PLACE IN RETURN BOX to remove this checkout from your record.
To AVOID FINE retum on or before date due.
MAY BE RECALLED with earlier due date if requested.

 

l DATE DUE DATE DUE DATE DUE

 

0&1'82 20000

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mo Wu

TESTING A MULTI-LEVEL MODEL OF FAMILY ADAPTABILITY
AND FUNCTIONING AFTER THE DEATH OF A PARENT

By

M. Lynn Breer

A DISSERTATION
Submitted to
Michigan State University
in partial fulﬁllment of the requirements
for the degree of
DOCTOR OF PHILOSOPHY
Department of Social Science

1997

ABSTRACT

TESTING A MULTI-LEVEL MODEL OF FAMILY ADAPTABILITY
AND F UNCTIONING AFTER THE DEATH OF A PARENT

By
M. Lynn Breer

This study developed and tested a conceptual model that hypothesized that both
individual and family level factors would impact individual grief and family functioning
after the death of a parent. The study examined the relationships between the individual
factors of social support, coping, and grief and the family factors of the nature of the
death, family communication, and family functioning. Participants consisted of 72
families with children between the ages of 12 and 18 who had experienced the death of a
parent within the last four years.

Although the overall conceptual model was not validated by the ﬁndings of this
study, parts of the model were conﬁrmed, and individual and family level variables
interact with each other. On the individual level, ﬁndings indicated that functional social
support inﬂuenced coping for both children and parents, and parent and child coping
affected parent and child grief. Functional social support also partially mediated the
relationship between the nature of the death and coping for parents. Family
communication signiﬁcantly influenced child coping, and parent and child coping
signiﬁcantly impacted family functioning for both parents and children. In other words,

for both parents and children. functional social support led to better coping, effective

coping led to progress through the grieving process, and progress through the grieving
process led to family functioning. The implications of these ﬁndings are that both family
and individual level variables play a role in the individual’s grief and on family
functioning. Future research needs to take this into consideration and examine both

family and individual level variables when working with a grieving population.

To all the families who have loved and lost.

iv

ACKNOWLEDGMENTS

This project required the help and support of many individuals. Fortunately for
me. I received immeasurable support and assistance from friends, family, faculty. and
participants. Without their help and support, this project would have been impossible to
complete.

I would like to thank all of my friends, Juliette, Bonnie, Christina, Jenna, Jessica.
Nicole, Dave, Dave. Melissa. Lance, Torn, Cheryl, Nancy, and especially Kris. You
always provided me with the support I needed. You listened, encouraged, inspired,
answered my questions, let me vent, and never allowed my frustrations to overwhelm me.
My words cannot convey what your support and friendship means to me. You have
helped me to grow as an individual and as a scholar. I just hope that at some point in
time I can give back some of what you all have given me.

I also need to thank my family, my mom. my sister, my brothers, their spouses,
and my nieces and nephews. You have taught me so much throughout my life. Your
love and strength have brought me to this point in my life. My trips home rejuvenated me
and helped to reset my priorities. Without all of you, I would not have made it through
graduate school. You inspire me, keep me grounded, and bring much needed laughter

into my life.

I would also like to express my appreciation to all the faculty that have helped me
throughout this process. First, I must thank Pennie for your enthusiasm and support
toward this project and for all the time you spent reading and reviewing my work. An
emphatic thanks to Deb for all the time you contributed to help me with my analyses and
answer all my questions. Thanks to Bob, Margaret, and Ellen for your ongoing support
and encouragement throughout this process.

Finally. I would like to express my thanks and appreciation to all the families that
had the courage and conviction to participate in the study and complete those excessively
long surveys. Their willingness to share their experiences regarding an extremely
traumatic and difﬁcult experience in their life in an endeavor to help others has provided
me with a valuable education. They are a constant source of support, inspiration, and

motivation.

vi

TABLE OF CONTENTS

LIST OF TABLES ...................................................... xi
LIST OF FIGURES .................................................... xiii
Chapter I .............................................................. 3
Deﬁning Grief ................................................... 10
Individual Grief Responses to Death ................................ 10
Childhood and Adolescent Grief ............................... 10
Normal Reactions. .................................... l 1
Long-term Reactions. .................................. 13
Summary. ........................................... 14
Adults and Grief Research .................................... 15
Summary. ........................................... 17
Time Since Death and Grief Reactions ................................ l8
Psychological Tasks of Grief: for Children ....................... 18
Adult Grieving: Schneider's Theory ............................. 20
Individual Level Factors Inﬂuencing Grief ............................. 22
Coping ................................................... 23
Coping and grief for parents. ............................ 26
Coping and grief for children. ........................... 27
Informal Social Support ...................................... 29
Informal support’s direct impact on coping for parents. ....... 3O
Informal support’s direct impact on coping for children. ...... 32

Summary of informal support for parents and children.
....................................... 35
Formal Support for Parent and Child ............................ 36
Summary of formal support for families .................... 38
Nature of Death as a Predictor of Social Support .................. 39
Support as a Moderator or Mediator of Nature of Death and Coping. .40
Age of Survivors ........................................... 41
Family and Grief ................................................. 43
Family Functioning ............................................... 45
Family Level Factors Inﬂuencing Grief and Functioning .................. 46
Nature of the Parent's Death ................................... 47

vii

Family Communication ...................................... 48

Conclusions ............................................... 51
Chapter 2
METHODS ........................................................... 54
Procedures ...................................................... 54
Recruitment ............................................... 54
Data Collection ............................................ 56
Participants ................................................ 57
Measures ....................................................... 58
Demographics ............................................. 58
Social Support ............................................. 58
Structural social support. ............................... 59
Functional social support. .............................. 60
Internal consistencies of the functional support scale. . . . 62
Family Communication ...................................... 67
Factor analysis of communication. ....................... 68
Psychometric properties of communication. ................ 69
Parent Coping .............................................. 71
Psychometric properties of the F-Copes scale ............... 72
Child Coping .............................................. 75
Psychometric properties of kidcope scale .................. 76
Parent/Child Grief .......................................... 77
Factor analysis of the RTL .............................. 80
Internal consistencies of the RTL survey ................... 82
Family Functioning ........................................ 100
Internal consistencies of FAD .......................... 101
Pilot .................................................... 105
Chapter 3
METHODS .......................................................... 106
Participants ............................................... 106
Use of Time and Age as Covariates in Analyses ........................ 106
Testing the Models with Structural Equation Modeling ............ 115
Testing the Models using Path Analysis ........................ 116
Analysis Strategy for Testing the Modiﬁed Models and Hypotheses . . 117
Testing Hypotheses 1 and 6 .................................. 118
Modiﬁed Model 1: Parent Coping as the Dependent Variable ............. 119
Predictors of Parent Coping .................................. 119
Testing parent version of hypbthesis 7: functional social support:
mediator or moderator of parent coping ............ 1 19
Testing hypothesis 8: structural social support as a mediator . . 122
Testing Parent Version of Hypotheses 2, 3, & 5 ............ 123

viii

Summary .......................................... 124

Modified Model 2: Child Coping as the Dependent Variable .............. 125
Predictors of Child Coping .................................. 125
Testing hypothesis 7: functional social support: mediator or
moderator of child coping ....................... 125
Testing hypothesis 8: structural social support as a mediator for
children ..................................... 127
Testing hypothesis 1 1: family communication as mediator of child
coping ....................................... 128
Direct Predictors of Child Coping ............................. 129
Testing child version of hypotheses 3 & 10. ............... 129
Summary .......................................... 130
Modiﬁed Model 3: Family Functioning and Grief ...................... 131
Family Functioning as the Dependent Variable ................... 131
Testing hypothesis 13: Family ﬁmctioning as the dependent
variable ...................................... 13]
Testing hypotheses 12 and 14: Coping on grief & mediation of
grief ........................................ 132
Summary .......................................... 134
CHAPTER 4
DISCUSSION ........................................................ 136
Time since Death and Age ................................... 137
Nature of Death Impacting Social Support and Coping ............. 138
Structural and Functional Support and Coping ................... 141
Formal Support and Child Coping ............................. 144
Formal Support and Parent Coping ............................ 145
Social Support as Moderator and Mediator ...................... 147
Coping and Communication ................................. 149
Coping, Grief and Family Functioning ......................... 150
Summary .......................................... 152
Limitations of the Present Research ............................ 153
Implications for Future Work ................................ 157
Interventions ........................................ 1 57
Conclusion ............................................... 159
APPENDICES
APPENDIX A: Recruitment Materials ............................... 160
APPENDIX B: Entrance Interview ............... ' ................... 163
APPENDD( C: Instruction Packet ................................... 166
APPENDIX D: Consent Forms ..................................... 170
APPENDIX E: Demographica Survey ................................ 172
APPENDIX F: Social Support Surveys .............................. 175

ix

APPENDIX G: Communication Survey .............................. 188

APPENDIX H: Coping Survey ..................................... 192
APPENDIX 1: Grief Surveys ...................................... 195
APPENDD( J: Family Assessment Device ............................ 213
APPENDIX K: Figures ........................................... 217
REFERENCES ....................................................... 229

LIST OF TABLES

Table l-Psychometric Properties of Family Support Scale for Parents .............. 63
Table 2—Psychometric Properties of Friends Support Scale for Parents ............. 64
Table 3-Psychometric Properties of Family Support Scale for Children ............. 65
Table 4-Psychometric Properties of Friends Support Scale for Children ............ 66
Table S-Psychometric Properties of Parent Communication Survey ................ 69
Table 6-Psychometric Properties of Child Communication Survey ................ 70
Table 7-Psychometric Properties of Mobilizing Coping Subscale ................. 72

Table 8-Psychometric Properties of the Seeking Spiritual Support Coping Subscale . . . 73

Table 9-Psychometric Properties of Passive Appraisal Coping Subscale ............ 73
Table lO-Psychometric Properties of Acquiring Social Support Coping Subscale ..... 73
Table ll-Psychometric Properties of Reframing Coping Subscale ................. 74
Table lZ-Psychometric Properties of Efﬁcacy Kidcope Scale .................... 76
Table 13-Varimax Rotated Factor Loading of Parent and Child RTL Subscales ...... 82
Table 14-Psychometric Properties of the Parent Coping Grief Scale ............... 83
Table lS-Psychometric Properties of the Parent Growth Grief Scale ............... 88
Table 16-Psychometric Properties of the Child Coping Grief Scale ................ 92
Table 17-Psychometric Properties of the Child Growth Grief Scale ................ 95
Table 18-Psychometric Properties of Affective Response FAD Subscale .......... 102
Table 19-Psychometric Properties of General Functioning FAD Subscales ......... 102

Table 20-Psychometric Properties of Affective Involvement FAD Subscale ........ 103

xi

Table 21 -Psychometric Prdperties of Communication FAD Scales ............... 103

Table 22-Psychometric Properties of Problem Solving FAD Scales ............... 104
Table 23-Psychometric Properties of Behavior FAD Subscale ................... 104
Table 24-Psychometric Properties of Roles FAD Subscales ..................... 105
Table 25-Characteristics of Participants .................................... 107
Table 26-Descriptive Statistics of Variables ................................. 109
Table 27-Intercorrelations of Variables Used in Regression Analysis ............. 111
Table 28-Intercorrelations of Variables Used in Structural Equation Model ........ 112

Table 29-Hypothesis 7A: Mediation effect of Functional Social Support for Parents . 120
Table 30-Hypothesis 7: Moderation Effect of Functional Social Support for Parents . 121

Table 3 1 -Testing Hypothesis 8: Mediation effect of Structural Social Support on
Nature of Death and Parent Coping .................................. 122

Table 32-Testing Hypotheses 2, 3, and 5: Parent Coping as the Dependent Variable . . 124
Table 33-Hypothesis 7A: Mediation effect of Functional Social Support for Children 126

Table 34-Testing Hypothesis 7: Moderation Effect of Functional Social Support for
Children ....................................................... 127

Table 35-Hypothesis 8: Mediation effect of Structural Social Support for Children . . 128
Table 36-Hypothesis 1 1: Mediation of Family Communication on Child Coping . . . . 129

Table 37-Testing Hypotheses 3, 5, 6 and 10 with Child Coping as the Dependent
Variable ....................................................... 130

Table 38-Testing Hypothesis 13: Impact of Grief on Family Functioning .......... 132

Table 39-Testing Hypothesis 14: Mediation effect of Parent and Child Grief on the
Relationship between Coping and Family Functioning ................... 135

xii

LIST OF FIGURES

Figure 1- Model 1: Social Support as a Direct Effect on Coping ................. 218
Figure 2-Model 2: Social Support as a Moderating Effect on Coping ............. 219
Figure 3-Functiona1 Social Support as a Mediator of Parent Coping .............. 220
Figure 4-Functional Social Support as a Moderator of Parent Coping ............. 220
Figure S-Structural Social Support as a Mediator of Parent Coping ............... 221
Figure 6-Parent Coping as the Dependent Variable ............................ 222
Figure 7-Functional Social Support as a Mediator of Child Coping ............... 223
Figure 8-Functiona1 Social Support as a Moderator of Child Coping .............. 223
Figure 9-Structural Social Support as a Mediator of Child Coping ................ 224
Figure lO-Child Coping as the Dependent Variable ........................... 225
Figure ll-Grief Predicting Family Functioning ............................... 226
Figure 12-Parent and Child Grief as Mediators of Family Functioning ............ 227

Figure 13-Modiﬁed Final Model .......................................... 228

xiii

Chapter 1

INTRODUCTION

Very few people manage to escape the loss of a loved one in their lifetime. When
a loved one dies. the world in which the survivor lives is not over, but the death changes
the character of that world signiﬁcantly (Stroebe, Stroebe, & Hansson, 1988). Picture a
family unit: a father, a mother, and two children. The family has the usual conﬂicts
between the siblings, between the parents, and between the children and parents, but
overall the family members feel secure and loved by each other. They all know their jobs
and responsibilities within the family unit. For example, each family member performs
chores around the house, spends time with each other, and provides advice, guidance, and
support for each other. They depend on each other to maintain equilibrium and balance
within the family. As a result, the behaviors of family members are reciprocally
interdependent: how one family member behaves affects the other family members,
which in turn inﬂuences the actions of the other members (Shapiro, 1994). Together the
family forms a complete four piece puzzle; each member represents one puzzle piece

connected to and dependent upon the three other pieces to complete the family system.

