Parental coping and bereavement outcome after the death of a child in the pediatric intensive care unit

OBJECTIVE: Parental grief after the death of a child may be influenced by the chronicity of the child's illness, the quality of care provided, and the parents' ability to cope. Our objective is to identify aspects of pediatric intensive care and parental coping that have a favorable effect on parental bereavement outcome. DESIGN: Follow-up survey. SETTING: University teaching hospital. PARTICIPANTS: Fifty-seven parents who experienced the death of their child in the pediatric intensive care unit between January 1, 1995, and June 30, 1998. INTERVENTIONS: Parents completed two standardized questionnaires, the Coping Resources Inventory and the Texas Revised Inventory of Grief. The Coping Resources Inventory quantifies five coping resources: cognitive, social, emotional, spiritual, and physical. The Texas Revised Inventory of Grief is a two-part questionnaire that quantifies the intensity of grief at two time points: (1) near the time of death, and (2) in the present. Parents had previously participated in an interview with the investigators that included questions regarding the emotional attitudes of the pediatric intensive care unit staff and the adequacy of information provided during their child's critical illness. MAIN OUTCOME MEASURES: Texas Revised Inventory of Grief scores were used as measures of early and long-term grief. RESULTS: Parents' whose child died acutely had greater intensity of early and long-term grief than those whose child died of chronic illness (p < 0.05, Mann-Whitney U test). Parents' physical coping resources and the emotional attitudes of pediatric intensive care unit staff predicted the intensity of early grief (R(2) =.27, multiple regression). Parents' cognitive coping resources, the emotional attitudes of staff, and the adequacy of information provided to parents predicted the intensity of long-term grief (R(2) =.42). CONCLUSIONS: Parents' physical well-being enables more effective handling of early grief. Parents' understanding of their own self-worth and their child's illness determine long-term adaptation to loss. A caring emotional attitude displayed by pediatric intensive care unit staff has beneficial short-term and long-term effects on parental bereavement.