Parental Grief After the Unexpected Death of a Child: A Scoping Review About the Impact on Parent's Social Networks and the Function of Self-Help Groups.

The unexpected death of a child, whether due to accident, sudden death syndrome, suicide, or homicide, causes profound parental grief that endures for years. Often, this grief is not fully understood by the social environment, leading parents to feel increasingly misunderstood and isolated. While initial support may be provided, it can become insufficient over time. Therefore, many parents turn to support groups, finding multiple benefits such as validation of their feelings, a safe space to discuss their children and express emotions, strengthening of their social identity, and a platform for reconstructing meaning in their lives. A scoping review was carried on to review the state of knowledge regarding the role that self-help groups can play in case of bereavement due to the unexpected death of a child and regarding the impact on social relationships referred to in these contexts. The search was conducted on 11 databases and grey literature and provided 22 final results. Reviewed studies confirm the impact of this loss, particularly on mothers, and suggest that self-help groups contribute to a more favorable development of the grieving process. Despite the scarcity of research, future studies could leverage newer theoretical models and measurement tools to confirm protective, predictive, and risk factors.

Death of a child and the risk of atrial fibrillation: a nationwide cohort study in Sweden.

AIMS: The role of psychological stress in the aetiology of atrial fibrillation (AF) is unclear. The death of a child is one of the most severe sources of stress. We aimed to investigate whether the death of a child is associated with an increased risk of AF. METHODS AND RESULTS: We studied parents with children born during 1973-2014 included the Swedish Medical Birth Register (n = 3 924 237). Information on death of a child, AF and socioeconomic, lifestyle and health-related covariates was obtained through linkage to nationwide population and health registers. We examined the link between death of a child and AF risk using Poisson regression. Parents who lost a child had a 15% higher risk of AF than unexposed parents [incidence rate ratio (IRR) and 95% confidence intervals (CI): 1.15 (1.10-1.20)]. An increased risk of AF was observed not only if the child died due to cardiovascular causes [IRR (95% CI): 1.35 (1.17-1.56)], but also in case of deaths due to other natural [IRR (95% CI): 1.15 (1.09-1.21)] or unnatural [IRR (95% CI): 1.10 (1.02-1.19)] causes. The risk of AF was highest in the 1st week after the loss [IRR (95% CI): 2.87 (1.44-5.75)] and remained 10-40% elevated on the long term. CONCLUSIONS: Death of a child was associated with a modestly increased risk of AF. Our finding that an increased risk was observed also after loss of a child due to unnatural deaths suggests that stress-related mechanisms may also be implicated in the development of AF.

Does Interpersonal Vulnerability Mediate the Association Between Parental Bereavement and Mental Health?

The current study examined the role of interpersonal vulnerability, that is, self-perceived threats to one's interpersonal domain, in the mental health of bereaved parents. Israeli bereaved parents in older adulthood (N = 105, aged 48-88, M = 64.06, SD = 9.93) were pair-matched with equivalent 105 non-bereaved parents. Participants completed questionnaires assessing interpersonal vulnerability, satisfaction with life, and depressive symptoms. The results showed higher levels of interpersonal vulnerability among bereaved parents compared to their non-bereaved counterparts. Additionally, parental bereavement and interpersonal vulnerability were associated with worse mental health. Finally, interpersonal vulnerability mediated the association of parental bereavement with worse mental health. This study reveals interpersonal vulnerability as an important vulnerability factor among a significant minority in older adulthood.

Prolonged Grief, Posttraumatic Stress, and Depression Among Bereaved Parents: Prevalence and Response to an Intervention Program.

Bereaved parents may experience diverse psychological symptoms. Possible interventions are not yet well established. In this study, the psychological symptoms of 323 bereaved parents (mean age = 39.97, SD = 7.21, 52.0% female), referred to a 4-week family-oriented rehabilitation (FOR) program, were assessed. The baseline assessments indicated that 160 (49.5%) parents showed symptoms of prolonged grief disorder (PGD). Complicated grief was indicated in 272 (84.2%), depression in 191 (59.1%), and posttraumatic stress disorder in 242 (74.9%) parents. Mothers were at higher risk of complicated grief (p ≤ .001), depression (p = .029), and posttraumatic stress disorder (p = .004), compared to fathers. Significant remissions of symptoms between admission and discharge from the program are presented as symptoms of complicated grief, depression, and posttraumatic stress. The effect sizes ranged between d = 0.68 and 1.22. In addition, significantly fewer parents fulfilled PGD criteria on discharge from the FOR program (p ≤ .001). The special FOR program appears promising with regard to improving the bereaved parents' mental health.

