Mental health services for parents who lost a child to cancer: if we build them, Will they come?
Open accessAbstract
Purpose To examine bereavement mental health service use, barriers to use, and factors associated with use in parents bereaved by cancer. Patients and Methods A multicenter, cross-sectional study of 120 parents bereaved by cancer between 6 months and 6 years after their loss was performed. Parents completed self-report assessments of mental health service use and barriers, prolonged grief, depression, anxiety, attachment styles, and sense of meaning by phone, in person, or on their own. Results Forty-one percent of bereaved parents were currently using mental health services (talk therapy, psychotropic medication, and/or a support group), most commonly within the first 2 years after their loss. Talk therapy was the most frequently used service, although 36% of parents who discontinued therapy did so because it was not helpful. Forty percent of parents who wanted bereavement support reported they were not receiving services. The most common barriers to service use were that it was too painful to speak about the loss (64%) and too difficult to find help (60%). Factors associated with current mental health service use included more recent loss, prior mental health service use, subclinical/increased depression, insecure attachment styles, and a decreased sense of meaning. Minority parents were more likely to have unmet needs than nonminority parents. Conclusion Parents appear to need, want, and often access bereavement mental health services, which could be offered in oncology settings. However, barriers to service use must be addressed, particularly for those with more debilitating grief symptoms and for minorities. High treatment dropout rates suggest the importance of improving retention, training providers, and developing effective grief interventions. © 2015 by American Society of Clinical Oncology.
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Cites
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Claims the paper makes
6 of 28 cited sources checked · 4 supported · 1 flagged · accuracy not yet measured
- Premisecitation
Bereaved parents are at heightened risk for psychological distress, including prolonged grief disorder.
“bereaved parents are believed to be at heightened risk for psychological distress, including prolonged grief disorder (PGD), 4,5”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [4] source
- cites [5] source
The Introduction (page unavailable) reports that bereaved people can experience adverse outcomes and describes long-term mental impairments among bereaved parents with unresolved grief. It does not establish that bereaved parents specifically have a heightened risk of developing prolonged grief disorder. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Premisecitation
Grief after the loss of a child is more intense and persistent than after other types of bereavement.
“It is widely accepted that grief after the loss of a child is more intense and persistent than after other types of bereavement.[1][2][3]”
Quote in the paperSubstantial claim1 of 3 sources checked - Premisecitation
Bereavement programs seem to be underused.
“Yet bereavement programs seem to be underused.9”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [9] source
- Findingown data
Mental health service use occurred most commonly within the first 2 years after the loss.
“most commonly within the first 2 years after their loss.”
- Also stated in: § DISCUSSION · plain
“MHSU occurred most commonly within the first 2 years after their loss, with rates highest in the second year after their loss.”
Quote in the paperNot a substantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
Forty-one percent of bereaved parents were currently using mental health services (talk therapy, psychotropic medication, and/or a support group).
“Forty-one percent of bereaved parents were currently using mental health services (talk therapy, psychotropic medication, and/or a support group)”
- Also stated in: § MHSU Since the Loss: Who Has Gotten Help? · plain
“Seventy-eight percent of parents were either currently using services (41%) or had used services since their loss (37%).”
Quote in the paperSubstantial claim - Also stated in: § MHSU Since the Loss: Who Has Gotten Help? · plain
- Findingown data
Talk therapy was the most frequently used mental health service among bereaved parents.
“Talk therapy was the most frequently used service”
- Also stated in: § MHSU Since the Loss: Who Has Gotten Help? · plain
“Talk therapy was the most commonly used service, and rates of support group use were lowest.”
Quote in the paperNot a substantial claim - Also stated in: § MHSU Since the Loss: Who Has Gotten Help? · plain
- Findingown data
Thirty-six percent of parents who discontinued therapy did so because it was not helpful.
“36% of parents who discontinued therapy did so because it was not helpful.”
- Also stated in: § Unmet Need: Who Needs Help but Is Not Getting It, and What Gets in the Way? · plain
“the most common reason for discontinuing therapy was that it was not helpful (36%).”
Quote in the paperNot a substantial claim - Also stated in: § Unmet Need: Who Needs Help but Is Not Getting It, and What Gets in the Way? · plain
- Findingown data
Forty percent of parents who wanted bereavement support reported they were not receiving services.
“Forty percent of parents who wanted bereavement support reported they were not receiving services.”
- Also stated in: § Unmet Need: Who Needs Help but Is Not Getting It, and What Gets in the Way? · plain
“40% of parents (n ϭ 20) with expressed need not receiving services”
Quote in the paperSubstantial claim - Also stated in: § Unmet Need: Who Needs Help but Is Not Getting It, and What Gets in the Way? · plain
- Findingown data
Decreased sense of meaning is associated with current mental health service use.
“and a decreased sense of meaning.”
- Also stated in: § DISCUSSION · hedged
“Parents who reported decreased meaning in life also tended to want and use services more”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · hedged
- Findingown data
More recent loss is associated with current mental health service use.
“Factors associated with current mental health service use included more recent loss”
- Also stated in: § DISCUSSION · hedged
“parents were more likely to use services if their loss was more recent”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · hedged
- Findingown data
Subclinical or increased depression is associated with current mental health service use.
“subclinical/increased depression”
- Also stated in: § DISCUSSION · plain
“they were experiencing at least subclinical depression symptoms”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
Insecure attachment styles are associated with current mental health service use.
“insecure attachment styles”
- Also stated in: § DISCUSSION · plain
“they had an insecure attachment style”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
Minority parents were more likely to have unmet needs than nonminority parents.
“Minority parents were more likely to have unmet needs than nonminority parents.”
- Also stated in: § Unmet Need: Who Needs Help but Is Not Getting It, and What Gets in the Way? · plain
“minority parents were more likely than nonminority parents to have unmet expressed need.”
Quote in the paperNot a substantial claim - Also stated in: § Unmet Need: Who Needs Help but Is Not Getting It, and What Gets in the Way? · plain
- Findingown data
The most common barrier to service use was that it was too painful to speak about the loss (64%).
“The most common barriers to service use were that it was too painful to speak about the loss (64%)”
- Also stated in: § Unmet Need: Who Needs Help but Is Not Getting It, and What Gets in the Way? · plain
“the most common service use barriers(Fig3)werethatitwastoopainfultospeakabouttheirloss(64%)”
Quote in the paperSubstantial claim - Also stated in: § Unmet Need: Who Needs Help but Is Not Getting It, and What Gets in the Way? · plain
- Findingown data
The second most common barrier to service use was that it was too difficult to find help (60%).
“and too difficult to find help (60%).”
- Also stated in: § Unmet Need: Who Needs Help but Is Not Getting It, and What Gets in the Way? · plain
“and it was difficult to find help (60%).”
Quote in the paperNot a substantial claim - Also stated in: § Unmet Need: Who Needs Help but Is Not Getting It, and What Gets in the Way? · plain
- Findingown data
Prior mental health service use is associated with current mental health service use.
“prior mental health service use”
- Also stated in: § DISCUSSION · plain
“they had previously used services”
Quote in the paperNot a substantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
Decreased meaning was associated with current mental health service use in multivariable models.
“Multivariable models showed that depression symptoms, anxious and avoidant attachment styles, existential vacuum, and decreased meaning were associated with current MHSU.”
Quote in the paperSubstantial claim - Findingown data
The study did not find stigma to be a barrier to accessing services in the sample.