2

One day, without wanting, one of the parent pieces dies, ripping a signiﬁcant
piece out of the puzzle. How does this missing piece affect the remaining pieces? If the
surviving pieces wish to keep the puzzle intact, they must try to reconﬁgure themselves to
account for the gaping hole and adjust to a new life. If not, they may break apart and fail
to adjust to life without the missing piece.

This metaphor produces some important questions. How does the death of a
parent affect the family? What impacts the family members’ grief and their adjustment to
life without the parent? What factors facilitate family survival-the closing of the gaping
whole and adjustment to a new life without the parent? Herz (1980, 1989; reprinted in
Shapiro, 1994) found that the family position of the dead member helps to determine the
level of disruption caused by a death in the family. The death of a parent in a family with
children is extremely disruptive since the family depends on this parent to meet its
emotional and physical needs (Shapiro, 1994). The family depends on the parent for
love, attention, support, ﬁnances, advice, stability, and everything else that children and
spouses depend on from a parent/ spouse. The death of a parent causes gaps to develop in
the family's functioning and may interrupt its ongoing development (Herz, 1980, 1989;
reprinted in Shapiro, 1994). Death also causes structural changes in the family, such as
impaired functioning of family roles caused by grief and the loss of a stable member who
helps maintain family equilibrium (Shapiro, 1994).

The bulk of grief research to date has primarily examined how the death of a
spouse or parent affects the individual survivors. In the past, researchers have examined

how the death of a spouse affects surviving spouses (Barret, 1981; Barrett, 1978; Hauser,

3
1983; Lopata, 1986; Malikson, 1987; Silverman, 1988; Silverman, 1972; Silverman,
1970) or how the death of a parent affects surviving children (Balk, 1983; Bieri, Parrilla,
& Clayton, 1982; Eederwegh, Elizur & Kaffrnan, 1982; Harris, 1991; Kane, 1979).
Across these studies, several consistent ﬁndings regarding grief and coping have
emerged. Overall, these researchers have discovered that a) social support is a constant
predictor of adjustment to loss (Gray, 1989; Raphael & Nunn, 1988; Windholz, Marmar,
& Horowitz. 1985); b) Effective coping strategies inﬂuence a person's ability to grieve
and adjust to loss (Bertman, 1984; Olowu, 1989); c) Open communication about the
death and the deceased inﬂuences how well a person copes (Cook & Oltjenbruns, 1989);
d) The nature of the death affects a survivor's ability to cope (Bumell & Bumell, 1989;
Rando. 1984; Sander, 1982 ); and e) The age of the survivor impacts the survivor’s ability
to grieve the death and adjust to the death (Baker, Sedney, & Gross, 1992; Ball, 1977;
Johnson & Rosenblatt, 1981).

While studying the individual, researchers and clinicians, such as Baker, Sedney,
and Gross (1992), Kubler-Ross (1969), Schneider, (1994), and Worden (1982) have
developed theories about the grieving process. Other researchers have provided valuable
background information about reactions that the death of a family member produces in
surviving children and spouses. They have identiﬁed prominent emotional reactions,
such as sadness, longing, confusion, guilt, depression and anger (Elizur & Kaffrnan,
1982; Furman. 1983; Harris, 1991; Van Eederwegh, Bieri, Parrilla, & Clayton, 1982).
They have also discovered behavioral reactions, such as social withdrawal, aggression,

and reduced academic achievement (Elizur & Kaffman, 1982; Furman, 1983; Harris,

4

1991; Van Eederwegh, Bieri, Parrilla, & Clayton, 1982). Researchers have also
uncovered physical reactions, such as sleep and eating disturbances, hypochondriacal
concerns, and physical symptoms similar to the deceased's illness (Bumell & Bumell,
1989; Elizur & Kafﬁnan, 1982; F urman, 1983; Krupnick & Solomon, 1987; Wass &
Stillion. 1988). The death of a parent in childhood can have long term behavioral and
emotional affects on the surviving children (Elizur & Kaffman, 1982; Mireault & Bond,
1992; Ragan & McGlashan, 1986). Losing a spouse shatters long-term attachment bonds,
requires acquisition of new roles and statuses, may lead to economic difﬁculties, and may
remove the survivor's main support system (Osterweis. Solomon, & Green, 1984; Zisook
et a1., 1987).

The impact of the death of a parent/spouse emanates beyond the individual
survivors. It can also signiﬁcantly inﬂuence the family's functioning and family
relationships (Shapiro, 1994). For example, the emotional well-being of the surviving
parent can signiﬁcantly inﬂuence the emotional well-being of the surviving children
(Baker, Sedney, & Gross, 1992; Elizur & Kaffman, 1982). Elizur and Kaffman(1982)
suggest that the child's reactions to the death of a parent is connected to the functioning of
the surviving parent. As a result, if the surviving parent is functioning well and
supporting the surviving children. the children will cope and grieve more effectively
(Baker et al.. 1992). The child can affect the parent as well. For example, the "problems"
that grieving children face may prevent the surviving parent from totally withdrawing
from the family or keep a deeply depressed parent at least minimally involved in the

family (Baker et al.. 1992). The reactions and well-being of one family member

5

inﬂuences and may depend upon the reactions and well-being of other family members.
Sometimes the interactions between family members are beneﬁcial and sometimes they
are not. In fact, interactions within the family system may have detrimental effects on the
progress that any one family member may make when faced with a stressful situation
(Lieberman. 1978).

These ﬁndings suggest that grief extends beyond the individual level. From a
systems perspective, family members are interdependent on each other (Minuchin, 1985).
This interdependency has a spiral effect on all members within a system. The actions and
behaviors of one member affects all other members within the system, which in turn
affects the functioning of all other members (Kelly, 1966; Minuchin, 1985; Shapiro,
1994). In other words, each member of a family inﬂuences the other members of the
family. As a result, grief is not only an individual experience, but also a shared
experience among family members (Kissane & Bloch, 1994), and the death of a family
member can signiﬁcantly impact family functioning (Kissane & Bloch, 1994; Shapiro,
1994). Speciﬁcally, the death of a parent requires the family to achieve a new balance
following the death, and the capacity of the family to achieve balance inﬂuences their
functioning as a family unit (Kosciulek, 1994). However, our understanding of the effect
of death on family functioning is minimal. In their review of the family grief literature,
Kissane and Bloch (1994) discovered that the family grief research is extremely limited.
Research that has targeted the family system has primarily focused on families that have
lost a child or has examined the efﬁcacy of support groups/therapy. Therefore, studying

families with children after the death of a parent is an important but overlooked area.

6

Researchers have concluded that the death of a parent in childhood causes a crisis
situation with long term consequences (Elizur & Kaffman, 1982), and that the death of a
spouse is an extremely disruptive life experience with long term effects (Zisook,
Shuchter, & Lyons, 1987). But we do not know enough about how the family who loses
a parent adapts to the death. Gaining more knowledge and understanding about
adjustment after loss could help prevent future behavioral, emotional, and physical
problems for both adults and children. In order to have a better understanding of how
professionals can help families who have lost a parent, researchers need to examine
variables that inﬂuence grief, their interactions, and how they help the family adapt to the
death of a parent. This study provides such insight. Speciﬁcally it examines how
families with children cope, communicate, grieve, and adapt to the death of a parent on an
individual and family level.

The primary purpose of this study was to develop and test a conceptual model that
is the ﬁrst to include both individual and family factors and their impact on individual
grief and the functioning of the family system. Given that few studies have examined
how the death of a parent affects the family system and the surviving family members
(Kissane & Bloch, 1994), this study examined families with children who have lost a
parent. This study evaluated variables that past researchers have examined and linked to
grief and attempted to determine the relationships that exist among these variables.
Speciﬁcally, it explored the relationships and interactions among the nature of the parent's

death. social support, coping, family communication, grief, and family ﬁrnctioning.

7

The study tested two competing hypotheses in regards to the impact of social
support on coping. In the past, researchers have demonstrated that social support can
signiﬁcantly impact the grieving process (Raphael & Nunn, 1988; Windholz, Marmar, &
Horowitz, 1985). However, it is uncertain how social support actually inﬂuences
grieving. In their review of the social support literature, Cohen and Wills ( 1985)
developed two opposing hypotheses regarding how social support impacts stress. Their
main effect hypothesis suggested that social support beneﬁts individuals whether or not
they are experiencing stress. The support system provides individuals with stable,
predictable, caring relationships that beneﬁt a person’s life in general (Cohen & Wills,
1985). On the contrary, the buffering hypothesis implies that social support protects an
individual from the adverse effects of stress (Cohen & Wills, 1985). As a result, in the
absence of stress, no differences exist in the emotional well—being between individuals
with social support and individuals without social support (Bailey, Wolfe, & Wolfe,
1993).

Past researchers in the grief area have identiﬁed social support as a key factor for
the bereaved (Raphael & Nunn, 1988; Windholz et al., 1985). These studies focused on
the perception of social support (Gray, 1989; Hopmeter & Werk, 1994), the role of social
support (Vachon & Stylianos, 1988), and the stability of social support (Lund, Caserta,
Van Pelt, & Gass, 1990). They examined the impact of social support on multiple
outcomes, such as depression, self-esteem, mood, and physical health. These studies
have shown that social support tends to decrease physical illnesses and depression, and

improve mood (emotions, such as anger and guilt, experienced after death) after the death

8

of a loved one. In other words, social support positively impacts the bereaved. Since
social support is such an important variable in the grieving process, and since social
support could have a mediating or moderating effect, this study will be the ﬁrst to
speciﬁcally examine if social support has a direct or buffering impact on coping for
bereaved spouses and children. One model in this study assessed if social support
mediates the relationship between the nature of the death and coping while the other
hypothesized that social support moderates the effect of the nature of the death on the
individual’s ability to cope.

To test these models. this study recruited 72 families who have lost a parent
within the past four years. The surviving parent and one surviving child between 12 and
18 completed questionnaires that target the variables in the provided conceptual models.
The study targeted 12 to 18 year olds in order to gain information from both
preadolescents and adolescents. The models were tested using structural equation
modeling, path analysis, and regressions.

Deﬁning Grief

Bereavement, grief, and mourning are the three components that comprise the
grieving process (Mayers, 1986). According to Raphael (1983) and Mayers (1986),
bereavement is a normal reaction and adjustment to the loss of a loved one, whether from
death or some other trauma. A person may experience bereavement after a divorce or
after a permanent or temporary separation from a loved one. The emotions (sadness,
longing. confusion, guilt, and anger) one experiences from the loss of a loved one

characterize grief. Mourning consists of the social expressions (wearing black clothing)

9

of bereavement. These three concepts are all part of the grieving process which often
occurs over an extended period of time (Mayers, 1986).

Individual Grief Responses to Death
ChildhmdaniAdQIemLﬁrief

The death of a loved one produces many emotions and reactions in both children
and adults (Bumell & Bumell, 1989; Johnson & Rosenblatt, 1981; Osterweis, Solomon,
& Green, 1984; Silverman, 1988). Bereaved children experience intense emotional and
behavioral expressions, but these expressions are not continuous. Rather they are
intermittent (Bumell & Bumell, 1989) because a child's capacity to experience intense
emotions is limited (Osterweis, Solomon, & Green, 1984). In other words, children grieve
when they are emotionally able to deal with their feelings. For example, a child may go
weeks or even months without asking questions or exhibiting any emotional or behavioral
outbursts related to his/her grief. Then all of a sudden he/she begins to have problems at
school or becomes temperamental and overly sensitive. After a few days of this behavior,
the child returns to his/her "normal" self.

Wong, Children and adolescents often express their grief through
troublesome emotions and behaviors which may reoccur months and even years after the
loss (Bumell & Bumell 1989; Johnson & Rosenblatt, 1981). Common immediate and
intermediate reactions (ﬁrst several years following the loss) include: a) emotional
reactions, such as guilt, anger, depression, and sadness, (Elizur & Kaffrnan, 1982;
Furman. 1983; Harris, 1991; Van Eederwegh, Bieri, Parrilla, & Clayton, 1982); b)

behavioral reactions, such as reduced academic achievement, social withdrawal, and

10
aggression. (Elizur & Kaffrnan, 1982; Furman, 1983; Harris, 1991; Van Eederwegh,
Bieri, Parrilla, & Clayton, 1982); and c) physical reactions, such as sleep and eating
disturbances, hypochondriacal concerns, and physical symptoms similar to the deceased's
illness (Bumell & Bumell, 1989: Elizur & Kaffman, 1982; Furman, 1983; Krupnick &
Solomon. 1987; Wass & Stillion. 1988). Anger and guilt are two common grief reactions
in children and adolescents. Children and adolescents often experience a great deal of
anger after the death of a parent. They may be angry with the deceased for dying, with the
surviving parent for not preventing the death or for surviving, with their peers who have
two parents. and with God (F unnan, 1984).

