Similarities and differences in mothers'' and fathers'' grief following the death of an infant

The differences between mothers' and fathers' grief following the death of an infant child were investigated. From a total sample of 117 parents, 53% women and 47% men, answering a survey on different grief reactions 1 to 4 years following the death. 55 families where both partners responded, were selected. Measures relating to anxiety, depression, impact of event, bodily discomfort, and general well being were included. The results demonstrated fairly strong differences between the partners' reactions, with mothers typically experiencing more intense and long-lasting reactions than fathers. Mothers also tended to perceive their family and friends as less supportive than fathers, while fathers were least satisfied with the support received from the hospital. Most parents felt the death had brought them closer together, although a considerable number reported feeling more distance to their partner. Mothers scored significantly higher than the fathers on experience of recovery, state anxiety (STAI), depression (Beck Depression Inventory), bodily symptoms (Bodily Symptom Scale) and intrusive images and thoughts (Impact of Event Scale, IES Intrusion). A high score in one spouse was correlated with a high score in the other, and vice versa. It is emphasized that the results showing parental differences in grief should help us tailor psychoeducational and therapeutical intervention for bereaved families.     

Anxiety and vulnerability in parents following the death of an infant

Empirical data on the subjectively reported anxiety reactions of 117 parents who lost an infant at birth or daring the first year of life are presented. From a retrospective survey conducted 1 to 4 years after the death it was evident that parents experienced a great deal of anxiety following the death of their child. Parents who experienced a sudden death in the home reported the strongest anxiety, but other parents who lost their child in hospital at birth or thereafter also experienced strong anxiety. The anxiety for surviving children and later-born children was extensive. In all areas mothers experienced more anxiety than fathers. More intense and longer grief in one's partner, the perceived lack of support from others, being older, and being a female were significantly correlated with anxiety. The results are interpreted as a confirmation that parents who lose their children experience a fundamental change in their beliefs about their family's future security. Better training of health personnel is required to secure an adequate follow up of families that lose a child.     

Negative cognitions and avoidance in emotional problems after bereavement: a prospective study

Cognitive behavioural conceptualisations of grief propose that negative cognitions and avoidance strategies play a key role in emotional problems after bereavement. In the current study, this assumption was examined. Ninety-seven individuals who had lost a relative less than 5 months ago completed questionnaires tapping background and loss-related variables, negative cognitions (about the self, life, the future, and one's own grief reactions), avoidance, and symptoms of complicated grief (CG) and depression. Of these mourners, 70 people (72%) completed symptom measures again 6 months later at T2 (7-10 months after the loss), and 60 (62%) completed symptoms measures still 9 months later at T3 (16-19 months after the loss). Among other things, results showed that all four cognitive variables and the avoidance variable were strongly associated with concurrent and prospective symptom levels, even when the influence of relevant background/loss-related variables was controlled. In addition, independent of initial symptom levels, most of the cognitive variables predicted later CG and depression. The avoidance variable only predicted additional variance in depression at T3 beyond T1 symptom levels. Findings indicate that negative cognitions are important in emotional problems after bereavement and that the role of avoidance in the development of these problems needs further scrutiny.     

The effectiveness of family-based cognitive-behavior grief therapy to prevent complicated grief in relatives of suicide victims: the mediating role of suicide ideation

Grief interventions are more effective for high risk individuals. The presence of suicide ideation following suicide bereavement was examined to determine whether it indicates a high risk status. Using data from a randomized controlled trial (n = 122) on the effectiveness of cognitive-behavior therapy, the effect of suicide ideation on the effectiveness of grief therapy on the bereavement outcome at 13 months post loss was examined. Results show that suicide ideators more often have a history of mental disorder and suicidal behavior than non-ideators, and suicide ideation indicates a high risk for adverse bereavement outcome. Grief therapy likely reduces the risk of maladaptive grief reactions among suicide ideators. Therefore, suicide ideators may benefit from grief therapy following a loss through suicide.     