“Unlike prior research, 32 we did not find stigma to be a barrier to accessing services in our sample”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [32] source
- Findingown data
Twenty-three percent of parents reported clinical levels of prolonged grief, depression, and/or anxiety, defined as symptom-based need.
“Twenty-three percent of parents reported clinical levels of prolonged grief, depression, and/or anxiety, which we defined as symptom-based need.”
Quote in the paperSubstantial claim - Findingown data
Depression symptoms were associated with current mental health service use in multivariable models.
“Multivariable models showed that depression symptoms, anxious and avoidant attachment styles, existential vacuum, and decreased meaning were associated with current MHSU.”
Quote in the paperSubstantial claim - Findingown data
Eighty-nine percent of parents with increased PGD symptoms reported they would like help with their coping.
“despite the fact that 89% of parents with increased PGD symptoms reported they would like help with their coping”
Quote in the paperSubstantial claim - Findingown data
Anxious attachment style was associated with current mental health service use in multivariable models.
“Multivariable models showed that depression symptoms, anxious and avoidant attachment styles, existential vacuum, and decreased meaning were associated with current MHSU.”
Quote in the paperNot a substantial claim - Findingown data
The study did not find significant associations between demographic variables and mental health service use in exploratory multivariable models.
“We did not find significant associations between demographic variables and MHSU in exploratory multivariable models”
Quote in the paperSubstantial claim - Findingown data
Increased prolonged grief was associated with feeling like no one can help with coping with the loss (OR, 3.18; 95% CI, 1.00 to 10.07; P < .05).
“and feeling like no one can help with coping with the loss (OR, 3.18; 95% CI, 1.00 to 10.07; P Ͻ .05).”
Quote in the paperSubstantial claim - Findingown data
Of all parents using talk therapy after their loss, a total of 40% dropped out for a reason other than symptom improvement.
“of all parents using talk therapy after their loss, a total of 40% dropped out for a reason other than symptom improvement.”
Quote in the paperSubstantial claim - Findingown data
Increased prolonged grief was associated with reporting that it was too painful to discuss the child's death (OR, 6.94; 95% CI, 2.13 to 22.67; P < .001).
“Increased prolonged grief was associated with it being too painful to discuss their child's death (OR, 6.94; 95% CI, 2.13 to 22.67; P Ͻ .001)”
Quote in the paperSubstantial claim - Findingown data
Existential vacuum was associated with current mental health service use in multivariable models.
“Multivariable models showed that depression symptoms, anxious and avoidant attachment styles, existential vacuum, and decreased meaning were associated with current MHSU.”
Quote in the paperSubstantial claim - Findingown data
Seventy-seven percent of parents endorsed longing or yearning for their child on at least a daily basis.
“77% endorsed longing or yearning for their child on at least a daily basis.”
Quote in the paperSubstantial claim - Findingown data
Seventy-eight percent of parents were either currently using services or had used services since their loss.
“Seventy-eight percent of parents were either currently using services (41%) or had used services since their loss (37%).”
Quote in the paperSubstantial claim - Findingown data
Thirty-eight percent of parents with symptom-based need were not receiving services.
“38% of parents (n ϭ 10) with symptom-based need not receiving services.”
Quote in the paperSubstantial claim - Findingown data
Fifty-six percent of parents with increased PGD symptoms were actually using mental health services.
“only 56% were actually using mental health services.”
Quote in the paperSubstantial claim - Findingown data
Twelve percent of parents met full criteria for prolonged grief disorder.
“although 12% of parents met full criteria for PGD”
Quote in the paperNot a substantial claim - Findingown data
When prior mental health service use was included in models, anxious attachment and existential vacuum were no longer significantly associated with current mental health service use.
“In models that were able to successfully run with prior MHSU included, the only predictors that were no longer significantly associated with current MHSU were anxious attachment and existential vacuum.”
Quote in the paperNot a substantial claim - Findingown data
Sixty-nine percent of minority parents who were not using services reported that it was too painful to discuss their loss, compared with 32% of nonminority parents (OR, 4.00; 95% CI, 1.42 to 11.29; P = .009).
“69%ofminorityparentswhowerenotusingservices reported that it was too painful to discuss their loss compared with 32% of nonminority parents (OR, 4.00; 95% CI, 1.42 to 11.29; P ϭ .009).”
Quote in the paperSubstantial claim - Findingown data
Avoidant attachment style was associated with current mental health service use in multivariable models.
“Multivariable models showed that depression symptoms, anxious and avoidant attachment styles, existential vacuum, and decreased meaning were associated with current MHSU.”
Quote in the paperSubstantial claim - Findingown data
More than one third of parents dropped out of talk therapy because they did not find it helpful.
“our finding that more than one third of parents dropped out of talk therapy because they did not find it helpful”
Quote in the paperSubstantial claim - Findingown data
47% of parents expressed need 2 to 4 years postloss.
“we observed that 47% of parents expressed need 2 to 4 years postloss”
Quote in the paperSubstantial claim - Findingown data
Minority parents in this study were more likely to have unmet expressed need.
“Minority parents in this study were more likely to have unmet expressed need and treatment fearfulness”
Quote in the paperSubstantial claim - Findingown data
Minority parents in this study were more likely to have treatment fearfulness.
“Minority parents in this study were more likely to have unmet expressed need and treatment fearfulness”
Quote in the paperSubstantial claim - Findingown data
Some parents felt providers could not understand the intensity of their pain.
“with some feeling that providers could not understand the intensity of their pain”
Quote in the paperNot a substantial claim - Premisecitation
There is limited research on rates of and barriers to mental health service use and factors associated with use in bereaved parents.
“there is limited research on rates of and barriers to MHSU and factors associated with use inbereavedparents 15”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] Feigelman W, 2012 source
- Premisecitation
Parents bereaved by cancer commonly want continued connection with the hospital following their loss.
“studies have shown that parents bereaved by cancer commonly want continued connection with the hospital following their loss.11,13”
Quote in the paperSubstantial claim0 of 2 sources checked - Study design and conductown data
Average time since loss was significantly lower for parents who declined participation than for study completers.
“The average time since loss was significantly lower for parents who declined (mean, 1.9 years; standard deviation, 1.7 years) than for study completers (mean, 2.4 years; standard deviation, 1.6 years; t[df, 179], 2.09; P ϭ .04)”
Quote in the paperNot a substantial claim - Premisecitation
The absence of continued care by hospital providers may be an additional loss to grieve.
“The absence of continued care by hospital providers may be an additional loss to grieve.11,13,14”
Quote in the paperNot a substantial claim0 of 3 sources checked - Premisecitation
Edlund et al found a treatment dropout rate of 19% in a community sample.
“Edlund et al 32 found a treatment dropout rate of 19% in a community sample.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [32] source
- Interpretationown data
Dropout from talk therapy seems related to the efficacy of the services received.
“As expected, dropout seems to be related to the efficacy of the services received.”
Quote in the paperSubstantial claim - Interpretationown data
Treatment fearfulness is an important barrier to mental health service use among bereaved parents.
“supporting our hypothesis that treatment fearfulness is an important barrier.”
- Also stated in: § DISCUSSION · hedged
“The magnitude of the emotional pain parents experience in the wake of their loss appears to impede service use”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · hedged
- Interpretationown data
The treatment dropout rate in this sample appears increased compared with the general population.
