Factors associated with grief and depression following the loss of a child: A multivariate analysis
Abstract
The present study aims to explore the factors which are associated with grief and depression outcomes in a group of bereaved parents in the first few years following the loss of a child. Sixty-four participants were recruited from bereavement support organisations, between two and 59 months post loss, mean 30 months (SD = 15). They completed a questionnaire packet which comprised standard instruments measuring grief, depression, coping styles, continuing bonds and optimism/pessimism, as well as a number of specific bereavement-related questions. Univariate analyses were conducted to establish which factors were associated with grief and depression. Those which were statistically significant were then entered into multivariate analyses to establish their relative importance. High levels of avoidance and depression and lower levels of cognitive restructuring (benefit finding) were associated with higher grief symptoms, whereas higher levels of avoidance and alcohol/substance use were associated with higher depression symptoms. The present study highlights the relative importance of different coping strategies adopted by this group of bereaved parents, compared to the relative unimportance of circumstances around the loss, e.g. sudden or violent death. The use of alcohol and other substances by bereaved parents requires urgent attention as a potentially life-threatening maladaptive coping strategy. The call for further research into risk factors for bereaved parents is emphasised.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Prolonged grief disorder is associated with avoidance of emotions and thoughts associated with the deceased, suppression of unwanted emotions or thoughts, avoidance of external reminders that trigger negative emotions, and impaired emotional flexibility.
“The disorder tends to be associated with avoidance of emotions and thoughts associated with the deceased 117,118 , suppression of unwanted emotions or thoughts 117,119 , avoidance of external reminders that trigger negative emotions 120 , and impaired emotional flexibility 121 .”
Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.67.6.1063 · Cited by 7,456 · see citing works
You want to measure coping but your protocol’ too long: Consider the brief cope
Carver, C. S. (1997) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm0401_6 · Cited by 7,361 · see citing works
THE DUAL PROCESS MODEL OF COPING WITH BEREAVEMENT: RATIONALE AND DESCRIPTION
Schut, M. S. (1999) · Death Studies · doi:10.1080/074811899201046 · Cited by 2,560 · cited 1× · see citing works
“…of the time when the Psychology, Health & Medicine bereaved person is neither in a state of attending to the loss or attending to the associated stressors, but needs to take a break from “ active grieving ” to accommodate the effort involved in this demanding process (Stroebe & Schut, 1999).”
BackgroundInventory of complicated grief: a scale to measure maladaptive symptoms of loss.
Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., Frank, E., Doman, J., & Miller, M. (1995) · Psychiatry Research · doi:10.1016/0165-1781(95)02757-2 · Cited by 1,582 · see citing works
Bonanno, G. A., Keltner, D. J., Holen, A., & Horowitz, M. J. (1995) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.69.5.975 · Cited by 355 · see citing works
Bonanno, G. A., Keltner, D., Holen, A., & Horowitz, M. J. (1995) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.69.5.975 · Cited by 355 · see citing works
The impact of trauma on meaning: From meaningless world to meaningful life.
Janoff‐Bulman, R., & Frantz, C. M. (1997) · Cited by 349 · see citing works
The prediction of bereavement outcome: Development of an integrative risk factor framework
Stroebe, M., Folkman, S., Hansson, R. O., & Schut, H. A. W. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2006.06.012 · Cited by 319 · see citing works
Complicated grief : Scientific foundations for health care professionals
Stroebe, M., Schut, H. A. W., & van den Bout, J. (2013) · Cited by 268 · see citing works
Continuing bonds and adjustment at 5 years after the death of a spouse.
Field, N. P., Gal-Oz, E., & Bonanno, G. A. (2003) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.71.1.110 · Cited by 215 · see citing works
Continuing bonds and adjustment at 5 years after the death of a spouse
Field, N. P., Gal-Oz, E., & Bonanno, G. A. (2003) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.71.1.110 · Cited by 215 · see citing works
Sense and significance: a mixed methods examination of meaning making after the loss of one's child
Lichtenthal, W. G., Currier, J. M., Neimeyer, R. A., & Keesee, N. J. (2010) · Journal of Clinical Psychology · doi:10.1002/jclp.20700 · Cited by 211 · see citing works
Predicting hopelessness and psychological distress: The role of perfectionism and coping.
