This application is designed to extend the findings of an ongoing NIMH funded study of acute grief reactions in prepubertal children 1, 6, and 13 months after a parent's death (Psychopathology & Grief in Children Post-Parental Death). In the currently funded study, matched samples of normal and clinically depressed children are being compared to the parent-bereaved children.
Aims are to describe the acute course of grief reactions, occurrence of psychopathology, and effects of individual, family, situational, and sociocultural variables on acute outcome.
Aims of the proposed study would be similar, and would extend the study to five years post-parental death. To date, 104 bereaved children, 30 depressed children, and 69 normal children have been studied. Enrollment will continue until 150 bereaved children, 50 depressed children and 100 normal children are interviewed. Preliminary analysis of the first 86 bereaved subjects indicates 31% become clinically depressed in the month following parental death and 42% are depressed at some time during the first year post-loss. These bereaved subjects with depression also have an increase in other psychiatric symptoms. Half of the children who were depressed at 6 months had been depressed at 1 month post-loss; the other half experienced their first depressive syndrome six months post-loss. At 13 months, one new case and one recurrent case of depression occurred. Clearly, acute psychopathology is present. However, intermediate and long-term effects of parental death of prepubertal children have not been studied. The proposed study would reexamine the bereaved, depressed and normal cohorts 5 years later, using the same methodology employed in the acute grief study. This includes conducting comprehensive, face-to-face interviews with the children and their parents and obtaining school ratings and health records. In this new proposal, Consensus Conference diagnoses would be determined for the 5 year interview, and the course of disorders until present would be established. A five-year follow up would be important for many reasons. 1) Subjects will be in their adolescence, an age of increased risk for developing psychopathology, particularly mood disorders. 2) Parental death in childhood has been associated with increased risk for depression. 3) Psychiatric complications following parental death are often delayed by five years. 4) Longitudinal studies of depressed children suggest 40% who recover from a major depressive episode relapse within two years. As 42% of bereaved children experienced a major depressive episode acutely following a parental death, 17% of this cohort are at significantly increased risk for subsequent depressive episodes during their intermediate phase of grief. 5) Kindling, which is associated with increased risk for rapid cycling bipolar disorder, may occur in these highly stressed children who may be particularly vulnerable to its effect (Goodwin, 1992). 6) This study will provide normative outcome data in nonclinical children who have experienced a significant stressor. 7) The statistical power of the original study would be improved. Thus, a 5 year follow-up is an important next step in the study of bereavement in normal children. This sample of well studied, acutely bereaved children presents a unique opportunity to study intermediate grief reactions in this age range.
