratively analyzed by three independent coders. Extracted themes described their experiences and wish for remembrances and specific communication left for them, information about the parent's values and feelings about them, and personal possessions. This study provides novel data about legacies that bereaved children wish for in adulthood.
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Affiliation(s)
- Anna C Muriel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Cynthia W Moore
- Department od Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Marguerite Beiser
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Medical Center, Boston, Massachusetts, USA
| | - Elyse R Park
- Department od Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher T Lim
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Paula Rauch
- Department od Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Martinčeková L, Jiang MJ, Adams JD, Menendez D, Hernandez IG, Barber G, Rosengren KS. Do you remember being told what happened to grandma? The role of early socialization on later coping with death. DEATH STUDIES 2018; 44:78-88. [PMID: 30541397 PMCID: PMC6561842 DOI: 10.1080/07481187.2018.1522386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Using a mixed-methods approach, we examined how participants' memories of socialization regarding death might influence their self-reported coping with losses in childhood and adulthood. We recruited 318 adults to complete an online survey. Path analyses indicated that participants who remembered their parents shielding them less from issues related to death reported better coping as children and adults. Qualitative responses suggested participants wanted to receive more information about death from their parents as they went through the grieving process. We highlight the potential benefits of socializing children about death, and how it may aid in their coping with death-related events.
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Affiliation(s)
- Lucia Martinčeková
- Institute of Experimental Psychology, Centre of Social and Psychological Sciences, Slovak Academy of Sciences
| | | | - Jamal D. Adams
- Department of Psychology, University of Wisconsin-Madison
| | - David Menendez
- Department of Psychology, University of Wisconsin-Madison
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