Follow-Up Study of Complicated Grief among Parents Eighteen Months after a Child's Death in the Pediatric Intensive Care Unit
Open accessAbstract
OBJECTIVE: We previously demonstrated that parents whose children die in a pediatric intensive care unit (PICU) have a high level of complicated grief symptoms 6 months after the death. In this study, we investigate the change in the extent of complicated grief symptoms among these parents between 6 and 18 months postdeath and identify factors predicting improvement. METHODS: One hundred thirty-eight parents of 106 children completed surveys at 6 and 18 months. Surveys included the Inventory of Complicated Grief (ICG), measures of grief avoidance, attachment, caregiving and social support, and demographics. Multivariable analysis was performed using generalized estimating equations to identify characteristics independently associated with improvement in ICG score. RESULTS: ICG scores were 33.4 ± 13.6 at 6 months and 28.0 ± 13.5 at 18 months, representing an improvement in ICG score of 5.4 + 8.0 (95% confidence interval [CI] 4.1-6.8, p < 0.001). Variables independently associated with greater improvement in ICG score included traumatic death and greater grief avoidance. Variables independently associated with less improvement included being the biological parent and having more responsive caregiving. Parents with one or two surviving children had more improvement in ICG score than those with no surviving children whereas parents with three or more surviving children had less improvement. CONCLUSION: Complicated grief symptoms decrease among parents between 6 and 18 months after their child's death in the PICU; however, high symptom levels persists for some. Better understanding of the trajectory of complicated grief will allow parents at risk for persistent distress to receive professional support.
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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 .”
Meert et al. (2011) supported a negative association between reductions on a generic measure of loss-avoidance and reductions in complicated grief symptoms between 6 and 18 months postloss.
“However, Meert et al. (2011) also supported a negative association between reductions on generic measure of loss-avoidance and reductions in CG symptoms between 6 and 18 months postloss.”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Meert et al. (2011)
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- Authors
- Meert, K. L., Shear, K., Newth, C. J. L., Harrison, R., Berger, J., Zimmerman, J., Anand, K. J. S., Carcillo, J., Donaldson, A. E., Dean, J. M., Willson, D. F., & Nicholson and the Eunice Kennedy Sh, C.
- Affiliations
- Children's Hospital of Michigan (US)
- Columbia University (US)
- Children's Hospital Los Angeles (US)
- University of California, Los Angeles (US)
- Children's National (US)
- Seattle Children's Hospital (US)
- Arkansas Children's Hospital (US)
- Children's Hospital of Pittsburgh (US)
- University of Utah (US)
- University of Virginia Children's Hospital (US)
- National Institute of Child Health and Human Development, Bethesda, Maryland.
- Corresponding author
- Meert, Kathleen L.
- Venue
- Journal of Palliative Medicine
- Publisher
- SAGE Publications
- Published
- 2011-02
- Volume
- 14
- Issue
- 2
- Pages
- 207-214
- ISSN
- 1096-6218 (ISSN-L)
- 1557-7740
- PMC
- PMC3037801
- OpenAlex
- W1997552077
- Cited by
- 121
- References
- 33
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 4 · 2023: 7 · 2022: 7 · 2021: 10 · 2020: 10 · 2019: 5 · 2018: 11 · 2017: 11 · 2016: 5 · 2015: 10 · 2014: 4 · 2013: 12 · 2012: 7
- FWCI
- 8.61
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Palliative Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Children's Hospital Los Angeles
- Seattle Children's Research Institute
- Children's National Hospital
- Children's Hospital of Michigan
- National Institutes of Health (5u10hd049983-07)
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10HD049981, U10-HD049983, U10HD050096, U01HD049934, U10HD050012, UG1HD050096, U10HD049945, RL1HD107773, U10 HD-500009)
- Children's Hospital of Pittsburgh
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- complicated grief, parental bereavement, child death, pediatric intensive care unit, grief trajectories, traumatic death, caregiving, social support, attachment, Inventory of Complicated Grief
- MeSH terms
- Adaptation, Psychological, Adult, Child, Child, Preschool, Data Collection, Death, Female, Follow-Up Studies, Grief, Humans, Male, Middle Aged, Parents, Intensive Care Units, Pediatric, Multivariate Analysis
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