Hostname: page-component-745bb68f8f-b95js Total loading time: 0 Render date: 2025-01-12T05:18:57.618Z Has data issue: false hasContentIssue false
  • English
  • Français

Long-term effects of the Family Bereavement Program on spousally bereaved parents: Grief, mental health problems, alcohol problems, and coping efficacy

Published online by Cambridge University Press:  18 July 2016

Irwin Sandler ,
Jenn-Yun Tein ,
Heining Cham ,
Sharlene Wolchik  and
Tim Ayers
Irwin Sandler*
Affiliation:
Arizona State University
Jenn-Yun Tein
Affiliation:
Arizona State University
Heining Cham
Affiliation:
Fordham University
Sharlene Wolchik
Affiliation:
Arizona State University
Tim Ayers
Affiliation:
Arizona State University
*
Address correspondence and reprint requests to: Irwin Sandler, Department of Psychology, Arizona State University, Tempe, AZ 85281; E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

This study reports on the findings from a 6-year follow-up of a randomized trial of the Family Bereavement Program (FBP) on the outcomes for spousally bereaved parents. Spousally bereaved parents (N = 131) participated in the trial in which they were randomly assigned to receive the FBP (N = 72) or literature control (N = 59). Parents were assessed at four time points: pretest, posttest, and 11-month and 6-year follow-up. They reported on mental health problems, grief, and parenting at all four time periods. At the 6-year follow-up, parents reported on additional measures of persistent complex bereavement disorder, alcohol abuse problems, and coping efficacy. Bereaved parents in the FBP as compared to those in the literature control had lower levels of symptoms of depression, general psychiatric distress, prolonged grief, and alcohol problems, and higher coping efficacy (for mothers) at the 6-year follow-up. Multiple characteristics of the parent (e.g., gender, age, and baseline mental health problems) and of the spousal death (e.g., cause of death) were tested as moderators of program effects on each outcome, but only 3 of 45 tests of moderation were significant. Latent growth modeling found that the effects of the FBP on depression, psychiatric distress, and grief occurred immediately following program participation and were maintained over 6 years. Mediation analysis found that improvement in positive parenting partially mediated program effects to reduce depression and psychiatric distress, but had an indirect effect to higher levels of grief at the 6-year follow-up. Mediation analysis also found that improved parenting at the 6-year follow-up was partially mediated by program effects to reduce depression and that program effects to increase coping efficacy at the 6-year follow-up was partially mediated through reduced depression and grief and improved parenting. FBP reduced mental health problems, prolonged grief, and alcohol abuse, and increased coping efficacy of spousally bereaved parents 6 years later. Mediation pathways for program effects differed across outcomes at the 6-year follow-up.

Type
Special Issue Articles
Information
Development and Psychopathology , Volume 28 , Special Issue 3: Longitudinal Transactional Models of Development and Psychopathology , August 2016 , pp. 801 - 818
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Achenbach, T. M. (1997). Manual for the Young Adult Self-Report and Young Adult Behavior Checklist. Burlington, VT: University of Vermont, Department of Psychiatry.Google Scholar
Achenbach, T. M. (2001). Manual for the ASEBA School-Age Forms and Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.Google Scholar
Achenbach, T. M. (2003). [Data from the CBCL and YABCL]. Unpublished raw data.Google Scholar
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.Google Scholar
Archer, J. (1999). The nature of grief: The evolution and psychology of reactions to loss. New York: Brunner–Routledge.Google Scholar
