• Posted March 22, 2023

When Kids Lose a Parent, New Therapy Might Prevent Long-Term Mental Harm

The death of a parent is heartbreaking for a child or teenager, and those who experience it are known to be at an increased risk for depression and other mental health issues later in life.

But a new study finds that children who participated in a bereavement program with their families following the loss of a parent were significantly less likely to experience depression up to 15 years later.

Soon, the program will be available online.

Study author Irwin Sandler, an emeritus professor with Arizona State University affiliated with the ASU REACH Institute in the Department of Psychology, said he and the other researchers had a theory about whether they could prevent depression in children after parent loss with the program.

"It turns out we were right,"Sandler said.

The program enrolled 244 kids ages 8 to 16 who had lost a parent between three months and 30 months before the study. It also enrolled their surviving caregivers, which is an important part of the program.

This randomized, controlled trial included a total of 156 families.

The families were either in the control group, mailed three age-appropriate books about dealing with grief, or they participated in 12 sessions of the bereavement program.

Those who did the program had specific caregiver sessions, separate youth sessions, and then came together for two joint sessions to practice their skills.

The caregiver sessions, for the surviving parent or other adult, focused on supporting their grief, reducing kids' exposure to stressful life events and strengthening positive parenting techniques, which include active listening.

The sessions for children and adolescents focused on strengthening positive coping and emotion regulation skills.

Researchers followed up with the youths in interviews meant to assess their grief, intrusive thoughts, internalizing symptoms, depression and anxiety.

They did these interviews several times over the years, including immediately after the program finished and then again at 11 months, six years and 15 years later.

By the time of the 15-year follow-up, 186 children -- who were now adults -- were still participating.

The caregiver component is so important because the impact on children's future depression risk is affected by the quality of parenting they receive following the parent's death, Sandler explained.

The surviving parent's ability to bring the family together in a stable supportive environment for children and the children's ability to cope with grief and express their emotions about the death when they feel the need to do so both make a difference, Sandler said.

This is just the latest finding from this study, Sandler noted. Earlier papers have found a reduction in other mental health issues.

"And as a bonus that we weren't even expecting, frankly, we have equally good effects to reduce depression and prolonged grief disorder in the [surviving] parents,"Sandler said.

"This is just the latest in a series of studies. It's probably the most dramatic finding because to show that you're able to prevent the onset of major depressive disorder ... was even more than we could have expected,"he added.

Specifically, at the six- and 15-year follow-up interviews, 13.5% of the adults who had participated in the program as children met the criteria for depression, compared to just over 28% who had only received the books on grief.

Meanwhile, just over 4.8% of the children who went through the program had generalized anxiety disorder, compared to 12.2% in the book group.

The research team adjusted for other variables, and calculated that the youths who participated in the program were 67% less likely to have depression 15 years later, compared to those not in the program.

The findings were published recently in the Journal of Child & Adolescent Psychiatry.

Grief in adolescents and children is different from grief in adults, noted Dr. Rana Elmaghraby, a child and adolescent psychiatrist in Seattle and a member of the American Psychiatric Association's Council on Children, Adolescents and their Families. She was not involved in the study.

"It becomes part of their identity,"Elmaghraby said.

It can also increase what are called ACE (adverse childhood experiences) scores, which put them at higher risk of psychiatric conditions in the future.

"It's a very serious and different dynamic than, for example, an adult experiencing grief where they're able to process, heal and continue with their lives,"Elmaghraby said. "But with children, it becomes rooted with them. It actually changes the way they view the world. It changes even the way they view themselves as a result of that."

But Elmaghraby noted that a lot of research has shown that the way children process grief and trauma is highly dependent on the caregiver.

Elmaghraby said she would like to see more programs like this across the country, including those that focus on children of parents who died of suicide and children of lower socioeconomic status who have less access to resources.

Sandler noted that it can be difficult to offer the bereavement program because it is resource-intensive. However, an online version will be available later this spring.

Among the many tools offered to children in the program are lessons on the connection between thoughts and feelings, some ideas about what to do when feeling stressed or sad, and communication skills for expressing their grief.

"They are simple, practical tools that work. All you have to do is do them,"Sandler said, noting that practicing the skills at home is key to the program.

"These are practical tools that parents and children can take home with them and actually apply to their lives,"he said.

More information

The Child Mind Institute has more on helping children with grief.

SOURCES: Irwin Sandler, PhD, research professor, REACH Institute, Department of Psychology and emeritus professor, Arizona State University, Tempe; Rana Elmaghraby, MD, member, Council on Children, Adolescents and their Families, American Psychiatric Association and child and adolescent psychiatrist and regional medical director, Behavioral Health Services, Sea Mar Center and clinical instructor, Department of Psychiatry, University of Washington, Seattle; Journal of Child & Adolescent Psychiatry, March 7, 2023