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Do Circumstances of the Death Matter? Identifying Socioenvironmental Risks for Grief-Related Psychopathology in Bereaved Youth


  • Julie B. Kaplow,

    Corresponding author
    1. Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
    • Correspondence concerning this article should be addressed to Julie B. Kaplow, Assistant Professor and Director, Trauma and Grief Center for Youth, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109-5765. E-mail:

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  • Kathryn H. Howell,

    1. Department of Psychology, University of Memphis, Memphis, Tennessee, USA
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  • Christopher M. Layne

    1. UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
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  • This research was supported in part by grants NIMH K08 MH76078, the Todd Ouida Clinical Scholars Award, the Laurence Polatsch Memorial Fund, the Lynn Wilson Memorial Fund, and the Rachel Upjohn Clinical Scholars Award given to the first author. Drs. Layne and Kaplow hold proprietary rights to the Persistent Complex Bereavement Disorder Checklist-Youth Version 1.0 and Adult Version 1.0, as well as the Bereavement Risk and Resilience Index. The authors wish to thank Michelle Belke, Alena Grieser, Heather Hammerstrom, Harriett Jones, Georgia Stamatopoulos, and Amanda Tarantowski for their assistance with conducting interviews. We also thank Amanda Burnside, Emilie Lerner, and Britney Wardecker for their assistance with project coordination and Valerie Elsesser, Kara Koppinger, Mirele Mann, and Meredith Merlanti for their assistance with data management and data entry. We also wish to thank Irwin Sandler, Tim Ayers, and Albert Cain for their guidance regarding study design. Finally, we wish to acknowledge the Gilda's Club of Grand Rapids staff for their administrative support, and all participating children and caregivers.


We examined bereaved children's and surviving caregivers’ psychological responses following the death of the other caregiver as a function of the stated cause of death. Participants included 63 parentally bereaved children and 38 surviving caregivers who were assessed using self-report instruments and in-person interviews. Surviving caregivers reported the causes of death as resulting from sudden natural death (34.9%), illness (33.3%), accident (17.5%), and suicide (14.3%). Results revealed differences between caregiver-reported versus child-reported cause of death, particularly in cases of suicide. Children who lost a caregiver due to a prolonged illness exhibited higher levels of both maladaptive grief (d = 3.13) and posttraumatic stress symptoms (PTSS; d = 3.33) when compared to children who lost a caregiver due to sudden natural death (e.g., heart attack). In contrast, surviving caregivers did not differ in their levels of maladaptive grief and PTSS as a function of the cause of death; however, caregivers bereaved by sudden natural death reported higher levels of depression than those bereaved by prolonged illness (d = 1.36). Limited sample size prevented analysis of outcomes among those bereaved by suicide or accident. These findings suggest that anticipated deaths may contain etiologic risk factors for maladaptive grief and PTSS in children.

Traditional and Simplified Chinese Abstracts by AsianSTSS

標題:死亡情況重要嗎? 辨別喪親少年與哀傷有關的精神病理學中社會環境的風險。

撮要:我們檢視述說死因與經歷照顧者死亡的兒童及倖存的另一照顧者的心理反應的關係。樣本是63名喪親兒童及38名倖存照顧者,而他們會由自我報告工具和個別面見來評估。倖存照顧者敍述親人死因為:突然自然死亡(34.9%),疾病(33.3%),意外(17.5%)和自殺(14.3%)。結果顯示照顧者與兒童述說親人死因有出入,特別在自殺方面。對比親人突然自然死亡(如心臟病)的兒童,親人死於長期病患的兒童有更嚴重的適應不良哀傷(d=3.13)和創傷後壓力症狀(PTSS; d=3.33)。但倖存照顧者則在適應不良哀傷和PTSS方面未有此分別。親人突然自然死亡比長期疾病死亡更令倖存照顧者增加抑鬱(d=1.36)。有限的樣本數量限制關於自殺或意外死亡方面的分析。本文指出預期死亡可能是兒童適應不良哀傷和PTSS的風險因由。

标题:死亡情况重要吗? 辨别丧亲少年与哀伤有关的精神病理学中社会环境的风险。

撮要:我们检视述说死因与经历照顾者死亡的儿童及幸存的另一照顾者的心理反应的关系。样本是63名丧亲儿童及38名幸存照顾者,而他们会由自我报告工具和个别面见来评估。幸存照顾者叙述亲人死因为:突然自然死亡(34.9%),疾病(33.3%),意外(17.5%)和自杀(14.3%)。结果显示照顾者与儿童报告亲人死因有出入,特别在自杀方面。对比亲人突然自然死亡(如心脏病)的儿童,亲人死于长期病患的儿童有更严重的适应不良哀伤(d=3.13)和创伤后压力症状(PTSS; d=3.33)。但幸存照顾者则在适应不良哀伤和PTSS方面未有此分别。亲人突然自然死亡比长期疾病死亡更令幸存照顾者增加抑郁(d=1.36)。有限的样本数量限制关于自杀或意外死亡方面的分析。本文指出预期死亡可能是儿童适应不良哀伤和PTSS的风险因由。