Raguindin Peter Francis, De Clercq Eva, Vokinger Anna Katharina, Pedraza Eddy Carolina, Bolliger Céline, Scheinemann Katrin, Tinner Eva Maria, Bergstraesser Eva, von Bueren Andre Oscar, Michel Gisela
Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, Lucerne, 6005, Switzerland.
Division of Hematology-Oncology, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, St Gallen, 9006, Switzerland.
BMC Palliat Care. 2025 Aug 4;24(1):218. doi: 10.1186/s12904-025-01854-8.
The death of a child profoundly impacts parents, often leading to anxiety, depression, and posttraumatic stress. However, factors such as resilience-defined as the capacity to adapt to adversity-are less explored. Resilience may mitigate grief-related distress. This study aimed to: (a) describe and compare resilience levels between bereaved parents and parents of childhood cancer survivors (CCS parents), (b) identify sociodemographic and cancer-related determinants of resilience among bereaved parents, and (c) investigate resilience's association with psychological distress and prolonged grief disorder.
This is a cross-sectional study done in Switzerland. Bereaved parents were recruited from three hospitals and through patient advocacy groups. CCS parents were taken from a nationwide, population-based study (Swiss Childhood Cancer Survivor Study-Parents). Resilience, psychological distress, and prolonged grief disorder were assessed using the Connor-Davidson Resilience Scale (CD-RISC 10), Brief Symptom Inventory-18 (BSI-18), and Prolonged Grief 13 (PG-13), respectively. Regression analysis (linear and logistic) was used to identify factors associated with resilience, and the association of resilience with psychological distress and prolonged grief disorder (adjusted for age, sex, and time since death).
We included 103 bereaved parents and 345 CCS parents in the analysis. Bereaved parents were younger compared to CCS parents (mean 53.7, SD 8.3 vs. 62.5, SD 6.7 years, p < 0.001), with both groups predominantly female (66% and 58%). Bereaved parents reported higher resilience scores than CCS parents (crude mean: 29.8 vs. 27.9; p = 0.005), with adjusted analyses confirming this finding. High risk of poverty was the only significant determinant of lower resilience (adjusted β = -7.37, 95% CI: -11.21, -3.54; p < 0.001). Higher resilience was associated with lower likelihood to report psychological distress (adjusted OR = 0.83, 95% CI: 0.74, 0.93, p = 0.002) and prolonged grief disorder (adjusted OR = 0.73, 95% CI: 0.58, 0.92, p = 0.008).
Bereaved parents exhibited higher resilience than CCS parents. Resilience in bereaved parents was strongly associated with reduced psychological distress and lower likelihood of having prolonged grief disorder. Targeting modifiable factors such as poverty may enhance resilience and thereby help to improve mental health outcomes for bereaved parents.
孩子的死亡会对父母产生深远影响，常常导致焦虑、抑郁和创伤后应激反应。然而，诸如复原力（定义为适应逆境的能力）等因素的研究较少。复原力可能减轻与悲伤相关的痛苦。本研究旨在：（a）描述并比较丧亲父母与儿童癌症幸存者的父母（CCS父母）的复原力水平；（b）确定丧亲父母中复原力的社会人口学和癌症相关决定因素；（c）调查复原力与心理痛苦和持续性悲伤障碍之间的关联。
这是一项在瑞士进行的横断面研究。丧亲父母是从三家医院以及通过患者支持团体招募的。CCS父母来自一项全国性的基于人群的研究（瑞士儿童癌症幸存者研究-父母版）。分别使用康纳-戴维森复原力量表（CD-RISC 10）、简明症状量表-18（BSI-18）和持续性悲伤量表13（PG-13）评估复原力、心理痛苦和持续性悲伤障碍。采用回归分析（线性和逻辑回归）来确定与复原力相关的因素，以及复原力与心理痛苦和持续性悲伤障碍之间的关联（对年龄、性别和死亡后的时间进行了调整）。
我们纳入了103名丧亲父母和345名CCS父母进行分析。与CCS父母相比，丧亲父母更年轻（平均年龄53.7岁，标准差8.3岁，而CCS父母平均年龄62.5岁，标准差6.7岁，p<0.001），两组中女性占主导（分别为66%和58%）。丧亲父母报告的复原力得分高于CCS父母（粗均值：29.8对27.9；p = 0.005），调整分析证实了这一发现。高贫困风险是复原力较低的唯一显著决定因素（调整后的β=-7.37，95%置信区间：-11.21，-3.54；p<0.001）。较高的复原力与报告心理痛苦的可能性较低（调整后的OR = 0.83，95%置信区间：0.74，0.93，p = 0.002）以及持续性悲伤障碍的可能性较低（调整后的OR = 0.73，95%置信区间：0.58，0.92，p = 0.008）相关。
丧亲父母表现出比CCS父母更高的复原力。丧亲父母的复原力与心理痛苦减轻以及持续性悲伤障碍可能性降低密切相关。针对贫困等可改变因素可能会增强复原力，从而有助于改善丧亲父母的心理健康状况。
