Death of a Child and the Risk of Stroke: A Binational Cohort Study From Denmark and Sweden

Background and Objectives:The death of a child is an extreme life event with potentially long-term health consequences. Accumulating evidence suggests that parents who lost a child have increased risks of cardiovascular diseases, including ischemic heart disease and atrial fibrillation. Whether bereaved parents have an increased risk of stroke is unclear and was investigated in this study.Methods:We conducted a population-based cohort study including parents who had a child born during 1973-2016 or 1973-2014 and recorded in the Danish and the Swedish Medical Birth Registers, respectively. We obtained information on child’s death, parent’s stroke and socioeconomic and health-related characteristics through linkage between several population-based registers. We used Poisson regression to examine the association between the death of a child and the risk of stroke.Results:Of the 6,711,955 study participants, 128,744 (1.9%) experienced the death of a child and 141,840 (2.1%) had a stroke during the follow-up. Bereaved parents had an increased risk of stroke; the corresponding incidence rate ratio (95% confidence intervals) was 1.23 (1.19-1.27). The association was present for all analyzed categories of causes of child death (cardiovascular, other natural and unnatural death), did not differ substantially according to the age of the deceased child, but was stronger if the parent had no or ≥3 than 1-2 live children at the time of the loss. The association was similar for ischemic and hemorrhagic stroke. The risk for hemorrhagic stroke was highest immediately after the death of a child and decreased afterwards. In contrast, there was no clear pattern over time in case of ischemic stroke.Discussion:The death of a child was associated with a modestly increased risk of stroke. The finding that an association was observed in case of unnatural deaths is suggestive of the explanation that bereavement-related stress may contribute to the development of stroke. Though the death of a child can often not be avoided, an understanding of its health-related consequences may highlight the need for improved support and attention from family members and healthcare professionals.

Time in Grief: How do Bereaved Parents Mentalize It?

In this multimethod study, we examine bereaved parents’ capacity for mentalizing the temporal dimension of their grief. The theoretical assumptions of our study draw on the clinical and anthropological perspectives on the passage of time in grief. Parents’ mentalization of their experience of grief was measured both in the attachment context, using the Adult Attachment Interview (AAI) and using the narrative Child Loss Interview (CLI). We used thematic analysis to code parents’ mentalizing utterances in order to categorize time-related changes during the grieving process. Parents generally mentalize their grief-related experiences at a lower level of reflective functioning than their general attachment experiences. However, a higher general ability to mentalize contributes to a higher level of RF and greater coherence in mentalizing their grief. Parents experience time in grief through oscillation between the past with the deceased child and a restricted form of existence in the present reality.

Compassionate Healthcare for Parents of Children with Life-limiting Illnesses: A Qualitative Study

Objectives: Premature death of a child from a serious illness is probably one of the most painful experiences for a parent. This study examined the clinical experiences of bereaved parents of children with a life-limiting illness to provide recommendations for quality care. Materials and Methods: Data were collected using semi-structured in-depth interviews with bereaved parents whose children had died at least 3 months before the interview. Parents were purposively sampled from two institutions offering end-of-life care to children with life-limiting illnesses. Data were analysed using thematic analysis. Results: Data analysis revealed three main themes: (1) Clinical communication, (2) Healthcare infrastructure and (3) Non-physical aspects of healthcare. The seven subthemes uncovered were as follows: (1) Honesty and clarity, (2) empathy, (3) interdisciplinary communication, (4) inconveniences in hospital, (5) home palliative care, (6) financial burden of illness and (7) psychosocial and spiritual support. Conclusion: Strategies to improve healthcare for children and their families are multifold. Underlying the provision of quality care is compassion; a child and family-friendly healthcare system with compassionate providers and compassionate institutional policies are vital components to achieving quality healthcare. Culturally sensitive psychosocial, emotional and spiritual support will need to be integrated as standard care.

Life After Death: Suicide, Care, and Responsibility

<p>This thesis focuses on suicide bereavement, particularly of those parents who have lost children to suicide while in care of the state. I argue that, for these parents, action taken following the suicide of their children is an extension of the care that was given throughout their child’s lives. For parents of those suffering with mental health issues, care is fraught with confusion and tension. This is no more apparent than when they and their children are seeking professional care. Care is inextricably linked with responsibility, which as I will show, is a very important concept in understanding suicide prevention. Governance of regimes of care shapes bereavement through biopolitical responsibilisation. The conflict found within understandings of care lays the foundation for the conflated tensions that arise in suicide bereaved parents’ search for recognition and accountability of and for their child’s suicide. In this thesis I explore these actions to understand the motives and desires of these parents. In exploring these, meaning becomes a useful analytical lens, for meaning, care, and the projects that my participants undertake in search of answers were all intimately linked. Through understanding the actions of bereaved parents as an extension of the care for their children we can understand how these actions are shaped by the governance and regimes of care within New Zealand.</p>