The death of a parent can have a lengthy and signiﬁcant impact on the surviving
children (Elizur & Kaffman. 1982; Johnson & Rosenblatt, 1981). Elizur and Kaffrnan
(1982) studied the loss of a father in young children and followed them for four years.
They found that half the children showed emotional disturbances at 6, 18, and 42 months
following their father's death, and more than two-thirds of the children reacted with
severe psychological problems and impairment during at least one phase of the study.
They link these symptoms to the loss of the father and to the child's difﬁculties in coping
with all the stressful changes that accompany the loss of a family member, such as
changes in family structure, in daily routines, and in the functioning of the bereaved
mother. After the ﬁrst six months, they found a considerable reduction in the frequency
and intensity of affective grief reactions (crying, moodiness, longing, anger, protest,
denial. reviving image of the father, anxiety), but the number and severity of behavioral

reactions (aggression, thumb sucking, eating problems, dependency on mother, enuresis)

11

remained stable through the fourth year of the study. These ﬁndings indicate that the
death of a parent has a long term impact on the surviving children, with children often
expressing their reactions to the death of a parent by developing behavior problems that
last several years after the death.

Long-1W Long term impacts of death usually involve anniversary
reactions. Anniversary reactions, "behaviors and/or psychological or emotional symptoms
or feelings which are associated with speciﬁc times of special signiﬁcance to the
individual", are acknowledged as a normal reaction in the adult bereavement literature,
but little has been done with children's anniversary reactions (Plotkin, 1983). Fox (1985)
found that children did describe physical behavioral, and/or psychological responses
which occurred at times of special signiﬁcance. These anniversary times varied and
included birthdays, holidays, weather phenomena, and meaningful activities shared with
the deceased. Anniversaries can trigger intense feelings of loss and association with the
deceased family member, but these responses may occur at various times, predictable or
not and with varying frequency and intensity, because of the unconscious aspects of some
of the associations (Plotkin, 1983). Johnson and Rosenblatt (1981) suggest that children
who lose a loved one in childhood will have brief "relapses" of grief as they mature and
experience life events, such as graduations, ﬁrst pregnancy, marriage, problems friends
have with parents, and questions asked by one's children or signiﬁcant other. The
intensity of reactions due to anniversaries after the ﬁrst year of bereavement may be

overlooked, leaving bereaved children and adolescents at the "mercy of these feelings"

12

and without access to the support they may have received in the ﬁrst year of mourning
(Plotkin, 1983).

Children who suffer the loss of a parent oﬁen suffer long term consequences.
Ragan and McGlashan (1986) studied psychiatric inpatients at a long-term residential
treatment facility and found that those patients who experienced the death of a parent in
childhood had a signiﬁcantly greater family pathology and impaired social and
heterosexual functioning, and that a childhood parental death may be a contributing factor
to adult psychopathology. Mireault and Bond (1992) found that college students who had
experienced the loss of a parent in childhood perceived themselves to be more vulnerable
to future losses than a nonbereaved peer group. This perceived vulnerability to loss was
identiﬁed as a better predictor of adult anxiety and depression than the actual loss.
Altschul and Beiser (1984) state that bereaved children have reported problems with
parenting their own children especially if they experienced the loss of a same-sex parent
between the ages of 7 and 12.

Unresolved grief can lead to pathological/complicated manifestations of grief
(Bumell et al., 1989). Researchers estimate that 10-15% of bereaved individuals will
develop pathological outcomes, such as major depression, psychosomatic conditions,
phobias, obsessive and anxiety disorders, drug and alcohol abuse, family problems, or
psychotic disorders, following loss (Bumell et al., 1989; Zisook & DeVaul, 1983).
Rando (1992) states that the prevalence of complicated grief is increasing due to
sociocultural and technological trends. These trends inﬂuence today's types of death

(more violent and sudden deaths and deaths to AIDS), characteristics of personal

l3

relationships severed by death (conﬂicted, dependent, abusive relationships), and
resources (social support, family) of today's survivors. These factors produce numerous
emotions (anger, ambivalence) which complicate grief (Rando, 1992).

Summary, The loss of a loved one impacts most aspects of a surviving child's life
(Silverrnan & Worden. 1992). Research has shown that the loss of a parent produces
many emotional and behavioral problems for surviving children, that these reactions are
not restricted to a speciﬁc time period and that support at these times is often lacking
because it occurs years after the loss (Plotkin, 1983). These ﬁndings suggest that
researchers should assess children's behaviors along with their emotions in regards to
their grief reactions to the death of their parent since children often express their grief
reactions through their behaviors. The behavioral and emotional reactions of grief will be
examined in this study.

Adultundﬂtiefﬁesemh

Grieving is commonly considered a unique and personal experience for all the
people who shared a relationship with the deceased. For surviving spouses, the grief and
bereavement can be especially trying for it affects every aspect of their lives (Shuchter &
Zisook. 1988). The relationship between a husband and wife can be a special, unique, and
tight bond. When this bond is severed by death, a tremendous strain is placed on the
surviving spouse. The loss of a spouse through death is "considered the most disruptive of
all experiences of ordinary life" (Zisook, Shuchter, & Lyons, 1987). The death of a

spouse shatters long-term attachment bonds, requires acquisition of new roles and

l4

statuses. may lead to economic difﬁculties, and may remove the survivor's main support
system (Osterweis. Solomon, & Green. 1984; Zisook et al., 1987).

When conﬁonting the issue of grief and bereavement, people often think that
"time heals all wounds," that "they will work it through," that "they will get over it", and
that "they will recover". Contrary to these popular thoughts, spousal bereavement is not a
short-term crisis easily resolved in a prescribed amount of time. Instead it is often an
ongoing life-long struggle (Zisook et al., 1987). Time may ease the pain, but the wound
remains. As a result. the widowed must reconstruct their lives to accommodate the new
social position of being single (Kitson & Zyzanski, 1987; Silverman, 1988). While
making the needed transitions after death, the widowed often explore and lose part of
their existing social network (lose touch with married friends) and build a new social
network of single friends and other widows (Breer, 1993; Silverman, 1988).

The attachment bonds established between a husband and wife are so strong that
they may persist beyond the physical death of a spouse (Shuchter et al., 1988). The
survivors' separation anxiety may be so great that they may distort reality and create the
perception of a spouse's continuing presence. Bereaved spouses often experience visual
and auditory hallucinations and a sense of the dead spouse's presence. These
hallucinations are often perceived as messages from the deceased. The most common
type of distortion experienced by bereaved spouses is the presence of the dead spouse
(i.e., feeling that the spouse is in the room or looking down on the survivor) (Schuchter et

al.. 1988). This presence often provides comfort and support for the survivor.

15

The loss of a spouse is considered the most stressful life event on the Holmes and
Rahe (1967) stressful life event scale. Numerous studies have examined the relationship
between stressful life events and physical/mental health (Bowling, 1988). In their review
of the literature, Windholz, Marmar, and Horowitz, (1985) discovered that a signiﬁcant
number of people suffer from ill health following the death of their spouse.

Survivors often experience physical symptoms, such as insomnia, weight loss,
headaches. and increase their use of drugs such as tobacco, alcohol, and tranquilizers
(Owen. Fulton. & Markusen, 1982). Although the effect of death on physical health is
supported by many studies, most of the symptoms suffered such as weight loss, appetite
loss. and sleep disturbance are more often linked to psychological distress (Windholz et
al.. 1985). These symptoms occur as part of the psychological response to the loss of a
spouse. They also characterize the grief reactions experienced by the majority of bereaved
people within the ﬁrst year after the loss (Windholz et al., 1985).

Researchers have also studied the risk of mortality after the death of a spouse.
Bowling (1988) compared mortality rates of widowed and married persons and found
higher mortality rates among widowed men over the age of seventy-ﬁve in the ﬁrst six
months of bereavement. Helsing and Szklo (1981) also found that widowed men over the
age of 55 suffer from a signiﬁcantly higher mortality risk than married men of the same
age.

3mm Unquestionably, the loss of a spouse is an extremely disruptive and
stressful life experience with many repercussions. This experience can cause health

problems, shatter long-term attachments, relieve the survivor of her/his primary source of

-.'..< » .

16

emotional support (the deceased spouse), cause economic difﬁculties, require the
acquisition of new roles and statuses in society (Osterweis et al., 1984; Zisook et al.,
1987) and result in changes in their social networks (Breer, 1993; Silverman, 1974). They
may need to acquire new ﬁiends because they no longer feel comfortable with their
married ﬁiends (Silverman, 1974) and their married friends may not feel comfortable
around the widowed (Breer, 1993). In effect, the widowed experience multiple losses
(e.g., emotional support, economics, ﬁiends, losing and acquiring roles) associated with
the death of a spouse. As a result, they may need years to grieve and recover ﬁ'om not
only the death of their spouse but also the changes the death brings into their lives.
Time Since Death and Grief Reactions

The impact that time since death plays on the grieving process is very complex.
Research has revealed that time since death impacts both child and adult grief, but it
affects children and adults differently. Researchers have noted that over time emotional
grief reactions become less frequent for young children, but their behavioral reactions
remain stable over time (Elizur & Kaffrnan, 1982). For adults, Ball (1977) and Sanders
(1981) found that time since death interacts with age of the survivor, affecting the
intensity of a widow's grief reactions. Young widows have intense initial reactions while
older widows have more intense reactions about 18 months following the loss of a
spouse. Time since death moderates the impact age has on the individual's adaptation to
the loss and does so differently for different age groups.

Perhaps these reactions over time exhibit the natural process of grief for children

and adults. The grieving process is often explained as a series of phases or tasks that a

17

person must progress through or accomplish over time (Kalish, 1985) in order to accept
the reality of the death and to potentially grow from their experience.
E l I . II I [3' EH :1.”

Baker, Sedney, and Gross (1992) conceptualize the grieving process for children
as a series of sequential tasks that need to be accomplished or completed over time. This
model is divided into early, middle, and late tasks. The two early tasks that grieving
children need to complete are understanding the fact that someone has died and the
implications of this fact and self-protection of themselves, their bodies, and their families.
If children are to successfully deal with the loss of a loved one, they need information
about death in general and about the nature of the death of their loved one. If this
information is withheld, the children may ﬁll in the missing pieces with fantasy. But
even with accurate information, children may still need time to process and understand
what they have been told about death. If children are to begin grieving, they need to be in
a safe secure environment. In an unstable environment, children may fear that they will
die or that their family may disintegrate. As a result, children and their families may
focus on protecting other members of their family and isolate themselves emotionally or
physically from others (Baker et al.. 1992).

The three middle phase tasks are accepting and emotionally acknowledging the
reality of the loss, exploring and reevaluating the relationship to the lost love object, and
facing and bearing the psychological pain that accompanies the realization of the loss
(Baker et al.. 1992). For these tasks children explore the shared relationship with the

deceased in detail. Through this exploration, the child reevaluates and reworks the

18

relationship they shared with the deceased. During this phase some children may
maintain a healthy internal attachment to the deceased. This phase also involves facing
the painful feelings of loss and despair that often occur after a loss. The children must
weather this pain. If they do not, they may persist in clinging to the deceased as their
primary source of emotional support which will in all likelihood stop their progression
through the grieving process (Baker et al., 1992).

The late tasks of grief involve reorganizing identity and relationships. Children
must ﬁrst develop a new sense of identity including the experience of the loss and some
identiﬁcation with the deceased. Next children need to seek out new relationships
without an excessive fear of loss and without constantly comparing the new person to the
deceased. Third children must develop and maintain a strong and lasting inner
relationship with the deceased. Also, children need to return to age-appropriate
developmental tasks and activities that were interrupted by emotional loss. Finally,
children need to cope with the recurrence of painful feelings of loss that may occur at
points of developmental transitions or on speciﬁc anniversaries (Baker et al., 1992).

Schneider (1996 p. 68) developed a theory based on three phases of grief. This
model highlights personal growth and integration of the loss into the adult survivor's life.
Schneider's ﬁrst phase of grief is discovering what is lost. Discovering what is lost
involves becoming aware of the full extent of the loss which is the most difficult and
painful aspect of grief. During this phase of the grieving process, the bereaved vacillates

between awareness of the loss and limiting that awareness. The bereaved must limit the

l9

awareness because constantly facing the pain of the loss can paralyze the bereaved
(Schnieder, 1996, p.68). In order to cope during this phase of the grieving process, the
bereaved may either ﬁght the loss by holding on or escape the loss by letting go. The
bereaved hold on to the loss by trying to prevent, overcome, or reverse the loss. If the
bereaved want to escape or let go of the loss, they tend to withdraw, hide, or distract
themselves from facing what they have lost. If they try hard enough, the bereaved believe
they can overcome the threat or the reality of the loss. Letting go of the loss allows the
bereaved to rest and to reduce the fear that everything meaningful in life has been taken
away. Using the coping strategies of holding on and letting go allows the bereaved to
slowly become conscious of the implications and extent of the loss and to experience the
full extent of the loss. This awareness is commonly referred to as “grieving”.
Awareness, the most difﬁcult and painful part of the grieving process, may challenge the
bereaved‘s will to live. At this point, the bereaved may determine whether or not what is
lost is too much to live with or that life is worth living (Schneider, 1996 p. 70-71).

Phase two of Schneider’s theory involves discovering what is left. This phase of
the grieving process involves healing, restoration, perspective, and integration (Schneider,
1996, p. 71). At this point in the grieving process, the bereaved may take one of three
paths. According to Schneider (1996) they may “1) return to coping to limit further
awareness, 2) move into a time of healing, passivity and resignation, or 3) proceed to a
more active discovery of what is left or can be restored.” If the bereaved return to coping,
the loss has not been fully examined and awareness is incomplete. If the bereaved does

not return to coping, they move on to gaining perspective on their loss. They look for

 

20

what they have left, what can be restored, what the positives and negatives of the may be,
consider the long term implications, remember as much as possible about the loss, and
rediscover the little things that keep them going and bring pleasure (Schneider, 1996, p.
72). Once perspective is attained, the bereaved may move on to integration. Integration
allows the bereaved to ﬁnd motivation for change and growth and to move on. Moving
on may include ending an active focus on the past, saying good-bye, ﬁnishing business,
forgiveness, releasing feelings, and committing to the future (Schneider, 1996, p. 72).

