End-of-Life-Related Factors Associated with Posttraumatic Stress and Prolonged Grief in Parentally Bereaved Adolescents

Posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) are well-documented in parentally bereaved adolescents. Whether or not the parent’s death is perceived as traumatic may be influenced by several end-of-life-related factors. This study aimed to examine the associations between end-of-life-related factors, symptoms of posttraumatic stress disorder (PTSD), symptoms of prolonged grief disorder and PGD, and the association between PTSD and PGD. Mann-Whitney U tests and Spearman correlation were used to analyze the relationships between end-of-life-related factors, PTSD, and PGD. Regretting one’s decision to be present or not present at the time of death resulted in a significant difference in self-reported scores for PTSD, but not PGD.

Posttraumatic Stress Disorder and Childhood Traumatic Loss: A Secondary Analysis of Symptom Severity and Treatment Outcome

Loss is a commonly experienced traumatic event among children. Although the experience of loss can potentially lead to posttraumatic stress symptoms (PTSS), little is known about PTSS levels after traumatic loss versus other traumatic events. We investigated data from a randomized controlled trial (RCT) on trauma-focused cognitive behavioral therapy (TF-CBT) versus a waitlist condition for children with PTSS. In a secondary analysis, we compared participants who reported traumatic loss as their index event (n = 23) to those who reported the two most frequently reported index events in the RCT: sexual abuse (SA; n = 59) and physical violence (PV; n = 55). The index event was rated according to the participants' most distressing traumatic event reported on the Clinician-Administered PTSD Scale for Children and Adolescents. Participants who experienced traumatic loss reported fewer PTSS and better general functioning than those who reported SA. A subgroup RCT (n = 19) revealed TF-CBT to be highly effective in reducing PTSS in cases of traumatic loss, d = 1.69. The effect sizes for PTSS indicated that all three trauma groups benefited from TF-CBT. In the waitlist group, PTSS symptoms improved for SA and PV, ds = 0.76 and 0.98, respectively, but not for traumatic loss, d = 0.23. These findings suggest that TF-CBT is a feasible and promising treatment for children who experience PTSS after traumatic loss. The results are limited by the post hoc quality of the analyses and lack of a measure of grief in the RCT.

Family Communication and Psychological Health in Children and Adolescents Following a Parent’s Death From Cancer

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.

Psychometrics of the PTSD and Depression Screener for Bereaved Youth

Interventions for bereaved children and families range from supportive counseling, designed to promote social connectedness and expression of feelings and thoughts about the deceased, to intensive trauma/grief-specific therapy, designed to ameliorate symptoms of posttraumatic stress disorder (PTSD) and depression. That said, professionals have few brief assessment instruments to match response and functioning to appropriate interventions. To expedite the screening and referral process for bereaved families, Brown, Goodman, and Swiecicki ( 2008 ) developed the PTSD and Depression Screener for Bereaved Youth, a 19-item measure of bereavement-related history and symptoms of PTSD and depression. The current study is a psychometric evaluation of the Screener for Bereaved Youth. Data were collected from 284 bereaved children, 6-17 years of age (M = 12.4; SD = 2.9). A factor analysis revealed distinct subscales for PTSD (eight items) and depression (four items). The PTSD and depression subscales showed both concurrent and discriminant validity. Endorsement of four items on either subscale was associated with meeting full criteria on more extensive measures of PTSD and depression. These findings are discussed with specific consideration to the multiple systems in which the measure could be used and applications to clinical services.

Loss Due to Death and its Association with Mental Disorders in Juvenile Detainees

This study investigated the prevalence of loss due to death and its association with mental disorders in a random sample of 898 newly detained adolescents in Chicago, Illinois. Nearly 90% of youth experienced the loss of an important person; most had also experienced a "high-risk" loss (e.g., loss due to violence, sudden loss). Minority youth were at particular risk. Youth with any loss or multiple losses were more likely to have mood disorders and ADHD/behavioral disorders, respectively, than youth who had no such losses. Interventions focusing on modifiable protective factors following loss may increase positive outcomes in this vulnerable population.

Do circumstances of the death matter? Identifying socioenvironmental risks for grief-related psychopathology in bereaved youth

We examined bereaved children's and surviving caregivers' psychological responses following the death of the other caregiver as a function of the stated cause of death. Participants included 63 parentally bereaved children and 38 surviving caregivers who were assessed using self-report instruments and in-person interviews. Surviving caregivers reported the causes of death as resulting from sudden natural death (34.9%), illness (33.3%), accident (17.5%), and suicide (14.3%). Results revealed differences between caregiver-reported versus child-reported cause of death, particularly in cases of suicide. Children who lost a caregiver due to a prolonged illness exhibited higher levels of both maladaptive grief (d = 3.13) and posttraumatic stress symptoms (PTSS; d = 3.33) when compared to children who lost a caregiver due to sudden natural death (e.g., heart attack). In contrast, surviving caregivers did not differ in their levels of maladaptive grief and PTSS as a function of the cause of death; however, caregivers bereaved by sudden natural death reported higher levels of depression than those bereaved by prolonged illness (d = 1.36). Limited sample size prevented analysis of outcomes among those bereaved by suicide or accident. These findings suggest that anticipated deaths may contain etiologic risk factors for maladaptive grief and PTSS in children.

