When Children Die: Improving Palliative and End-of-life Care for Children and Their Families

The prevalence of Prolonged Grief Disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis

Background: Violent loss (i.e. loss through homicide, suicide, or accident) is associated with high levels of prolonged grief disorder (PGD).Objective: The current meta-analysis aims at identifying...

https://tandfonline.com/doi/pdf/10.1080/20008198.2019.1583524

A systematic review and meta-analysis of correlates of prolonged grief disorder in adults exposed to violent loss.

Research demonstrates that severe forms of grief and grief-related pathology exist in the general population. Less attention, however, has been paid to the grief of parents following the death of a young, dependent child. In this review, we summarize a search of Pubmed, PsycINFO and Web of Science from 1995 to 2017, using the terms 'parental complicated grief', 'parental traumatic grief', and 'parent Prolonged Grief Disorder', specifically addressing parental grief and identified risk factors for complicated or prolonged grief. Forty-two studies met criteria and indicate a significant burden of complicated or prolonged grief in parents of children dying from virtually any cause. It appears that the empiric literature is undermined by great variability, including the composition of samples, the causes of death studied, the psychometric measures used, and post-loss intervals. We conclude that the uniform severity of grief experiences following the death of a young child is potentially a distinct subtype of grief, deserving of attention in its own right in future research and diagnostic formulations.

The Grief of Parents After the Death of a Young Child.

In recent decades, the influence of natural disasters such as hurricanes, earthquakes, heat waves, droughts, floods and epidemics, on Global Health Security have become more prominent. In addition, disaster events stemming from civil unrest or natural disasters create humanitarian and refugee crisis thereby contributing to local, regional and global health security challenge. These disaster events also highlight the social, physical, psychological and economic vulnerabilities among population groups. Vulnerable populations, including pregnant women, families with children, older adults, disabled and low-income individuals suffer disproportionate harm in disasters. Vulnerable populations are less likely to undertake self-protective actions before, during or after disasters. They are also at greater risk for poor physical and psychological health outcomes after a disaster. This chapter focuses on the impact of disasters on the following vulnerable population groups: pregnant women and families with children, and older adults. It highlights the complex and unique needs of women, children, and older adults which can lead to catastrophic consequences during and after a disaster. Case studies are included to demonstrate the vulnerabilities and ensuing consequences for women and children and older adults during or after disasters.

Natural and Manmade Disasters: Vulnerable Populations

OBJECTIVE: To assess whether having a subsequent child had an effect on the mental health of Chinese mothers who lost a child during an earthquake. METHODS: A cross-sectional survey of bereaved mothers was conducted 30 to 34 months after the 2008 Sichuan earthquake using individual structured interviews to assess sociodemographic characteristics, post-disaster experiences and mental health. The interviews incorporated standardized psychometric measures of anxiety, depression, post-traumatic stress disorder (PTSD) and complicated grief (CG). Social support was also assessed. An adjusted model taking potential confounders into account was used to explore any association between psychological symptoms and the birth of a subsequent child. FINDINGS: The prevalence of psychological symptoms was higher in mothers who did not have a child after losing the first one. In an adjusted model, symptoms of anxiety (odds ratio, OR: 3.37; 95% confidence interval, CI: 1.51-7.50), depression (OR: 9.47; 95% CI: 2.58-34.80), PTSD (OR: 5.11; 95% CI: 2.31-11.34) and CG (OR: 10.73; 95% CI: 1.88-61.39) were significantly higher among the 116 women without a subsequent child than among the 110 mothers who had another child after bereavement. More than two thirds of the mothers with new infants had clinically important psychological symptoms. CONCLUSION: Women who have lost an only child in a natural disaster are especially vulnerable to long-term psychological problems, especially if they have reached an age when conception is difficult. Research should focus on developing and evaluating interventions designed to provide women with psychosocial support and reproductive services.