“This appears to be increased compared with the general population; Edlund et al 32 found a treatment dropout rate of 19% in a community sample.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [32] source
- Study design and conductnone given
The data collected was self-report without clinician assessments.
“the data collected was self-report without clinician assessments”
Quote in the paperSubstantial claim - Study design and conductreasoning
Formal psychiatric diagnoses could not be made.
“thus formal psychiatric diagnoses could not be made”
Quote in the paperNot a substantial claim - Interpretationown data
A significant subset of bereaved parents' need was not being met.
“In short, a significant subset of bereaved parents' need was not being met.”
Quote in the paperSubstantial claim - Interpretationreasoning
The need observed may be an underestimate.
“the need observed may be an underestimate”
Quote in the paperNot a substantial claim - Study design and conductreasoning
The symptoms were suggestive of diagnoses.
“rather, the symptoms were suggestive of diagnoses”
Quote in the paperNot a substantial claim - Study design and conductnone given
There was limited racial/ethnic diversity in the sample.
“There was also limited racial/ethnic diversity in the sample.”
Quote in the paperNot a substantial claim - Study design and conductreasoning
The large number of predictors included in the multivariable models reduced statistical power.
“in reduced statistical power because of the large number of predictors included in the multivariable models”
Quote in the paperNot a substantial claim
- Classified as probably not a substantial claim. 19
- May combine two claims. 7
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA PG-13 threshold of 34 was similarly used to recruit participants for a preventive intervention trial.
“A threshold of 34 was similarly used to recruit participants for a preventive intervention trial.20”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [20] source
The Method > Participants passage says the trial screened participants with the PG-13 but required a score of 23 or higher, plus functional impairment, for inclusion. It does not give 34 as the recruitment threshold; page numbers are not provided in our copy. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured
May combine two claims.
Findingown dataParents need, want, and often access bereavement mental health services.
“Our data suggest that parents need, want, and often access bereavement mental health services.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationFew bereaved parents who used mental health services in the first year of bereavement found them to be helpful.
“past research has suggested that few bereaved parents who used mental health services in the first year of bereavement found them to be helpful.1”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe study had a 61% response rate among reached households.
“We ultimately reached 204 households, and 160 parents from 125 households consented (61% response rate).”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataParents appear to need, want, and often access bereavement mental health services.
“Parents appear to need, want, and often access bereavement mental health services”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationProlonged grief symptoms were measured using the PG-13, a reliable 13-item self-report measure.
“Prolonged grief symptoms were measured using the PG-13, 19 a reliable 13-item self-report measure that evaluates the frequency and intensity of PGD symptoms on a 5-point Likert-type scale.19”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe study had a 75% participation rate among consented parents.
“Of the 160 parents who consented, 120 completed study measures (90 from the Memorial Sloan Kettering Cancer Center; 30 from the National Cancer Institute Pediatric Oncology Branch; 75% participation rate).”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataThere were no significant differences between parents who declined and study completers in the child's age, type of cancer, or geographic location.
“there were no significant differences in the child's age, type of cancer, or geographic location (Ps Ͼ .10).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataA PG-13 score of 34 or above was considered to indicate increased levels of prolonged grief symptoms based on a sensitivity analysis.
“Parents who scored 34 or above were considered to have increased levels of prolonged grief symptoms based on a sensitivity analysis which showed that these parents had significantly more mental health problems than those scoring lower than 34 (ps Ͻ .05).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationAttachment styles were measured using the ECR-R, a well-validated, reliable 36-item measure.
“The Experience of Close Relationships-Revised (ECR-R) is a well-validated, reliable 36-item measure of anxious and avoidant attachment.21,22”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationSense of meaning and purpose in life were assessed using the LAP-R, a well-validated, reliable 48-item measure.
“Sense of meaning and purpose in life were assessed by using the well-validated, reliable 48-item Life Attitude Profile-Revised (LAP-R), 25”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [25] Reker GT, 1992
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductcitationDepression and anxiety symptoms were measured using the Adult Self-Report (ASR), a well-validated 126-item instrument.
“The Adult Self-Report (ASR) is a well-validated, 126-item instrument that provides normed scores in several mental health functioning areas.23”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [23] Achenbach TM, 2003
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
Study design and conductnone givenThe analytic approach was exploratory and hypothesis-generating.
“the exploratory, hypothesis-generating nature of the analytic approach”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductown dataIncluding prior mental health service use as a covariate resulted in quasi-separation and multicollinearity concerns.
“its inclusion resulted in quasi-separation in the data, which prevented many models from running successfully, and because of multicollinearity concerns.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenThe needs of surviving siblings may influence when and how parents reach out for professional support.
“which may influence when and how parents reach out for professional support”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationIn the general population, being younger, non-Hispanic white, previously married, not having low income, and not living in a rural area are associated with increased service use.
“This literature has suggested that being younger, non-Hispanic white, previously married, not having low income, and not living in a rural area are associated with increased service use.29”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [29] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe study was approved by an institutional review board.
“Parents were mailed invitation letters approved by an institutional review board for a study of grief, meaning, and adjustment in parents bereaved by cancer.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe 10 outcome events per predictor variable rule was relaxed as recommended by Vittinghoff and McCulloch.
“As Vittinghoff and McCulloch 27 recommended, the 10 outcome events per predictor variable rule was relaxed.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningThe number of models run could have resulted in spurious findings.
“which could have resulted in spurious findings because of the number of models run”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationnone givenParents who were excluded from or declined participation may have been more distressed.
“because parents who were excluded from or declined participation (explicitly or passively) may have been more distressed”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThis study did not examine the needs of surviving siblings.
“or the needs of surviving siblings”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductown dataThe study used a cross-sectional design.
“including the cross-sectional design”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThis study did not examine the quality of mental health services received.
“this study did not examine the quality of mental health services received”
Quote in the paperNot a substantial claim
The paper relies on this without support.
No prior research focuses specifically on parents bereaved by cancer regarding rates of and barriers to mental health service use.
“However, there is limited research on rates of and barriers to MHSU and factors associated with use inbereavedparents 15 andnonefocusingspecificallyonparents bereaved by cancer.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Completed-household percentage is miscalculated
MinorThe flowchart uses 1,080 assessed households as the denominator. The 97 completed households are 9.0% of that total to one decimal place, not 8.8%.
Reported 8.8 · recomputed 8.981481
“Households completed (n = 97; 8.8%; 120 parents)”
Odds ratio falls outside its reported confidence interval
MinorThe multivariable odds ratio for partnered parents' talk therapy use is 0.30, but its reported 95% confidence interval runs from 0.71 to 1.24. A confidence interval for this estimate cannot exclude the estimate itself.
“0.30”
“(0.71 to 1.24)”
Flowchart percentage for 14 households is misrounded
MinorWith 1,080 assessed households as the flowchart denominator, 14 households represent 1.3% to one decimal place, not 1.2%.
Reported 1.2 · recomputed 1.296296
“(n = 14; 1.2%)”
Two rates are given for the same unmet-need group
MinorThe results report 38% of parents with symptom-based need as not receiving services, while the discussion reports 37% for that group. Table 1 also lists 10 of 27 parents, or 37%.
“38% of parents (n ϭ 10) with symptom-based need not receiving services.”
“Similarly, among the 23% of parents reporting clinical levels of psychological symptoms, 37% were not receiving services.”
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A case for inclusion of prolonged grief disorder in DSM-V.
