Edited by: Raffaella Calati, Centre Hospitalier Universitaire de Montpellier, France
Reviewed by: Adriano Schimmenti, Kore University of Enna, Italy; Carmen María Galvez-Sánchez, Universidad de Jaén, Spain
This article was submitted to Clinical and Health Psychology, a section of the journal Frontiers in Psychology
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The death of a parent in the 1st year of a child’s life represents one of the most significant painful events in his or her emotional development (
In spite of these results, only a few studies have been interested in the possible mechanisms underlying the associations between early parental loss and later mental and physical health, focusing on the quality of emotional-social support following the death (
Within the psychodynamic perspective (
From a developmental point of view, as suggested by studies by
In adolescence, the impact of early parental death also seems to affect other domains associated with the specific evolutionary tasks of this phase. In particular, adolescence is described as a transitional period of consolidation and integration of identity transformations (
Recent studies have suggested that the main mechanisms responsible for increased vulnerability to psychological and physical illnesses after parental death in childhood arise from the impact of this event on the system of response to physiological stress (
In this regard, among the primary resources that could help a child to adapt positively to his/her parental loss are the quality of the relationship with the surviving parent (
On the basis of the present literature, the aims of this 6-year longitudinal study were to (1) assess the possible predictive values of offsprings’ and parents’ psychopathological symptoms for the occurrence of physical problems in adolescents and (2) determine the sex differences in the predictive value of psychopathological symptoms for the occurrence of physical problems in adolescents.
The subjects recruited for this study were part of a larger sample (
In accordance with the Declaration of Helsinki, the study was approved before its start by the Ethical Committee of the Faculty of Psychology at Uninettuno University (n. 2/2010), and written informed consent was obtained from the parents before assessment.
From the larger sample, we selected for the aims of this study adolescents who had lost a parent in their first 3 years of life (
The assessments were carried out in four steps over 6 years. The mean (SD) age of the children at Time 1 was 6.31 (0.42) years; Time 2 was at 8 years of age; Time 3 was at 10 years of age; and Time 4 was at 12 years of age. The surviving parents’ mean age at Time 1 was 43.55 (2.3) years. At Time 2, the surviving parents’ mean age was 45.85 (1.9) years; at Time 3, it was 47.91 (2.4) years; and at Time 4, it was 50.01 (1.4) years. Sixty-two percent of surviving parents were mothers. All the children were of homogeneous nationality and were their parents’ biological children. Most families were of middle socioeconomic status (94%) (SES;
Physical health assessment was measured by pediatricians at all sessions through a modified questionnaire derived from Health Appraisal Questionnaire of the Centers for Disease Control and Prevention. The questions concerned gastrointestinal diseases (irritable bowel symptoms, duodenal, or gastric ulcer), cardiovascular diseases (hypertension, angina pectoris), and respiratory symptoms and diseases (asthma, chronic bronchitis, shortness of breath). A detailed description of this measure and its characteristics can be found in
The Child Dissociative Checklist (
The Symptom Check-List (SCL-90-R) is a 90-item self-report symptom inventory aimed at measuring psychological symptoms and psychological distress (
The parents of the recruited subjects completed the assessments for demographic information, offspring emotional-behavioral functioning, and their dissociation symptoms at their home, while the pediatricians filled out the measure to assess physical health at schools. Parents also filled out the measure for the screening of their own psychopathological risk (at home). Parents and pediatricians were asked to fill out the measures at 6, 8, 10, and 12 years of the child. To determine the risk factors for physical problems, data from participants who were classified as healthy in the initial assessment were selected for statistical analysis. Statistical analyses were performed using the Statistical Package for the Social Sciences, SPSS software (
The outcome variable (survival time) in the Cox proportional hazard regression was defined as the period between the initial assessment and the detection of occurrence of physical problems during follow-up. If a participant showed a relevant physical problem in a follow-up assessment, an event was recorded and that case’s data were not censored. On the other hand, if no relevant physical problem was detected by the pediatrician in any follow-up assessment, no event was recorded and the participant’s data were censored. Thus, censored individuals were those who either had no physical problem by the end of the study or were lost to follow-up during the course of the study before the physical problem had been identified. We examined the predictive values of sex and age for the occurrence of physical problems using the univariate Cox proportional hazard regression, and then we evaluated the predictive values of the psychopathological symptoms on the basis of those indicated by
A total of 418 mourning families completed the protocol, and all children were assessed by pediatricians in the course of their development toward adolescence. Of these, 12% (
To examine the predictive values of offsprings’ and parents’ psychopathological symptoms and offsprings’ dissociation and demographic characteristics (sex and age) for the occurrence of physical problems during the 6-year period, we carried out a univariate Cox proportional hazard regression analysis with time-dependent variables. In particular, we examined the predictive values of sex and age for the occurrence of physical problems using a univariate Cox proportional hazard regression and then we evaluated the predictive values of the psychopathological symptoms.
The results of the univariate Cox proportional hazard regression analysis are shown in
Predictive value of sex and psychopathological problems for the occurrence of a relevant physical problem in the univariate Cox proportional hazard regression.
