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Bereaved mothers and fathers: Grief and psychological health 1 to 5 years after losing a child to cancer
Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC.ORCID iD: 0000-0002-4142-5967
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Bereaved parents often experience severe suffering and are at elevated risk for developing grief complications such as prolonged grief and other negative psychological health outcomes. The general aim of this thesis was to investigate symptoms of prolonged grief, depression, posttraumatic stress, anxiety, rumination, and sleep disturbance in parents who had lost a child to cancer 1 to5 years earlier. Attention was also given to the potential impact on the parents’grief of their experiences during the child’s illness, and finally to the parents’ views on their coping with grief. Methods: A cross-sectional design for data collection was used for all four studies in this thesis. Both quantitative and qualitative methods were used for data analysis, to provide various and complementing perspectives on bereaved parents’ grief and their psychological health. Results:Bereaved parents’ symptom levels of prolonged grief and psychological symptoms were found to be elevated and neither time- nor gender-dependent across the first five years after the loss. We also found that some of the parents’experiences during their child’s illness were associated with their grief and psychological symptoms. These factors differed for mothers and fathers. Mothers valued trustful relations with health care professionals, while fathers reported better psychological health when they had received support in practical matters. Findings also showed that parents found certain factors facilitated or complicated their coping with grief. Unsurprisingly, social support promoted positive coping with grief, while a less familiar factor – going back to work – could make coping with grief harder. Clinical implications: The findings provide knowledge which can improve the care for children, through development of support to their parents in pediatric oncology contexts and in bereavement.

Place, publisher, year, edition, pages
Stockholm: Ersta Sköndal Bräcke University College , 2020. , p. 80
Series
Avhandlingsserie inom området Människan i välfärdssamhället, ISSN 2003-3699 ; 3
Keywords [en]
Bereavement, grief, pediatric oncology, parents, psychological health
National Category
Nursing
Research subject
The Individual in the Welfare Society, Palliative Care
Identifiers
URN: urn:nbn:se:esh:diva-8006Libris ID: htvzwxn8fdbz1pqkISBN: 978-91-985808-3-9 (print)OAI: oai:DiVA.org:esh-8006DiVA, id: diva2:1415221
Public defence
2020-04-17, Aulan, Campus Ersta, Stigbergsgatan 30, Stockholm, 09:30 (English)
Opponent
Supervisors
Available from: 2020-03-27 Created: 2020-03-17 Last updated: 2023-09-22Bibliographically approved
List of papers
1. Psychometric properties of the Prolonged Grief Disorder-13 (PG-13) in bereaved Swedish parents.
Open this publication in new window or tab >>Psychometric properties of the Prolonged Grief Disorder-13 (PG-13) in bereaved Swedish parents.
2018 (English)In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 267, p. 560-565, article id S0165-1781(18)30138-0Article in journal (Refereed) Published
Abstract [en]

This study aimed to validate the Swedish version of the Prolonged Grief Disorder-13 tool (PG-13) by examining its psychometric properties, including factor structure, discriminant and concurrent validity. The PG-13 was assessed in a sample of Swedish parents who had lost a child to cancer 1-5 years previously. The sample included 225 parents (133 mothers and 92 fathers) with a mean age of 46.02 years (SD = 8.15) and 16.0% met the criteria for Prolonged Grief Disorder (PGD). A principal component analysis was performed, and the results supported a one-factor structure of the PG-13. The PG-13 was shown to have high internal consistency and intelligible associations with concurrent psychological symptoms and grief rumination as well as with known risk factors for PGD. These results indicate satisfactory psychometric properties of the instrument, thus supporting the use of the PG-13 as a valid measure of PGD.

Keywords
Bereavement, Parents, Pediatric oncology, Principal component analysis, Prolonged Grief Disorder, Validation
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-6995 (URN)10.1016/j.psychres.2018.06.004 (DOI)29982112 (PubMedID)
Available from: 2018-10-31 Created: 2018-10-31 Last updated: 2021-10-27Bibliographically approved
2. Bereaved mothers' and fathers' prolonged grief and psychological health 1 to 5 years after loss-A nationwide study.
Open this publication in new window or tab >>Bereaved mothers' and fathers' prolonged grief and psychological health 1 to 5 years after loss-A nationwide study.
2019 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 28, no 7, p. 1530-1536Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To assess differences in prolonged grief, depression, posttraumatic stress, and sleep disturbances in bereaved parents across years since loss (1-5 years) and by gender and to assess potential interactive effects of time since loss and gender on bereavement outcomes.

METHODS: This study examined symptom levels of prolonged grief disorder, depression, posttraumatic stress, and insomnia in bereaved parents. A sample, including 133 mothers and 92 fathers who had lost a child to cancer 1 to 5 years previously, subdivided to five subsamples, one for each year since loss. Analysis of variance (ANOVA) was used to assess differences in symptom levels, related to years since loss, and gender.