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Self-citationPsychiatric Disorders and Mental Health Service Use Among Caregivers of Advanced Cancer Patients
Vanderwerker, L. C., Laff, R. E., Kadan-Lottick, N. S., McColl, S., & Prigerson, H. G. (2005) · Journal of Clinical Oncology · doi:10.1200/jco.2005.01.370 · Cited by 270 · see citing works
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Caring for Bereaved Patients: "All the Doctors Just Suddenly Go"
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Self-citationThe relation of treatment fearfulness and psychological service utilization: An overview.
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Underutilization of Mental Health Services Among Bereaved Caregivers With Prolonged Grief Disorder
Lichtenthal, W. G., Nilsson, M., Kissane, D. W., Breitbart, W., Kacel, E., Jones, E. C., & Prigerson, H. G. (2011) · Psychiatric Services · doi:10.1176/ps.62.10.pss6210_1225 · Cited by 167 · see citing works
Self-citationWhen Children Die: Improving Palliative and End-of-Life care for Children and their Families
Chambers, T. L. (2003) · Journal of the Royal Society of Medicine · doi:10.1258/jrsm.96.8.419-a · Cited by 157 · see citing works
Hospital-based bereavement services following the death of a child: A mixed study review
Donovan, L., Wakefield, C. E., Russell, V., & Cohn, R. J. (2014) · Palliative Medicine · doi:10.1177/0269216314556851 · Cited by 151 · see citing works
Availability and Use of Palliative Care and End-of-Life Services for Pediatric Oncology Patients
Johnston, D. L., Nagel, K., Friedman, D. L., Meza, J. L., Hurwitz, C. A., & Friebert, S. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2008.16.1562 · Cited by 150 · see citing works
Litz, B. T., Schorr, Y., Delaney, E., Au, T., Papa, A., Fox, A. B., Morris, S., Nickerson, A., Block, S., & Prigerson, H. G. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.07.005 · Cited by 139 · see citing works
Self-citationBarriers to mental health care utilization for U.S. Cambodian refugees.
Wong, E. C., Marshall, G. N., Schell, T. L., Elliott, M. N., Hambarsoomians, K., Chun, C.-A., & Berthold, S. M. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.6.1116 · Cited by 117 · see citing works
Exploring Parental Grief: Combining Quantitative and Qualitative Measures
Arnold, J., Gemma, P. B., & Cushman, L. F. (2005) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2005.07.008 · Cited by 110 · see citing works
Bereaved parents' perspectives on their needs
D'Agostino, N. M., Berlin-Romalis, D., Jovcevska, V., & Barrera, M. (2008) · Palliative and Supportive Care · doi:10.1017/s1478951508000060 · Cited by 96 · see citing works
A Qualitative Study of Advice From Bereaved Parents and Siblings
Thompson, A. L., Miller, K. S., Barrera, M., Davies, B., Foster, T. L., Gilmer, M. J., Hogan, N., Vannatta, K., & Gerhardt, C. A. (2011) · Journal of Social Work in End-Of-Life & Palliative Care · doi:10.1080/15524256.2011.593153 · Cited by 85 · see citing works
Downar, J., Barua, R., & Sinuff, T. (2014) · Journal of Critical Care · doi:10.1016/j.jcrc.2013.11.024 · Cited by 62 · see citing works
Devastating Losses: How Parents Cope With the Death of a Child to Suicide or Drugs
(2012) · Choice Reviews Online · doi:10.5860/choice.50-2369 · Cited by 57 · see citing works
Darbyshire, P., Cleghorn, A., Downes, M., Elford, J., Gannoni, A., McCullagh, C., & Shute, R. (2013) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2012.04266.x · Cited by 49 · see citing works
The central role of meaning in adjustment to the loss of a child to cancer
Lichtenthal, W. G., & BREITBART, W. S. (2015) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0000000000000117 · Cited by 47 · see citing works
Self-citationPublic Attitudes About Normal and Pathological Grief
Penman, E. L., Breen, L. J., Hewitt, L. Y., & Prigerson, H. G. (2014) · Death Studies · doi:10.1080/07481187.2013.873839 · Cited by 43 · see citing works
Self-citationPatterns of Complicated Grief among Bereaved Parents
Ginzburg, K., Geron, Y., & Solomon, Z. (2002) · OMEGA - Journal of Death and Dying · doi:10.2190/xuw5-qgq9-kcb8-k6ww · Cited by 39 · see citing works
Mothers Now Childless: Survival after the Death of an Only Child
Talbot, K. (1997) · OMEGA - Journal of Death and Dying · doi:10.2190/wxa0-hnx1-3cn6-9a2w · Cited by 22 · see citing works
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van Warmerdam, J., Zabih, V., Kurdyak, P. A., Sutradhar, R., Nathan, P. C., & Gupta, S. (2019) · Pediatric Blood & Cancer · doi:10.1002/pbc.27677 · Cited by 217 · see citing works
Pediatric palliative care in oncology
Snaman, J., McCarthy, S., Wiener, L., & Wolfe, J. (2020) · Journal of Clinical Oncology · doi:10.1200/jco.18.02331 · Cited by 181 · see citing works
“Bereavement care is an evidencebased psychosocial standard of care in pediatric oncology.(95) Although data support that the loss of a child is associated with heightened risk for discord in the parental marital relationship, physical and mental health problems, and parental mortality,(96,97) routine assessment of nee…”
BackgroundBereavement Follow‐Up After the Death of a Child as a Standard of Care in Pediatric Oncology
Lichtenthal, W. G., Sweeney, C. R., Roberts, K. E., Corner, G. W., Donovan, L. A., Prigerson, H. G., & Wiener, L. (2015) · Pediatric Blood & Cancer · doi:10.1002/pbc.25700 · Cited by 143 · see citing works
Self-citationThe Grief of Parents After the Death of a Young Child
Morris, S. E., Fletcher, K., & Goldstein, R. D. (2018) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-018-9590-7 · Cited by 135 · see citing works
“A number of risk factors for prolonged grief have been identified (Bonanno et al., 2002; Currier, Holland, & Neimeyer, 2006; Goodenough et al., 2004; Keesee, Currier, & Neimeyer, 2008; Kersting et al., 2011; Klingspon, Holland, Neimeyer, & Lichtenthal, 2015; Kreicbergs et al., 2007; Stroebe et al., 2007; Vanderwerker,…”
Web-Based Bereavement Care: A Systematic Review and Meta-Analysis
Wagner, B., Rosenberg, N., Hofmann, L., & Maaß, U. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00525 · Cited by 117 · see citing works
“The most common barriers to utilizing professional mental health support are the worry that it might be too painful to speak about the grief experience (20), the belief that it is too difficult to find help (21), or a fear of stigmatization, specifically for those bereaved by suicide (22).”
