Melhem Nadine M, Porta Giovanna, Shamseddeen Wael, Walker Payne Monica, Brent David A
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15213, USA.
Arch Gen Psychiatry. 2011 Sep;68(9):911-9. doi: 10.1001/archgenpsychiatry.2011.101.
Major advances have been made in our understanding of the phenomenology and course of grief in adults. However, little is known about the course of grief in children and adolescents.
We report on the course of children's and adolescents' grief reactions after sudden parental death and the effect of those reactions on subsequent psychiatric and functional status.
Longitudinal study (July 1, 2002, through January 16, 2007) of bereaved children, adolescents, and families, with yearly comprehensive assessments as long as 3 years after parental death.
Bereaved children and adolescents and their surviving parents recruited through coroners' records and a newspaper advertisement.
A total of 182 parentally bereaved children and adolescents aged 7 through 18 years whose parent died due to suicide, unintentional injury, or sudden natural causes.
Grief, functional impairment, and incident depression.
Three distinct trajectories of grief reactions were observed in the study participants. In 1 group, which consisted of 10.4% of the sample, grief reactions showed no change 33 months after death. Children and adolescents with prolonged grief reactions had higher rates of previous personal history of depression. Prolonged grief made unique contributions to increased levels of functional impairment, even after controlling for the clinical characteristics before and after the death. Conversely, prolonged grief in children, adolescents, and the surviving caregiver predisposed children and adolescents to an increased hazard of incident depression. Another group (30.8%) showed increased grief reactions 9 months after the death, which gradually decreased over time. Despite this finding, grief reactions in this group also were associated with functional impairment and increased risk of incident depression.
Grief reactions abate over time for most children and adolescents bereaved by sudden parental death; however, a subset shows increased or prolonged grief reactions, which in turn increases the risk of functional impairment and depression. Research regarding interventions designed to relieve the burden of grief in bereaved children and adolescents are needed. Such efforts also should assess and address grief reactions in the surviving parent.
我们对成年人悲伤的现象学和过程的理解取得了重大进展。然而，对于儿童和青少年悲伤的过程却知之甚少。
我们报告儿童和青少年在父母突然去世后的悲伤反应过程，以及这些反应对其随后的精神状态和功能状况的影响。
对丧亲儿童、青少年及其家庭进行纵向研究（2002年7月1日至2007年1月16日），在父母去世后长达3年的时间里每年进行全面评估。
通过验尸官记录和报纸广告招募丧亲儿童、青少年及其在世的父母。
共有182名7至18岁的父母丧亲儿童和青少年，其父母死于自杀、意外伤害或突然的自然原因。
悲伤、功能损害和新发抑郁症。
在研究参与者中观察到三种不同的悲伤反应轨迹。在一组占样本10.4%的人群中，悲伤反应在死亡33个月后没有变化。悲伤反应持续时间较长的儿童和青少年有更高的既往个人抑郁史发生率。即使在控制了死亡前后的临床特征后，持续的悲伤对功能损害水平的增加也有独特的影响。相反，儿童、青少年及其在世照料者的持续悲伤使儿童和青少年新发抑郁症的风险增加。另一组（30.8%）在死亡9个月后悲伤反应增加，随后逐渐下降。尽管有这一发现，但该组的悲伤反应也与功能损害和新发抑郁症风险增加有关。
对于大多数因父母突然去世而丧亲的儿童和青少年来说，悲伤反应会随着时间的推移而减轻；然而，有一部分人表现出悲伤反应增加或持续时间延长，这反过来又增加了功能损害和抑郁症的风险。需要开展旨在减轻丧亲儿童和青少年悲伤负担的干预措施研究。此类努力还应评估并解决在世父母的悲伤反应。
