Publication year
2016
Citation Title
The indirect effect of positive parenting on the relationship between parent and sibling bereavement outcomes after death of a child
Journal Name
Journal of Pain and Symptom Management
Journal Volume
51
Issue Number
1
Page Numbers
60-70
DOI
10.1016/j.jpainsymman.2015.08.011
Summary
It is important to understand risk factors in the development of psychological problems for members of families who have experienced the death of a child. This study examined associations between bereaved parental mental health problems and surviving sibling mental health problems, with attention to the role of positive parenting. Results indicated that there were relationships between parental mental health problems and sibling mental health problems and that positive parenting played a role in this relationship for fathers.
Key Findings
The more symptoms of depression, posttraumatic stress disorder (PTSD), or prolonged grief disorder the bereaved mother experienced after a child’s death, the more mental health symptoms the surviving sibling was likely to experience.
Fathers’ depression symptoms after a child’s death were associated with siblings’ symptoms of depression, but fathers’ symptoms of PTSD and prolonged grief disorder were not associated with siblings’ outcomes.
For fathers experiencing depression, positive parenting decreased, which was then associated with an increase in siblings’ symptoms of depression.
Implications for Military Professionals
Be aware of the ways in which parental responses to loss of a loved one may impact children in the family
Include caregivers and children when supporting a family who has experienced a death
Implications for Program Leaders
Create support groups for military families who have experienced the death of a loved one so that they can build social networks with people who are sensitive to the context in which their family lives
Develop workshops to teach Service members and their partners how to use positive parenting even in the midst of mental health problems or other difficulties
Implications for Policy Makers
Encourage training for professionals who work with military families that includes information about the impact of parental reactions to grief on their children’s well-being
Support the development of programs for military families who experience terminal illness or death of a child
Methods
Eligible families were recruited by mail. They were enrolled in a pediatric hospice and had a child who died with a surviving sibling between the ages of 8 and 18 years living at home.
Families who expressed interest were sent questionnaires including information regarding demographics, parenting behaviors, and symptoms of PTSD, depression, and prolonged grief disorder. Each member of the family completed questionnaires separately.
Data were analyzed to determine the relationship between caregiver and sibling mental health symptoms and how parenting behaviors influenced that relationship.
Participants
The sample included 62 families, with parents and siblings, for 150 total individual participants.
Participants were primarily White (85%) and most (83%) of the deceased children’s cause of death was a medical illness.
The siblings were on average 13 years old (SD = 3.59); parents’ age was not indicated.
Limitations
Most of the families in this study lost children due to a medical illness, which limits the ability to extend these findings to families whose children may die due to other causes.
All of the families in this study were involved in a pediatric palliative care program; these families may differ from families not participating in a way that would affect the results.
The sample lacked racial and ethnic diversity, so results may not generalize to a more diverse population.
Avenues for Future Research
Examine the grief of military families who experience the death of a child and how parental and sibling reactions may influence one another
Follow families over time after the death of a child to determine what type of support is needed at different times
Investigate the experience of families of children with a terminal illness to determine whether programs initiated before the child’s death may assist with coping after the child’s death
Focus
Civilian
Population Focus
Abstract
Context: Families are referred to pediatric palliative care (PPC) programs when a child is diagnosed with a medical condition associated with less than a full life expectancy. When a child dies, PPC programs typically offer a range of bereavement interventions to these families, often focusing on parents. Currently, it is unclear which factors increase the likelihood that bereaved siblings will experience negative outcomes, limiting the development of empirically supported interventions that can be delivered in PPC programs. Objectives: The present study explored the relationship between parents' and surviving sibling's mental health symptoms (i.e., post-traumatic stress disorder [PTSD], prolonged grief disorder (PGD), and depression symptoms) after a child's death. Additionally, the extent to which parent functioning indirectly impacted sibling functioning through parenting behaviors (i.e., positive parenting and parent involvement) was also examined, with a specific focus on differences based on parent gender. Methods: Sixty bereaved parents and siblings (aged 8_18) who enrolled in a PPC program from 2008 to 2013 completed measures of PTSD, PGD, and depression related to the loss of a child/sibling. Siblings also completed a measure of general parenting behaviors. Results: Maternal, but not paternal, symptoms of PTSD and PGD were directly associated with sibling outcomes. Paternal symptoms were associated with sibling symptoms indirectly, through parenting behaviors (i.e., via decreasing positive parenting). Conclusion: These results underscore the importance of examining both maternal and paternal influences after the death of a child, demonstrate differential impact of maternal vs. paternal symptoms on siblings, and stress the importance of addressing postloss symptoms from a family systems perspective.
Abstract Document
Attach