Reducing suicide risk in parentally bereaved youth through promoting effective parenting: testing a developmental cascade model

Children who experience parental death are at increased risk for suicide. The Family Bereavement Program (FBP) is an upstream preventive intervention for parentally bereaved families that was found to reduce suicide risk in parentally bereaved youth up to 6 and 15 years later. We tested whether FBP-induced improvements in effective parenting led to changes in multiple proximal factors that prior theory and research implicated in the cascading pathway to suicide risk, namely, aversive self-views, caregiver connectedness, peer connectedness, complicated grief, depressive symptoms, and emotion suppression. The sample was 244 bereaved youth and their surviving caregiver from 156 families. Families were randomized into the FBP (12 group-based sessions for parents, youth, and two joint sessions) or a literature control condition. Multimethod and multiinformant data were collected at baseline, posttest, 6-year and 15-year follow-up assessments. Results showed that program-induced improvements in effective parenting at posttest were associated with reduced aversive self-views and increased caregiver connectedness at the 6-year follow-up, and each mediator was in turn associated with reduced suicide risk at the 6- and 15-year follow-up. The mediated pathways via aversive self-views remained significant while controlling for caregiver connectedness. Self-related concepts may be important targets in upstream suicide prevention for at-risk youth.

Higher Self-Esteem Associated With Less Symptoms of Anxiety and Depression Among Young Adults After the Loss of a Parent to Cancer—A Longitudinal Study

Objective: The purpose of the study was to examine associations between self-esteem and symptoms of anxiety and depression among young adults who lost a parent to cancer. Methods: Older adolescents and young adults, aged 16 to 28 years, who had lost their parent to cancer and had accepted an invitation to join a support group, completed a questionnaire 5 to 8 months after the loss and a similar questionnaire about 10 months later (follow-up). Of a total of 77 young adults who participated in the study, 56 completed both questionnaires. Self-esteem was measured with the Rosenberg Self-Esteem Scale. Symptoms of anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Univariate and multiple linear regression models were used to analyze the associations. Result: Self-esteem was significantly associated with symptoms of anxiety and depression at baseline and at follow-up. Conclusion: This study reveals that self-esteem is a valuable explanatory variable, and that it is associated with both symptoms of anxiety and depression in bereavement. This new knowledge could be used to guide future support to parentally bereaved young adults.

Leaving Home for Marital and Non-Marital Reasons in the Netherlands, 1850-1940 – The Impact of Parental Death and Parental Remarriage

Previous research shows that parentally bereaved children in north-western Europe in the past left home earlier than children who lived together with both biological parents. This article analyses the mechanisms behind this phenomenon with a special focus on the routes out of the parental household and the entry of step-parents and step-siblings. The Historical Sample of the Netherlands (HSN) is exploited which contains detailed infor-mation about household composition and life courses of more than 22,000 female and male adolescent and young adult children born between 1850 and 1922. Event-history analysis is applied and two exclusive routes out of the parental household, for marital and non-marital reasons, are studied in a competing risk design. The results show that parental loss does not increase the risk of early marriage before age 23, but strongly en-hances the chances for leaving home for non-marital reasons, which are mainly work-related. This is especially true in case of maternal loss. No support is found for the hy-pothesis that the entry of a step-parent and step-siblings increases the risk of leaving home compared to living with a single widowed parent. Tensions with step-parents therefore do not suffice to explain why parentally bereaved children left earlier for non-marital reasons. Instead, we argue that children’s exit was in the interest of both the single widowed parent and the bereaved child.