Gender differences in the risk of depressive disorders following the loss of a young child: a nationwide population-based longitudinal study.

BACKGROUND: Losing a child to death is one of the most stressful life events experienced in adulthood. The aim of the current study is to investigate parental risk of seeking treatment for major depression disorders (MDD) after a child's death and to explore whether such connection may operate differentially by parents' prior medical condition. METHODS: We studied a retrospective cohort of 7245 parents (2987 mothers and 4258 fathers) identified in the National Health Insurance Research Database of Taiwan (NHIRD) who had lost a child with age between 1 and 12 years. For comparison, the parents of 1:4 birth year- and gender-matched non-deceased children were retrieved (16,512 mothers and 17,753 fathers). Gender-specific Cox regression analyses were performed to estimate risk. RESULTS: Nearly 5.0% and 2.4% of bereaved mothers and fathers sought treatment for MDD within three years after a child's death, significantly higher than 0.8% and 0.5% in the non-bereaved parents. With covariate adjustment, the hazard ratio (HR) for maternal and paternal seeking treatment for MDD was estimated 4.71 (95% confidence interval [CI]: 3.35-6.64) and 1.93 (95% CI: 1.27-2.95), respectively. The increased risk of MDD varied by prior disease history; specifically, the increased risk of seeking treatment for MDD was especially prominent for those without chronic physical condition (CPC) (e.g., mothers with CPC: aHR = 2.38, 95% CI: 1.56-3.65 vs. no CPC: aHR = 9.55, 95% CI: 6.17-14.79). CONCLUSIONS: After the death of a child, parental elevated risk of MDD was especially prominent for the women and those without prior medical condition. Effective strategies addressing bereavement may require family-based, integrated physical and mental healthcare and even extended counseling service.

The effects of peer support on post-traumatic stress reactions in bereaved parents.

The purpose of this study was to describe the impact of peer support on post-traumatic stress disorder in parents who have experienced the death of a child, the factors associated with the parents' post-traumatic stress reactions and the parents' experiences of peer support. The research data comprise the responses of parents who participated in a family weekend organised by Child Death Families Finland (KÄPY). The data were collected 2 weeks before (n = 110) and 2 weeks after (n = 73) the family weekend by a questionnaire consisting of items designed to identify the relevant background variables and the Impact of Event Scale-Revised (IES-R), a self-report measure for assessing post-traumatic stress disorder (PTSD). Statistical methods were applied in the data analysis. No statistically significant differences were observed in the parents' stress reactions 2 weeks before and 2 weeks after the family weekend. The stress reactions, on the other hand, had a statistically significant association with the self-perceived health of the parents, the age at which their child had died and the time that had elapsed since the death. Two-thirds of the parents regarded the peer support provided during the family weekend as supportive or very supportive. The parents also regarded the support provided during the weekend as important, although the support had no statistically significant impact on their stress reactions. One can draw the conclusion that the parents experienced the family weekend and the peer support provided during it as supportive.

Bereavement Follow-Up After the Death of a Child as a Standard of Care in Pediatric Oncology.

After a child's death to cancer, families commonly want continued connection with the healthcare team that cared for their child, yet bereavement follow-up is often sporadic. A comprehensive literature search found that many bereaved parents experience poor psychological outcomes during bereavement and that parents want follow-up and benefit from continued connection with their child's healthcare providers. Evidence suggests that the standard of care should consist of at least one meaningful contact between the healthcare team and bereaved parents to identify those at risk for negative psychosocial sequelae and to provide resources for bereavement support.

Effectiveness of professional training in bereavement care: Survey of Japanese pediatricians supporting families who have lost a child.

BACKGROUND: The aim of this study was to assess the effectiveness of professional training in bereavement care. METHOD: We mailed a questionnaire to 554 Japanese pediatricians. It asked about demographic characteristics, personal support experiences, professional training, psychological distress, recognition of high risk after a child's death, and eight items relating to awareness in bereavement care. We divided the subjects into two groups based on the presence or absence of professional training and compared them on the basis of each item (χ(2) test), and conducted logistic regression analysis. RESULTS: Of the 239 respondents, 193 (80.8%) had performed bereavement care. The final number included in the analysis was 175, after excluding responses with missing data. A total of 46 respondents (26.3%) had attended bereavement care training. The subjects who had had training were more likely to recognize those at high risk for poor psychological recovery, have information about support groups, have a desire to study bereavement care, and understand the necessity of cooperation with mental health specialists. CONCLUSION: Many pediatricians had personally provided support for the bereaved. On logistic analysis, it was considered that four factors (recognition of high risk for poor recovery, information about support, desire to study, and cooperation with professionals) were significantly associated with the professional training. There were no significant differences, however, in psychological distress, helplessness, and fatigue. Training programs related to stress management must be improved for pediatricians who feel high levels of psychological distress.