O’Connor, R. C., & O'Connor, D. B. (2003) · Journal of Counseling Psychology · doi:10.1037/0022-0167.50.3.362 · Cited by 170 · see citing works
Self-citationNegative cognitions and avoidance in emotional problems after bereavement: A prospective study
Boelen, P. A., van den Bout, J., & van den Hout, M. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.12.006 · Cited by 154 · see citing works
Stroebe, M., Schut, H. A. W., & Finkenauer, C. (2001) · PubMed · Cited by 98 · see citing works
Martin, J., Blum, T. C., & Roman, P. M. (1992) · Journal of Organizational Behavior · doi:10.1002/job.4030130106 · Cited by 92 · see citing works
Living in a World without Closure: Reality for Parents who have Experienced the Death of a Child
Woodgate, R. L. (2006) · Journal of Palliative Care · doi:10.1177/082585970602200203 · Cited by 84 · see citing works
Murphy, S. A., Chung, I., & Johnson, L. C. (2002) · Research in Nursing & Health · doi:10.1002/nur.10060 · Cited by 70 · see citing works
Suicide Ideation Among Parents Bereaved by the Violent Deaths of Their Children
Murphy, S. A., Tapper, V. J., Johnson, L. C., & Lohan, J. A. (2003) · Issues in Mental Health Nursing · doi:10.1080/01612840305307 · Cited by 55 · see citing works
Alcohol and drug usage in parents soon after stillbirth, neonatal death or SIDS
Vance, J. C., Najman, J. M., Boyle, F. M., Embelton, G., Foster, W. J., & Thearle, M. J. (1994) · Journal of Paediatrics and Child Health · doi:10.1111/j.1440-1754.1994.tb00632.x · Cited by 32 · see citing works
Lohan, J. A., & Murphy, S. A. (2007) · Journal of Loss and Trauma · doi:10.1080/15325020701296794 · Cited by 9 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Reed, G. M., First, M. B., Billieux, J., Cloitre, M., Briken, P., Achab, S., Brewin, C. R., King, D. L., Kraus, S. W., & Bryant, R. A. (2022) · World Psychiatry · doi:10.1002/wps.20960 · Cited by 182 · see citing works
Emotion Regulatory Strategies in Complicated Grief: A Systematic Review
Eisma, M. C., & Stroebe, M. S. (2021) · Behavior Therapy · doi:10.1016/j.beth.2020.04.004 · Cited by 152 · see citing works
Bereavement: Course, Consequences, and Care
Zisook, S., Iglewicz, A., Avanzino, J. A., Maglione, J. E., Glorioso, D., Zetumer, S. D., Seay, K., Vahia, I. V., Young, I. T., Lebowitz, B. D., et al. (2014) · Current Psychiatry Reports · doi:10.1007/s11920-014-0482-8 · Cited by 132 · see citing works
The impact of losing a child on the clinical presentation of complicated grief
Zetumer, S. D., Young, I. T., Shear, M. K., Skritskaya, N. A., Lebowitz, B. D., Simon, N. M., Reynolds, C. F., Mauro, C., & Zisook, S. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.08.021 · Cited by 103 · see citing works
The relationship between substance misuse and complicated grief: A systematic review
Parisi, A. B., Sharma, A., Howard, M. O., & Wilson, A. B. (2019) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2019.05.012 · Cited by 87 · see citing works
Cao, X., Yang, C., & Wang, D. (2018) · OMEGA - Journal of Death and Dying · doi:10.1177/0030222818755284 · Cited by 80 · see citing works
Jaaniste, T., Coombs, S., Donnelly, T. J., Kelk, N., & Beston, D. (2017) · Children · doi:10.3390/children4110096 · Cited by 55 · see citing works
Das, M. K., Arora, N. K., Gaikwad, H. S., Chellani, H. K., Debata, P. K., Rasaily, R., Meena, K. R., Kaur, G., Malik, P., Joshi, S., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0240270 · Cited by 56 · see citing works
Vegsund, H. K., Reinfjell, T., Moksnes, U. K., Eilegård, A., Hjemdal, O., & Eilertsen, M. B. (2019) · PLoS ONE · doi:10.1371/journal.pone.0214138 · Cited by 40 · see citing works
Zhou, N., Yu, W., Huang, H., Shi, G., Luo, H., Song, C., Yilun, X., Wang, J., & Killikelly, C. (2018) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1544026 · Cited by 38 · see citing works
Parent Grief 1–13 Months After Death in Neonatal and Pediatric Intensive Care Units
Youngblut, J. M., Brooten, D. A., Glaze, J., Promise, T., & Yoo, C. (2016) · Journal of Loss and Trauma · doi:10.1080/15325024.2016.1187049 · Cited by 33 · see citing works