Ayers, T. S., Sandler, I. N., & Twohey, J. (1998). Conceptualization and measurement of coping in children and adolescents. In Ollendick, T. H. & Prinz, R. J. (Eds.), Advances in clinical child psychology (Vol. 20, pp. 243–301). New York: Plenum Press.CrossRefGoogle Scholar
Ayers, T. S., Wolchik, S. A., Sandler, I. N., Towhey, J. L., Lutzke Weyer, J. R., Jones, S., et al. (2013–2014). The Family Bereavement Program: Description of a theory-based prevention program for parentally-bereaved children and adolescent. Omega: Journal of Death and Dying, 68, 293–314.Google Scholar
Ayers, T. S., Wolchik, S. A., Weiss, L., Sandler, I. N., Jones, S., Cole, E., et al. (2008). Family Bereavement Program: Group leader intervention manual for parent program. Tempe, AZ: Arizona State University Press.Google Scholar
Barlow, J., Smailagic, N., Huband, N., Roloff, V., & Bennett, C. (2012). Group-based parent training programmes for improving parental psychosocial health. Campbell Systematic Reviews, 8.Google Scholar
Beck, A. T., & Steer, R. A. (1993). Manual for the Beck Depression Inventory. San Antonio, TX: Psychological Corporation.Google Scholar
Benjamini, Y., & Yekutieli, D. (2001). The control of the false discovery rate in multiple testing under dependency. Annals of Statistics, 29, 1165–1188.CrossRefGoogle Scholar
Boelen, P. A., de Keijser, J., van den Hout, M. A., & van den Bout, J. (2007). Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 75, 277–284.CrossRefGoogle ScholarPubMed
Boelen, P. A., & Prigerson, H. G. (2007). The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults: A prospective study. European Archives of Psychiatry and Clinical Neuroscience, 257, 444–452.CrossRefGoogle ScholarPubMed
Bonanno, G. A., Neria, Y., Mancini, A., Litz, B., Coifman, K. G., & Insel, B. (2007). Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity. Journal of Abnormal Psychology, 116, 342–351.Google Scholar
Bonanno, G. A., Wortman, C. B., Lehman, D. R., Tweed, R. G., Haring, M., Sonnega, J., et al. (2002). Resilience to loss and chronic grief: A prospective study from preloss to 18-months postloss. Journal of Personality and Social Psychology, 83, 1150–1162.CrossRefGoogle ScholarPubMed
Braver, S. L., Shapiro, J. R., & Goodman, M. R. (2005). The consequences of divorce for parents. In Fine, M. A. & Harvey, H. (Eds.), Handbook of divorce and relationship dissolution (pp. 313–337). Mahwah, NJ: Erlbaum.Google Scholar
Bruce, M. L., Kim, K., Leaf, P. J., & Jacobs, S. (1990). Depressive episodes and dysphoria resulting from conjugal bereavement in a prospective community sample. American Journal of Psychiatry, 147, 608–611.Google Scholar
Bryant, R. A., Kenny, L., Joscelyne, A., Rawson, N., Maccullum, F., Cahill, C., et al. (2014). Treating prolonged grief disorder: A randomized clinical trial. JAMA Psychiatry, 71, 1332–1339.CrossRefGoogle ScholarPubMed
Carnelley, K. B., Wortman, C. B., Bolger, N., & Burke, C. T. (2006). The time course of grief reactions to spousal loss: Evidence from a national probability sample. Journal of Personality and Social Psychology, 91, 476–492.Google Scholar
Cole, D. A., & Maxwell, S. E. (2003). Testing mediational models with longitudinal data: Questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology, 112, 558–577.Google Scholar
Conger, K. J., Rueter, M. A., & Conger, R. D. 2000. The role of economic pressure in the lives of parents and their adolescents: The Family Stress Model. In Crockett, L. J. & Silbereisen, R. K. (Eds.), Negotiating adolescence in times of social change (pp. 201–223). New York: Cambridge University Press.Google Scholar
Cook, R. D. (1977). Detection of influential observations in linear regression. Technometrics, 19, 15–18.Google Scholar
Currier, J. M., Neimeyer, R. A., & Berman, J. S. (2008). The effectiveness of psychotherapeutic interventions for bereaved persons: A comprehensive quantitative review. Psychology Bulletin, 134, 648–661.Google Scholar
