Developmental pathways for the prevention of depression in parentally-bereaved youth

A study opens in new tab/window in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, “Developmental Pathways of the Family Bereavement Program to Prevent Major Depression 15 Years Later,” found that a 12-session Family Bereavement Program (FBP) led to a significant decrease in the onset of major depression in bereaved youth over 15 years. The study found that the effects of the program to strengthen protective processes one year later led to a reduction in internalizing problems and negative views of the self six years later, which in turn partially accounted for the reduction in major depression 15 years following the program. In addition to these effects other factors such as the direct effect of the program were also significant.

The study involved 244 youth ages 8 – 16 in 156 families who were randomized to receive either the 12- session FBP or commercially available books on child and caregiver grief. The FBP involved two components that were designed to strengthen specific parent and child protective processes that were believed to promote resilience of youth following the death of a parent. The caregiver component taught skills for self-care and for quality parenting of their bereaved children. The youth component taught skills for emotion regulation to deal with their grief-related feelings and effective coping skills to help them deal with stressful changes in their lives.

Prior published evaluations of the FBP found that the program strengthened many of the targeted protective processes. The current study provides new information that children who participated in the FBP were less likely to meet the criteria for depression in adulthood compared to those who received books on bereavement ( 13% vs. 28%). Furthermore, the results indicated that strengthening the protection processes one year after the program produced a cascade of benefits over time, leading to a later decrease in major depression. More specifically, strengthening positive coping, reducing the need to hide their feelings, and reducing intrusive thoughts about their grief, as well as strengthening positive parenting one year after the program led to a reduction in youth’s negative views about the self and internalizing problems six years later . Negative views of the self and internalizing problems at six years in turn predicted the onset of major depression over the following nine years.

Dr. Sandler, Research Professor of Psychology at Arizona Sate University and the principal investigator on this study said that he is excited by these findings because they add to a growing literature from other researchers that demonstrates that promoting protective family- and child processes in childhood can be effective pathways for the prevention of depression many years later. For youth who have experienced the death of a parent the study demonstrates the potential long-term benefits of services that strengthen the protective processes identified in this study to help children deal with their grief and to help caregivers provide the supportive family environment in which children can thrive.

Dr. Sandler and his team are currently evaluating an online version of the caregiver component of the Family Bereavement Program to assess its effectiveness in fostering family processes that promote the well-being and mental health of parentally bereaved children. Given that approximately 6% of children in the United States experience the death of a parent, the authors hope that this study can contribute to the development of increasingly effective services for these children.

Dr. Sandler believes that this study has significant implications for future research and practice. The study should be replicated by others to ensure the stability of the findings and to test whether strengthening the protective processes identified for bereaved families in this study also protects youth who have experienced other stressful events, such as parental divorce or parental depression. There is also a need to translate findings from this experimental study into the clinical practice setting to promote the well-being of bereaved children in the general community.

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Notes for editors

The article is "Developmental Pathways of the Family Bereavement Program to Prevent Major Depression 15 Years Later," by Irwin Sandler, PhD, Jenn-Yun Tein, PhD, Na Zhang, PhD, Sharlene A. Wolchik, PhD (https://doi.org/10.1016/j.jaac.2023.02.012 opens in new tab/window). It appears inJournal of the American Academy of Child and Adolescent Psychiatry (JAACAP), volume 62, issue 11 (November 2023), published by Elsevier opens in new tab/window.

Copies of this paper are available to credentialed journalists upon request; please contact Irwin Sandler, PhD at [email protected] opens in new tab/window or bereavedparenting.org for more information about our work.

About JAACAP

Journal of the American Academy of Child and Adolescent Psychiatry opens in new tab/window (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

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