BackgroundPsychometric properties of the Prolonged Grief Disorder-13 (PG-13) in bereaved Swedish parents
Pohlkamp, L., Kreicbergs, U., Prigerson, H. G., & Sveen, J. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.06.004 · Cited by 120 · see citing works
Guidance for Pediatric End-of-Life Care
Linebarger, J., Johnson, V., Boss, R. D., & MEDICINE, T. S. O. H. A. P. (2022) · PEDIATRICS · doi:10.1542/peds.2022-057011 · Cited by 119 · see citing works
Pohlkamp, L., Kreicbergs, U., & Sveen, J. (2019) · Psycho-Oncology · doi:10.1002/pon.5112 · Cited by 110 · see citing works
Empowering Bereaved Parents Through the Development of a Comprehensive Bereavement Program
Snaman, J. M., Kaye, E. C., Levine, D. R., Cochran, B., Wilcox, R., Sparrow, C. K., Noyes, N., Clark, L., Avery, W., & Baker, J. N. (2016) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2016.10.359 · Cited by 85 · 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
“These types of spaces are only open to PLOCs in the community, and the similarity in traumatic events experienced by these individuals could insulate PLOCs from negative cultural messages (Frable, Platt, & Hoey, 1998), possibly improving their mental health (Lichtenthal et al., 2015).”
BackgroundRegret and unfinished business in parents bereaved by cancer: A mixed methods study
Lichtenthal, W. G., Roberts, K. E., Catarozoli, C. R., Schofield, E., Holland, J. M., Fogarty, J., Coats, T., Barakat, L. P., Baker, J. N., Brinkman, T. M., et al. (2020) · Palliative Medicine · doi:10.1177/0269216319900301 · Cited by 70 · see citing works
Self-citationFamily Spillover Effects in Pediatric Cost-Utility Analyses
Lavelle, T. A., D’Cruz, B. N., Mohit, B., Ungar, W. J., Prosser, L. A., Tsiplova, K., Vera‐Llonch, M., & Lin, P. (2018) · Applied Health Economics and Health Policy · doi:10.1007/s40258-018-0436-0 · Cited by 71 · see citing works
Parental Grief Following the Death of a Child from Cancer: The Ongoing Odyssey
Snaman, J. M., Kaye, E., Torres, C., Gibson, D. V., & Baker, J. N. (2016) · Pediatric Blood & Cancer · doi:10.1002/pbc.26046 · Cited by 61 · see citing works
Wiener, L., Rosenberg, A., Lichtenthal, W. G., Tager, J. B., & Weaver, M. S. (2018) · Palliative & Supportive Care · doi:10.1017/s1478951517001249 · Cited by 55 · see citing works
“Not surprisingly, child loss has been associated with adverse parental outcomes, including a heightened risk for psychological distress, poor physical health and diminished psychosocial well-being (Lichtenthal et al., 2015; Rosenberg et al., 2012) each of which has implications for service provision.”
BackgroundInfluentialSelf-citationReitsma, L., Boelen, P. A., de Keijser, J., & Lenferink, L. I. M. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104286 · Cited by 64 · see citing works
Thimm, J. C., Kristoffersen, A. E., & Ringberg, U. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1844440 · Cited by 65 · see citing works
“However, previous study findings suggest that the bereaved generally underutilize mental health services because they find it too painful to talk about the loss and experience difficulties finding help (Lichtenthal et al., 2015, 2011).”
The Grief of Mothers After the Sudden Unexpected Death of Their Infants
Goldstein, R. D., Lederman, R. I., Lichtenthal, W. G., Morris, S. E., Human, M., Elliott, A., Tobacco, D., Angal, J., Odendaal, H. J., Kinney, H. C., et al. (2018) · PEDIATRICS · doi:10.1542/peds.2017-3651 · Cited by 60 · see citing works
Self-citationPediatric palliative oncology: the state of the science and art of caring for children with cancer
Snaman, J. M., Kaye, E. C., Baker, J. N., & Wolfe, J. (2017) · Current Opinion in Pediatrics · doi:10.1097/mop.0000000000000573 · Cited by 58 · see citing works
Current Grief Support in Pediatric Palliative Care
Schuelke, T., Crawford, C., Kentor, R., Eppelheimer, H., Chipriano, C., Springmeyer, K., Shukraft, A., & Hill, M. (2021) · Children · doi:10.3390/children8040278 · Cited by 50 · see citing works
“Forty percent of parents in one study voiced desire for support but noted they did not pursue treatment [97].”
BackgroundThe central role of meaning in adjustment to the loss of a child to cancer
Lichtenthal, W. G., & BREITBART, W. S. (2015) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0000000000000117 · Cited by 47 · see citing works
Self-citationMorris, S. E., Dole, O. R., Joselow, M., Duncan, J., Renaud, K., & Branowicki, P. A. (2016) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2016.04.013 · Cited by 45 · see citing works
Snaman, J. M., Morris, S. E., Rosenberg, A. R., Holder, R. L., Baker, J. N., & Wolfe, J. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-019-05249-3 · Cited by 44 · see citing works
Roberts, K. E., Holland, J. C., Prigerson, H. G., Sweeney, C., Corner, G. W., BREITBART, W. S., & Lichtenthal, W. G. (2016) · Palliative & Supportive Care · doi:10.1017/s1478951516000626 · Cited by 44 · see citing works
“Despite the increased risk for protracted distress that bereaved family members of cancer patients may face (Vanderwerker et al., 2005; Allen et al., 2013), they also tend to underutilize mental health services (Cherlin et al., 2007; Lichtenthal et al., 2015).”
BackgroundInfluentialSelf-citationSupporting the bereaved in greatest need: We can do better
Lichtenthal, W. G. (2018) · Palliative & Supportive Care · doi:10.1017/s1478951518000585 · Cited by 34 · see citing works
“…important for those struggling more; we found that parents who lost a child to cancer and who reported higher levels of prolonged grief symptoms were three times more likely to indicate that feeling that no one could help was a barrier to actually getting help (Lichtenthal et al., 2015a).”
BackgroundResultInfluentialSelf-citationPrevalence of grief disorders in bereaved families of cancer patients: A meta-analysis
Kustanti, C. Y., Chu, H., Kang, X. L., Huang, T., Jen, H., Liu, D., Hsiao, S. S., & Chou, K. (2021) · Palliative Medicine · doi:10.1177/02692163211066747 · Cited by 33 · see citing works
Sweetman, J., Knapp, P., Varley, D., Woodhouse, R., McMillan, D., & Coventry, P. A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.01.089 · Cited by 29 · see citing works
The Influence of Parent Distress and Parenting on Bereaved Siblings’ Externalizing Problems
Sharp, K. M. H., Meadows, E. A., Keim, M. C., Winning, A. M., Barrera, M. E., Gilmer, M. J., Akard, T. F., Compas, B. E., Fairclough, D. L., Davies, B. I., et al. (2019) · Journal of Child and Family Studies · doi:10.1007/s10826-019-01640-0 · Cited by 31 · see citing works
Trauma- and Stressor-Related Disorders
(2022) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9780890425787.x07_trauma_and_stressor_related_disorders · Cited by 32 · see citing works
Treatment gap in bereavement care: (Online) bereavement support needs and use after traumatic loss
Lenferink, L. I. M., de Keijser, J., Eisma, M. C., Smid, G. E., & Boelen, P. A. (2020) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2544 · Cited by 35 · see citing works
“In line with prior research (Lichtenthal et al., 2015), people who received psychological support before the loss were more likely to be interested in receiving bereavement care.”
BackgroundMethodResultInfluentialEngaging Parents of Children Who Died From Cancer in Research on the Early Grief Experience
Snaman, J. M., Helton, G., Baker, J. N., Morris, S. E., Al‐Sayegh, H., Ma, C., & Wolfe, J. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.09.014 · Cited by 29 · see citing works
Sveen, J., Pohlkamp, L., Kreicbergs, U. C., & Eisma, M. C. (2019) · PLoS ONE · doi:10.1371/journal.pone.0213152 · Cited by 31 · see citing works
Berrett‐Abebe, J., Levin-Russman, E., Gioiella, M. E., & Adams, J. M. (2016) · Palliative & Supportive Care · doi:10.1017/s1478951516000821 · Cited by 27 · see citing works
“Research supports the idea that for some bereaved parents a barrier to accessing services is that it is too difficult to speak about the loss (Lichtenthal et al., 2015a).”