Variable (no. missing data) | Number of relevant physical problems |
Wald χ2 ( |
Hazard ratio (95% confidence interval) | |
---|---|---|---|---|
Event | Censored | |||
Sex | 2.25 (1.46–2.69) | |||
M | 87 | 135 | 3.12 ( |
1 |
F | 91 | 105 | ||
Affective problems (2) | 22.42∗ ( |
1.96 (1.36–2.41) | ||
Yes | 47 | 176 | 1 | |
No | 75 | 118 | ||
Anxiety problems (4) | 19.71∗ ( |
2.12 (1.67–2.41) | ||
Yes | 52 | 98 | 1 | |
No | 162 | 102 | ||
Somatic problems (1) | 4.11 ( |
1.23 (1.12–2.25) | ||
Yes | 27 | 129 | 1 | |
No | 133 | 128 | ||
Attention Deficit/Hyperactivity problems (2) | 5.21 ( |
2.24 (1.32–2.68) | ||
Yes | 19 | 149 | 1 | |
No | 108 | 140 | ||
Oppositional Defiant problems (0) | 4.12 ( |
2.51 (1.44–2.99) | ||
Yes | 22 | 164 | 1 | |
No | 105 | 127 | ||
Conduct problems (3) | 3.51 ( |
2.31 (1.41–2.72) | ||
Yes | 47 | 105 | 1 | |
No | 145 | 118 | ||
Dissociation (5) | 15.51∗ ( |
2.14 (1.38–2.62) | ||
Yes | 51 | 153 | 1 | |
No | 111 | 98 | ||
GSI (2) | 12.49∗ ( |
2.19 (1.36–2.71) | ||
Yes | 46 | 128 | 1 | |
No | 143 | 99 |
Moreover, as can be seen in the procedure section, the children’s and parents’ psychopathological symptoms were input into a forward stepwise multivariate Cox proportional hazard regression (see
Number of cases with relevant physical problems at each follow-up assessment point.
Time 2 | Time 3 | Time 4 | |
---|---|---|---|
M 87 | 31 | 34 | 22 |
F 91 | 28 | 36 | 27 |
Predictive value of age, sex, and psychopathological symptoms for the occurrence of a relevant physical problem: Multivariate Cox proportional hazard (forward) regression.
Variable (no. missing data) | Wald χ2 ( |
Hazard ratio (95% confidence interval) |
---|---|---|
All participants (21) | ||
Age | 0.04 ( |
0.89 (0.76–1.37) |
Sex | 0.07 ( |
0.99 (0.79–1.42) |
Affective problems | 9.92∗ ( |
1.65 (1.21–2.12) |
Anxiety problems | 11.73∗∗ ( |
2.23 (1.42–2.52) |
Dissociation | 16.72∗∗∗ ( |
2.32 (1.48–2.84) |
GSI | 14.22∗ ( |
1.59 (1.11–2.02) |
The loss of a parent in childhood is one of the most significant painful events for a child’s emotional development. Several studies have highlighted that individuals who have lost a parent in early childhood have a greater risk of developing depressive symptoms in adolescence (
To examine the predictive values of offspring’s and parents’ psychopathological symptoms, dissociation, and demographic characteristics (sex and age) for the occurrence of physical problems during a 6-year period, we carried out a univariate Cox proportional hazard regression analysis with time-dependent variables. Results showed that, regardless of sex, offspring’s affective problems and dissociation and parents’ GSI were risk factors for the occurrence of relevant physical problems.
With regard to the surviving parent’s psychopathological risk, the international literature has underlined that a relationship characterized by warmth, emotional support, and acceptance (i.e., positive or effective parenting) is associated with lower psychopathological difficulties in bereaved children and adolescents (
Our findings would seem to confirm the influence of parental psychological difficulties and the emotional problems of children on their physical health. In order to understand the predictive value of these variables better and to determine which psychopathological symptom was the most significant predictor of physical problems, we used all significant psychopathological predictors found in the univariate analysis in a forward stepwise multivariate Cox proportional hazard regression. Results showed that offspring dissociation was the most significant predictor for the occurrence of relevant physical problems after controlling for sex and age.
According to our study, both the psychopathological parental risk and the youth dissociation contribute to physical problems, although the main predictor of these is dissociation. We can assume that the traumaticity of the event involves not only the loss of the parent but also the consequent change in the relationship with the surviving parent. In addition,
It is important to note that, in our sample, it appears that dissociating symptoms predict physical diseases in the specific period of puberty. Adolescence makes its debut with puberty. In this period, there are two changes that are fundamental to the psychophysical development of the individual: pubertal development and the consolidation of logical-formal thinking that makes it possible to organize the contents of the experience. Boys and girls go through a rapid and often unexpected bodily maturation, with the consequent modification of the relationship with themselves that is often perceived as outside their control. In addition, during adolescence, the maturation of cognitive structures and functions allows the acquisition of concepts, such as irreversibility and causality of events, connected with the concept of death (
On the basis of our results and
The present study has some limitations. First, the gender of the missing parent was not considered.
On the other hand, this study has several strengths. In particular, this is a longitudinal study, which takes into consideration a large sample of children who have lost a parent in early childhood, following them with assessments until early adolescence. Numerous studies have in fact underlined the importance of this delicate passage (
MT designed the study and wrote the draft of the introduction section. LC wrote the introduction and the methods sections. SC wrote the discussion section and the draft of the introduction section. GB and EM performed statistical analyses. RT supervised the study and approved the final draft.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.