The relative importance of avoidance and restoration-oriented stressors for grief and depression in bereaved parents.

Previous research has identified a number of individual risk factors for parental bereavement including the sex of the parent, the sex of the child, avoidance-focussed coping style and time since death. These factors emerged from research where variables were tested univariately and their relative importance is currently unknown. The current research, therefore, aims to investigate which risk factors are important, multivariately, for the outcomes of grief and depression in parents following the death of their child. Psychosocial measures were completed by 106 bereaved parents four years post-loss, recruited from death records in Scotland. The cause of the child's death included long-term illness and stillbirths as well as sudden and violent deaths. In multivariate regression analyses, depression was predicted by higher avoidance-focussed coping and higher number of restoration-oriented stressors such as relationship difficulties, problems at work and financial issues. Grief was predicted by higher avoidance, restoration stressors and level of continuing bonds. The present study adds to the knowledge about the phenomenon of parental bereavement with participants recruited directly from death records rather than through support, clinical or obituary sources. Factors previously found to be associated with outcomes when tested univariately such as sudden, violent death or sex of the parent were not significant when tested multivariately. This study highlights that different vulnerability factors exist for grief and depression in bereaved parents.

Evaluating a bereavement follow-up intervention for grieving mothers after the death of a child.

AIM: The aim of this study was to produce information about parental grief intervention and its impacts on maternal grief. BACKGROUND: The grief after death of a child is a lifelong process. Social support is often stated as the most important factor in coping after the death of a child. DESIGN: A single measure post-test control group design was used to evaluate whether there are differences in the grief reactions between the mothers in the intervention program (n = 83) and the mothers in the control group (n = 53). METHOD: The data were collected by using a questionnaire which included background variables and Hogan Grief Reactions Checklist 6 months after the child's death. The data were analysed by statistical methods. RESULTS: There were no significant differences in the grief reactions between the intervention group and the control group. However, greater support from the healthcare professionals was associated with stronger personal growth. The mothers' age, self-perceived health status and the age of deceased child were associated with the grief reactions. This study emphasises the importance of social support to grieving mothers. CONCLUSION: Health care professionals are in an important role when considering support for grieving mothers; the given support may relieve the mothers' grief reactions.

Death of a child in the emergency department.

The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of the death of a child in the acute setting, providing a closing ritual at the time of terminating resuscitation efforts, and managing the child with a terminal condition who presents near death in the ED.

Death of a child in the emergency department.

The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of the death of a child in the acute setting, providing a closing ritual at the time of terminating resuscitation efforts, and managing the child with a terminal condition who presents near death in the ED.

Using Simulation Exercises to Deal With the Death of a Child as Part of Healthcare Studies.

BACKGROUND: Almost all healthcare professionals find themselves in a situation where they witness death in their work. Meeting a family in crisis is challenging for healthcare professionals and students. Simulation is an effective tool to practice complex and emotionally challenging situations in healthcare education. METHODS: The aims of the study were to find out what challenges healthcare students experience when facing a family in crisis and to assess the usability of simulation in teaching healthcare students how to manage this situation. Voluntary simulations for paramedic students and medical students (a total of 29 students) were held in the autumn of 2021. Before and after the simulations, the students evaluated their skills to meet a family in crisis (the loss of a child) with the help of a questionnaire that contained mostly open-ended questions. The study was completed using a qualitative method. RESULTS: The challenges raised by our students were divided into three categories: child-, family-, and self/student-related. Child-related challenges included the developmental stage which impacted communication. Family-related challenges included family members' different reactions to a devastating situation. Student/self-related challenges were few previous child contacts, communication with the family, and a situation that requires paying attention to multiple things at the same time. CONCLUSION: According to our study, the students find simulation as a useful method for preparing to communicate with a family in crisis. The students see that with the help of simulation, they can practice different modes of operation and communication when facing a family in crisis. They also have the possibility to think about the processing of their own emotions during a crisis.

Death of a child and the risk of heart failure: a population-based cohort study from Denmark and Sweden.