DeGarmo, D. S., Patterson, G. R., & Forgatch, M. S. (2004). How do outcomes in a specified parent training intervention maintain or wane over time? Prevention Science, 5, 73–89.CrossRefGoogle ScholarPubMed
Dohrenwend, B. P., Shrout, P. E., Ergi, G., & Mendelsohn, F. S. (1980). Non-specific psychological distress and other dimensions of psychopathology. Archive of General Psychiatry, 39, 1229–1236.Google Scholar
Evenson, R. J., & Simon, R. W. (2005). Clarifying the relationship between parenthood and depression. Journal of Health and Social Behavior, 46, 341–358.Google Scholar
Faschingbauer, T. R. (1981). Texas Inventory of Grief—Revised manual. Houston, TX: Honeycomb.Google Scholar
Gardner, F., Burton, J., & Klimes, I. (2006). Randomized controlled trial of a parenting intervention in the voluntary sector for reducing child conduct problems: Outcomes and mechanisms of change. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 47, 1123–1132.Google Scholar
Gottfredson, D. C., Cook, T. D., Gardner, F. E. M., Gorman-Smith, D., Howe, G. W., Sandler, I. N., et al. (in press). Standards of evidence for efficacy, effectiveness, and scale-up research in prevention science: New generation. Prevention Science.Google Scholar
Hagan, M. J., Tein, J.-Y., Sandler, I. N., Wolchik, S. A., Ayers, T. S., & Luecken, L. J. (2012). Strengthening effective parenting practices over the long term: Effects of a preventive intervention for parentally bereaved families. Journal of Clinical Child and Adolescent Psychology, 41, 177–188.CrossRefGoogle Scholar
Haine, R. A., Sandler, I. N., Wolchik, S. A., Tein, J.-Y., & Dawson-McClure, S. R. (2003). Changing the legacy of divorce: Evidence from prevention programs and future directions. Family Relations, 52, 397–405.Google Scholar
Hussong, A. M., Jones, D. J., Stein, G. L., Baucom, D. H., & Boeding, S. (2011). An internalizing pathway to alcohol use and disorder. Psychology of Addictive Behavior, 25, 390–404.Google Scholar
Jones, S., & Twohey, J. L. (1998). Parents' Expression of Emotions Questionnaire: Psychometric properties. Paper presented at the 106th Annual Convention of the American Psychological Association, San Francisco, CA.Google Scholar
Keyes, K. M., Pratt, C., Galea, S., McLaughlin, K. A., Koenen, K. C., & Shear, M. K. (2014). The burden of loss: Unexpected death of a loved one and psychiatric disorders across the life course in a national study. American Journal of Psychiatry, 171, 864–871.Google Scholar
Kwok, O.-M., Haine, R., Sandler, I. N., Ayers, T. S., & Wolchik, S. A. (2005). Positive parenting as a mediator of the relations between parental psychological distress and mental health problems of parentally-bereaved children. Journal of Clinical Child and Adolescent Psychology, 34, 261–272.Google Scholar
Levinson, D., Darrow, C. N., Klein, E. B., Levinson, M. H., & McKee, B. (1978). The seasons of a man's life. New York: Ballantine Books.Google Scholar
Luthar, S. S. (2003). Resilience and vulnerability: Adaptation in the context of childhood adversities. New York: Cambridge University Press.CrossRefGoogle Scholar
MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test the significance of the mediated effect. Psychological Methods, 7, 83–104.Google Scholar
Masten, A., & Cicchetti, D. (2010). Developmental cascades. Development and Psychopathology, 22, 491–495.CrossRefGoogle ScholarPubMed
Melhem, N. M., Walker, M., Moritz, G., & Brent, D. A. (2008). Antecedents and sequalae of sudden parental death in offspring and surviving caregivers. Archives of Pediatric and Adolescent Medicine, 162, 403–410.CrossRefGoogle Scholar
Múthen, L. K., & Múthen, B. O. (1998–2012). Mplus user's guide (7th ed.). Los Angeles: Author.Google Scholar