Next, the bereaved may move toward discovering what is possible. Reforrnulating
the loss may be a very self-empowering experience for the bereaved. During this phase,
the bereaved reforrnulate how they look at life and themselves and transform loss. They
focus on potential, challenge limits, refonnulate beliefs, expand deﬁnition of self, ﬁnd
new patterns and life themes, and place the loss in a context of growth (Schneider, 1996,
p.72-73).

Obviously, these tasks and stages cannot be accomplished in a few days, weeks, or
even months for most people. Individuals progress through their grief at different paces,
probably due in part to the survivor’s coping abilities, the relationship shared with the
deceased, and the nature of the loss. Some bereaved individuals may never accomplish
all the tasks of grief or progress through the phases of grief. Although individuals
progress in different ways, time since death is an important factors. In this study, time
since loss will be measured in years since the death and will be linked with grief to see if

it impacts where individuals are in the grieving process. Grief will be measured in phases

21

for both adolescents and adults. The advanced phases of grief indicate that individuals
are progressing and adapting.
Individual Level Factors Inﬂuencing Grief

Thus far, the literature has shown that the death of a parent/spouse has emotional,
behavioral, physical, economic, and long term implications for both children (Elizur &
Kaffman. 1982; Van Eederwegh et al., 1983) and spouses (Breer, 1993; Osterweis et al.,
1984; Silverman, 1974). The loss of friends and primary support is also a consideration
for the bereaved (Breer, 1993; Ostervveis et al., 1984; Silverman, 1974). Clearly, it is
important to identify factors that can potentially lighten this impact. There are many
individual level factors that may inﬂuence the physical and emotional well-being of the
bereaved individual. These factors include age of the survivor (Ball, 1977; Berlinsky et
al., 1982), the survivor's coping ability, and the adequacy of social support, (Zisook,
Shuchter, & Lyons. 1987). Figures 1 and 2 portray the proposed models that describe
these variables, their interactions. and their effect on grief and adaptation that were tested
in this study. The individual level variables in these ﬁgures are indicated by solid lines
and the family level variables are indicated by dotted lines. According to this model, the
social support that the individual family members receive will inﬂuence how well they
cope with the death. A parent's coping ability will inﬂuence his/her own grief, and a
child's coping ability will inﬂuence his/her own grief. In addition, on the family level,
parent's coping ability and the child's coping ability will share a reciprocal relationship.
These variables and their hypothesized relationships are described below.

Canine

22

The death of a parent or spouse is a highly stressful event (Levine & Perkins,
1987. p. 163; Zisook et al.. 1987; ). In fact, the death of a parent or spouse is often
classiﬁed as a crisis requiring change and adaptation because it is an event beyond the
individual's control, and it may place strain on the "material, physical, or psychological
resources of the individual, his or her family, or others who might be a part of the
individual's social support network" (Levine & Perkins, 1987, p. 161). The outcome of
the death of a loved one may vary depending on the individual's psychological
characteristics and resources (Billings & Moos, 1981; Dohrenwend, 1978; Levine &
Perkins. 1987; ). Dohrenwend (1978) proposed three possible outcomes of a stressful
event. She hypothesized that the individual either becomes stronger, returns to the
previous level of functioning. or develops psychopathology as a result of experiencing a
stressful event.

In the past. coping was seen as a set of intrapsychic (i.e., cognitive) mechanisms
(e. g., denial) which guard an individual's emotional functioning from external threats
(Billings & Moos. 1981 ). More recently, the coping process has been described as
including both cognitive responses which help one deal with external stressors as well as
behavioral responses which help one to avoid the problem (Billings & Moos, 1981;
Fleishman. 1984). Lazarus (1966) deﬁned coping as strategies used to deal with stressful
events or threats. In order to deal with a stressful event, individuals use their coping
strategies which help 1) reduce vulnerability to stress (Dohrenwend, 1978), 2) maintain
psychosocial adaptation during stressful periods (Lazarus & Folkman 1984), and 3)

decrease emotional distress (Pearlin & Schooler, 1978). Coping has also been deﬁned as

23

a set of processes used to moderate the repercussions of stressftrl life events on an
individual's physical, emotional, and social functioning (Billings & Moos, 1981).

Coping strategies and responses are classiﬁed in a variety of ways (Moos &
Schaefer, 1993); however, most responses fall into one of two categories: approaching
and confronting the problem or avoiding the problem (Roth & Cohen, 1986). Folkman
and Lazarus (1980) categorized coping strategies into problem focused coping and
emotion focused coping. Both emotion and problem focused coping strategies have
strategies that both approach and confront the problem as well as deny the problem
depending on the type of problem or emotional strategy the individual uses.

F olkman and Lazarus (1980) deﬁned problem focused coping as attempts to
eliminate or decrease demands and/or to expand resources for managing them. For
example, seeking information about the problem from books or other resources and
relying on past experiences to help decide what to do are both examples of problem
focused coping that helps the individual confront the problem. Keeping active and busy
so that there is no time to think about the problem is a problem focused coping strategy
that avoids the problem. Emotion focused coping was deﬁned as endeavors to manage
emotional states associated with stressful events. Seeking support from family and
friends and sharing feelings and emotions are examples of emotion focused coping that
confronts the problem. However, avoiding discussions or burying feelings regarding the
problem are examples of avoiding the problem using emotion focused coping. Both
avoiding and confronting emotion and problem focused strategies can have positive

effects for people (Sanders, 1980; Schneider, 1996). For example, denial can provide the

24

bereaved time to emotionally prepare for the feelings and reactions they have in response
to the death of a loved one. However, the prolonged use of avoidance techniques may
have less positive consequences for the bereaved (Sanders, 1980). For example, if the
bereaved continue to deny the death, they can never accept that the death happened, and
as a result, they may never accept or cope with their loss.

In order for researchers and professionals to help the bereaved, it is necessary to
understand how the bereaved cope with their loss and how coping impacts grief. Given
that the death of a family member is such a highly stressful event for both parents and
children (Levine & Perkins, 1987, p. 163; Zisook et al., 1987) and that both parents and
children tend to have both emotional (i.e., emotion focused) and behavioral (i.e.,, problem
focused) reactions (Schneider, 1996; Worden, 1996), it is important that researchers and
professionals examine both problem focused and emotion focused coping strategies for
both parents and children and investigate how effective coping impacts the grieving
process.

Comm None of the studies in the grief area have adequately
examined the relationship between grief and coping for parents or children. Most of the
studies performed in this area discuss coping in a general sense (e.g., behaviors,
emotions, physical symptoms, and stress). They do not specify the coping techniques
used by their participants, nor do they examine coping directly. These studies also tend to
examine grief in terms of adjustment to a new life situation (e.g., psychological well-
being) instead of examining where the bereaved are in the grieving process. In order for

professionals to help the bereaved effectively, they need to know what coping strategies

25

are the most constructive and useful to the bereaved for coping and the grieving process.
Since the grief studies have not adequately examined coping or grief, the current study
evaluates these factors directly. It also examines coping in relation to grief and the
factors that affect coping.

Researchers have examined coping after the death of a spouse for adults in
relation to adjustment and variables that affect their coping abilities. Ben-Sira (1983)
examined adjustment and coping with bereavement using an adult population and found
that coping did predict adjustment after the death. Adults coping effectively tended to
adjust better than adults who were not coping well. Carey (1980) found that adults who
had forewarning about the death of a spouse (i.e., anticipated the death) tended to cope
better and as a result adjust better after the death. Sanders (1980) found that coping
impacted how well the widowed adjusted to the death. She identiﬁed that some bereaved
individuals employ strong denial defense mechanisms. These individuals tended to
accept the death as real but avoided dealing with their emotions. They continued to
function adequately in every day life, but never dealt with their grief. This group had
difficulty coping without their spouse. On the other hand, Sanders (1980) found that
widowed persons who expressed little confusion or unreality and could share their
feelings with someone coped and grieved very well.

These ﬁndings ﬁ'om these studies suggest that coping does impact the grieving
process for adults who experience the death of a loved one, and that other factors such as
the nature of the death have an important impact on coping (Carey, 1980). As a result,

this study hypothesizes that parents who anticipated their spouse's death will cope more

.33“... - ..

26

effectively than parents whose spouse died suddenly and that parents who are coping
effectively will grieve more effectively than parents who are not coping well.

WM Hogan and DeSantis (1994) looked at factors that
help and hinder adolescents coping with grief. They found that bereaved adolescents used
a variety of coping strategies, such as emotion and problem focused coping, to deal with
the death of a parent. Adolescents reported that keeping busy (problem focused coping),
releasing emotions (emotion focused coping), and playing an instrument (problem
focused coping) were helpful techniques when dealing with the death of their parent. The
adolescents also depended on members of their families and ﬁiends "who were there for
them" for support (emotion focused coping) during their grieving process. However,
Hogan and DeSantis (1994) found that a) intrusive thoughts, b) feelings of guilt, shame,
and loneliness, and c) recognizing the permanence of the death decreased adolescents’
ability to cope with their grief.

These ﬁndings suggest that the adolescent's perception of how hem they found
both emotion focused and problem focused coping strategies impacted how well they
coped with the death of their parent. In fact, Knapp, Stark, Kurkjian, and Spirito (1993)
suggest that when evaluating coping with children it is important to examine the child's
perceived efﬁcacy (i.e., how helpful did you ﬁnd that strategy) since norms for coping
strategies used by children have not been established. Measuring coping in this manner
also reduces the biases regarding "appropriate" coping strategies for children and evades
problems linked to making assumptions about a strategy being adaptive or maladaptive

(Knapp et al., 1993). As a result, this study evaluates the child's perceived efﬁcacy (i.e.,

27

how much did it help) of both emotion and problem focused coping strategies. This study
hypothesizes that when children perceive their coping strategies as helpful they will
grieve more effectively.

Baker, Sedney, and Gross (1992) suggest that how children cope can inﬂuence
parental coping. For example, children who are experiencing numerous behavioral and
emotional outbursts may keep their withdrawn and depressed parent involved with the
family. Elizur and Kaffrnan (1982) suggest that parental coping inﬂuences child coping.
They also found that when surviving parents are coping effectively and are able to
provide stable environments their children tend to cope effectively. Hogan and DeSantis
(1994) found that adolescents felt uncomfortable when their parents cried in front of them
and appeared distressed over the death of their parent. These ﬁndings imply that how a
parent copes and deals with the death of a spouse inﬂuences how their adolescent
children cope with the death. They also indicate that how children cope could inﬂuence
parent coping. This reciprocal relationship between the parent’s and the child's abilities
to cope is examined in this study.

Informaliocialﬁrmnon

Social support is a vague term that has been deﬁned in a variety of ways (Mitchell
& Trickett, 1980). In the framework adopted for this study, Cohen and Wills (1985)
conceptualize social support as having either structural or functional components.
Structural social support describes the nature and existence of the relationships within an
individual’s support network (Cohen & Wills, 1985). Measures of structural social

support examine the number of supporters, relationships between supporters and the

28

individual. and the interrelationships between the supporters (Kincaid & Caldwell, 198).
Functional social support evaluates the extent to which the relationships among the
support network provide a particular function (Cohen & Wills, 1985). Measures of
functional support tend to assess the perceptions of perceived and available support, such
as availability of emotional and practical support (Kincaid & Caldwell, 198). Functional
emotional support includes demonstrations of sympathy, encouragement, and
understanding while functional practical support involves help with material and ﬁnancial
problems (e.g.. babysitting, ﬁxing things around the house) (Malikson, 1987). In
addition, support networks can be divided into informal networks (family, friends, and
acquaintances) and formal networks (support groups, and professional support, such as
therapists, counselors). The grief literature has identiﬁed social support as an important
factor impacting grief outcomes. In fact, social support has been identiﬁed as the one
constant predictor of good outcomes after the death of a loved one (Raphael & Nunn,
1988; Windholz et al., 1985). However, no one has examined if social support has a
mediating or moderating effect on coping.
WWW Given that the death of a
family member is considered a highly disruptive and stressful event (Holmes & Rahe,
1967; Zisook, Shuchter, & Lyons, 1987), survivors may naturally turn to their networks
for the support they need in order to cope effectively with their loss. Researchers have
found a strong link between positive/effective perceptions of social support and healthy

adjustment, as evidenced by low distress. less depression, coping, and well-adjustment

29

(Ben-Sira. 1983; Gottlieb, 1983; Raphael & Nunn, 1988; Vachon et al., 1982; Windholz
etaL,l985)

Social support can signiﬁcantly enhance one’s coping ability (Ben-Sira, 1983;
Gottlieb, 1983). Both children and adults feel helped most when they have supportive
interactions with their social networks (friends and family) ( Dimond et al., 1987; Gray,
1989: Raphael & Nunn, 1988;). Widowed persons who perceive their networks as
supportive experience less distress and better outcomes in the ﬁrst two years of
bereavement (Dimond et al., 1987; Vachon et al., 1982; Raphael & Nunn, 1988). For
example, Raphael (1977) and Raphael and Nunn (1988) found that widows who lack
support or perceive their social networks as nonsupportive have adjusted poorly to their
spouses’ death a year after the death of their spouses. Vachon, Lyall, and Rogers (1980)
found that a disturbance in the social network (not seeing or contacting friends as often)
predicted poor adjustment to the death of a spouse. Vachon et al., (1982) found that
widows experiencing high distress two years after the death of their spouse felt isolated
from their social network and had infrequent contacts with their network. Dimond et al.
(1987) found that frequent contact and feeling comfortable expressing themselves and
sharing feelings and conﬁdences with the social network produced less depression, better
coping, higher life satisfaction, and better health in bereaved adults. Malikson (1987)
found that widows reported higher satisfaction with practical functional support (i.e.,
babysitting, help with household chores, money) than with emotional functional support
(i.e., expressions of sympathy, encouragement, understanding). In fact, all the

participants reported that people’s attitudes and comments were perceived as unhelpful

30

and often painful and that they had twice as many unhelpful emotional experiences than
unhelme practical experiences.