AIMS: We aimed to investigate whether the death of a child, one of the most severe stressors, is associated with the risk of heart failure (HF). METHODS AND RESULTS: We conducted a population-based cohort study involving parents of live-born children recorded in the Danish and Swedish Medical Birth Registers during 1973-2016 and 1973-2014, respectively (n = 6 717 349). We retrieved information on child death, HF diagnosis and sociodemographic characteristics of the parents from several nationwide registries. We performed Poisson regression models to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for HF in relation to bereavement. A total of 129 829 (1.9%) parents lost at least one child during the follow-up. Bereaved parents had a 35% higher risk of HF than the non-bereaved (IRR 1.35, 95% CI 1.29-1.41; p < 0.001). The increased HF risk was observed not only when the child died due to cardiovascular or other natural causes, but also when the loss was due to unnatural causes. The association tended to be U-shaped when we categorized the exposed parents by the number of remaining live children at loss or by the age of the deceased child. CONCLUSION: We found that the death of a child was associated with an increased risk of HF. The finding that not only cardiovascular and other natural deaths, but also unnatural deaths were associated with HF suggests that stress-related mechanisms may contribute to the development of HF.

Race, death of a child, and mortality risk among aging parents in the United States.

The death of a child is a stressful and traumatic life event that has been linked to increased mortality risk among parents. Tragically, black parents are significantly more likely than white parents to lose a child in the United States; however, prior research has not addressed this racial disadvantage in relation to parents' mortality risk. In this study, we focus on the racial context of the United States to suggest that black parents already face higher mortality rates compared to white parents, and the unequal burden of child death adds to their mortality risk. Using discrete-time event history models, we consider whether the death of a child by midlife is associated with increased mortality risk for black parents and for white parents in mid- to later-life using longitudinal data from the Health and Retirement Study (HRS; 1996-2016). Descriptive results show that by midlife, black parents, especially black mothers, experience substantially higher child mortality compared with white parents. At the same time, we find that losing a child prior to midlife is associated with heightened mortality risk for aging black mothers and white mothers. Controlling for educational attainment explains the association between child death and parental mortality risk among white mothers, whereas heightened biopsychosocial and behavioral risk factors explain the association for black mothers. Overall, the death of a child is associated with increased mortality risk for black mothers and for white mothers, but the processes linking child death to parental mortality seem to differ for black and white parents. These findings have implications for policies and interventions that address increased mortality risk for parents following the death of a child.

Mortality in parents after the death of a child.

OBJECTIVE: The death of a child is a traumatic stressor that takes a toll on the health of parents. This study examined long-term impacts of the death of a child on the risk of early mortality in bereaved parents. In a follow-up analysis, a twin subsample was analyzed to examine potential genetic confounding. METHOD: We analyzed data from the Midlife in the United States (MIDUS) study. The primary sample consists of two groups of MIDUS 2 participants (2004-06); (1) parents who experienced the death of a child prior to MIDUS 2 (n = 451) and (2) comparison parents who had not experienced death of any children (n = 1804) (mean age = 63). We also analyzed 52 twin pairs in which one twin experienced the death of a child and 271 twin pairs in which both twins had all living children. Mortality status of parents was assessed in 2017. RESULTS: Parents who had experienced the death of a child had a 32% higher likelihood of early mortality (defined as dying earlier than life expectancy) than their peers who did not have any deceased children, and they were more likely to die of heart disease. Analyses of the twin subsample revealed significantly lower concordance for early mortality among the pairs with a bereaved twin than among control twins, consistent with non-genetic effects. CONCLUSIONS: The findings suggest that the death of a child has lasting impacts on the risk of early mortality in bereaved parents. This study provides the first U.S. estimate of bereavement effects on mortality extending through the parents' full life course, with significant public health implications. In addition, analysis of concordance of early death rates in the twin subsample suggests the impact on mortality of parental bereavement, net of genetic factors.

Dyadic coping mediates the relationship between parents' grief and dyadic adjustment following the loss of a child.

BACKGROUND AND OBJECTIVES: This study aimed to examine forms of dyadic coping (DC) as mediators of the association between parents' grief response and dyadic adjustment and to determine whether these indirect effects were moderated by the child's type of death, timing of death, and age. DESIGN: The study design was cross-sectional. METHOD: The sample consisted of 197 bereaved parents. Participants completed the Prolonged Grief Disorder Scale, Revised Dyadic Adjustment Scale, and Dyadic Coping Inventory. RESULTS: Significant indirect effects of parents' grief response on dyadic adjustment were found through stress communication by oneself and by the partner, positive and negative DC by the partner, and joint DC. The timing of death moderated the association between grief response and dyadic adjustment and between joint DC and dyadic adjustment. Grief response was negatively associated with dyadic adjustment only when the death occurred after birth. Grief response was negatively associated with joint DC, which, in turn, was positively associated with dyadic adjustment, when the death occurred both before and after birth. However, the association was stronger in the latter. CONCLUSIONS: Specific forms of DC might be mechanisms through which grief response is associated with dyadic adjustment and should be promoted in clinical practice.