Parental Bereavement After Suicide and Accident: A Comparative Study

In what way is the bereavement process following suicide different from other types of bereavement? The participants were 30 survivors of suicide and 30 survivors of car accidents who were interviewed twice at an average of six months, and the second measure was taken at an average of nine months after the death, with standardized questionnaires to measure depression and grief reaction. Measures of shame, social support, family adaptation, psychological distress, and prior losses were also obtained during the second interview. All survivors were parents who had lost a son aged between 18 and 35 years. The results indicate that suicide survivors were more depressed than accident survivors at the first measure but this difference disappeared at the second measure. Survivors of suicide experienced greater feelings of shame and had experienced more life events after the death than did accident survivors. There was also a greater history of loss in parents bereaved by suicide. Parental bereavement after suicide appears to differ in several ways from other types of bereavement and appears to happen more often in vulnerable families.     

Stillbirth, neonatal death and Sudden Infant Death (SIDS): parental reactions

The differences between parental grief reactions following different types of infant losses were investigated. A total of 117 parents (55 couples) from three groups of parents (stillbirth, neonatal death and Sudden Infant Death), 53% women and 47% men, answered a survey on different grief reactions one to four years following the death. Included in the survey were psychometric measures relating to anxiety, depression, impact of event, bodily discomfort, and general wellbeing. The results demonstrated that the three groups differed in their experience of various grief reactions. Sudden Infant Death Syndrome (SIDS) parents reported significantly more anxiety and intrusive thoughts than the other two groups in the early post-loss period, as well as significantly more anger, restlessness, and sleep disturbances than the neonatal group. The SIDS parents also scored significantly higher on some of the measures (experience of recovery, IES intrusion) relating to how they felt at the time of study. While the death being sudden did not show any correlation with the parents experience of recovery or the psychometric measures, the length of time the child had lived showed a strong relationship to these measures. It is emphasized that counselling to parents must be based on increased knowledge about parental reactions, tailored to the individual family's needs.     

The role of cognitive variables in psychological functioning after the death of a first degree relative

The present study sought to explore the relationship between negative cognitions and emotional problems after bereavement, with a group of 329 adults who had suffered the loss of a first degree relative. The following cognitions were assessed: global negative beliefs, cognitions about self-blame, negative cognitions about other people's responses after the loss, and negative cognitions about one's own grief reactions. Results showed that each of these cognitive variables was significantly related to the severity of symptoms of traumatic grief, depression and anxiety, even when background and loss-related variables that were initially found to influence symptom severity, were statistically controlled. When the shared variance between the cognitive variables was controlled, it was found that global negative beliefs about life, the world, and the future, and threatening interpretations of grief reactions each explained a unique proportion of variance in traumatic grief symptom severity. Global negative beliefs about life, the self and the future, and threatening interpretations of grief explained most variance in depression, while negative beliefs about the self and threatening interpretations of grief explained most variance in anxiety. Overall, the findings are in support of cognitive theories of grief, and suggest that effective treatment of problematic grief will need to address negative cognitions.     

Anxiety within families: interrelations, consistency, and change

In a community sample of mothers (N = 763), each with a focal child aged 4.5 years, anxiety levels were high. Only 54% of mothers had anxiety scores within the "normal" Hospital Anxiety and Depression Scale (HADS) range, compared with 85% for depression. A subsample (N = 116) was selected for two-parent families, one to three children, and mothers spread over low, medium, and high anxiety levels. Mothers' anxiety was not significantly related to age, education, or work status, but rather to mothers' and fathers' independent ratings of marital satisfaction and family functioning, and to fathers' own anxiety and depression. Fathers' anxiety was related not to their own views of marital satisfaction and family functioning, but rather to mothers' views and to maternal anxiety. Assessments 8 years later--of anxiety, depression, and family functioning--showed high consistency over time, particularly maternal anxiety (r = .70) and paternal depression (r = .81). Although means did not change significantly over time for fathers, mothers' anxiety, depression, and perceptions of family functioning all improved (p < .001). For parents who were later to separate (compared with the others), initial family functioning, dyadic adjustment, and maternal anxiety were significantly "worse." The strongest predictor of later break-up was fathers' dyadic adjustment.     

