A Support Group Intervention for Children Bereaved by Parental Suicide

Journal of Child and Adolescent Psychiatric Nursing, Feb 2007 by Mitchell, Ann M, Wesner, Sue, Garand, Linda, Gale, Deborah Dysart, Et al

TOPIC: Bereavement is considered by many to be among the most stressful of life events, and it becomes particularly distressing when it concerns the suicide death of a parent. Such an event is especially traumatic for children.

PURPOSE AND SOURCES: The purpose of this paper is to present a case for support group interventions designed specifically for child survivors of parental suicide. The authors provide a theoretical framework for supportive group interventions with these children and describe the structure of an 8-week bereavement support group for this special population of suicide survivors.

CONCLUSIONS: A case is made for designing and implementing group interventions to meet the mental health needs of this important group of individuals.

Search terms: Bereavement, support group, child, survivors of suicide

Background

While the death of a parent is a traumatic event for anyone, it may be especially intensified for young children. Children who experience the death of a parent may experience anxiety and/or depressive symptoms, fears, angry outbursts, and regression in developmental milestones (Dowdney et al., 1999). Studies suggest that when the parental death is due to suicide, the impact can be associated with more severe and longlasting problems in comparison to nonsuicidal deaths (Cerel, Fristad, Weller, & Weller, 1999). This assertion is supported by studies demonstrating higher rates of anxiety, depression, poor school performance, and decreased social adjustment among children who are survivors of parental suicide than among those whose parents died by natural causes (Cerel et al.; Pfeffer et al., 1997; Sethi & Bhargava, 2003).

Child survivors of parental suicide are left with the challenge not only of trying to understand why their parents died by suicide, but also of coping with the social stigma of a suicidal death (Cerel et al., 1999). Yet, clinicians find little information concerning appropriate and effective psychotherapeutic techniques to guide their attempts to help these children adjust to the death of their parents. In a paper entitled "Effective Communication with Bereaved Child Survivors of Suicide" (Mitchell et al., 2006), the authors review psychosocial outcomes and communication issues associated with bereaved children of parental suicide. In the present paper, the authors outline the theoretical underpinnings and the practical design of a survivors suicide support group for bereaved children (of parental suicide).

Support Group Interventions for Childhood Survivors of Suicide

Despite the results of studies suggesting an increased risk for psychiatric disorders and social maladjustment in children grieving the loss of a parent due to suicide (Pfeffer et al., 1997; Cerel et al., 1999; Sethi & Bhargava, 2003), there is a dearth of studies that assess the use of support group interventions to address the special needs of this population. This may be due to the relative lack of mental health services specifically designed to assist children bereaved by suicide. In the United States and Canada, most psychotherapeutic group interventions are designed for adults, thereby serving very few children (Ruby & McIntosh, 1996).

Nevertheless, research suggests that support groups benefit children by allowing them the opportunity to talk with others who share the unusual and disruptive experience of parental suicide. Pfeffer and colleagues examined 39 suicide-bereaved children who received 10 psychotherapeutic group sessions aimed at helping them to cope with the death and compared results to another 36 suicide-bereaved children who received no intervention. The results demonstrated fewer reports of anxiety and depressive symptoms in the psychotherapeutic intervention group than the control group (Pfeffer, Jiang, Kakuma, Hwang, & Metsch, 2002).

Such empirical studies outline the risks of increased psychiatric disorders and social problems following parental suicide. The consequences of these struggles are often seen years later by clinicians who work with adult childhood survivors of suicide. Campbell notes that adult childhood survivors of suicide are "forever changed by this indescribable and complicated bereavement" (Campbell, 1997, p. 330). The subjects in his sample reported problems with social relationships, occupational functioning, and frequent problems with drug and alcohol use. When asked, they unanimously agreed that they would have benefited from the chance to talk about the suicide that they experienced as children while still in childhood (Campbell, 1977). Interventions in the form of therapeutic support groups are one way to address this need.

A Framework for Children's Support Group Interventions

Lego (1984) defines the support group as an intervention which uses the client's present ego strength, and through the use of support and encouragement further strengthens it. Webb (1993) points out that the group serves an important purpose; that is, to help the child cope with bereavement in the company of other children who are similarly bereaved. The common ground of group support helps to decrease feelings of embarrassment or being different that might otherwise lead the child to withdraw while grieving (Lego).