Clearly, social support plays a signiﬁcant role in the bereaved’s ability to cope
with their loss. However, the crisis of death may place tremendous strain on a previously
adequate network that then becomes perceived as "failing" in the time of need, leaving
the bereaved even more bereft (Raphael & Nunn, 1988). But the crisis of the death may
not be the only factor in a "failing" social support network. The bereaved may isolate
themselves from their network in an attempt by the bereaved to distance themselves from
painful reminders of their loss (Rosenblatt, 1988). The social network may also try to
distance themselves because they may not understand what happened and may lack
appropriate rituals or etiquette for dealing with the situation. Or, they may see the loss as
a threatening event which may happen to them. Finally, they may be uncomfortable with
another's grief, and the loss may remind them of their own vulnerability. Often the needs
of the bereaved family are too burdensome or uncomfortable for others to deal with
(Rosenblatt, 1988). While social support may be difficult to sustain, it is a critical
component for coping with the loss of a spouse. In fact, in Windholz et al.'s (1985)
review of bereavement literature, the one constant predictor of coping following the loss
of a spouse is social support. Grief researchers have thoroughly examined the impact of
functional social support for the bereaved, however, they have yet to examine adequacy
of social support (i.e,. the extent to which the emotional and practical needs of the

bereaved are met) speciﬁcally in terms of meeting the needs of the bereaved. In other

31

words, does the social support network meet the emotional and practical needs of the
bereaved?

WM Bereaved children also
appear to beneﬁt from the social support received from their network (Gray, 1989;
Worden, 1996;). In fact, Gray (1989) found that adolescents who reported low levels of
social support experienced signiﬁcantly higher levels of depression than adolescents who
reported high levels of social support. The adolescents in Gray’s (1989) study reported
that talking about the loss was the most helpful way to deal with their loss, and 40% of
these adolescents identiﬁed a peer as being most helpful. Silverrnan and Worden (1992)
also found that the bereaved children and adolescents in their study talked with their
friends about their deceased parent and found it helpful. Adolescents also appreciated
contact with people who understood what they were going through, especially those who
had also experienced the death of a loved one (Gray. 1989). However, adolescents may
not get the support they need from peers due to their peers’ limited experience and
understanding of the grieving process (Gray, 1989). This ﬁnding implies that children
and adolescents may need to seek social support from sources other than their peers in
order to receive the support they need and that adequacy of social support is vital to
children and adolescents.

Worden (1996) found that family support seems to play an even more important
role in children's adjustment to the death than support from ﬁiends. Worden (1996)
suggests that even though peer support is important, the home environment and the ability

of the surviving parent to adapt after the death of a parent is the most crucial component

32

of support for the surviving children in the family. If the surviving parent is not adapting
well, the support that is received from the peer group may not be enough to provide an
adequate amount of overall support for the child (Worden, 1996).

Rosen (1985) found that interactions with less signiﬁcant others such as adult
friends, extended family, police, and religious representatives can potentially have a great
impact on adolescents’ support and coping. Bereaved adolescents often receive
numerous negative responses from less signiﬁcant others regarding "be strong for your
parents" and pointed silences about the loss, which survivors oﬁen perceive as neglecting
their needs. She believes that less signiﬁcant others can encourage survivors to repress
and deny their grief, but they also have a great potential for helping survivors because
they may be the most appropriate person to whom the grieving child can turn. These
people are close enough to be trusted by the survivor, yet are detached enough not to be
deeply grieving at the same time (Rosen, 1985).

This research supports the importance of social support for children and
adolescents, but also highlights the difﬁculties children and adolescents may have in
ﬁnding this support. Adolescents tend to seek out friends for support and ﬁnd them
helpful (Silverman & Worden, 1992; Gray, 1989). However, these friends may lack the
emotional maturity needed to help, or the bereaved may not feel comfortable expressing
their emotions and reactions to these friends (Gray, 1989). When investigating the role
social support plays in the coping of adolescents, it is critical to determine the adequacy

of social support for the bereaved. In other words, it is vital to discover if the provided

33

social support meets the emotional and practical needs of adolescents as well as who
provides the support (e.g., family, ﬁ'iends/peers).

For children, structural social support has not been evaluated to the extent of
functional social support. Studies looking at structural support have mainly examined
with whom the adolescents interact. For example, Rosen (1985) found that interactions
with less signiﬁcant others such as adult ﬁ'iends, extended family, police, and religious
representatives can affect or inﬂuence adolescents. These less signiﬁcant others can
encourage survivors to further repress and deny their grief and loss. They also have a
great potential for helping survivors because they may be the most appropriate person to
whom the grieving child can turn. These people are close enough to be trusted by the
survivor, yet are detached enough not to be deeply grieving at the same time (Rosen,
1985). Harris (1991) found that adolescents rarely shared their immediate reactions with
friends or family. Harris found that older adolescents spent more time with friends than
at home. and even though adolescents rarely shared their reactions with others, older
adolescents oﬁen depended on a best friend for support. Younger adolescents (13-15)
tended to be more withdrawn and isolated and less involved with their peers (Harris,
1991). These adolescents tended to focus on their families and became immersed in their
grief. Over time, this may result in the loss of friendships, becoming "stuck" in one's
grief, poor adaptation to the loss, and becoming overwhelmed with the family and its
grief.

Taken together, these

 

ﬁndings suggest that both children and adults beneﬁt from effective social support from

34

their families and peers. Grief researchers have examined functional social support
through the availability of support (Malikson, 1987; Raphael & Nunn, 1988) and the
bereaved’s ability to express their feelings and concerns within their support network
(Dimond et al.. 1987; Malikson, 1987; Raphael & Nunn, 1988). Grief researchers have
also evaluated satisfaction with social support in terms of the supportiveness of the
network (Vachon et al., 1982) and the helpfulness of the network (Malikson, 1987). So
far, structural social support has been studied only through ﬁequency of contacts with the
social network (Dimond et al., 1987; Vachon et al., 1982). These studies have focused on
who provides the support and ﬁrnctional social support in terms of availability of support
and the perception of support (i.e., was it helpful or unhelpful) (Gray, 1989; Malikson,
1987: Raphael & Nunn, 1988). These researchers have identiﬁed and highlighted both
functional and structural social support as key factors for coping with the death of a
spouse and parent. However, none of these studies have examined adequacy of social
support in terms of meeting the emotional and practical needs of the bereaved which is an
important but overlooked component of functional support.

Given that social support is a key factor for bereaved individuals and that past
studies have not evaluated social support in terms of meeting the emotional and practical
needs of the bereaved, this study deﬁnes social support in the following manner: a)
structural social support is deﬁned as the frequency of contact with the network; b)
functional support is deﬁned as the adequacy of emotional and practical support (i.e., are
their emotional and practical needs being met by their support network) received from

family and friends; and c) both structural and functional questions will be asked regarding

35

the individual's informal support networks (family and friends). It is hypothesized that
individuals who received adequate support (needs are met) from family and friends will
cope better than individuals whose support is not adequate. In other words, adequate
social support directly impacts coping for both parents and children.
Wm

Walsh and McGoldrick (1991) believe that a family must face two adaptational
tasks after the death of a family member. First the family must share an acknowledgment
that the death occurred and share the experience of the loss. Second, the family needs to
reorganize itself so it can reinvest in other relationships and life pursuits (Walsh &
McGoldrick, 1991). Baker et al. (1992) and Schneider (1994) suggest similar tasks must
occur in both children and adults individually. They propose that grieving children and
adults must recognize their loss. face the emotional pain, and then integrate the loss into
their "new" life and perhaps potentially experience a sense of growth from their
experience. Family therapy, support groups, and preventive interventions are venues that
could facilitate this transition. These interventions could not only provide support and
validation of the bereaved's experiences but may also allow participants to face the pain,
make easier transitions and adaptations to their "new" life, integrate their loss, and/or
progress through their grief more effectively. Support groups and family interventions
are also possible resources that families can access to gain the emotional support they
need.

Black and Urbanowicz (1987) compared families that had attended family therapy

after the death of a parent to families that had not attended therapy. They found that

36
families participating in family therapy experienced fewer behavior and mood (worry,
depression, suicidal thoughts) problems and were physically healthier than the control
group. After two years, the children in the treatment group had fewer behavior problems
and talked more about their deceased parent. Their parents were in better physical health
than the control group. Zambelli, Clark, Barile, and de Jong (1988) developed a program
for bereaved children. Parents of participating children reported that at the end of the
intervention their children were more secure and expressive and better able to deal with
their anger about the death. Children whose parents also participated seemed to be more
comfortable discussing the death and their feelings and had fewer difﬁculties dealing with
their grief. Masterman and Rearns (1988) also found that children who participate in a
support group appear less constricted and angry over time and seem more able to
understand and cope with their emotional reactions. Parents of the participants reported
decreases in behavior problems and increases in communication about bereavement and
death that were not previously discussed (Masterman & Reams, 1988).

Gray (1989) found that the adolescents felt they were helped most frequently
when they were allowed to talk about their loss, especially with adolescents who
understood their loss or who had similar experiences. They found the relationships with
peers in a support group more helpful than other peer relationships. Adolescents who had
not participated in a support group often found distraction from their emotions more
helpful which may postpone the pain they need to feel to grieve. Others who valued

distraction used it more for a feeling of normalcy than for running ﬁom their pain. These

37

adolescents needed time away from their painful home environment, needed to feel as
though they belonged to the group, and needed to feel normal.

WWW Support groups and family interventions
seem to beneﬁt the participants. They often reduce misconceptions about death, make the
death less confusing for children, and normalize reactions to the death (Masterman &
Reams, 1988; York & Weinstein, 1981; Zambelli & DeRosa, 1992) which could impact
the individual’s coping abilities. Parents and facilitators report that children in support
groups are less angry and have fewer behavioral problems aﬁer attending a support group
(Masterman & Reams, 1988). Children and adults also appear to beneﬁt from gaining
support from peers with similar experiences. In the current study, it is hypothesized that
individuals and/or families who have participated in a support group or counseling will
cope more effectively than those who do not participate in formal support.
WWW

When examining the effects of social support on coping, one must gain a greater
understanding of what factors could predict social support for the bereaved. The nature
of the parent/spouse’s death could potentially impact the support received from friends
and family of the surviving family members. For example, anticipated deaths, such as
those due to unpreventable diseases are often easier to understand for both adults and
children (Crase & Crase, 1989). As a result. social support may be more readily available
for survivors of anticipatory deaths. However. in cases of long-term chronic illnesses.
survivors often ﬁnd themselves socially isolated after the death which would impact their

social support (Sanders. 1982). Some types of sudden deaths, such as homicide, suicide.

38

and AIDS. leave survivors feeling stigmatized which in turn may negatively affect the
availability of the survivor’s social support in a negative manner (Crook & Oltjenbruns,
1989). In sudden death situations, the support network may not know how to respond to
the bereaved or the situations surrounding the death, which impacts not only the
availability of social support but the bereaved’s perception of the social support received
(Crook & Oltjenbruns, 1989). Given that the nature of the death could potentially predict
social support for bereaved people (Crook & Oltjenbruns, 1989; Sanders, 1982), it is
important to form an understanding of the impact that the nature of the death has on
social support for the bereaved. As a result, this study examines the relationship between
the nature of death and social support. The study hypothesizes that parents and children

who experienced a sudden death will have less adequate social support than parents and

children who experienced an anticipated death.

 

Previous research indicates that the nature of the death impacts both coping and
social support (Crook & Oltjenbruns, 1989; Sanders, 1982). However, the grief literature
has yet to examine the relationships among all three factors: nature of the death, social
support and coping. This study examines the relationships among these three factors. It
attempts to determine if social support is a mediator or moderator between the nature of
the death and coping based on Cohen and Wills (1985) theory. regarding main or
buffering effects of social support on coping.

Cohen and Wills (1985) hypothesize that social support could either mediate or

moderate coping. Given that social support is such a signiﬁcant factor for the bereaved

39

(Raphael & Nunn, 1988; Windholz et al., 1985), it is important to examine both potential
relationships in regards to the bereaved since researchers have not determined if social
support moderates or mediates the impact of the nature of the death on coping. In order
for professionals and researchers to develop effective interventions for the bereaved, they
need to understand these relationships. As a result, this study examines both
relationships. Cohen and Wills (1985) determined that structural social support tends to
support the mediating hypothesis while ﬁmctional social support tends to support the
moderating hypothesis. However, other grief researchers have found that functional
social support tends to support the mediating hypothesis (Crook & Oltjenbruns, 1989;
Sanders, 1982). Consequently, this study examines the mediating hypothesis using both
structural and functional support and tests the moderating hypothesis using ﬁrnctional
social support.