Using multidimensional grief theory to explore the effects of deployment, reintegration, and death on military youth and families

To date, the US military has made major strides in acknowledging and therapeutically addressing trauma and post-traumatic stress disorder (PTSD) in service members and their families. However, given the nature of warfare and high rates of losses sustained by both military members (e.g., deaths of fellow unit members) and military families (e.g., loss of a young parent who served in the military), as well as the ongoing threat of loss that military families face during deployment, we propose that a similar focus on grief is also needed to properly understand and address many of the challenges encountered by bereaved service members, spouses, and children. In this article, we describe a newly developed theory of grief (multidimensional grief theory) and apply it to the task of exploring major features of military-related experiences during the phases of deployment, reintegration, and the aftermath of combat death--especially as they impact children. We also describe implications for designing preventive interventions during each phase and conclude with recommended avenues for future research. Primary aims are to illustrate: (1) the indispensable role of theory in guiding efforts to describe, explain, predict, prevent, and treat maladaptive grief in military service members, children, and families; (2) the relevance of multidimensional grief theory for addressing both losses due to physical death as well as losses brought about by extended physical separations to which military children and families are exposed during and after deployment; and (3) a focus on military-related grief as a much-needed complement to an already-established focus on military-related PTSD.

DSM-V diagnostic criteria for bereavement-related disorders in children and adolescents: developmental considerations

Two bereavement-related disorders are proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V): Adjustment Disorder Related to Bereavement, to be located in the main body of the text as an official diagnostic entity; and Bereavement-Related Disorder, including a Traumatic Death Specifier, to be located in the Appendix as an invitation for further research. These diagnoses currently do not include developmentally informed criteria, despite the importance of developmental processes in the ways children and adolescents grieve. In this article, we draw upon a selective review of the empirical literature and expert clinical knowledge to recommend developmentally informed modifications and specifiers of the proposed criteria for both bereavement disorders and strategies to improve future research. This article is derived from an invited report submitted to the DSM-V Posttraumatic Stress Disorder, Trauma, and Dissociative Disorders Sub-Work Group, and suggested modifications have received preliminary approval to be incorporated into the DSM-V at the time of this writing. Adoption of these proposals will have far-reaching consequences, given that DSM-V criteria will influence both critical treatment choices for bereaved youth and the next generation of research studies.

A Meta-Analysis of Coefficient Alpha for the Impact of Event Scales: A Reliability Generalization Study

We conducted a score reliability meta-analysis across studies using the Impact of Event Scales. Five hundred and ninety-four studies using the measure were located through electronic database searches and then separated to identify studies that had calculated and reported reliability coefficients from their own data. The 66 articles that remained were then coded to identify potential study characteristics that might influence the variation in reliability estimates. Results indicate adequate internal consistency estimates for all subscales across both scale versions. Furthermore, coefficient alpha was positively correlated with studies involving war and abuse victims for the IES Avoidance subscale. The alpha coefficient was also positively correlated with the percentage of female participants for the Intrusion subscale and negatively correlated to journal type for the composite reliability estimate. Results from this study provide useful information, in terms of scale performance, for researchers interested in using the scale for future academic pursuits and for school psychologists. In particular, implications for school psychologists are considered.

Psychiatric symptoms in bereaved versus nonbereaved youth and young adults: a longitudinal epidemiological study

OBJECTIVE

To examine potential differences in psychiatric symptoms between parent-bereaved youth (N = 172), youth who experienced the death of another relative (N = 815), and nonbereaved youth (N = 235), aged 11 to 21 years, above and beyond antecedent environmental and individual risk factors.

METHOD

Sociodemographics, family composition, and family functioning were assessed one interview wave before the death. Child psychiatric symptoms were assessed during the wave in which the death was reported and one wave before and after the death. A year was selected randomly for the nonbereaved group.

RESULTS

The early loss of a parent was associated with poverty, previous substance abuse problems, and greater functional impairment before the loss. Both bereaved groups of children were more likely than nonbereaved children to show symptoms of separation anxiety and depression during the wave of the death, controlling for sociodemographic factors and prior psychiatric symptoms. One wave following the loss, bereaved children were more likely than nonbereaved children to exhibit symptoms of conduct disorder and substance abuse and to show greater functional impairment.

CONCLUSIONS

The impact of parental death on children must be considered in the context of pre-existing risk factors. Even after controlling for antecedent risk factors, both parent-bereaved children as well as those who lost other relatives were at increased risk for psychological and behavioral health problems.

The Prevalence of Childhood Traumatic Grief—A Comparison of Violent/Sudden and Expected Loss

The purpose of this study was to examine the prevalence of childhood traumatic grief (CTG) and posttraumatic stress disorder (PTSD) symptoms in parentally bereaved children and compare scores between those who had lost a parent to a sudden/violent death and those who had lost a parent to an expected death. Asample of 158 parentally bereaved children ages 7–16 completed the Extended Grief Inventory (EGI); 127 of those also completed the UCLA PTSD Index. A large number of children were experiencing CTG symptoms at moderate and severe levels. There was no significant difference in EGI or UCLA PTSD Index scores between the two types of losses. Findings are discussed in relation to trauma theory, research on parentally bereaved children and implications for practice.