Decreasing the Risk of Complicated Bereavement and Future Psychiatric Disorders in Children

Journal of Child and Adolescent Psychiatric Nursing, Apr-Jun 2005 by Kirwin, Kathleen M, Hamrin, Vanya

Weller, et al. (1991) conducted a nonexperimental, between-subjects, and cross-sectional, structured design study, with a subject size of 38 bereaved children. The comparison group consisted of 38 depressed children from a child psychiatric inpatient unit. The children from the comparison group were matched to the bereaved subject for age, sex and socioeconomic status.

The bereaved children and parents were interviewed 312 weeks after the death of the parent. Structured interviews and rating scales were used, which included the Diagnostic Interview for Children and Adolescents. These structured interviews established the presence or absence of psychiatric diagnoses for the child on the basis of DSM-III criteria. The parents of the children completed the Psychiatric Interview genogram. The results of the study were rescored to fit the DSM-III-R criteria for a major depressive episode. The nine symptoms are based on the DSM-III-R criteria: dysphoria, loss of interest, appetite disturbance, psychomotor agitation or retardation, fatigue, excessive guilt, and worthlessness, trouble thinking, and morbid or suicidal ideation (Weller et al., 1991).

The results of the study indicated that symptom endorsement was least frequent for the bereaved children when only the parent's report was used. When the child's report was used, endorsements were more frequent. Symptom endorsement was most frequent when the child and parent reports were combined. When both reports were used, more than 37% of the bereaved children met the DSM-III-R criteria for a major depressive episode (Weller et al., 1991).

This study revealed that bereaved children experienced numerous depressive symptoms but had fewer symptoms than inpatient children with major depression reported. The symptoms seen more in bereaved than depressed children were guilt and worthlessness. This study also indicates that some bereaved children have symptoms of depression. There is a need for more research to further investigate the prevalence of depression and other psychiatric disorders in bereaved children (Weller et al, 1991).

In Weller et al. (1991), bereaved children may have suicidal ideation, but attempts are rare. The suicidal ideation is related to a desire to be with the deceased for bereaved children, opposed to a devaluation of life for depressed children.

Dowdney et al. (1999) conducted a prospective case control study to identify whether psychiatric disturbance in parentally bereaved children and surviving parents is related to the family receiving mental health services. This study had 45 bereaved families participate, the measurement used on the parents was a semistructured interview and for the children, child behavioral checklists completed by the parents and for school-aged children, their teachers' completed report form. These child mental health assessment tools measured a broad range of symptoms, which included:

a) internalizing scale: withdrawn, anxious, and depressed behaviors; and

b) externalizing scale: disruptive, aggressive, or delinquent behaviors.