Development and Preliminary Evaluation of a Cognitive-Behavioral Intervention for Perinatal Grief

Perinatal loss, typically defined as fetal death beyond 20 weeks gestation through infant death 1-month postpartum, is a potentially traumatizing experience for parents occurring in approximately 1% of births in the United States. Although many women recover, 15% to 25% have enduring grief-related symptomatology and functional impairment. Perinatal grief is a unique bereavement experience, but clinical resources for detecting and treating severe perinatal grief are rare and interventions are largely without empirical support. We developed and pilot tested a cognitive-behavioral intervention targeting the psychological and behavioral sequelae of perinatal bereavement. To initially evaluate the feasibility and efficacy of the intervention, 5 women who suffered a perinatal loss were randomized to a 2-week, 4-week, or 6-week baseline period in a multiple-baseline single-case experimental design. In most cases, after the respective baseline periods, there was a steady decline in reported grief symptoms. These gains were largely maintained at a 6-week follow-up assessment. This study provides initial evidence in support of future research and clinical efforts tailoring cognitive behavioral interventions to meet the specific needs of women who experience perinatal loss.     

Children's bereavement reactions following death of the father

The war situation compelled a reinvestigation into the characteristics, course, the outcome, and the variety of bereavement reactions in early childhood. In this study, the behaviors and changes reported by the mothers and teachers of 24 normal kibbutz children over a period of 1 to 6 months after bereavement are presented. The findings lead to one clear and central conclusion: The death of a father in war brings about a severe stress situation for the child at both the preschool and the middle-childhood age. The abrupt disequilibrium created by the death itself and the resulting changes in the family place very difficult demands on the adaptation and coping capacities of the child.In this sample of normal children with no special problems before the loss, ample evidence of acute emotional strain along with noticeable grief reactions were found in the early months of bereavement. A marked increase in the number and variety of symptomatic behavior changes testified to the seriousness of the threat to the child's sense of well-being after notification of the death. Ten of the 22 children between the ages of 2 and 10 years reacted to the trauma severely and were so markedly hindered in their daily functioning that psychological help was considered imperative. The disorganizing effect of the trauma of the loss of a father as reflected in this high percentage of disturbance in normal children indicates that without doubt a child who has lost a parent is a child at risk. It is therefore desirable if not imperative that there be more balance in the efforts to help bereaved families.     

Patterns of attachment and parents' adjustment to the death of their child

The impact of adult attachment on psychological adjustment among bereaved parents and the mediating effect of relationship satisfaction were examined among a sample of 219 couples of parents. Data collection took place 6, 13, and 20 months after loss. Use of the actor partner interdependence model in multilevel regression analysis enabled exploration of both individual as well as partner attachment as predictors of grief and depression. Results indicated that the more insecurely attached parents were (on both avoidance and anxiety attachment), the higher the symptoms of grief and depression. Neither the attachment pattern of the partner nor similarity of attachment within the couple had any influence on psychological adjustment of the parent. Marital satisfaction partially mediated the association of anxious attachment with symptomatology. Contrary to previous research findings, avoidant attachment was associated with high grief intensity. These findings challenge the notion that the avoidantly attached are resilient.     

Constructions of Mexican American family grief after the death of a child: an exploratory study

Using a collective case study ethnographic approach, nine individuals comprising three Mexican American families were interviewed about their family bereavement experiences after the death of a child. All families were Catholic, had surviving siblings, and had had three or more years to grieve their loss when interviewed. The deceased children ranged in age from 3 to 14, and all experienced sudden, traumatic, nonsuicide deaths. To provide a broader, contextual picture of their grief experiences, four individuals who supported these family members after the loss were also interviewed. Unique grief experiences were identified, and eight common themes emerged, reflecting the ways in which family members maintained their bond to the deceased: dreams, storytelling, keepsakes, sense of presence, faith-based connections, proximity connections, ongoing rituals, and pictorial remembrances. The cultural implications of family bereavement are highlighted.     