In this study, Model 1 (see Figure 1) tests the mediating hypothesis using both
structural and functional support, and Model 2 (see Figure 2) examines the moderating
hypothesis using functional support. The mediating hypothesis hypothesized that
regardless of the nature of the death both adequacy of support (functional support) and
frequency of contact with the network (structural support) will mediate coping for both
parents and children. In other words, adequate social support and contact with the
support network positively impact coping regardless of the nature of the death for both
parents and children. Social support could also moderate the relationship between the
nature of the death and coping. This model hypothesizes that adequacy of social support

moderates the effect of the nature of death on the individual’s coping abilities. In other

40

words, parents and children who have adequate social support will cope better when they
have experienced an anticipated death.
W

A strong relationship exists between the age of child survivors and adaptability to
the loss (Berlinsky et al., 1982). A child's age when they lose a loved one impacts the
child's adjustment to the loss and his/her subsequent development (Berlinsky et al., 1982).
Several researchers (Berlinsky et al., 1982; Cleiren, 1993; & Crase & Crase, 1989)
suggest that younger children have a more difficult time adjusting to the death of a loved
one. Berlinsky et al. (1982) provide two potential reasons for this potentially diﬁicult
adjustment. These reasons are a) young children are not capable of understanding the
significance or meaning of death and b) the absence of a parent and the role model
provided by the parent could be detrimental to the child's development and autonomy.

According to Baker, Sedney, and Gross (1992) cognitive abilities of children
affect how they approach the early tasks of bereavement, that is their understanding death
has occurred and its implications. Preadolescents are likely to confuse the cause of death
and assign responsibility of the death erroneously. Younger children may see death as
reversible and expect to see the loved one sometime in the future (Baker et al., 1992).
Children oﬁen use denial, distract themselves, or use fantasy to cope with their emotions
(Sekaer, 1987).

Harris (1991) found that older adolescents spent more time with friends than at
home. These adolescents often depended on a best friend for support. This type of

relationship offered protection from family issues and support, but the disruption of this

41

relationship left the adolescents vulnerable to even more emotional distress. Younger
adolescents (13-15) tended to be more withdrawn and isolated and less involved with
their peers (Harris, 1991). These adolescents tended to focus on their families and
became immersed in their grief. Over time, this may result in the loss of friendships,
becoming "stuck" in one's grief, poor adaptation to the loss, and becoming overwhelmed
with the family and its grief. Harris’ (1991) ﬁndings suggest that age inﬂuences who the
adolescent seeks out for support and how they interact with their support system.

Age also inﬂuences the adj ustrnent to widowhood for adults. Research has shown
that initially older widows adjust better than younger ones (Cook et al., 1989). In fact,
Ball (1977) reported that six to nine months after the loss of a spouse young widows are
more likely than older widows to experience severe grief responses. Sanders (1981)
found similar results. She found that younger widows experienced greater intensities of
grief following the loss of a spouse; however, aﬁer 18 months these young widows
showed reductions on all scales with the exception of guilt and anger (Sanders, 1981).
Older widows. on the other hand, expressed less intense grief responses initially, but aﬁer
18 months, they experienced worsened scores at the time of the ﬁnal interview (Sanders,
1981). In other words, for adult survivors age of the survivor and time since loss interacts
to inﬂuence the magnitude and intensity of grief.

The impact of age on the grieving process is complex., Age affects how both
children and adults adjust to the death of a parent and spouse on the individual level and
this relationship is moderated by time since loss. For both adults and children, age as

well as time since death (Sanders, 1981) impacts their grief (Berlinsky et al., 1982). The

42

age of the individual inﬂuences the individual's grief. As a result, age and time will be
partialed out when examining the models.
Family and Grief

Thus far we have seen how the death of a parent and a spouse affects children and
adults individually. The death of a parent and a spouse creates numerous emotional,
physical, and behavioral reactions and disrupts the current life cycle for the individual.
However, grief is both an individualized and a shared experience (Kissane & Bloch,
1994). In other words, individuals react and cope differently to the death of a loved one
because of the unique relationship they shared with the deceased, their personality, other
family member‘s reactions, and their coping skills. However, individuals must cope with
their own grief within the context of all other people who are affected by the loss (Cook
& Oltjenbruns, 1989). In effect, individuals share the loss with members of their family,
and the way one member reacts to the death will affect all other family members (Kelly,
1966; Minuchin, 1985). As a result, the family also needs to grieve the deceased and
adapt to a life without the deceased. In the past, researchers have focused primarily on
the individual and have overlooked the impact of grief on the family system (Kissane &
Bloch, 1994).

According to Cook and Oltjenbruns (1989), a family is a system because it
consists of interacting parts and is governed by rules. In other. words, a family is
composed of individual members, their relationships with each other, and their
relationships with others outside the family. As a system, a family has shared values and

norms that help guide family functioning and predictable behaviors of family members.

43

These values and norms help the family maintain their balance or equilibrium. When a
death occurs the family is thrown into a state of chaos and must work to regain
equilibrium and balance (Cook & Oltjenbruns, 1989).

Within a systems perspective, the family composes the most signiﬁcant social
group where grief is experienced (Kissane & Bloch, 1994). Family members shared a
relationship with the deceased and each other and share memories and experiences with
the deceased. The family is the natural built in support network for each other, however,
grief researchers have not adequately examined the impact that grief has on the family
system (Kissane & Bloch, 1994). To understand this system impact, this study examines
the relationships between parent and child grief and family functioning. It tests the
impact of parent and child grief on family functioning and explores the possible
mediating relationship that grief may have between parent and child coping and family
functioning. As a result, this study hypothesizes that parents and children who are
grieving effectively will also have families that are functioning well and that parent and
child grief mediates the relationship between parent and child coping and family
functioning.

Family Functioning

According to McCubbin and McCubbin (1991; reprinted in Kosciulek, 1994)
family adaptation involves the family's attempt to achieve a new level of balance,
harmony. and coherence following a crisis. Kosciulek (1994) deﬁnes positive family
adaptation as a balance that aids unity and organization and fosters individual growth and

development which is facilitated by coping resources.

44

Part of the family's adaptation after the death of a parent includes adjusting to
changes in family roles. Family roles may change as a result of a loss. Families, like any
system, "require ongoing support of each individual component to keep the system
operating in balance. When an element is added or taken away, the system becomes
unbalanced and there is a struggle to reach homeostasis again" (Rando, 1984). So when a
family member dies and can no longer perform their roles, the roles may be reassigned,
placing more demands on the remaining family members (Rando, 1984). As a result,
each family member must not only deal with the loss, but with an out-of-balance system,
new responsibilities. the loss of certain roles. and the demands of the new responsibilities
which will increase the demand for adaptation of the mourners (Berardo, I988; Rando,
1984). For example, a surviving child may attempt to assume the responsibility of the
deceased parent, but the expectations of assuming this responsibility is not within the
child's capabilities (Johnson et al., 1981). As a result, the child has the potential of
developing personal and relationship problems because he/she may be less able to fulﬁll
"normal" childhood needs and may be learning behavior patterns that are not appropriate
for developing relationships with others (Johnson et al., 1981).

This research suggests that the loss of a parent affects numerous aspects of family
life, including changes in family stability and family roles. These changes place added
pressure on the surviving family members. As a result, the family must not only adapt to
the loss of the parent, but they must also adapt to the changes in the home and family as

well. This study evaluates how well the family functions aﬁer the death of a parent.

45

Family Level Factors Inﬂuencing Grief and Functioning

Numerous characteristics of the death itself and the family’s reaction to the death
will affect family member’s grief and adaptation. The nature of the parent's death affects
both the surviving parent's and child's coping ability. Surviving parents and children who
had a chance to say goodbye will cope more effectively than people who did not have an
opportunity to ﬁnish business. The family's communication about the death and the
deceased will inﬂuence the parent and child's coping ability. The parent’s coping abilities
will inﬂuence the child’s ability to cope. Families that discuss the death openly and
honestly and share memories of the deceased will have parents and children who cope
more effectively than families who do not discuss the death and the deceased. Families
who attend support groups will cope more effectively than families who do not.
Wm

One important factor that can inﬂuence how family members deal with loss is the
nature of the death. Unexpected death often produces a shock that has a debilitating
effect on the bereaved, which both prolongs grief and produces excessive physical and
emotional trauma (Rando, 1984). Similarly, a short duration of a terminal illness, a long
chronic illness (e.g., anticipate death more than 6 months), or no opportunity to discuss
the death with the deceased can also lead to poor outcomes. Lundin (l 984) found that
survivors of sudden death showed greater somatic and psychiatric illness than those who
experience an anticipated death. Other studies have found that both sudden and long term
chronic illness (> 6 months) deaths produced poorer bereavement adjustments than deaths

due to an illness that was intermediate in length (Rando, I983).

46

In cases of long chronic illness families can become immersed in the illness, have
difﬁculty "letting go" of the relationship, and tend to develop feelings of increased loyalty
and commitment which may intensify grief at the time of death (Bumell & Bumell,
1989). Survivors of long-chronic illness often ﬁnd themselves socially isolated which
can be very debilitating if the disease becomes the focal point in their lives leaving them
with little energy and time to keep up social ties (Sanders, 1982). Sanders (1982) also
found that survivors of sudden death had elevated levels of guilt because of the lack of
opportunity to make restitution or complete unﬁnished business with the deceased. They
also experience more physical symptoms, and the shock of the sudden death was still
evident 18 months following the loss. Sudden and violent deaths may produce complex
reactions and unanswerable questions that may produce more difﬁculties in coping (Crase
& Crase. 1989). Feeling stigmatized by the nature of the death (homicide, suicide) may
affect the availability of the survivor’s social support (Crook & Oltjenbruns, 1989).
Anticipating the death over a period of time may increase the survivor’s acceptance of the
death. Deaths due to unpreventable diseases are oﬁen easier to understand for both adults
and children (Crase & Crase, 1989). As a result, social support may be more readily
available for survivors of anticipatory deaths. These ﬁndings have linked the nature of
the death to physical health, somatic and psychiatric illness, bereavement adjustments,
shock, and other reactions to the death. These ﬁndings imply that the nature of the death
affects how well the bereaved cope and could potentially affect adequacy of social

support. Families who experience a sudden loss or a long chronic illness will have a

47

more difﬁcult time coping with their loss than families who have experienced an
anticipated loss.

The grief literature emphasizes and stresses the importance of communicating
about the death and the deceased within the family (Bertman, 1984; DeSpelder et al.,
1987; Olowu. 1990; & Schumacher, 1984), but research has shown that parents and
children do not communicate effectively about death if at all (Crase, & Crase, I989).
Crase and Crase (1989) suggest the following two possible explanations for this lack of
communication: a) parents are uncomfortable with the subject, do not relate well to it, and
tend to avoid discussing its implications; and b) parents want to protect their young
children from sensitive matter, assuming it will be detrimental to the child. Silverman
and Silverrnan (1979) suggest that sometimes a parent's inability to communicate about
the death may be due to their need to ﬁnd a way of coping with their new reality (living
without the lost loved one present) before they can begin to talk about their experience.

Researchers may have difﬁculty determining the role that communication plays
because parents and children may present conﬂicting accounts of family communication.
For example, Johnson (1982) looked at parent's and children's perception of their family's
communication about death. Johnson (1982) found that parents believe that they
discussed death with their children before the death of a loved one while the children
reported no communication about death prior to loss. She found the same phenomena
regarding the discussion of what will occur during the wakes and/or ﬁmeral homes. She

did ﬁnd that parents and children wanted to discuss the death and their reactions.

 

48

However, parents and children disagreed about the frequency of these discussions and
who initiated these discussions. The parents and children did not agree on how often they
discussed the death and who began these discussions. Parents overestimated the
frequencies of these discussions and the number of times their children initiated these
discussions. These ﬁndings reinforce the need to have both the parents and children
targeted in grief research since their perceptions of what occurs in the family may differ.
The differences in the parents and children's perceptions could be attributed to the parents
not fulﬁlling the needs of the children, or the children misinterpreting the parent's
messages. Perhaps the children leave these discussions with the feeling that they were
not heard and with unanswered questions.

DeSpelder, et al. (1987) stress how important open communication is to effective
coping for children. They suggest that parents can help their children cope by a)
acknowledging and accepting the child's feelings b) answering the child's questions
openly and honestly and c) listening to the child openly and actively. A child's ability to
cope with death increases if the child is allowed to grieve openly with the family, if the
child is allowed to participate in the funerals or rituals associated with the loss, if the
child is given prompt and accurate information, and if the child has the comforting
presence of surviving parent(s) or a known and trusted substitute (Bertman, 1984; Olowu,
1989). Support groups have also been an important outlet forpromoting communication
about death in the family (Masterman & Reams, 1988; York & Weinstein, 1981;
Zambelli & DeRosa, 1992). In other words, open communication is critical to effective

coping.

49

The surviving parent's ability to cope inﬂuences the child's ability to cope and to
adapt (Elizur et al., 1983; Gray, 1989; Silverrnan & Worden, 1992). The death of a
parent saturated most aspects of the surviving child's life. As a result, the surviving
parent's ability to maintain stability and routines, assume new roles, support the surviving
children, and adapt to a single-parent household inﬂuences how well the child copes and
adapts (Silverman & Worden, 1992). Parents who allow open expressions of feelings,
listen to their children's questions and fears, and answer their questions honestly enhance
their children's ability to cope with death (Bertman, 1984; DeSpelder et al., 1987; Olowu,
1989). Also. children may experience emotional disturbances years after the loss, and if
the surviving parent withdraws and becomes isolated, the surviving children may have a
more difﬁcult time coping with their grief especially since they lack the support they need
from their surviving parent (Crase et al., 1989; Elizur et al., 1983).

