Kissane D W, Bloch S, Onghena P, McKenzie D P, Snyder R D, Dowe D L
Department of Psychological Medicine, Monash Medical Centre, Australia.
Am J Psychiatry. 1996 May;153(5):659-66. doi: 10.1176/ajp.153.5.659.
The aim of this study was to describe the intensity of grief, the psychosocial morbidity, and the coping patterns in members of families classified according to a typology of family functioning comprising supportive, conflict-resolving, intermediate, sullen, and hostile classes.
One hundred fifteen families were assessed longitudinally 6 weeks (time 1), 6 months (time 2), and 13 months (time 3) after the death of a parent (constituting 670 individual responses) on measures of grief intensity, psychological state, social adjustment, and family coping. A previously described typology of perceptions of family functioning was applied. Repeated measures multivariate analysis of variance based on both individuals and families and post hoc comparisons of significant results were undertaken.
Sullen families displayed the most intense grief and the most severe psychosocial morbidity. Well-functioning families (supportive and conflict-resolving) resolved their grief and adjusted more adaptively than their dysfunctional counterparts (intermediate, sullen, and hostile families). There were no cluster-by-time interactions. The clusters accounted for 15.7% of the variance in depression (Beck Depression Inventory) and 27.9% of the variance in social functioning (Social Adjustment Scale). Well-functioning families used more family coping strategies (Family Crisis Oriented Personal Evaluation Scales).
More intense grief and greater psychosocial morbidity are found in sullen, hostile, and intermediate bereaved families than in the more adaptive supportive and conflict-resolving types. At-risk families are identifiable and could be treated preventively to reduce morbidity.
本研究旨在描述根据家庭功能类型分类的家庭成员的悲伤强度、心理社会发病率及应对模式,家庭功能类型包括支持型、冲突解决型、中间型、沉闷型和敌对型。
115个家庭在父母一方去世后6周(时间1)、6个月(时间2)和13个月(时间3)接受纵向评估(共670份个体反应),评估指标包括悲伤强度、心理状态、社会适应和家庭应对。采用先前描述的家庭功能认知类型。基于个体和家庭进行重复测量多变量方差分析,并对显著结果进行事后比较。
沉闷型家庭表现出最强烈的悲伤和最严重的心理社会发病率。功能良好的家庭(支持型和冲突解决型)比功能失调的家庭(中间型、沉闷型和敌对型家庭)更能化解悲伤并更适应性地进行调整。不存在类型与时间的交互作用。这些类型解释了抑郁(贝克抑郁量表)中15.7%的方差变异以及社会功能(社会适应量表)中27.9%的方差变异。功能良好的家庭使用更多的家庭应对策略(家庭危机导向个人评估量表)。
与适应性更强的支持型和冲突解决型家庭相比,沉闷型、敌对型和中间型丧亲家庭的悲伤更强烈,心理社会发病率更高。有风险的家庭是可识别的,可以进行预防性治疗以降低发病率。