Life After Death: Suicide, Care, and Responsibility

<p>This thesis focuses on suicide bereavement, particularly of those parents who have lost children to suicide while in care of the state. I argue that, for these parents, action taken following the suicide of their children is an extension of the care that was given throughout their child’s lives. For parents of those suffering with mental health issues, care is fraught with confusion and tension. This is no more apparent than when they and their children are seeking professional care. Care is inextricably linked with responsibility, which as I will show, is a very important concept in understanding suicide prevention. Governance of regimes of care shapes bereavement through biopolitical responsibilisation. The conflict found within understandings of care lays the foundation for the conflated tensions that arise in suicide bereaved parents’ search for recognition and accountability of and for their child’s suicide. In this thesis I explore these actions to understand the motives and desires of these parents. In exploring these, meaning becomes a useful analytical lens, for meaning, care, and the projects that my participants undertake in search of answers were all intimately linked. Through understanding the actions of bereaved parents as an extension of the care for their children we can understand how these actions are shaped by the governance and regimes of care within New Zealand.</p>

Mobile app for prolonged grief among bereaved parents: study protocol for a randomised controlled trial

IntroductionBereaved parents, who have lost a child, have an elevated risk to develop mental health problems, yet, few studies have evaluated the effect of psychosocial interventions developed for bereaved parents. Cognitive–behavioural therapy (CBT), both face to face or digitally delivered, has shown to be an effective intervention for prolonged grief symptoms. Self-help mobile apps offer various advantages and studies show improved mental health after app interventions. No app has yet been evaluated targeting prolonged grief in bereaved parents. Therefore, the aim of this planned study is to develop and examine the effectiveness of a CBT-based mobile app, called My Grief, in reducing symptoms of prolonged grief, as well as other psychological symptoms, in bereaved parents. Another aim is to assess users’ experiences and adverse events of My Grief.Methods and analysisWe will conduct a two-armed randomised waitlist-controlled trial. Parents living in Sweden, who lost a child between one and ten years ago, with elevated symptoms of prolonged grief, will be recruited to participate in the trial. The content of My Grief covers four main domains (Learn; Self-monitoring; Exercises; Get support) and builds on principles of CBT and the proven-effective PTSD Coach app. Participants in the intervention group will fill out online questionnaires at baseline and at 3, 6 and 12 months follow-ups, and the waitlist-controls at baseline and at 3 months. The primary outcome will be prolonged grief symptoms at the 3 months follow-up. Secondary outcomes are post-traumatic stress and depression symptoms, quality of life and cognitive behavioural variables (ie, avoidance, rumination, negative cognitions).Ethics and disseminationEthical approval has been received from the Swedish Ethical Review Authority (project no. 2021-00770). If the app is shown to be effective, the app will be made publicly accessible on app stores, so that it can benefit other bereaved parents.Trial registration numberNCT04552717.

Preliminary findings on the experiences of care for parents who suffered perinatal bereavement during the COVID-19 pandemic

Background The COVID-19 pandemic poses an unprecedented risk to the global population. Maternity care in the UK was subject to many iterations of guidance on how best to reconfigure services to keep women, their families and babies, and healthcare professionals safe. Parents who experience a pregnancy loss or perinatal death require particular care and support. PUDDLES is an international collaboration investigating the experiences of recently bereaved parents who suffered a late miscarriage, stillbirth, or neonatal death during the global COVID-19 pandemic, in seven countries. In this study, we aim to present early findings from qualitative work undertaken with recently bereaved parents in the United Kingdom about how access to healthcare and support services was negotiated during the pandemic. Methods In-depth semi-structured interviews were undertaken with parents (N = 24) who had suffered a late miscarriage (n = 5; all mothers), stillbirth (n = 16; 13 mothers, 1 father, 1 joint interview involving both parents), or neonatal death (n = 3; all mothers). Data were analysed using a template analysis with the aim of investigating bereaved parents’ access to services, care, and networks of support, during the pandemic after their bereavement. Results All parents had experience of utilising reconfigured maternity and/or neonatal, and bereavement care services during the pandemic. The themes utilised in the template analysis were: 1) The Shock & Confusion Associated with Necessary Restrictions to Daily Life; 2) Fragmented Care and Far Away Families; 3) Keeping Safe by Staying Away; and 4) Impersonal Care and Support Through a Screen. Results suggest access to maternity, neonatal, and bereavement care services were all significantly reduced, and parents’ experiences were notably affected by service reconfigurations. Conclusions Our findings, whilst preliminary, are important to document now, to help inform care and service provision as the pandemic continues and to provide learning for ongoing and future health system shocks. We draw conclusions on how to enable development of safe and appropriate services during this pandemic and any future health crises, to best support parents who experience a pregnancy loss or whose babies die.

The Function of Ritualized Acts of Memory Making after Death in the Neonatal Intensive Care Unit

(1) Background: Some infants die shortly after birth, leaving both parents and nurses in grief. In the specific setting where the data were collected, the bereaved parents receive a scrapbook made by the nursing staff in the NICU, and a box made by a local parent support group. Making a scrapbook and a box when an infant dies in the NICU can be regarded as ritualized acts. The aim of this study is to explore the functions of these ritualized acts of making a scrapbook and memory box when an infant dies in the NICU. (2) Methods: Focus group interviews were performed with experienced nurses in the NICU, and with members of a parent support group. Reflexive thematic analysis was used to interpret the data. (3) Three main themes were constructed: “Making memories”, “showing evidence of the infant’s life and of the parenthood”, and “controlling chaos”. (4) Conclusions: Through the ritualized acts of making scrapbooks and boxes, nurses and members of the parent support group collect and create memories and ascribe the infant with personhood, and the parents with the status of parenthood. In addition, the ritualizing functions to construct meaning, repair loss, relieve sorrow, and offer a sense of closure for the makers of these items.