Fisher, J. E., Zhou, J. W., Zuleta, R. F., Fullerton, C. S., Ursano, R. J., & Cozza, S. J. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00749 · Cited by 35 · see citing works
Adverse outcomes in bereaved mothers: The importance of household income and education
Cacciatore, J., Killian, M., & Harper, M. (2016) · SSM - Population Health · doi:10.1016/j.ssmph.2016.02.009 · Cited by 28 · see citing works
Self-citationEli, B., Zhou, Y., Liang, Y., Fu, L. S., Zheng, H., & Liu, Z. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1766770 · Cited by 22 · see citing works
Bereaved Parents’ Health Outcomes Following the Death of Their Child
Dias, N., Friebert, S. E., Donelan, J., Schoemann, A. M., Morris, A., Guard, K., & Grossoehme, D. H. (2021) · Clinical Practice in Pediatric Psychology · doi:10.1037/cpp0000414 · Cited by 21 · see citing works
Ranjbar, H. A., Hekmati, I., Eşkin, M., & Jobson, L. (2021) · Current Psychology · doi:10.1007/s12144-021-02010-0 · Cited by 18 · see citing works
Gorman, R., & Cacciatore, J. (2020) · NJAS - Wageningen Journal of Life Sciences · doi:10.1016/j.njas.2020.100339 · Cited by 17 · see citing works
The suffering in silence of older parents whose child died of cancer: A qualitative study
Humbeeck, L. V., Dillen, L., Piers, R. D., Grypdonck, M. H. F., & Noortgate, N. V. D. (2016) · Death Studies · doi:10.1080/07481187.2016.1198942 · Cited by 17 · see citing works
Wang, E., Hu, H., He, Y., & Xu, Y. (2020) · Health & Social Care in the Community · doi:10.1111/hsc.13108 · Cited by 17 · see citing works
Zhao, S., Ren, L., Wang, Q., Long, M., Wu, H. L., & Wang, Y. (2021) · Asia-Pacific Psychiatry · doi:10.1111/appy.12489 · Cited by 19 · see citing works
Harper, M., O’Connor, R. C., & O’Carroll, R. E. (2014) · Psychology Health & Medicine · doi:10.1080/13548506.2014.990908 · Cited by 17 · see citing works
Self-citationOptimism in prolonged grief and depression following loss: A three-wave longitudinal study
Boelen, P. A. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.03.009 · Cited by 16 · see citing works
Bereavement during the COVID-19 Pandemic: Impact on Coping Strategies and Mental Health
Fisher, J. E., Rice, A. J., Zuleta, R. F., & Cozza, S. J. (2022) · Psychiatry · doi:10.1080/00332747.2022.2051141 · Cited by 13 · see citing works
Liu, I., Huang, Y., Wang, L., Tsai, Y., Hsu, S.-L., Chang, C., Li, Y., Hsiao, Y., Chen, C., & Wann, S. (2021) · International Journal of Older People Nursing · doi:10.1111/opn.12410 · Cited by 12 · see citing works
Mothers’ narratives about having a child with cancer: A view through the attachment lens
Bishop, S., Stedmon, J., & Dallos, R. (2014) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104514542302 · Cited by 11 · see citing works
Prolonged grief disorder in bereaved parents: Exploring impacts and treatment pathways
Yaffe, Y., & Levkovich, I. (2025) · World Journal of Psychiatry · doi:10.5498/wjp.v15.i5.104711 · Cited by 9 · see citing works
Huang, F. (2022) · Mindfulness · doi:10.1007/s12671-022-01944-1 · Cited by 9 · see citing works
Zheng, Y., Kim, J., & Wuest, L. (2023) · Journal of Loss and Trauma · doi:10.1080/15325024.2023.2285969 · Cited by 7 · see citing works
Whitebrook, J., Lafarge, C., & Churchyard, J. S. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1596961 · Cited by 6 · see citing works
Forming our grief rhythm: The relational window of tolerance for bereaved parents
Barboza, J., Seedall, R. B., Hooghe, A., Kaplow, J. B., & Bradshaw, S. D. (2024) · Family Process · doi:10.1111/famp.13048 · Cited by 5 · see citing works
Assessing the impact of factors on parental grief among older Chinese parents
Zheng, Y., & Wuest, L. (2019) · Death Studies · doi:10.1080/07481187.2019.1616854 · Cited by 5 · see citing works
Song, H., & Li, Z. (2024) · Death Studies · doi:10.1080/07481187.2024.2309482 · Cited by 4 · see citing works
Hamama‐Raz, Y., Kraus, S., & Hamama, L. (2023) · Journal of Loss and Trauma · doi:10.1080/15325024.2023.2234822 · Cited by 4 · see citing works
Peak, A. M., Martin, L. A., Post, K. M., & Hua, W. (2024) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228241275195 · Cited by 4 · see citing works
