Approximately 4% of children and adolescents in the United States (1.2 million) experience the death of at least one parent before the age of 15. However, little is known about the normal grieving process, specific symptoms of grief, factors leading to its healthy resolution, or factors relating to the development of psychopathology following parental death in adolescents. In earlier work we found one third of prepubertal bereaved children meet DSM-III-R criteria for major depression 5 weeks post parental death. New preliminary work from our group indicates depressive symptoms are also common in acutely bereaved adolescents. However, compared to bereaved prepubertal children bereaved adolescents report fewer depressive, anxiety, and somatic symptoms. In adolescents, as in prepubertal children, the natural course of such psychopathology is unknown. Adult findings cannot be generalized to adolescents because of differences in the type of loss typically experienced (death of spouse versus parent) as well as developmentally-mediated differences in emotional, cognitive, biological, and social functioning that might result in different expressions of psychopathology. Likewise, evidence indicates grief reactions of adolescents to their parents' deaths cannot be assumed to be the same as those experienced by prepubertal children. Without a clear understanding of the normal grief process in adolescents, it is impossible to separate normal grief symptoms from psychiatric disorders, particularly depression. As a result, adolescents manifesting normal grief might be misdiagnosed as psychiatrically ill and receive unnecessary treatment. Conversely, a bereaved adolescent suffering from depression might mistakenly have these symptoms attributed to """"""""normal"""""""" grief and, not receive needed treatment. This project will study 90 adolescents aged 13-16 who have lost a parent, 45 matched normal controls, and 45 matched outpatient depressed controls. Subjects will be evaluated 1, 6, 13 and 25 months following the death of a parent. Subjects and surviving parents will be interviewed independently using a battery of standardized instruments to assess grief reactions, psychopathology, home environment, health status, and overall level of functioning. It will also be possible to compare these bereaved adolescents to a similarly studied sample of bereaved prepubertal children.
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