/pdf/effect-of-having-a-subsequent-child-on-the-mental-health-of-40x237gkmq.pdf

Effect of having a subsequent child on the mental health of women who lost a child in the 2008 Sichuan earthquake: a cross-sectional study

Using data from China's population-based 2000 census, this ecological study examined the association between gender equity and women's contraceptive use in 30 provinces. Five province-level indicators of gender equity were used: sex ratio at birth, health, employment, education, and political participation. With the exception of sex ratio, all indices were comprised of several components. The indicators and components were grouped into tertiles. Generalized linear models were used to examine the associations between these indicators and contraceptive use. Provinces in the middle tertile of political participation had higher prevalence of contraceptive use than those in the lowest tertile (β = 0.27, 95% CI: 0.02-0.52, p < 0.034). Compared to regions in the lowest tertile, regions in the highest tertile of the proportion of females in provincial-level parties and government (β = 0.25, 95% CI: 0.04-0.46, p < 0.020) and middle tertile of female employment in all the economic activities except agriculture, industry and construction (β = 0.25, 95% CI: 0.04-0.46, p < 0.021) had a higher prevalence of contraceptive use. Regions in the middle tertile of female illiteracy (β = -0.25, 95% CI: -0.42-0.07, p < 0.006) had a lower prevalence of use of contraceptives than those in the lowest tertile. The authors of this study found mixed evidence of an association between gender equity and contraceptive use in China.

Gender Equity and Contraceptive Use in China: An Ecological Analysis

Background Acute exacerbations of asthma are common in children, however, treatment decisions for severe exacerbations are challenging due to a lack of robust evidence. In order to create more robust research, a core set of outcome measures needs to be developed. In developing these outcomes, it is important to understand the views of clinicians who care for these children in particular, views that relate to outcome measures and research priorities. Methods To determine the views of clinicians, a total of 26 semistructured interviews based on the theoretical domains framework were conducted. These included experienced clinicians from emergency, intensive care and inpatient paediatrics across 17 countries. The interviews were recorded, and later transcribed. All data analyses were conducted in Nvivo by using thematic analysis. Results The length of stay in hospital and patient-focused parameters, such as timing to return to school and normal activity, were the most frequently highlighted outcome measures, with clinicians identifying the need to achieve a consensus on key core outcome measure sets. Most research questions focused on understanding the best treatment options, including the role of novel therapies and respiratory support. Conclusion Our study provides an insight into what research questions and outcome measures clinicians view as important. In addition, information on how clinicians define asthma severity and measure treatment success will assist with methodological design in future trials. The current findings will be used in parallel with a further Paediatric Emergency Research Network study focusing on the child and family perspectives and will contribute to develop a core outcome set for future research.

/pdf/international-perspective-on-research-priorities-and-outcome-2zeoa7az.pdf

International perspective on research priorities and outcome measures of importance in the care of children with acute exacerbations of asthma: a qualitative interview study

Exposure to natural and human-made disasters is associated with long-term health consequences, including for mental health. Parents who have lost children, particularly their only children, in any circumstances are also at increased risk of developing mental health problems. The aim of this study was to review the available evidence about the psychological and social consequences for parents who had faced these circumstances simultaneously through losing children in a disaster. Systematic searching of the English and Chinese language literatures about the psychological and social functioning of bereaved parents after disasters revealed that a small number of studies met inclusion criteria. The results showed that bereaved parents had more mental health problems than bereaved spouses and non-bereaved parents, and mothers appeared to be more vulnerable to mental health problems than fathers. Potential protective factors for bereaved parents' mental health included having psychological interventions, having adequate social support, seeing their children's bodies and having a subsequent baby. Although the literature was modest and methodologically diverse, there was a consistent finding that parents who have lost children in disasters were at high risk of suffering mental health problems, especially bereaved mothers. As there was little evidence, further studies are needed to understand the best advice and interventions to offer bereaved parents and provide enhanced mental health care of such bereaved populations after disasters.

Psychological and social consequences of losing a child in a natural or human-made disaster: a review of the evidence.

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Effect of having a subsequent child on the mental health of women who lost a child in the 2008 Sichuan earthquake: a cross-sectional study

Gender Equity and Contraceptive Use in China: An Ecological Analysis

International perspective on research priorities and outcome measures of importance in the care of children with acute exacerbations of asthma: a qualitative interview study

Psychological and social consequences of losing a child in a natural or human-made disaster: a review of the evidence.