Suicide bereavement and recovery patterns compared with nonsuicide bereavement patterns

This study compared bereavement experiences of suicide survivors with those of other survivors. The primary focus of investigation was upon grief reactions suggested to be unique to suicide bereavement and upon quality of grief resolution 2-4 years after death. Fifty-seven women and men, between the ages of 24 and 48, who had experienced the death of a marital partner were interviewed. Subjects were assigned to one of four groups by mode of death (suicide, accident, unanticipated natural, and expected natural). Analyses of variance and Scheffe procedures indicated no significant differences among survivors on frequencies of grief reactions considered common to all bereavements. The suicide survivors were significantly different from all others on certain grief measures, including rejection and unique grief reactions. On various other grief measures, significant differences were indicated among the groups of survivors. Four primary conclusions, implications of the findings, and limitations of the study are discussed.     

The Aging Of Grief: Parents' Grieving Of Israeli Soldiers

Abstract

This chapter examines long-term parental grief of soldiers within the context of the Israeli society. Parental grief is discussed along the life span, commencing at the immediate phase following the loss through the bereavement process in middle to late adulthood and its manifestations in aging. Interviews with a group of elderly bereaved parents whose sons were killed during military service give further support to previous findings regarding the notion that the passage of time has no diminishing effect on their grief nor does it relinquish their attachment to the deceased. With aging, there appears to be an increase in internalized involvement with the long-lost child, fears of fading memories, and the need to eternalize the deceased. In reviewing the past, parents reevaluate their coping with the loss and their relationship with the surviving children. The parents' preoccupation is twofold: On one hand, the strong attachment seems to continue in inner representations of the lost child, and, on the other, this preoccupation is enhanced externally owing to Israeli society's attitude toward dead soldiers. An intersection is therefore established between society and bereaved families. Grief is apparently a central theme in aging parents who are preoccupied with the “aging” of their grief rather than their own aging.     

Resilience to loss and chronic grief: a prospective study from preloss to 18-months postloss

The vast majority of bereavement research is conducted after a loss has occurred. Thus, knowledge of the divergent trajectories of grieving or their antecedent predictors is lacking. This study gathered prospective data on 205 individuals several years prior to the death of their spouse and at 6- and 18-months postloss. Five core bereavement patterns were identified: common grief, chronic grief, chronic depression, improvement during bereavement, and resilience. Common grief was relatively infrequent, and the resilient pattern most frequent. The authors tested key hypotheses in the literature pertaining to chronic grief and resilience by identifying the preloss predictors of each pattern. Chronic grief was associated with preloss dependency and resilience with preloss acceptance of death and belief in a just world.     

Child mortality and parental grief: An evolutionary analysis

Across most of human history, infant and child mortality rates were very high, suggesting the death of a child was a challenge faced by many ancestral parents. Prolonged grief likely harmed grievers’ fitness, yet grief is ubiquitous and often protracted, thereby presenting a puzzle for evolutionary arguments. We integrate existing theories of grief with patterns of parental bereavement to examine how human psychology has been shaped to respond to the death of a child. We contend that variation in life history strategy may explain the relative difficulty with which individuals recover from losing a child. We propose that the same physiological mechanisms underlying detachment and grief during dissolved romantic relationships may also underlie the intensity of parental attachment and bereavement. This theoretical review thus integrates evolutionary theory with extant grief research to provide a functional analysis of the immense suffering associated with the loss of a child.     