These ﬁndings suggest that effective communication can signiﬁcantly improve an
individual's coping with the death of a loved one. They also suggest that communication
needs careful evaluation. Surveys with both children and parents need to occur to gain
both perspectives since these perspectives may differ signiﬁcantly. Researchers should
ask all family members questions regarding a) family’s ability to discuss and answer
questions regarding death b) family's ability to discuss and answer questions about the
deceased and c) family’s ability to express their feelings openly. Parents who are coping
effectively will foster better communication within their family than parents who are not

coping well. Families in which parents and children communicate openly about the death

50

and the deceased will have children who cope more effectively with their loss than
families who do not discuss the death or deceased.
29mm

Researchers have made great strides towards understanding the grieving process
(Baker et al., 1992; Schneider, 1994, Shapiro, 1994), grief reactions (Bumell et al., 1989;
Berlinsky & Biller, I982; Elizur & Kaffman, I982; Osterweis et al., 1984) and factors
that inﬂuence the grieving process (Baker et al., 1992; Crase & Crase, I989; Elizur et al.,
1983; Gray. 1989; Silverman et al., 1992;). Various researchers imply how important
nature of death, social support, coping. communication, and age are to the grieving
process (Baker et al., 1992; Clieren, I993, Crase & Crase, 1989; Zisook et al., 1987).
These factors have been studied separately for individuals (children and adults) and to a
more limited degree for families. However, researchers have not studied the interactions
among these variables nor have they examined the multi-level nature of these variables as
they relate to grief and family adaptability.

One limitation in the grief literature concerns data collection. Many studies have
depended on the surviving parent to inform the researchers about the family (Van
Eerdewegh, Bieri, Parilla, & Clayton, 1982). This methodology assumes that the parent's
perspective fully and accurately represents the experiences of all family members.
Grieving families experience major transitions and changes in the family and family roles
on top of their grief. When a family member dies and can no longer perform their roles,
the roles may be reassigned, placing more demands on the remaining family members

(Rando. 1984). As a result, each family member must not only deal with the loss, but

51

with an out-of-balance system, new responsibilities, the loss of certain roles, and the
demands of the new responsibilities which will increase the demand for adaptation of the
mourners (Berardo, I988; Rando, 1984). Under these circumstances, it is unlikely that a
surviving parent can possibly know everything about what his/her children are doing at
school and how they are reacting to the loss. In fact, previous research suggests that
parents and children often have different perceptions of the coping, grieving, and adapting
that occurs after a loss (Johnson, 1982). As a result, this study will focus on gathering the
perspective of both the surviving parent and one child within the family. This study will
use children as their own informants and look at the death of a loved one on both an
individual and family level.

This study focuses on comparing two conceptual models (see Figures 1-2) of
family grief and functioning using the factors that have been identiﬁed as important
inﬂuences on the grieving process and adaptability. On an individual level, this model
examines the relationships between the nature of the parent's death, parent and child
coping, social support (ﬁtnctional and structural), and coping on the grief of family
survivors. On a family level, this model will look at the impact that family
communication has on parent/child coping, how parent coping inﬂuences child coping,
and how all these factors inﬂuence family functioning. Potential confounds of age of
survivors and time since death are partialled out of the analysis.

Using the proposed model, the following hypotheses will be investigated in this

study: 1) Parents and children who experienced a sudden death will be less likely to have

52

their functional support needs (adequacy of emotional and practical needs) met by friends
and family than individuals who experience an anticipated death.

2) Parents and children who experienced a sudden death will have a more difﬁcult
time coping than parents and children who experienced an anticipated death.

3) Functional (adequacy: emotional and practical needs met) social support will
directly impact coping for both parents and children.

4) Parents and children in frequent contact with their support networks will cope
better than parents and children who are not in frequent contact with their networks.

5) The parent's ability to cope will inﬂuence the child's ability to cope, and the
child's ability to cope will inﬂuence the parent's ability to cope.

6) Individuals who participate in formal support will be more likely to cope more
effectively than individuals who did not participate in formal support.

7) Functional social support (adequacy of social support) will either a) mediate the
parent's and child's ability to cope regardless of the nature of the death or b) moderate the
effect of the nature of death on the parent's and child's ability to cope.

8) Structural social support (frequency of contact with the network) will mediate
the parent's and child's ability to cope regardless of the nature of the death.

9) Parents who are coping effectively will have better communication within the
family than those parents who are not coping well.

10) Families who communicate openly about the death and the deceased will have
children who cope more effectively with the death than families who do not discuss the

death or deceased.

53

l I) Family communication will mediate the relationship between parent and child
coping.

12) Parents and children who cope effectively will grieve more effectively than
parents and children who have difﬁculty coping.

13) Families which have parents and children grieving more effectivley will
function better as a family than those families whose members are not grieving
effectively.

14) Parent and child grief will mediate the relationship between parent and child

coping and family functioning.

Chapter 2

METHODS

Procedures
Wm

To recruit farniiles several methods were used in this study. A letter to the editor

was sent to 1500 weekly newspapers that had circulations under 10,000 in Michigan,
Indiana. Illinois. Iowa, Ohio. Wisconsin, West Virginia, Pennsylvania, South Dakota,
Kansas. Oregon. Colorado and Minnesota (Appendix Al). The letter to the editor
discussed a personal experience with loss and the importance of studying families. It also
provided readers with an 800 phone number and e-mail address to contact the researcher
if they were interested in participating. A cover letter accompanied the letter requesting
the newspapers to use it as a letter to the editor, as a newsworthy item, or as a feature
article (Appendix A2). The cover letter also contained the researcher’s phone number
and address in case the newspaper had questions regarding the study or about grief in
general. This letter to the editor was also published in the November/December 1996
issue of Bereavement Magazine (a national magazine that publishes personal death and
grief related stories and articles from both lay people and professionals in the ﬁeld of

grief and loss).

54

55

Another resource accessed by the researcher was the INTERNET. The researcher
utilized "griefchat" and grief bulletin boards on the INTERNET. An announcement and
brief description of the study was sent to the members of griefth which consists of an
online support group and information resource for bereaved individuals and professionals
interested in grief. The researcher also contacted support groups, funeral homes, hospices,
and other support agencies in large communities, such as Lansing, Ann Arbor, Traverse
C ity, Detroit, Grand Rapids, Chicago, St. Paul, Cleveland, Fort Wayne, Alto Palto, and
Cincinnati. Information sheets (Appendix A3) and information letters (Appendix A4)
introducing the researcher and brieﬂy describing the study were distributed to these
agencies and circulated to their current members and people on their mailing lists.
DataLLQﬂsstiQn

Through all of the recruiting methods, the researcher provided interested families
with a local Lansing phone number, an 800 phone number, or an e-mail address in order
to contact the researcher to obtain further information. Upon contact, the researcher
determined if the family was appropriate for the study. If they ﬁt the criteria. the
researcher explained the study, answered all questions the family had, and performed a
preliminary interview which included collecting the age of everyone in the family, who
died in the family, when the family member died, how he/she died, and how much the
family anticipated the death (Appendix B). If the family was not appropriate for the
study, the researcher thanked the caller. Once the parent agreed to participate, the
researcher determined which child should participate in the study. Data was collected

from the surviving parent and one child in each family. If only one child in the family fell

56

between the ages of 12 and 18, that child was asked to participate in the study. In
families with more than one child between 12 and 18, one child was randomly selected.
If that child refused to participate, another child was randomly selected.

All parents and children independently completed self report measures. Local
families chose one of three options at the initial contact to complete the questionnaires.
The family could have 1) received the measures through the mail, completed them, and
sent them back in self-addressed stamped envelopes, 2) completed the questionnaires on
Michigan State University’s campus at their convenience, 3) or welcomed the researcher
into their home and completed the questionnaires while the researcher waits. If families
were not located in the Lansing area. the researcher obtained their address and sent them
the questionnaires in the mail with self-addressed stamped envelopes to return the
completed measures. If the questionnaires were not returned within 2 to 3 weeks, the
researcher called the families to determine how close they were to ﬁnishing the surveys
and to see if they had decided to not participate.

A letter (Appendix C), an instruction sheet for the parent (Appendix C 1) and child
(Appendix C2). and a mailing checklist for the parent (Appendix C3) and child
(Appendix C4) accompanied the mailed questionnaires. The instructions asked the parent
and the child to please sign and date the appropriate consent forms (Appendix D & D1),
to complete the questionnaires in separate rooms, and to seal their questionnaires in the
envelopes when completed to maintain the conﬁdentiality of both the parent and the
child. The envelope sent to the family included both the child and parent questionnaire

packets and the two self-addressed stamped envelopes. one for the parent and one for the

57

child. It was estimated that both the parent and the child surveys would take
approximately 2 hours to complete. Those families who participated received a thank you
letter and a summary of the results of the study.

B . .

Families that had experienced the death of a parent within the last four years with
at least one child between the ages of 12 and 18 years of age at the time of this study were
targeted. Families that were interested in participating but did not ﬁt the criteria of the
study were thanked for their interest and were asked to pass on the information to anyone
they knew. All the parents in the study completed a demographic measure, two social
support measures. the family communication measure, a coping measure, the family
functioning measure, and the split half version of the grief measure. All of the children
completed a brief demographic measure, two social support measures, the family
communication measure. a coping measure, and the shortened version of the grief
measure. All participants received the measures through the mail.

Measures
Dsmmrzhiss

Demographic data was collected to provide background and descriptive
information on the families. This instrument included questions regarding the age of each
family member, income, current marital status, ethnic background, education level,
religion. the number of deaths the family has experienced in the past 4 years, which
parent died. time since loss. and type of loss (sudden or anticipated). The parent

completed these questions. The child completed a brief demographic survey which asked

58

for the child’s age and if he or she had participated in a support group or therapy as a
result of the parent‘s death. The parent answered some of these questions in the
preliminary interview over the phone and the rest of the questions were completed with
the rest of the surveys. Included in the demographic questions was the nature of the
parents death (l=sudden and 2=anticipated) (Appendix E & E1).
Miriam

Two aspects of social support were measured. Structural social support was
evaluated for both parents and children in regards to both their informal support (family
and friends) and participation in formal support (support group, therapy, counseling).
Functional support was assessed for both parents and children in regards to the emotional
and practical support received from their informal support networks (family and friends).

WW Structural support was measured using a structural
support instrument developed by the researcher. Both the parent version (Appendix F)
and the child version (Appendix F 1) of this measure had 8 items. Three items evaluated
the size of the participants network in regards to family, friends, and formal support
members (e.g. Since the death of your parent/spouse, how many family members can you
really help you when you have a problem and really listen to you and talk to you?) These
questions were open ended. Three items asked the participants about the frequency of
contact with family. friends. and formal support members (e.g. Since the death of your
parent/spouse. how often do you talk with the friends who really help you when you have
a problem and who really listen to you and talk to you?) These questions asked the

participants if they were in contact with their network O=never, l=less than one time per

59

month. 2=one time per month, 3=2~3 times per month, 4=weekly, and 5=daily. This scale
also asked about changes within the parent’s and child’s social network. The participants
were asked about the extent to which their circle of friends has changed since the death
(l=not at all, 2=have lost a few and gained a few, 3l=have lost all friends and gained a few
new friends. 4=have all new friends, and Swther). This question was used for
descriptive purposes. The ﬁnal question of this scale asked whether or not the parent or
child participated in formal support (support groups, therapy, counseling). The impact of
participating in formal support on coping was evaluated.

Structural support, as measured by the size and frequency of contact with one‘s
network, was used to test Model 1 (Figure 1) which supports the Main Effect Hypothesis
developed by Cohen and Wills (1985). Means for the size of the network (number of
people in the network) were computed. and means for frequency of contact were also
computed. These two means were used as indicators for social support in Model 1 when
testing the structural equation model. Since there was a lot of missing data for the size of
the network (e.g. people tended to answer with few. several, all, or most instead of
providing an actual number). this mean was not used with the regressions. Instead, the
mean for frequency of contact with the support network was used with the regression
analyses.

WW To measure functional support, questions regarding the
adequacy of emotional and practical support provided by family and ﬁiends were
assessed for both parents and children. The Multidimensional Support Scale (MDSS)

deveIOped by Wineﬁeld, Wineﬁeld, and Tiggerrnann (1992) was used. The original

60

MDSS measures the frequency and adequacy of emotional and practical social support
from three sources--conﬁdants (7 questions), peers (6 questions), and supervisors (6
questions). For the purpose of this study, the sources were changed to family and ﬁiends
and only the adequacy questions were used for the analyses. The original MDSS has 19
items and has reliabilities ranging from .81 to .90 and the authors reported good
concurrent validity (Wineﬁeld, Wineﬁeld, & Tiggerrnann, 1992).

Six of the seven original questions on the family (conﬁdant) scale and ﬁve of the
six original questions on the ﬁiends (peer) scale were assessed by the parents and
children. The practical support question on both scales (e.g. how often did they help you
in practical ways. like doing things for you or lending you money?) was expanded into
more speciﬁc practical support typically needed by parents and children who have
experienced a death in the family. The added practical support questions for the parents
included: 1) legal help and advice you need; 2) ﬁnancial help and advice you need; 3)
help you need managing your household, such as chores. ﬁxing things, or generally
getting things done around the house; 4) help with transportation needs; 5) help with child
care needs; 6) help with other things you need. The additional practical support questions
for the children consisted of: 1) how often do you get rides to school activities when you
need them; 2) how often do you get rides to places you want to go when you need them;
3) how often do you get help with your homework when you need it; 4) how often do you
get money from your family when you need it (family scale only); 5) how often do you
get to do the things you did before your parent died, such as play sports, go to movies or

concerts, hang out with friends (family scale only); 6) how often do you receive the

6l

guidance you need since the death of your parent. Four emotional support questions were
also added for both parents and children. These questions included since the death of
your parent/spouse how often have your family/friends: 1) been supportive of you in
general; 2) really understand your feelings about the death of your spouse/parent; 3) give
you the comfort and reassurance you need; and 4) do you express your feelings about
your deceased spouse/parent with family/ﬂiends. The phrase since the death of your
spouse/parent was added to all the questions on the MDSS to reﬂect their experience
since the death of their parent or spouse.