BackgroundInfluentialDolan, N., Grealish, A., Tuohy, T., & Bright, A. (2022) · Journal of midwifery & women's health · doi:10.1111/jmwh.13335 · Cited by 28 · see citing works
Weaver, M. S., Lichtenthal, W. G., Larson, K., & Wiener, L. S. (2018) · Pediatric Blood & Cancer · doi:10.1002/pbc.27489 · Cited by 26 · see citing works
Self-citationSnaman, J. M., Mazzola, E., Helton, G., Feifer, D., Morris, S. E., Clark, L., Baker, J. N., & Wolfe, J. (2023) · JCO Oncology Practice · doi:10.1200/op.22.00538 · Cited by 26 · see citing works
Heeke, C., Franzen, M., Hofmann, H., Knaevelsrud, C., & Lenferink, L. I. M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.878773 · Cited by 26 · see citing works
“There is some evidence highlighting potential barriers to seeking mental health care among bereaved people, such as thinking the problems will naturally disappear, pain of talking about the loss, and difficulty finding help (64, 65).”
BackgroundLegacy Building in Pediatric End-of-Life Care through Innovative Use of a Digital Stethoscope
Andrews, E., Hayes, A., Cerulli, L., Miller, E. G., & Slamon, N. B. (2020) · Palliative Medicine Reports · doi:10.1089/pmr.2020.0028 · Cited by 23 · see citing works
Bereavement risk screening: A pathway to psychosocial oncology care
Roberts, K. E., Jankauskaite, G., Slivjak, E. T., Rubin, L., Schachter, S. R., Stabler, S. M., Wiener, L. S., Prigerson, H. G., & Lichtenthal, W. G. (2020) · Psycho-Oncology · doi:10.1002/pon.5526 · Cited by 24 · see citing works
“The limited number of parent participants is problematic, as research suggests parents who have lost a child to cancer have unique needs during caregiving and bereavement.(33) Additional research will be critical to determine how to sensitively approach bereavement risk screening in a pediatric cancer context.”
BackgroundSelf-citationBereavement care to minimize bereaved parents' suffering in their lifelong journey towards healing
Denhup, C. (2019) · Applied Nursing Research · doi:10.1016/j.apnr.2019.151205 · Cited by 22 · see citing works
Eklund, R., Eisma, M., Boelen, P., Arnberg, F. K., & Sveen, J. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-052763 · Cited by 5 · see citing works
Reitsma, L., Boelen, P. A., de Keijser, J., & Lenferink, L. I. M. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.1987687 · Cited by 19 · see citing works
“This could counteract barriers to care reported by bereaved people, including problems with finding help, transportation difficulties or problems with planning sessions (Lenferink, de Keijser, Eisma, Smid, & Boelen, 2020; Lichtenthal et al., 2015).”
BackgroundLenferink, L. I. M., de Keijser, J., Eisma, M. C., Smid, G. E., & Boelen, P. A. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-035050 · Cited by 17 · see citing works
Social media as a recruitment method to reach a diverse sample of bereaved parents
Johnson, L. A., Dias, N., Clarkson, G., & Schreier, A. M. (2019) · Applied Nursing Research · doi:10.1016/j.apnr.2019.151201 · Cited by 17 · see citing works
Helton, G., Morris, S. E., Dole, O. R., Wolfe, J., & Snaman, J. M. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.11.012 · Cited by 16 · see citing works
The Impact of Pediatric Cancer on the Family
Gerhardt, C. A., Salley, C. G., & Lehmann, V. (2015) · Springer eBooks · doi:10.1007/978-3-319-21374-3_9 · Cited by 19 · see citing works
Lamsal, R., Yeh, E. A., Pullenayegum, E., & Ungar, W. J. (2023) · PharmacoEconomics · doi:10.1007/s40273-023-01331-1 · Cited by 15 · see citing works
Banyasz, A., Weiskittle, R., Lorenz, A., et al. (2017) · Journal of Palliative Medicine · doi:10.1089/jpm.2016.0235 · Cited by 14 · see citing works
“16 The timely identification and education of individuals who meet criteria for depression and/or complicated grief remain a crucial first step to engaging these individuals in treatment.”
Bereaved parents’ quality of life: resilience and professional support
Rasouli, O., Vegsund, H. K., Eilegård, A., Hjemdal, O., Reinfjell, T., Moksnes, U. K., Lund, B., & Eilertsen, M. B. (2021) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2020-002840 · Cited by 12 · see citing works
“34 The follow-up received from their home community after the loss was also inadequate.”
BackgroundBereavement care for family caregivers of neuro-oncology patients
Morris, S. E., & Sannes, T. S. (2020) · Annals of Palliative Medicine · doi:10.21037/apm-20-708 · Cited by 11 · see citing works
Being a Bereavement-Conscious Hospice and Palliative Care Clinician
Roberts, K. E., Lichtenthal, W. G., & FERRELL, B. R. (2021) · Journal of Hospice and Palliative Nursing · doi:10.1097/njh.0000000000000775 · Cited by 10 · see citing works
Self-citationMeaning-centered group psychotherapy in Portuguese cancer patients: A pilot exploratory trial
da Ponte, G., Ouakinin, S., Santo, J. E., Ohunakin, A., Prata, D., Amorim, I., Gameiro, Z., dos Santos, E. S., & BREITBART, W. S. (2021) · Palliative & Supportive Care · doi:10.1017/s1478951521000602 · Cited by 10 · see citing works
“…and after consulting previous adaptations of MCGP to different settings (Breitbart et al., 2010, 2012, 2015, 2018; Van der Spek et al., 2014, 2016; Lichtenthal et al., 2015; Rosenfeld et al., 2017), the participants´ preference for some themes (in the first steps of the study), and discussing…”
InfluentialSelf-citationFeasibility of Present-Centered Therapy for Prolonged Grief Disorder: Results of a Pilot Study
Vogel, A., Comtesse, H., Nocon, A., Kersting, A., Rief, W., Steil, R., & Rosner, R. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.534664 · Cited by 7 · see citing works
“%) no longer met the PGD criteria according to the PG-13, and 13 participants (65”
BackgroundMethodInfluentialEffects of the COVID-19 Pandemic on Grief: A Prospective Survey Among Community Hospital Next-of-Kin
Edwards, A., Do, D., & Dao, T. (2022) · Journal of Palliative Medicine · doi:10.1089/jpm.2022.0218 · Cited by 8 · see citing works
Effectiveness of a Cancer Bereavement Therapeutic Group
Jerome, H., Smith, K. V., Shaw, E. J., Szydlowski, S., Barker, C., Pistrang, N., & Thompson, E. H. (2018) · Journal of Loss and Trauma · doi:10.1080/15325024.2018.1518772 · Cited by 11 · see citing works
“Preintervention, the sample had moderate levels of depression, anxiety, and PTSD symptoms; selfcompassion scores were lower than in general population samples (Antúnez, Navarro, & Adan, 2015), and grief intensity was lower than that of bereaved parents (Lichtenthal et al., 2015).”