Does worry affect adjustment to bereavement? A longitudinal investigation

Background and objectives: Repetitive thought is a trans-diagnostic risk-factor for development of psychopathology. Research on repetitive thought in bereaved individuals has focused primarily on clarifying the role of rumination, repetitive thinking about past negative events and/or negative emotions. While detrimental effects of rumination have been demonstrated following bereavement, surprisingly few studies have aimed to clarify the role of worry, repetitive thinking about potential future negative events, in adjustment to loss. This study sought to fill this gap in knowledge. Methods/Design: One hundred eighty-three bereaved individuals (85.3% women) filled out questionnaires on sociodemographic and loss-related characteristics, worry, and symptom measures of depression, anxiety, and prolonged grief. After six months, 155 participants completed worry and symptom measures again. Using multiple regression analyses, concurrent and longitudinal associations between loss-related variables, worry, and symptoms of psychopathology were examined. Results: Main results were that worry was strongly positively associated with symptoms of anxiety, depression and prolonged grief concurrently and also predicted higher levels of anxiety, depression and prolonged grief longitudinally. Conclusions: Findings suggest that worry influences adjustment to bereavement negatively and may be a potential target in grief therapy, especially when aiming to reduce anxiety.     

Promoting Meaning-Making to Help our Patients Grieve: An Exemplar for Genetic Counselors and Other Health Care Professionals

Genetic counselors and other health professionals frequently meet with patients who are grieving a loss. It is thus helpful for medical professionals to be familiar with approaches to bereavement counseling. Grief theory has evolved over the last few decades, from primarily stage theories of grief such as Kübler-Ross’s “five stages of grief” to frameworks that promote more complex and long-term ways to cope with a loss. Herein I present one recent grief theory – meaning-making - and describe how it can be applied to help parents of children with disabilities grieve the loss of the child that they expected. In particular, I describe a scenario that many genetic counselors face - meeting with the parents of a child with Down syndrome. I outline the research done on the reactions, grief and coping experienced by parents in this circumstance, and I present suggestions for encouraging healthy coping and adjustment for parents, based on the meaning-making perspective. The meaning-making theory can also be applied to many of the other losses faced by genetic counseling patients.     

Phone follow up to families of COVID-19 patients who died at the hospital: families' grief reactions and clinical psychologists' roles

A proportion of persons affected by coronavirus disease-19 (COVID-19) die and do so in extraordinary circumstances. This can make grief management extremely challenging for families. The Clinical Psychology unit of an Italian hospital offered a bereavement follow-up call to such families. This study aimed to explore the families' experiences and needs collected during these calls, and the role that the psychologists played through the call. A total of 246 families were called over 3 months. Multiple qualitative methods included: (i) written reports of the calls with relatives of patients who died at the hospital for COVID-19; (ii) qualitative semi-structured interviews with psychologists involved in the calls; (iii) observation of psychologists' peer group discussions. A thematic analysis was conducted. Six themes emerged: without death rituals, solitary, unexpected, unfair, unsafe, coexisting with other stressors. Families' reactions were perceived by psychologists as close to a traumatic grief. Families' needs ranged from finding alternative rituals to giving meaning and expressing different emotions. The psychologists played both a social-institutional and a psychological-human role through the calls (e.g., they cured disrupted communication or validated feelings and choices). This study highlighted the potential of traumatic grief of families of COVID-19 victims, and provided indications for supporting them within the space of a short phone call.     

Children's bereavement reactions following death of the father

The war situation compelled a reinvestigation into the characteristics, course, the outcome, and the variety of bereavement reactions in early childhood. In this study, the behaviors and changes reported by the mothers and teachers of 24 normal kibbutz children over a period of 1 to 16 months after bereavement are presented. The findings lead to one clear and central conclusion: The death of a father in war brings about a severe stress situation for the child at both the preschool and the middle-childhood age. The abrupt disequilibrium created by the death itself and the resulting changes in the family place very difficult demands on the adaptation and coping capacities of the child.In this sample of normal children with no special problems before the loss, ample evidence of acute emotional strain along with noticeable grief reactions were found in the early months of bereavement. A marked increase in the number and variety of symptomatic behavior changes testified to the seriousness of the threat to the child's sense of well-being after notification of the death. Ten of the 22 children between the ages of 2 and 10 years reacted to the trauma severely and were so markedly hindered in their daily functioning that psychological help was considered imperative. The disorganizing effect of the trauma of the loss of a father as reflected in this high percentage of disturbance in normal children indicates that without doubt a child who has lost a parent is a child at risk. It is therefore desirable if not imperative that there be more balance in the efforts to help bereaved families.1979, Fall