Mini Review:The Mental and Physical Consequences of Chinese Shidu Parents
Liu, W. (2018) · JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY · doi:10.29245/2578-2959/2018/3.1127 · Cited by 4 · see citing works
Holocaust memory reconstruction among bereaved parents
Cohen‐Louck, K., & Saka, Y. (2016) · Death Studies · doi:10.1080/07481187.2016.1214634 · Cited by 3 · see citing works
Ali, J. I., & Smart, C. M. (2016) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2016.06.546 · Cited by 2 · see citing works
Kumaravel, K. S., Anurekha, V., Balamurugan, M. S., Kumar, P., Gobinathan, S., & Danishraja, M. (2025) · Apollo Medicine · doi:10.1177/09760016251357091 · Cited by 1 · see citing works
Grieving the Loss of a Child and the Use of Online Social Support: An Exploratory Survey Study
Clarkson, G., Sheikh, N. S., & Johnson, L. A. (2024) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20240227-02 · Cited by 1 · see citing works
Friedrichsdorf, S. J. (2019) · MDPI eBooks · doi:10.3390/books978-3-03897-351-5 · Cited by 1 · see citing works
Bereavement and Parents Who Have Experienced the Sudden Death of a Child
Fulbrook, T. B. (2015) · ScholarWorks (Walden University) · Cited by 1 · see citing works
Bekkeheien, H. A., Reigstad, R. D., Dyregrov, K., Kristensen, P., & Hystad, S. W. (2019) · Scandinavian Psychologist · doi:10.15714/scandpsychol.6.e11
Surviving the death of a baby : end of life and the enormity of grief
Barnard, M. (2019) · University of Salford Institutional Repository (University of Salford)
Bereavement support after the death of a child with cancer: implications for practice
Neilson, S. J., Gibson, F., & Greenfield, S. (2020) · Bereavement Care · doi:10.1080/02682621.2020.1728094
EMDR with grief: Exploring the client experience and potential benefits
Soule, K. J. (2016) · ThinkTech (Texas Tech University)
Structural Reforms and the Individual
Wei, H. H. (2022) · Ius gentium · doi:10.1007/978-981-16-9752-4_3
Association between Child Loss and Parental Depression Among Middle-Aged and Older Adults in ChinaPreprint
Zhang, H., Jiang, W., & Yang, L. (2023) · Research Square · doi:10.21203/rs.3.rs-2844615/v1
Struggling to live a new normal life among Chinese women after losing the only child
Wang, H., Chaiyawat, W., & Yunibhand, J. (2018) · doi:10.58837/chula.the.2018.375
Schmidt, V., Treml, J., Linde, K., Peterhänsel, C., & Kersting, A. (2024) · Current Psychology · doi:10.1007/s12144-023-05525-w
‘Losing a Part of Yourself’: How Women Grieve Their Close Friend’s Death
Sauber, E., & O’Brien, K. M. (2025) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228251334716
Grief Counselling: A Soothing Balm for Bereaved MothersPreprint
Myburgh, N., ziqubu, D., Shivambo, L., Ntsie, L., Maixenchs, M., Blevins, J., Dangor, Z., & Madhi, S. A. (2025) · Research Square · doi:10.21203/rs.3.rs-6890320/v1
- Authors
- Harper, M., O’Connor, R. C., & O’Carroll, R. E.
- Affiliations
- Heriot-Watt University (GB)
- University of Glasgow (GB)
- University of Stirling (GB)
- Corresponding author
- Harper, Mairi
- Venue
- Psychology, Health & Medicine
- Publisher
- Informa UK Limited
- Published
- 2013-06-26
- Volume
- 19
- Issue
- 3
- Pages
- 247-252
- ISSN
- 1354-8506 (ISSN-L)
- 1465-3966
- OpenAlex
- W2077834278
- Cited by
- 51
- References
- 20
- Citations by year
- 2025: 5 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 5 · 2020: 6 · 2019: 6 · 2018: 4 · 2017: 1 · 2016: 6 · 2015: 2 · 2014: 4
- FWCI
- 4.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychology Health & Medicine (publishedVersion)
- PubMed (publishedVersion)
- Stirling Online Research Repository (University of Stirling) (submittedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Keywords
- grief, depression, bereaved parents, child death, coping strategies, avoidance, cognitive restructuring, benefit finding, alcohol consumption, substance use, optimism and pessimism, continuing bonds, risk factors
- MeSH terms
- Adaptation, Psychological, Adult, Death, Depression, Grief, Humans, Middle Aged, Parents, Multivariate Analysis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review