ResultHaider, N.-U.-A., & Zaman, N. I. (2024) · Journal of Intellectual Disability Research · doi:10.1111/jir.13131 · Cited by 8 · see citing works
Applebaum, A. J., Gebert, R. R., Behrens, M. R., Loschiavo, M. J., Parker, P. A., Shaffer, K. M., Carver, A. C., & Diamond, E. L. (2022) · Palliative & Supportive Care · doi:10.1017/s1478951522001080 · Cited by 8 · see citing works
Assessment of Psychological Distress among Parents of Children with Cancer
Feki, J., Baklouti, F., & Khanfir, A. (2021) · Open Journal of Psychiatry · doi:10.4236/ojpsych.2021.114019 · Cited by 10 · 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
Xiong, J., Ma, H., Ma, R., Xu, T., & Wang, Y. (2022) · BMC Psychiatry · doi:10.1186/s12888-023-05206-9 · Cited by 8 · see citing works
Law, K., & Kirk, S. A. (2021) · Cancer Nursing · doi:10.1097/ncc.0000000000000998 · Cited by 7 · see citing works
Viola, M., Ouyang, D. J., Xu, J. C., Maciejewski, P. K., Prigerson, H. G., & Derry, H. M. (2021) · Stress and Health · doi:10.1002/smi.3061 · Cited by 7 · see citing works
“…(Shear et al., 2016), several barriers present challenges to receiving mental health services, such as apprehensions about pathologizing the bereavement experience (Dowrick & Frances, 2013), financial concerns or difficulty talking about the loss in psychotherapy (Lichtenthal et al., 2015).”
BackgroundSelf-citationSmid, G. E., Blaauw, M., & Lenferink, L. I. M. (2020) · Intervention · doi:10.4103/intv.intv_55_19 · Cited by 7 · see citing works
“Among parents of children who died from cancer, the most 12 frequently reported barriers to seeking and finding support were that it was too painful to 13 speak about the loss and too difficult to find help (Lichtenthal et al., 2015).”
BackgroundIshida, M., Onishi, H., Morita, T., Uchitomi, Y., Shimizu, M., Tsuneto, S., Shima, Y., & Miyashita, M. (2018) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2017.12.493 · Cited by 7 · see citing works
Carreño-Moreno, S., Chaparro-Díaz, L., & Rangel, R. L. (2017) · Persona y Bioética · doi:10.5294/pebi.2017.21.1.4 · Cited by 7 · see citing works
My grief app for prolonged grief in bereaved parents: a randomised waitlist-controlled trial
Sveen, J., Eisma, M. C., Boelen, P. A., Arnberg, F. K., & Eklund, R. (2024) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2024.2429068 · Cited by 6 · see citing works
“A study on bereaved parents showed that common barriers to receiving mental health services were that it was difficult to find services as well as financial issues (Lichtenthal et al., 2015).”
Bottomley, J. S., Smigelsky, M. A., Campbell, K. W., Neimeyer, R. A., & Rheingold, A. A. (2024) · Journal of Loss and Trauma · doi:10.1080/15325024.2024.2357776 · Cited by 6 · see citing works
Intervenção do profissional de saúde mental em situações de perda e luto no Brasil
Santos, G. C. B. F. (2019) · Revista M Estudos sobre a morte os mortos e o morrer · doi:10.9789/2525-3050.2017.v2i3.116-137 · Cited by 6 · see citing works
Migrant families’ experiences in pediatric oncology: A scoping review
Rakic, M., Sandri, A., Gysin, O., & Rost, M. (2025) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2025.102948 · Cited by 5 · see citing works
Mothers' bereavement and evolving relationships with their dead child in South Korea
Yi, J., Younce, B., Chung, E., Kim, M. A., & Bradbury, L. (2023) · Family Relations · doi:10.1111/fare.12841 · Cited by 5 · see citing works
Hovén, E., Hagström, J., Pöder, U., Grönqvist, H., & von Essén, L. (2019) · Acta Oncologica · doi:10.1080/0284186x.2019.1686535 · Cited by 5 · see citing works
“However, consistent with a previous American study on unmet needs of mental health services [14], a substantial proportion of mothers reported unmet needs of support from healthcare professionals.”
ResultFactors associated with mental health service use among families bereaved by pediatric cancer
Hill, K. N., Olsavsky, A. L., Barrera, M. E., Gilmer, M. J., Fairclough, D. L., Akard, T. F., Compas, B. E., Vannatta, K. A., & Gerhardt, C. A. (2022) · Palliative & Supportive Care · doi:10.1017/s1478951522001018 · Cited by 4 · see citing works
Access to Mental Healthcare in the 21st Century: An Evolutionary Concept Analysis
Smith-East, M., Conner, N. E., & Neff, D. F. (2021) · Journal of the American Psychiatric Nurses Association · doi:10.1177/10783903211011672 · Cited by 4 · see citing works
Carreño-Moreno, S., Arias-Rojas, M., & Chaparro-Díaz, L. (2021) · Indian Journal of Palliative Care · doi:10.4103/ijpc.ijpc_72_20 · Cited by 2 · see citing works
Needs of bereaved parents following the death of a child or young person from cancer
Law, K., & Farrell, C. (2018) · Cancer Nursing Practice · doi:10.7748/cnp.2018.e1487 · Cited by 4 · see citing works
Vegsund, H. K., Rannestad, T., Reinfjell, T., Moksnes, U. K., Eilegård, A., & Eilertsen, M. B. (2018) · Social Sciences · doi:10.3390/socsci7100187 · Cited by 4 · see citing works
“In addition, parents who lose a child have a high risk of developing psychological problems, such as anxiety, depression (Barrera et al. 2007; Kreicbergs 2004; Lichtenthal et al. 2015), and prolonged grief (Lichtenthal et al. 2015; Van der Geest et al. 2014).”
BackgroundFamily Bereavement Care in Pediatric Oncology
Lövgren, M., & Sveen, J. (2018) · Pediatric oncology · doi:10.1007/978-3-319-61391-8_12 · Cited by 4 · see citing works
Guilt and Unfinished Business in Bereavement: Rumination as a Pathway to Prolonged Grief and Trauma
Albuquerque, S., Pereira, B. B., Coelho, A., & Pinto, R. J. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14238582 · Cited by 3 · see citing works
“Research among bereaved parents has shown that distress related to unfinished business heightens both grief and trauma responses [48].”
“Trying to Find North”: Fathers Voice the Nature of Their Bereavement
Denhup, C. (2024) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228241238383 · Cited by 3 · see citing works
“…(Aho et al., 2006; Chen, 2022; Christiansen, 2017; Dias et al., 2017; Dias et al., 2021; Heazell et al., 2016; Hendrickson, 2009; Li et al., 2003; Lichtenthal et al., 2015; Ljungman et al., 2015; Murphy et al., 2002; October et al., 2018; Rosenberg et al., 2012; Rostila et al., 2012; Weiner et…”
Availability of bereavement support following traumatic pediatric death in a large metropolitan area
Divakar, A., James, K., Mayorga, A., & Michelson, K. N. (2023) · Death Studies · doi:10.1080/07481187.2023.2170492 · Cited by 3 · see citing works
“Minority parents express more unmet bereavement needs compared to their non-minority counterparts (Lichtenthal et al., 2015), and culturally appropriate bereavement services for Black people are lacking (Dean et al., 2014).”