Neimeyer, R. A., Hogan, N. S., & Laurie, A. (2008). The measurement of grief: Psychometric considerations in the assessment of reactions to bereavement. In Stroebe, M. S., Hansson, R. O., Schut, H., Stroebe, W., & Van den Blink, E. (Eds.), Handbook of bereavement research and practice: Advances in theory and intervention (pp. 133–161). Washington, DC: American Psychological Association.Google Scholar
Neter, J., Wasserman, W., & Kutner, M. (1989). Applied linear regression analysis. Homewood, IL: Irwin.Google Scholar
Nolen-Hoeksema, S., & Ahrens, C. (2002). Age differences and similarities in the correlates of depressive symptoms. Psychology and Aging, 17, 116–124.Google Scholar
Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Asian, M., Goodkin, K., et al. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLOS Medicine, 6, e1000121.CrossRefGoogle ScholarPubMed
Prigerson, H. G., Vanderwerker, L. C., & Maciejewski, P. K. (2008). A case for inclusion of prolonged grief disorder in DSM-V. In Stroebe, M. S., Hansson, R. O., Schut, H., Stroebe, W., & Van den Blink, E. (Eds.), Handbook of bereavement research and practice: Advances in theory and intervention (pp. 165–186). Washington, DC: American Psychological Association.Google Scholar
Prigerson, H. O., & Jacobs, S. C. (2001). Traumatic grief as a distinct disorder: A rationale, consensus criteria, and a preliminary empirical test. In Stroebe, M. S. H., Hansson, Robert O., Stroebe, W., & Schut, H. (Eds.), Handbook of bereavement research: Consequences, coping, and care (pp. 613–645). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Rubin, S., & Malkinson, R. (2001). Parental response to child loss across the life cycle: Clinical and research perspectives. In Stroebe, M. S., Hansson, R. O., Stroebe, W., & Schut, H. (Eds.), Handbook of bereavement research: Consequences, coping and care (pp. 219–240). Washington, DC: American Psychological Association.Google Scholar
Sandler, I. N., Ayers, T. S., Tein, J. Y., Wolchik, S., Millsap, R., Khoo, S. T., et al. (2010). 6-year follow-up of a preventive intervention for parentally-bereaved youth: A randomized controlled trial. Archives of Pediatrics and Adolescent Medicine, 164, 907–914.CrossRefGoogle Scholar
Sandler, I. N., Ayers, T. S., Wolchik, S. A., Tein, J.-Y., Kwok, O. M., Haine, R. A., et al. (2003). Family Bereavement Program: Efficacy of a theory-based preventive intervention for parentally-bereaved children and adolescents. Journal of Consulting and Clinical Psychology, 71, 587–600.Google Scholar
Sandler, I. N., Ingram, A., Wolchik, S., Tein, J. Y., & Winslow, E. (2015). Long-term effects of parenting-focused preventive interventions to promote resilience of children and adolescents. Child Development Perspectives, 9, 164–171.Google Scholar
Sandler, I. N., Ma, Y., Tein, J. Y., Ayers, T. S., Wolchik, S., Kennedy, C., et al. (2010). Long-term effects of the Family Bereavement Program on multiple indicators of grief in parentally bereaved children and adolescents. Journal of Consulting and Clinical Psychology, 78, 131–144.Google Scholar
Sandler, I. N., Schoenfelder, E. N., Wolchik, S. A., & MacKinnon, D. P. (2011). Long-term impact of prevention programs to promote effective parenting: Lasting effects but uncertain processes. Annual Review of Psychology, 62, 299–329.CrossRefGoogle ScholarPubMed
Sandler, I. N., Tein, J.-Y., Mehta, P., Wolchik, S. A., & Ayers, T. S. (2000). Coping efficacy and psychological problems of children of divorce. Child Development, 71, 1097–1118.Google Scholar
Sandler, I. N., Wolchik, S. A., & Ayers, T. S. (2008). Resilience rather than recovery: A contextual framework on adaptation following bereavement. Death Studies, 32, 59–73.CrossRefGoogle ScholarPubMed
Sandler, I. N., Wolchik, S. A., Ayers, T. S., Tein, J. Y., & Luecken, L. (2013). Family Bereavement Program (FBP) approach to promoting resilience following the death of a parent. Family Science, 4, 87–95.Google Scholar
