Psychological disturbance and service provision in parentally bereaved children: prospective case-control study

Abstract

Objectives To identify whether psychiatric disturbance in parentally bereaved children and surviving parents is related to service provision. Design Prospective case-control study. Setting Two adjacent outer London health authorities. Participants 45 bereaved families with children aged 2 to 16 years. Main outcome measures Psychological disturbance in parentally bereaved children and surviving parents, and statistical associations between sample characteristics and service provision. Results Parentally bereaved children and surviving parents showed higher than expected levels of psychiatric difficulties. Boys were more affected than girls, and bereaved mothers had more mental health difficulties than bereaved fathers. Levels of psychiatric disturbance in children were higher when parents showed probable psychiatric disorder. Service provision related to the age of the children and the manner of parental death. Children under 5 years of age were less likely to be offered services than older children even though their parents desired it. Children were significantly more likely to be offered services when the parent had committed suicide or when the death was expected. Children least likely to receive service support were those who were not in touch with services before parental death. Conclusions Service provision was not significantly related to parental wishes or to level of psychiatric disturbance in parents or children. There is a role for general practitioners and primary care workers in identifying psychologically distressed surviving parents whose children may be psychiatrically disturbed, and referring them to appropriate services.

DSM-V Diagnostic Criteria for Bereavement-Related Disorders in Children and Adolescents: Developmental Considerations

“…A growing body of research with bereaved children provides insight regarding the types of reactions considered "typical" for children within the first two years of the death. Common reactions include elevated symptoms of dysphoria and depression (Brent et al, 1994;Cerel, Fristad, Verducci, Weller, & Weller, 2006;Melhem, Walker, Moritz, & Brent, 2008;Weller, Weller, Fristad, & Bowes, 1991;Worden & Silverman, 1996), generalized anxiety (Kranzler, Shaffer, Wasserman, & Davies, 1990;Saucier & Ambert, 1986), separation anxiety (Kaplow et al, 2010;Lin, Sandler, Ayers, Wolchik, & Luecken, 2004;Sanchez, Fristad, Weller, Weller, & Moye, 1994), and posttraumatic stress (Brent et al, 1994;Goenjian et al, 2009;Melhem et al, 2008;Stoppelbein & Greening, 2007), as well as behavioral problems (Dowdney et al, 1999;Kaplow et al, 2010), substance use (Kaplow et al, 2010), and other more general problems, including social withdrawal, irritability, somatic complaints, and increased risk for physical illness (Luecken, 2008;Van Eerdewegh, Clayton, & Van Eerdewegh, 1985;Worden & Silverman, 1996). Although most studies cover a wide age range-often from mid-childhood through adolescence-several small-scale age-restricted studies, including preschool children after parental loss due to illness (Kranzler et al, 1990) and adolescents after peer suicide (Brent & Mann, 2005;Melhem, 2004), suggest a possible developmentally linked shift in symptom presentation from predominantly anxiety symptoms in younger children to predominantly depressive symptoms in adolescents.…”

And Then the Dog Died

“…Grief and bereavement can have immediate and potentially long-lasting consequences (Black, 1996;Dowdney et al, 1999;Luecken, 2000). Child and adolescent bereavement may result in depression, anxiety, social withdrawal, behavioral disturbances, and secondary school underachievement (Abdelnoor & Hollins, 2004;Christ, Siegel, & Christ, 2002;Dowdney, 2000;Sanchez, Fristad, Weller, Weller, & Moye, 1994;Sandler et al, 1992;E.…”

Managing Bereavement in the Classroom: A Conspiracy of Silence?

“…Maclure & Walker (2000) caution however that little empirical work has been focused on encounters between parents and teachers, and has not addressed how these relationships might be sustained. This raises the question of how the effectiveness of social services can be measured when other factors, particularly the behaviour of the surviving parent (Dowdney et al, 1999), are influential in the outcome of a child's bereavement.…”