How to tell when normal grief over losing a parent becomes pathologic

Some 5% of US children will lose a parent during their childhood or adolescence, and it often can be difficult for pediatricians to detect when normal grief turns into something more pathologic, resulting in depression and dysfunction.

Looking for clues to help with that determination, a recent study looked at grief reactions of children and adolescents after a parent's sudden death to determine how bereavement affected their mental well-being and ability to function.

Using coroners' reports and a newspaper advertisement, researchers led by Nadine M. Melhem, PhD, recruited young people aged 7 through 18 years who had experienced a parental death from suicide, unintentional injury, or sudden natural causes from July 2001 to January 2007. Researchers administered a modified version of the adult Inventory of Complicated Grief to the children in order to assess their grief state. Surviving parents completed the original version of the inventory.

Other assessment tools were employed to determine whether children and adolescents experienced psychiatric disorders and functional impairment and to measure the severity of their grief symptoms. Researchers developed a baseline assessment and then reevaluated at about 8.5 months after the parent died; approximately 1 year later; and then about 2 years after the parent died. The study had 165 and 141 completing the 1- and 2-year follow-up, respectively, of the 182 initial child and adolescent participants.

“The death of a parent is consistently rated as one of the most stressful events a child can experience; however, little is known about the course of grief and its effects on children,” Melhem said, pointing out that functional effects can last 3 years or more.

Researchers found that grief scores decreased significantly between 9 and 21 months after a parent’s death and stayed low for most participants (58.8%). In just more than 30% of the participants, however, grief reactions increased at about 9 months but then steadily declined through the 33rd month after the parent died. For the final group (10.4%), grief scores were high at the 9th month and remained high through the 33rd month.

Higher grief scores at 9 months were associated with parental death resulting from unintentional injury and higher self-reported depression. Participants in the third group, those with high grief scores that did not decline much, were more likely to have functional impairment 9 months after their parents’ deaths, previous history of depression, and new-onset posttraumatic stress disorder.

“These findings have important clinical implications for intervention and prevention efforts,” Melhem said. “Treatment of prolonged grief in children may require interventions that are family focused, rather than individually focused.”

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