This is a 5-year A1 competitive renewal to study the impact of sudden parental death on children. During the initial project period, we recruited a cohort of 245 children who have lost a parent to suicide, accident, or sudden natural death, and a demographically similar, non-bereaved control group of 185 children and assessed them at 1 and 2 years after parental death. We find evidence of a persistent impact two years after the death: parental bereavement quadruples the risk for child depression, even adjusting for pre-death risk factors. We propose to reassess this cohort at 3 and 6 years after the parental death for a total of 4 follow-up assessment points in order to examine the relationship between parental loss and child outcomes in the domains of psychopathology (e.g., incident disorder, symptom trajectory), attainment of developmental competence (educational, vocational, relational), and health-related outcomes (e.g., BMI, impact on the hypothalamic pituitary adrenal [HPA] axis). We evaluate the construct and discriminant validity of complicated grief to determine if it has a stable factor structure and explains a unique proportion of the variance in outcome. We test an explanatory model by examining specific pathways that may mediate (e.g., child coping, family cohesion) or moderate (e.g., pre-death psychopathology, gender) the relationship between parental death and child mental health, developmental, and physical health outcomes. As an exploratory aim, we examine if polymorphisms in genes may moderate the relationship between parent death and cortisol response to a social stressor (e.g., glucocorticoid receptor) or depression (e.g., serotonin transporter promoter). This project will lead to new knowledge, because it: (1) is the only controlled, prospective study of parentally bereaved children with a follow-up period of longer than 2 years;(2) assesses outcomes complementary to psychiatric outcome, namely developmental competency, health, and the HPA axis;(3) tests models of mediation and moderation;(4) is large enough to assess if parental bereavement by suicide is uniquely deleterious;and (5) will address whether complicated grief in youth has construct and discriminant validity and has a direct impact on functional outcome. These results will help to identify bereaved youth and families at risk for sub-optimal mental and physical health and developmental outcomes, thus framing targets for future prevention and intervention studies.Project Narrative: The loss of a parent is widely recognized to be among the most stressful events that a child can experience, and numerous retrospective studies indicate that parent loss has serious and enduring mental health effects. However, there have been no long-term, controlled, prospective studies of the effects of parental bereavement on children.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Psychosocial Development, Risk and Prevention Study Section (PDRP)
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Garriock, Holly A
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University of Pittsburgh
Schools of Medicine
United States
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Pan, Lisa; Segreti, Annamaria; Almeida, Jorge et al. (2013) Preserved hippocampal function during learning in the context of risk in adolescent suicide attempt. Psychiatry Res 211:112-8
Melhem, Nadine M; Porta, Giovanna; Walker Payne, Monica et al. (2013) Identifying prolonged grief reactions in children: dimensional and diagnostic approaches. J Am Acad Child Adolesc Psychiatry 52:599-607.e7
Hamdan, Sami; Melhem, Nadine M; Porta, Giovanna et al. (2013) Alcohol and substance abuse in parentally bereaved youth. J Clin Psychiatry 74:828-33
Hamdan, Sami; Mazariegos, David; Melhem, Nadine M et al. (2012) Effect of parental bereavement on health risk behaviors in youth: a 3-year follow-up. Arch Pediatr Adolesc Med 166:216-23
Hamdan, Sami; Melhem, Nadine M; Porta, Giovanna et al. (2012) The phenomenology and course of depression in parentally bereaved and non-bereaved youth. J Am Acad Child Adolesc Psychiatry 51:528-36
Pan, Lisa A; Batezati-Alves, Silvia C; Almeida, Jorge R C et al. (2011) Dissociable patterns of neural activity during response inhibition in depressed adolescents with and without suicidal behavior. J Am Acad Child Adolesc Psychiatry 50:602-611.e3
Melhem, Nadine M; Porta, Giovanna; Shamseddeen, Wael et al. (2011) Grief in children and adolescents bereaved by sudden parental death. Arch Gen Psychiatry 68:911-9
Brent, David A (2010) Protecting families from harm. Arch Pediatr Adolesc Med 164:976-7
Muniz-Cohen, Melissa; Melhem, Nadine M; Brent, David A (2010) Health risk behaviors in parentally bereaved youth. Arch Pediatr Adolesc Med 164:621-4
Brent, David; Melhem, Nadine; Donohoe, M Bertille et al. (2009) The incidence and course of depression in bereaved youth 21 months after the loss of a parent to suicide, accident, or sudden natural death. Am J Psychiatry 166:786-94

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