Commentary by Hal Siden
Feature Article: Kennedy, B., Chen, R., Valdimarsdottir, U., Montgomery, S., Fang, F., & Fall, K. (2018). Childhood Bereavement and Lower Stress Resilience in Late Adolescence. The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine, 63(1), 108–114.
Other Articles Referenced: Eilertsen MB; Lovgren M; Wallin AE; Kreicbergs U, Cancer-bereaved siblings’ positive and negative memories and experiences of illness and death: A nationwide follow-up, Pediatric Palliative Care Library, accessed October 31. 2018
Howard SKM; Russell C; Keim M; Barrera Maru; Gilmer Mary Jo; Foster AT; Compas BE; Fairclough DL; Davies B; Hogan Nancy; Young-Saleme T; Vannatta K; Gerhardt CA, Grief and growth in bereaved siblings: Interactions between different sources of social support, Pediatric Palliative Care Library, accessed October 31, 2018.
This month͛s commentary looks at bereavement, a topic that strikingly enough we have not covered in previous commentaries. The featured article is Childhood Bereavement and Lower Stress Resilience in Late Adolescence.
The major feature of this study is that it was unusual if not unique in following a cohort longitudinally. Using military recruit data they identified a 10 year cohort of men who lost a first-degree relative in childhood, and then measured the impact of that on resilience to stress.
The loss of a parent or sibling in childhood conferred a 49% increased risk of subsequent low-stress resilience (RRR, 1.49, 95% CI, 1.41-1.57) and an 8% increased risk of moderate stress resilience (RRR, 1.08, 95% CI, 1.03-1.13) in late adolescence. (One wants to have high-stress resilience ideally). There was also a graded increase in risk with increasing age at loss; We noted elevated risks of low-stress resilience in association with bereavement in all age categories. The associations were stronger for school age and teenage children than for the preschoolers.
The excess risk was observed for all causes of death, including suicide and unexpected deaths as well as deaths due to other illnesses. The associations remained after exclusion of parents with a history of hospitalization for psychiatric diagnoses.
Loss of mother yielded an increased risk of 42%, and loss of sibling an increased risk of 29%. Loss of father, however, entailed an increased risk of 71%, which was higher than for both loss of mother and loss of sibling (p < .01 and p < .0001, respectively). Library, accessed October 22, 2018, https://pedpalascnetlibrary.omeka.net/items/show/11148.
At times it seems that there is a divide in pediatric palliative care with those who study and publish about pre-death care (advance directives, symptom management) not necessarily engaged with bereavement. Perhaps this is because the physician͛s role diminishes after death and because the framework and outcomes for bereavement are less well-defined than symptom management.
But bereavement is one of the key outcome events that need to be addressed by [pediatric] palliative care, and reducing suffering for families is a long-term activity. This study is one that points out why we need pre- and post-death support services for siblings. Counselling through bereavement needs to be part of every PPC program.
There are two other studies of interest to the subject of bereavement found in TPPCR Citation Lists: From the Oncology 2017 List, Eilertsen MB; Lovgren M; Wallin AE; Kreicbergs U, “Cancer-bereaved siblings’ positive and negative memories and experiences of illness and death: A nationwide follow-up,” https://pedpalascnetlibrary.omeka.net/items/show/11148.
And from the October 2018 List: Howard SKM; Russell C; Keim M; Barrera Maru; Gilmer Mary Jo; Foster AT; Compas BE; Fairclough DL; Davies B; Hogan Nancy; Young-Saleme T; Vannatta K; Gerhardt CA, ͞Grief and growth in bereaved siblings: Interactions between different sources of social support,͟ Pediatric Palliative Care Library, accessed October 22, 2018, https://pedpalascnetlibrary.omeka.net/items/show/15566
On a related note, Sir Al Aynsley-Green has been a prominent voice for Child Health in the United
Kingdom. In addition to being a prominent pediatric endocrinologist, he was the first National Clinical Director for Children in government, the first Children͛s Commissioner for England and President of the British Medical Association.
Sir Al brought the importance of childhood bereavement to national attention with an interview on the BBC describing how his father died when he was 10 years old – and was told that he was now the man of the family͛. That interview and subsequent writing eloquently describes the long-term impact that had on him.
From his perspective as a leader for Child Health in the UK he now writes about the ways that the country has not cared for its young. His book was recently released to great reviews, and I look forward to reading it.