RESULTS: Regardless of how many years had passed since the loss, symptom levels of prolonged grief, depression, posttraumatic stress symptoms, and insomnia were elevated in all subsamples. Mothers showed higher symptom levels of prolonged grief, depression, and posttraumatic stress than fathers. However, no significant interaction effects were found between years since loss and gender on any of the symptom levels.

CONCLUSIONS: Cancer-bereaved mothers and fathers are vulnerable to prolonged grief and psychological symptoms up to 5 years after the death of their child. Findings highlight that bereaved parents may need long-term support, and the results deserve further attention in research and clinical care.

Keywords
PGD, childhood cancer, depression, fathers, insomnia, mothers, pediatric oncology, posttraumatic stress, prolonged grief
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-7665 (URN)10.1002/pon.5112 (DOI)31108000 (PubMedID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2020-06-03Bibliographically approved
3. Factors During a Child's Illness Are Associated With Levels of Prolonged Grief Symptoms in Bereaved Mothers and Fathers
Open this publication in new window or tab >>Factors During a Child's Illness Are Associated With Levels of Prolonged Grief Symptoms in Bereaved Mothers and Fathers
2020 (English)In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 38, no 2, p. 137-144Article in journal (Refereed) Published
Abstract [en]

Purpose: Previous research shows that bereaved parents are at an increased risk for intense and prolonged grief responses. To offer effective support to parents during a child's cancer treatment and after their child's death, more knowledge is needed about factors related to the child's illness trajectory that may contribute to prolonged grief in bereaved parents and about possible sex differences related to such factors. Therefore, we examined possible contributing factors associated with prolonged grief in cancer-bereaved mothers and fathers 1 to 5 years after their child died of cancer.

Methods: We studied data from a population-based nationwide survey, including 133 mothers and 92 fathers who had lost a child to cancer 1 to 5 years earlier, using univariable and multiple regression analyses to assess the associations between prolonged grief and possible contributing variables.

Results: The variables associated with lower levels of prolonged grief symptoms for mothers were being able to talk about feelings within the family (P = .00) and trusting that health care professionals made every possible effort to cure the child (P = .01). The statistically significantly associated variables for fathers were having said farewell to the deceased child in the way they wanted (P = .00) and feeling that they had received practical support from health care professionals during the child's illness trajectory (P = .01).

Conclusion: We found factors during the illness of children with cancer that contributed to prolonged grief for parents; these were different for mothers and fathers. The results may have implications for design of family bereavement support within pediatric oncology care, including addressing the differing needs of mothers and fathers more effectively.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-7982 (URN)10.1200/JCO.19.01493 (DOI)31725342 (PubMedID)
Available from: 2020-02-06 Created: 2020-02-06 Last updated: 2020-09-29Bibliographically approved
4. Parents’ views on what facilitated or complicated their grief after losing a child to cancer
Open this publication in new window or tab >>Parents’ views on what facilitated or complicated their grief after losing a child to cancer
2021 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 19, no 5, p. 524-529Article in journal (Refereed) Published
Abstract [en]

Objectives: The loss of a child is a devastating event, and bereaved parents often suffer intense and long-lasting grief reactions and are at risk for psychological symptoms. More knowledge about how parents cope with grief may improve the support to bereaved parents. This study, therefore, aimed to explore parents' views on what facilitated or complicated their grief coping after losing a child to cancer.

Methods: This study was derived from a nationwide postal survey. Cancer-bereaved parents (n = 161) provided written responses to two open-ended questions: "Is there anything that has helped you cope with your grief after your child's death?" and "Is there anything that made it difficult for you to cope with your grief?" Content analysis was used to analyze the responses.

Results: Parents reported that a supportive social network of family and friends, and having remaining children, facilitated their coping with grief. Meeting professional counselors and meeting other bereaved parents, connecting to memories of the deceased child in various contexts, including school and pediatric care settings, were also reported facilitating grief coping. Parents stated that the following experiences had complicated grief coping: additional losses in their family or social network; not being able to share emotions with their partner; when they perceived that friends, relatives, or colleagues lacked empathy or patience; when they felt challenging demands from employers at a too early stage.

Significance of results: This study contributes to the understanding of parents' grief experiences and what has facilitated or complicated their coping with grief, which can help health care professionals and others improve bereavement support services.

Keywords
Bereavement, Coping, Grief, Parents, Pediatric oncology
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-8005 (URN)10.1017/S1478951520001212 (DOI)000721279300004 ()33239119 (PubMedID)
Funder
Swedish Childhood Cancer Foundation
Note

Publication status in dissertation: Submitted

Forskningsfinansiärer:

- Gålöstiftelsen

- Ersta Sköndal Bräcke högskola

Available from: 2020-03-16 Created: 2020-03-16 Last updated: 2022-01-05Bibliographically approved

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