Parenting through grief: A cross-sectional study of recently bereaved adults with minor children

Background: Grieving adults raising parentally-bereaved minor children experience persistently elevated symptoms of depression and grief. However, the factors associated with their mental health outcomes are not well understood. Aim: To investigate the psychosocial and demographic characteristics associated with grief distress and depressive symptom severity in bereaved adults with minor children. Design: Cross-sectional, web-based survey. Setting/participants: Eight hundred forty-five bereaved adults raising minor (age <18 years) children who had experienced the death of a co-parent. Primary outcomes were grief distress (Prolonged Grief Disorder-13), depressive symptoms (Patient-Reported Outcomes Measurement Information System-Depression), and widowed parenting self-efficacy (WPSES). Results: Mean grief scores were 33.5; mean depression scores were 58.3. Among the 690 individuals more than 6 months bereaved, 132 (19.3%) met criteria for prolonged grief disorder. In adjusted models, participants reporting higher grief scores were more recently bereaved, identified as mothers, non-Caucasian, had lower education and income, and had not anticipated their co-parent’s death. The statistical modeling results for depression scores were similar to grief scores except that depression was not associated with anticipation of co-parent death. Parents reporting lower WPSES scores had higher grief and depression scores. Retrospective assessments of more intense parenting worries at the time of co-parent death were also associated with higher grief and depression scores. Conclusions: For bereaved adults with minor children, unanticipated co-parent death was linked with higher grief distress but not symptoms of depression. Addressing parenting concerns may represent a common pathway for improving the mental health of parentally-bereaved families.

A systematic review of controlled studies of suicidal and self-harming behaviours in adolescents following bereavement by suicide

Background Research suggests that being exposed to the suicide of others increases risk of subsequent suicidal or self-harming thoughts or behaviours. What is less clear is whether this applies to adolescents, and if the risk exceeds that following other causes of death, which has implications on suicide prevention approaches. This study aimed to systematically review the evidence on adolescent bereavement experiences by different causes to address this gap. Methods A comprehensive literature search using four databases (MEDLINE, PsycInfo, Web of Science, and Embase) identified 21 studies which measured suicidal or self-harm outcomes among bereaved adolescents aged between 12 to 18 years old. The literature was screened, data was extracted using pre-piloted forms, and risk of bias was assessed using versions of the Newcastle-Ottawa Scale; a proportion of papers were double extracted and assessed for bias. The review has been registered with PROSPERO (CRD42016051125). Results A narrative synthesis of the literature demonstrated divergent findings depending on the outcome being measured. Suicide bereavement appears to be strongly associated with suicide mortality among parentally bereaved youth, while self-harm or non-fatal suicide attempts (either presenting to hospital or self-reported) showed mixed evidence. Suicidal ideation was not uniquely associated with suicide bereavement. An exploration of circumstances surrounding the death, characteristics of the person who died, and characteristics of the young person across each outcome measure suggested that earlier experiences of loss, shorter timeframes following the death, and maternal death are associated with particularly elevated risk of suicidal outcomes. Conclusions Findings suggest that suicide loss is associated with subsequent suicide, and may be associated with non-fatal self-harm. A detailed account of the risk and protective factors surrounding suicide bereavement among young people is crucial to understand the pathways through which suicidal behaviours develop. Researchers, policy makers and practitioners with an interest in suicide prevention will benefit from clarity around the needs of young bereaved individuals.

Reducing suicide risk in parentally bereaved youth through promoting effective parenting: Testing a developmental cascade model.

Children who experience the death of a parent are at increased risk for suicidality. The Family Bereavement Program (FBP) is a preventive intervention for parentally bereaved families that was found to reduce suicidal thoughts or attempts in parentally bereaved youth up to 6 and 15 years later. In this study, we tested whether FBP-induced improvement in parenting led to changes in multiple factors that prior theory and research implicated in the pathway to suicide risk, namely, aversive self-views, caregiver and peer connectedness, grief, depressive symptoms and emotion suppression. The sample was 244 bereaved youth and their surviving caregiver from 156 families. Families were randomized into the FBP (twelve group-based sessions for parents, youth, and two joint sessions) or literature control condition. Caregivers and youth completed baseline, post-test, 6 years and 15 years follow-up assessments. Results showed that program-induced improved parenting at post-test was associated with reduced aversive self-views and increased caregiver connectedness at 6 years follow-up, and each was in turn associated with reduced suicide risk at 6 and 15 years follow-up. The mediated pathways via aversive self-views remained significant while controlling for the pathways via caregiver connectedness. We discussed the theoretical and clinical implications of the findings.

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.