What aspects of post-traumatic growth are experienced by bereaved parents? A systematic review.

Background: The death of a child of any age can be traumatic and can leave bereaved parents experiencing negative psychological outcomes. Recent research has shown the potential utility for understanding more about the development of post-traumatic growth following bereavement. Objective: This paper sought to identify the aspects of post-traumatic growth experienced by bereaved parents and the factors that may be involved in facilitating or preventing post-traumatic growth. Methods: A systematic search of peer-reviewed articles with a primary focus on positive personal growth in bereaved parents was conducted. Thirteen articles met the inclusion criteria, and were analysed and synthesized according to common and divergent themes. Results: Bereaved parents were able to experience elements of growth proposed by the post-traumatic growth model (changes in self-perception, relationships, new possibilities, appreciation of life and existential views). The papers also indicated that (1) mothers appeared to experience more growth than fathers, (2) cultural variation may impact on some participants' experience of growth, and (3) participants were able to identify growth only once some time had passed. Potential facilitators of post-traumatic growth involved making meaning, keeping ongoing bonds with the child, being with bereaved families, and family and personal characteristics. Social networks were identified as having the potential to be either a facilitator or a barrier to growth. Conclusions: In addition to experiencing grief, bereaved parents may experience aspects of post-traumatic growth, and a variety of factors have been identified as potential facilitators and barriers of these changes. The findings may have implications for support services (e.g. expert-by-experience services).

Antecedentes: La muerte de un niño de cualquier edad puede ser traumática y provocar resultados psicológicos negativos a los padres en duelo. Investigaciones recientes han demostrado la utilidad potencial de comprender más sobre el desarrollo del crecimiento postraumático luego del duelo.Objetivo: Este artículo buscó identificar los aspectos del crecimiento postraumático experimentados por los padres en duelo y los factores que pueden estar involucrados en facilitar o prevenir el crecimiento postraumático.Métodos: se realizó una búsqueda sistemática de artículos revisados por pares con un enfoque principal en el crecimiento personal positivo en padres en duelo. Trece artículos cumplieron los criterios de inclusión y se analizaron y sintetizaron de acuerdo con temas comunes y divergentes.Resultados: Los padres en duelo fueron capaces de experimentar los elementos de crecimiento propuestos por el modelo de crecimiento postraumático (cambios en la autopercepción, relaciones, nuevas posibilidades, apreciación de la vida y perspectivas existenciales). Los artículos también indicaron que (i) las madres parecían experimentar más crecimiento que los padres, (ii) la variación cultural puede afectar la experiencia de crecimiento de algunos participantes, y (iii) los participantes solo pudieron identificar el crecimiento una vez que pasó el tiempo. Los posibles facilitadores del crecimiento postraumático incluían encontrar significado, mantener lazos constantes con el niño, estar con familias en duelo y las características familiares y personales. Se identificó que las redes sociales tienen el potencial de ser tanto un facilitador como una barrera para el crecimiento.Conclusiones: Además de experimentar dolor, los padres en duelo pueden experimentar aspectos de crecimiento postraumático, y se han identificado una variedad de factores como posibles facilitadores y barreras de estos cambios. Los hallazgos pueden tener implicaciones para los servicios de apoyo (por ejemplo, servicios de expertos por experiencia).

Parents' experience of a follow-up meeting after a child's death in the Paediatric Intensive Care Unit.

OBJECTIVE: 'To identify parents' experience of a follow up meeting and to explore whether the conversation was adequate to meet the needs of parents for a follow-up after their child's death in the Paediatric Intensive Care Unit (PICU). DESIGN AND SETTING: Qualitative method utilising semi-structured interviews with six pairs of parents 2-12 weeks after the follow-up conversation. The interviews were held in the parents' homes at their request. Data were analysed using a qualitative, descriptive approach and thematic analysis. FINDINGS: Four main themes emerged: (i) the way back to the PICU; (ii) framework; (iii) relations and (iv) closure. CONCLUSION: The parents expressed nervousness before the meeting, but were all pleased to have participated in these follow-up meetings. The parents found it meaningful that the follow-up meeting was interdisciplinary, since the parents could have answers to their questions both about treatment and care. It was important that the staff involved in the follow-up meeting were those who had been present through the hospitalisation and at the time of the child's death. Parents experienced the follow-up meeting as being a closure of the course in the PICU, regardless the length of the hospitalisation.