Anticipating parental death in families with school -aged children.

Abstract

This dissertation examines the impact of anticipated parental death on postmortem adjustment for families with school-aged children. Empirical research on anticipated death has been inconclusive and based on adult samples. No one has considered theoretically or empirically the impact of forewarning of death on children. This study provides both quantitative comparisons between sudden and anticipated deaths, and a descriptive exploration of challenges faced by families in anticipated deaths. Emphasis is placed on the role of parenting in mediating child adaptation to parental illness and death. Data for this investigation come from interview material and standardized outcome measures collected in Wave One of the Family Styles Project, a longitudinal community study of 41 parentally-bereaved families. Additional <italic> qualitative</italic> data come from interviews with parents and children in eight families added in an extension of Wave One. Independent variables include circumstances of death, length of illness and an assessment of parenting based on coding of interviews with surviving spouses. This coding rated child-centeredness of the surviving spouse on nine parenting tasks critical to shepherding children through a parental illness and death. Adult outcome measures included self-report of general symptomatology, self-esteem, grief and parenting confidence. Child outcome measures included self-report of depression and anxiety, and parent-report and teacher-report of general symptomatology. Quantitative findings demonstrate that anticipated death is associated with worse outcomes than sudden death for both surviving spouses and children. Illness length and parenting quality proved important variables in mediating child outcomes: compared to sudden deaths, anticipated deaths were found to expose youngsters to less child-centered parenting, for longer periods of time, as the well parent was physically and emotionally preoccupied with caring for the ailing spouse. Qualitative analysis highlighting the adverse impact of children's exposure to graphic stimuli, underscores the need for clinicians to attend to the traumatic strain of ordinary anticipated deaths, rather than maintaining an exclusive grief orientation. In contrast to the anticipatory grief literature which emphasizes the advantages of forewarning in cushioning post-mortem adjustment, findings from this study suggest that death preceded by an illness presents families with stressors that outweigh, and often preclude, the benefits of forewarning.