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

Reasons for the Lack of Psychiatric Services for Bereaved Children

According to Black (1998), Dowdney, Wilson, Maughan, Allerton, Schofield & Skuse (1999), and Weller, Weller, Fristad, & Bowes (1991), bereaved children have higher levels of emotional disturbance and symptoms than nonbereaved children for up to 2 years after the death of a parent and up to 40% of bereaved children show disturbance 1 year after bereavement. Weller et al. (1991) found in their study, that 37% of the 38 bereaved children had a major depressive disorder 1 year after bereavement.

In the Dowdney et al. (1999) prospective case-control study, parentally bereaved children and surviving parents showed higher then expected levels of psychiatric difficulties. The psychiatric services offered was related to the age of the child and the manner in which the deceased parent died. Children under 5 years old were less likely to be offered services than older children even if their parents wanted the services. The children who lost the parent through suicide or from a terminal illness had significantly higher change of being offered services. The children least likely to receive psychiatric services were those who were not involved with any services before the parental death.

Dowdney et al. (1999) found that despite the risk for bereaved children of developing major psychiatric disorders, mental health services are not routinely offered. Some of the reasons they found for the lack of services to this population of children are as follows: Mental health professionals disagree about whether bereaved children require mental health services. There is a lack of information about the grieving process of children. Also, there is a lack of specifics for identifying children who might be at high risk for the development of complicated grief. Surviving parents may be preoccupied with the everyday difficulties of caring for the needs of the family and may not be aware of the children's need to express their feelings about their loss. If the surviving parent is the father, he may be less aware of his children's needs to work through the grief tasks and emotional pain. Also, the surviving parent may be dealing with their own mental health issues and complicated grief.

Other reasons for the lack of services are the myths about grieving children. There has been a long-standing debate about children's capacity to grieve. Children's grief has not received much attention from clinicians and researchers. This adds to the lack of consensus about whether children actually mourn (Dowdney et al., 1999). see the myths of children's grief in Table 2.

Early theorists such as Wolfenstein in 1966, (as cited in, Geis et al., 1998, p. 75) felt that grieving does not occur until adolescence, as a result of the younger child's psychological structure and the fact that object relations are not fully developed. Bowlby in 1960, (as cited in Geis et al., 1998, p. 75) on the other extreme described very young children's reactions to loss of a loved one. The reactions included protest, despair and detachment. Furman in 1974 (as cited in Geis et al., 1998, p. 75), believed that children are able to mourn once object constancy of the loved one has been maintained. This task is usually achieved between 6 months and 1 year of age.