WebMD Medical News
Laura J. Martin, MD
Sept. 6, 2011 -- Losing a parent can be difficult at any age. Researchers in a new study in the Archives of General Psychiatry seek to better understand how loss, including the sudden death of a parent, affects children and teens.
More than half of children and teens will adjust to the sudden loss of a parent within one year. But others have difficulty coming to terms with this loss and may face a higher risk of depression that interferes with their lives, the study shows.
"People used to think that all children and adolescents are resilient and don't show grief or have it," says study researcher Nadine M. Melhem, PhD, of the Western Psychiatric Institute and Clinic at University of Pittsburgh School of Medicine.
The study shows that this is not always the case.
The study included 182 children and teens aged 7 to 18 who experienced the sudden loss of a parent from suicide, accidental injury, or sudden, natural causes. The researchers studied how the children and the surviving parent were coping with the loss around 8.5 months after the death and then again one and two years after the death.
For most of the children and teens (58.8%), their grief lessened over nine to 21 months, and then remained low.
But some children experienced prolonged grief after losing a parent. For 30.8% of the children, their grief rose at about nine months, then gradually declined over two years.
For about 10% of the children, the grief was still with them after two years and they were more likely to be depressed.
Risks for such prolonged grief included a personal or family history of depression or other mood disorders. Children were also at greater risk if their surviving parent was having difficulty coping with the death.
Knowing who is at high risk may improve prevention and treatment efforts, Melhem says. "There are treatments for grief in adults that have been shown to be more effective than others, and the same may be true for children."
The loss of a parent affects the whole family. It may be that family therapy is more appropriate than one-on-one counseling, she says.
Amanda L. Thompson, PhD, a child psychologist at the Children's National Medical Center in Washington, D.C., has worked with many children who have lost parents. "Not all children and adolescents experience grief in same way," she says.
Understanding why certain children may be at more risk for prolonged grief or depression after losing a parent is important, Thompson says. But it is equally important to look at why some children are more resilient in the face of such profound loss.
A strong social support system including other family members, friends, and members of community or religious groups may help protect children from debilitating grief and depression, she says. "This is particularly important considering that the surviving parent is also in distress," Thompson says. "Sometimes parents aren't in a place where they can provide the type of support that children need after a loss."
New York City-based child psychoanalyst Leon Hoffman, MD, agrees.
When a child loses a parent, he or she almost always loses two parents -- the one who passed away and the one who is mourning the loss of their spouse, Hoffman says. Hoffman co-directs the New York Psychoanalytic Society's Pacella Parent Child Center.
"The importance of the psychological state of the surviving parent is crucial to help children and adolescents cope with the death, especially with younger children," he tells WebMD.
"The surviving parent may not realize what is so painful to a child," says Louis Kraus, MD, chief of child and adolescent psychiatry at Rush University Medical Center in Chicago. Therapy may allow a child to share feelings they can't express to their parents.
It can't be a two-way street. "Parents can't rely on their children for emotional support," he says.
He likens it to putting on oxygen mask while on an airplane in the event of an emergency. Parents need to have their mask on before tending to their child.
The same holds with grief.
"They have to get themselves straight to be able to be there for the children," Kraus says.
SOURCES:Louis Kraus, MD, chief, child and adolescent psychiatry, Rush University Medical Center, Chicago.Nadine M. Melhem, PhD, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.Amanda L. Thompson, PhD, child psychologist, Children's National Medical Center, Washington, D.C.Melhem, N.M. Archives of General Psychiatry, 2011; vol 68: pp 911-919.Leon Hoffman, MD, co-director, Parent Child Center, New York Psychoanalytic Society.
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