BackgroundDebrot, A., Kheyar, M., Efinger, L., Berthoud, L., & Pomini, V. (2022) · JMIR Research Protocols · doi:10.2196/39026 · Cited by 3 · see citing works
“This is particularly true in the case of interventions targeting grief symptoms, as a significant proportion of people reporting the need for support after bereavement do not get it [82,83].”
An Interdisciplinary Hospital-Based Committee to Improve Pediatric Bereavement Care
Goldberg, J. M., Duplechain, A. C., Fraser, C. E., & Boles, J. C. (2021) · Hospital Pediatrics · doi:10.1542/hpeds.2021-005964 · Cited by 3 · see citing works
Bedoya, S. Z., Battles, H. B., Gerhardt, C. A., & Wiener, L. S. (2021) · Journal of Psychosocial Oncology Research and Practice · doi:10.1097/or9.0000000000000050 · Cited by 3 · see citing works
Self-citationAnticipatory Grief and Bereavement Support
Hunt, J., Talawadekar, P., & Friedel, M. (2020) · Springer eBooks · doi:10.1007/978-3-030-27375-0_16 · Cited by 3 · see citing works
Duelo en el cuidador del niño fallecido por cáncer: revisión exploratoria
Carreño-Moreno, S., Chaparro-Díaz, L., González, G. M. C., & Ramírez, O. J. G. (2019) · Duazary · doi:10.21676/2389783x.2755 · Cited by 3 · see citing works
End-of-Life Care and Cancer: Psychosocial Needs of Patients and the Bereaved
Roberts, K. E., Panjwani, A. A., Marziliano, A. M., Applebaum, A. J., & Lichtenthal, W. G. (2018) · Springer eBooks · doi:10.1007/978-3-319-78649-0_14 · Cited by 3 · see citing works
Self-citationNordström, E.-E. L., Kaltiala‐Heino, R., Kristensen, P., & Thimm, J. C. (2024) · Death Studies · doi:10.1080/07481187.2024.2400366 · Cited by 2 · see citing works
“For health professionals, it is essential to know that bereaved individuals can experience pain when talking about their bereavement and grief, and may therefore be reluctant to use healthcare services, which can lead to underutilization (Lichtenthal et al., 2015; Lichtenthal et al., 2011).”
InfluentialPsychosocial burden after the death of a child from cancer: Results of a bereaved parent survey
Wimberly, C. E., Davis, E., Towry, L., Walsh, K. M., & Johnston, E. E. (2024) · Death Studies · doi:10.1080/07481187.2024.2371074 · Cited by 2 · see citing works
“Bereavement programming is considered an essential part high-quality end of life care for children with cancer and their families (Johnston et al., 2021; Lichtenthal et al., 2015; Weaver et al., 2015), but remains inconsistently implemented (Wiener et al., 2018).”
InfluentialHanauer, C., Telaar, B., Barke, A., Rosner, R., & Doering, B. K. (2024) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2024.100784 · Cited by 2 · see citing works
Treatment Gap in Mental Health Care for Victims of Road Traffic Accidents
Boelen, P. A., Eisma, M. C., de Keijser, J., & Lenferink, L. I. M. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2970 · Cited by 2 · see citing works
Fisher, R. S., Dattilo, T. M., DeLone, A. M., Basile, N. L., Kenney, A. E., Hill, K. N., Chang, H.-F., Gerhardt, C. A., & Mullins, L. L. (2024) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsae008 · Cited by 2 · see citing works
Morris, S. E., Ryan, A. K., Malinowski, P. K., Pozo‐Kaderman, C., & Fasciano, K. M. (2023) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2023.0060 · Cited by 2 · see citing works
Staniland, L., Too, C., Butshiire, L., Skinner, S., & Breen, L. J. (2023) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228231199876 · Cited by 2 · see citing works
“Indeed, research suggests that not all people fi nd bereavement services to be helpful (Lichtenthal, Corner, et al., 2015) and there is a need to better understand the needs of individuals receiving this support.”
Ahmed, A. T., Crabtree, V. M., Sirrine, E. H., Elliott, A. J., Antoniotti, N. M., Horn, S., Turner, E., & Parris, K. R. (2023) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2023.0004 · Cited by 2 · see citing works
“29,30 Most of our caregiver referrals and those who ultimately sought treatment were female (86% and 87%, respectively).”
Hovén, E., Ljungman, L., Sveen, J., Skoglund, C. B., Ljungman, G., Ljung, R., & Wikman, A. (2022) · Cancer Medicine · doi:10.1002/cam4.5347 · Cited by 2 · see citing works
Reitsma, L., Boelen, P. A., de Keijser, J., & Lenferink, L. I. M. (2022) · doi:10.31234/osf.io/8xb5h · Cited by 2 · see citing works
Kissane, D. W. (2021) · doi:10.1093/med/9780198821328.003.0075 · Cited by 2 · see citing works
Self-citationBereavement service deserts: A 2024 statewide assessment of bereavement services
Giang, C. W., Kcomt, L., Truchan, J., Dickinson, K., Evans‐Polce, R. J., & McCabe, S. E. (2025) · Death Studies · doi:10.1080/07481187.2025.2595997 · Cited by 2 · see citing works
Fathers’ Perspectives of Bereavement Support
Denhup, C. (2025) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228251371767 · Cited by 1 · see citing works
Debrot, A., Efinger, L., Kheyar, M., Pomini, V., & Berthoud, L. (2024) · JMIR Formative Research · doi:10.2196/57294 · Cited by 2 · see citing works
“Face-to-face interventions show moderate to large effect sizes to treat these symptoms [3,4] but lack accessibility (eg, [5,6]).”
BackgroundBereavement in the Beginning Phase of Life
Cincotta, N. F. (2022) · doi:10.1093/med/9780197537855.003.0077 · Cited by 1 · see citing works
- Authors
- Lichtenthal, W. G., Corner, G. W., Sweeney, C. R., Wiener, L., Roberts, K. E., Baser, R. E., Li, Y., Breitbart, W., Kissane, D. W., & Prigerson, H. G.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2015-07-10
- Volume
- 33
- Issue
- 20
- Pages
- 2246-2253
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC4486343
- OpenAlex
- W1903769299
- Cited by
- 111
- References
- 34
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 10 · 2023: 10 · 2022: 12 · 2021: 18 · 2020: 13 · 2019: 11 · 2018: 14 · 2017: 4 · 2016: 5 · 2015: 3
- FWCI
- 10.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR000457)
- National Cancer Institute (CA009461, R03CA139944, CA172216, K07CA172216, CA08748, P30 CA08748-48, CA139944, P30CA008748, T32CA009461)
- National Center for Advancing Translational Sciences
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- bereavement, parental bereavement, child cancer, mental health service utilization, barriers to care, prolonged grief disorder, depression, anxiety, attachment styles, meaningfulness, minority parents, unmet needs, treatment discontinuation, grief intervention
- MeSH terms
- Adaptation, Psychological, Adolescent, Adult, Age Factors, Cause of Death, Child, Child, Preschool, Cross-Sectional Studies, Female, Grief, Health Services Accessibility, Humans, Infant, Male, Mental Health Services, Middle Aged, Minority Groups, Neoplasms, Parents, Patient Acceptance of Health Care, Psychotherapy, Psychotropic Drugs, Self-Help Groups, Time Factors, United States, Young Adult, Self Report
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