Sandler, I., Wolchik, S. A., Cruden, G., Mahrer, N. E., Ahn, S., Brincks, A., et al. (2014). Overview of meta-analyses of the prevention of mental health, substance use, and conduct problems. Annual Review of Clinical Psychology, 10, 243–273.Google Scholar
Schaefer, E. S. (1965). Children's report of parental behavior: An inventory. Child Development, 36, 413–424.Google Scholar
Schoenfelder, E. N., Sandler, I. N., Millsap, R. E., Wolchik, S. A., Berkel, C., & Ayers, T. S. (2013). Caregiver responsiveness to the Family Bereavement Program: What predicts responsiveness? What does responsiveness predict? Prevention Science, 14, 545–557.Google Scholar
Selzer, M. L., Vinokur, A., & van Rooijen, L. (1975). A self-administered Short Michigan Alcoholism Screening Test (SMAST). Journal of Studies on Alcohol, 36, 117–126.CrossRefGoogle ScholarPubMed
Shapiro, E. R. (1994). Grief as a family process: A developmental approach to clinical practice. New York: Guilford Press.Google Scholar
Shear, K., & Shair, H. (2005). Attachment, loss and complicated grief. Developmental Psychobiology, 47, 253–267.Google Scholar
Shear, M. K. (2015). Complicated grief. New England Journal of Medicine, 372, 153–160.Google Scholar
Shear, M. K., Wang, Y., Skritskaya, N., Duan, N., Mauro, C., & Ghesquiere, A. (2014). Treatment of complicated grief in elderly persons: A randomized clinical trial. JAMA Psychiatry, 71, 1287–1295.Google Scholar
Simon, N. M., Shear, K. M., Thompson, E. H., Zalta, A. K., Perlman, C., Reynolds, C. F., et al. (2007). The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief. Comprehensive Psychiatry, 48, 395–399.Google Scholar
Simon, R. W. (1992). Parental role strains, salience of parental identity and gender differences in psychological distress. Journal of Health and Social Behavior, 33, 25–35.Google Scholar
Stroebe, M. S., & Schut, H. A. W. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23, 1–28.Google ScholarPubMed
Taylor, A. B., MacKinnon, D., & Tein, J.-Y. (2008) Test of the three path mediated effect. Organization Research Methods, 11, 241–269.Google Scholar
Tein, J. Y., Sandler, I. N., Ayers, T. S., & Wolchik, S. A. (2006). Mediation of the effects of the Family Bereavement Program on mental health problems of bereaved children and adolescents. Prevention Science, 7, 179–197.Google Scholar
Walters, E., Kessler, R., Nelson, C., & Mroczek, D. (2002). Scoring the World Health Organization's Composite International Diagnostic Interview—Short Form (CIDI-SF). Retrieved from http://www3.who.int/cidi/index.htm Google Scholar
West, S., Finch, J., & Curran, P. (1995). Structural equation models with nonnormal variables: Problems and remedies. In Hoyle, R. H. (Ed.), Structural equation modeling: Concepts, issues and applications (pp. 56–75). Thousand Oaks, CA: Sage.Google Scholar
Wittouck, C., Van Autreve, S., De Jaegere, E., Portzky, G., & van Heeringen, K. (2011). The prevention and treatment of complicated grief: A meta-analysis. Clinical Psychology Review, 31, 69–78.Google Scholar
Wyman, P., Sandler, I. N., Wolchik, S. A., & Nelson, K. (2000). Resilience theory and interventions: Cumulative developmental promotion and protection. In Cichetti, D., Rappaport, J., Sandler, I. N., & Weissberg, R. (Eds.), The promotion of wellness in children and adolescents (pp. 133–189). Washington, DC: CWLA Press Google Scholar
Yuan, K. H., & Bentler, P. M. (2000). Three likelihood-based methods for mean and covariance structure analysis with nonnormal missing data. Sociological Methodology, 30, 165–200.Google Scholar
Zisook, S., & Schucter, S. R. (1991). Depression through the first year after the death of a spouse. American Journal of Psychiatry, 148, 1346–1352.Google Scholar
Zisook, S., Shucter, S. R., Sledge, P., & Mulvihill, M. (1993). Aging and bereavement. Journal of Geriatric Psychiatry and Neurology, 6, 137–143.CrossRefGoogle ScholarPubMed