Parents were asked 16 questions about the emotional and practical support
received from family. and 15 questions about the emotional and practical support attained
from ﬁiends (Appendix F2). Children were asked 16 questions about the emotional and
practical support received from family members and 13 questions about the emotional
and practical support received from friends (Appendix F3). Within each set of questions,
respondents answered two questions. Participants analyzed both the quantity of social
support and the adequacy of social support. However only the adequacy responses were
used in analyses since the bereaved individual’s perception of adequacy of their social
support (are emotional and practical needs met) has yet to be examined by grief
researchers. The adequacy questions asked participants if they would have liked to
receive this support 1 = More Often. 2 = Less Often, or 3 = It- Was Just Right.

WWW Both parents and children
received two scores for adequacy of the emotional and practical support obtained from

informal support. The two scores represent support received from 1) family and 2)

62

ﬁiends. The two scales for the parents had internal consistencies of .90 (family) and .93
(friends). No questions were removed from the family, friends, or formal support scales
for the parents. Tables I and 2 contain the psychometric properties and the internal
consistencies of the parent scales.

For the children’s scales measuring adequacy of social support received from
family and friends. the internal consistencies consisted of .85 (family) and .86 (ﬁiends).
A total of 6 questions were deleted from the children’s functional social support scales
due to corrected item total correlations below .30. Three were omitted from the family
scales and three were eliminated from the friends scale. These items are identiﬁed in
Appendix F4. Tables 3 and 4 contain the psychometric properties and the internal
consistencies of the child scales.

Functional social support, as measured by the adequacy of emotional and practical
support received from family and friends, was used to test both Mode] I (Figure 1) which
supports the direct effect hypothesis and Model 2 (Figure 2) which supports the buffering
effect hypothesis developed by Cohen and Wills (1985). Two means (family and friends)
for both parents and children were calculated. The means from the family and ﬁiends
scales were used to test the structural equation model. A grand mean of the family and

friends scales was computed and used with the regression analyses.

63

Table 1

151 'E 'EE'15 SIEE

 

Scale Items Mean SD Corrected
Item Total
Correlations
1. Since the death of your spouse, how often does your family 1.60 .49 .56
really listen to you and try to understand your problems and
concerns?
2. Since the death of your spouse, how often do you conﬁde in 1.63 .49 .59

members of your family about feelings or concerns you have about
your deceased spouse?

3. Since the death of your spouse. how often has your family been 1.72 .45 .62
supportive of you in general?

4. Since the death of your spouse, how often does your family give 1.62 .49 .64
you the comfort and reassurance you need?

5. Since the death of you spouse. how often does your family really 1.47 .50 .59
understand your feelings about the death of your spouse?

6. Since the death of your spouse. how often do you express your 1.58 .50 .61
feelings about your deceased spouse with family members.

7. Since the death of your spouse. how often does your family 1.70 .46 .69
really make you feel loved?

8. Since the death of your spouse. how often do they try to take 1.78 .41 .49
your mind off your problems by telling jokes or chattering about

other things?

9. How often do they answer your questions or give you advice 1.68 .47 .49

about how to solve your problems?

10. How often can you use your family as examples of how to deal 1.68 .47 .58
with your problems?

1 1. Legal help and advice you need? 1.73 .45 .58
12. Financial help and advice you need? 1.70 .46 .49
13. Help you need managing your household such as chores. ﬁxing 1.42 .50 .52
things. or generally getting things done around the house? .

14. Help with transportation needs? 1.65 .48 .48
15. Help with child care needs? 1.53 .50 .48
16. Help with other things you need? 1.57 .50 .61

Alpha=.90

 

Table 2

El 'E ‘EE'lS SlﬁE

 

Scale Items Mean SD Corrected
Item Total

Conelations

1. Since the death of your spouse. how often do your friends really 1.68 .47 .75

listen to you and try to understand your problems and concerns?

2. Since the death of your spouse. how often do you conﬁde in your 1.58 .50 .68

friends about feelings or concerns you have about your deceased

spouse?

3. Since the death of your spouse. how often have your friends been 1.71 .46 .76

supportive of you in general?

4. Since the death of your spouse. how often do your friends give 1.68 .47 .79

you the comfort and reassurance you need?

5. Since the death of your spouse. how often do your friends really 1.52 .50 .68

understand your feelings about the death of your spouse?

6. Since the death of your spouse how often do you express your 1.66 .48 .67

feelings about your deceased spouse with ﬁiends?

7. Since the death of your spouse. how often do they try to take 1.66 .48 .58

your mind off your problems by telling jokes or chattering about

other things?

8. How often do they answer your questions or give you advice 1.76 .43 .61

about how to solve your problems?

9. How often can you use your friends as examples of how to deal 1.66 .48 .76
with your problems?

10. Legal help and advice you need? 1.71 .46 .64
1 1. Financial help and advice you need? 1.76 .43 .46
12. Help you need managing your household such as chores, ﬁxing 1.53 .50 .66
things. or generally getting things done around the house?

13. Help with transportation needs? 1.69 .46 .53
14. Help with child care needs? 1.66 .48 .50
15. Help with other things you need? 1.56 .50 .66

Alpha=.93

 

65
Table 3

El 'E '[E'IS SlﬁL‘l'll

 

Scale Items Mean SD Corrected

Item-Total
Correlations

1. Since the death of your parent. how often does your family 2.50 .84 .56

really listen to you and try to understand your problems and

concerns?

2. Since the death of your parent. how often do you conﬁde in 2.56 .78 .41

members of your family about feelings or concerns you have about

your deceased parent?

3. Since the death of your parent. how often has your family been 2.42 .90 .64

supportive of you in general?

4. Since the death of your parent. how often does your family give 2.27 .94 ..64

you the comfort and reassurance you need?

5. How often does your family understand your feelings since the 2.23 .96 .60

death of you parent?

6. Since the death of your parent how often do you express your 2.34 .90 .53

feelings about your deceased parent with family members.

7 . Since the death of your parent. how often does your family 2.34 .94 .47
really make you feel loved?

8. How often do they answer your questions or give you advice 2.50 .78 .59
about how to solve your problems?

9. How often can you use your family as examples of how to deal 2.40 .88 .35
with your problems?

10. How often do you get rides to school activities when you need 2.71 .71 .37
them?

1 1. How often do you get rides to places you want to go when you 2.53 .84 .51
need them?

12. How often do you get to do the things you did before your 2.48 .88 .41

parent died. such as play sports. go to movies or concerts. hang
out with friends?

13. How often do you receive the guidance you need since the 2.50 .84 .45
death of your parent?

Alpha=.85

 

66

Table 4

El 'PriEE'lS SlﬁL‘l'll

 

Scale ltems Mean SD Corrected
Item-Total
Correlations
1. Since the death of your parent. how often do your friends really 2.43 .90 .52
listen to you when and try to understand your problems and
concerns?
2. Since the death of your parent. how often do you conﬁde in 2.48 .87 .61

your friends about feelings or concerns you have about your
deceased parent?

3. Since the death of your parent, how often have your friends 2.55 .83 .74
been supportive of you in general?

4. Since the death of your parent. how often do your friends give 2.31 .95 .72
you the comfort and reassurance you need?

5. How often do your friends really understand your feelings since 2.03 .99 .59
the death of you parent?

6. Since the death of your parent how often do you express your 2.31 .93 .54
feelings about your deceased parent with friends.

7. Since the death of your parent. how often do your friends try to 2.65 .60 .41
take your mind off your problems by telling jokes or chattering

about other things?

8. How often do your ﬁ'iends answer your questions or give you 2.41 .85 .38

advice about how to solve your problems?

9. How often can you use your friends as examples of how to deal 2.23 .98 .53
with your problems?

10. How often do you receive the guidance you need from friends 2.35 .94 .57
since the death of your parent?

Alpha=.86

 

67
E'lC ..

The communication scale for both the parents and children consisted of 14
questions relating to the discussion of the deceased loved one and the deceased's death.
The researcher designed this questionnaire which consisted of several questions regarding
areas deemed critical to effective communication by previous researchers, such as the
child’s ability to talk freely about the parent who died with family members, to express
their feelings openly within the family unit, to ask questions about the death and the
deceased and have them answered honestly, and to participate in the funeral or memorial
services (DeSpelder, et al., 1987). As a result, this scale included 14 questions in relation
to l) the extent to which the parents support open communication about the parent who
died, 2) the extent to which the family supports the child’s ability to express their feelings
openly within the family. 3) the extent to which the family allows questions about the
death and deceased and have them answered honestly, and 4) the degree to which the
child participated in the funeral or memorial service. The parents evaluated their
perspective of family communication between parent and child (e.g. I answer my
child(ren)’s questions about my spouse who died) (Appendix G). The children assessed
their perspective of family communication in regards to their ability to share questions
and feelings within the family (e.g. I am encouraged by members of my family to talk
about my parent who died.) (Appendix G1). The questions were answered using a 6 point

likert scale with 1=Strongly Disagree and 6=Strongly Agree.

68
W A factor analysis was conducted to determine

if the scales were unidimensional. The factor analysis for both the parent and the child
scales resulted in four subscales. The four subscales resulting from the factor analysis
made little sense conceptually; therefore, the whole scale was used for the purpose of this
study.

Wm Internal consistencies of .84 (parent
survey) and .86 (child survey) were established for this 14 item measure. Two items from
the child scale and four items from the parent scale were eliminated since their corrected
item total correlations were below .30. These items are identiﬁed in Appendix G2.
Removing these items increased the internal consistencies of these scales to .87 (parent)
and .90 (child). Tables 5 and 6 list the remaining items comprising the communication
scales. the internal consistency estimate, and the corrected item-total correlations (deleted
items are not included in the tables). The alphas from these scales indicate that the scales
are internally consistent. An overall mean score was computed for both the parent and
the child. These mean scores reﬂect how positively family communication about the
death is perceived within the family for both the parent and the child. Both the parent and
child mean scores were used in the structural equation model. In the regression analyses
the child's score was used to represent family communication since the parent and child

communication scores had a low correlation (F31) and since researchers have

determined that the child's perception is more important (DeSpelder, et al., 1987).

 

69
Table 5

EI'E'EE: ..§,

 

Scale Items Mean SD Corrected
Item-Total

Correlations

1. My child(ren) freely talk with me about their deceased parent. 4.28 1.38 .80

2. My child(ren) share memories about their deceased parent 4.88 1.05 .74

with myself and/or their siblings.

3. My child(ren) never ask me questions about their deceased 4.63 1.41 .53

paren. (R)

4. 1 encourage my child(ren) to talk about their deceased parent. 5.04 1.06 .58

5. My child(ren) ask me questions about their deceased parent. 4.54 1.29 .78

6. I honestly answer my child(ren)’s questions about their 5.59 .80 .52

deceased parent.

7. My child(ren) ﬁ'eely express their feelings with me about the 4.32 1.38 .68

death of their parent.

8. My child(ren) and I avoid talking about their deceased parent. 5.15 1.21 .62

(R)

9. 1 encourage my child(ren) to ask any questions they have 5.21 1.04 .36

about how their parent died.

10. I listen to my child(ren) when they want to talk about their 5.69 .50 .58

parent who died.

Alpha = .87

 

"(R) = Question recoded

70

 

Table 6
E I '13 . [2].”; 't' 5 ,
Scale Items Mean SD Corrected
Item-Total
Correlations
1. l freely talk about my deceased parent with members of my 4.13 1.44 .72
family.
2. 1 share memories about my deceased parent with members of 4.95 .97 .67
my family.
3. 1 never ask my family questions about my parent who died. 5.03 1.07 .46
(R)
4. 1 am encouraged by members of my family to talk about my 4.18 1.48 .61
parent who died.
5. 1 ask my family questions about my parent who died. 4.85 1.14 .52
6. The questions 1 ask about my parent who died are answered 5.20 1.06 .60
honestly.
7. My family does not encourage me to talk about my parent 4.98 1.45 .49
who died. (R)
8. 1 freely express my feelings about my parent with members of 4.15 1.45 .68
my family.
9. My family avoids talking about my parent who died. (R) 4.76 1.35 .58
10. 1 am encouraged by members of my family to ask any 4.41 1.50 .72
questions 1 have about how my parent died.
1 1. My family listens to me when I want to talk about my parent 5.06 1.02 .70
who died.
12. When 1 want to talk about my parent who died. my family 5.29 1.03 .67

changes the subject. (R)

Alpha = .90

 

" (R) = Question recoded

71
W

To measure coping the parents completed the Family Crisis Oriented Personal
Evaluation Scales (F -COPES) (McCubbin, Olson, & Larsen, 1994) which consisted of a
i 30 item measure designed to identify coping abilities for families in problematic
situations. The items on the scales were changed to the ﬁrst person in order to reﬂect the
individual survivor’s coping abilities alone, and they were asked to assess their coping
abilities since the death of their spouse (e.g. Since the death of my spouse, I face
problems or difﬁculties in my family by seeking encouragement and support ﬁ'om
ﬁiends). Questions were answered on a ﬁve point likert scale where I=strongly disagree
and 5=strongly agree. The F-COPES has an alpha of .86, and test retest reliabilities of .81
for the entire scale. and the 5 subscales have test retest reliabilities ranging from .61 to
.95. (Appendix H)

We, Tables 7 to 11 contain the
psychometric properties and internal consistencies of the ﬁve subscales. The internal
consistencies of the subscales for this study ranged from .30 to .87. The four item Passive
Appraisal subscale (e.g. watching television) and the four item Mobilizing subscale (e.g.
seeking information and advice ﬁom family doctor) were eliminated from this study
because their internal consistencies were poor (.30 and .69 respectively). The three
remaining subscales included: 1) Seeking Spiritual Support (e.g. attending/participating
in church services/activities) which measures the individual's participation in faith and
religion; 2) Reframing (e.g. accepting that difficulties occur unexpectedly) which

determines the individual's ability to evaluate and gain perspective on their problems; and

72

3) Acquiring Social Support (e.g. sharing my difﬁculties with relatives) which evaluates
the individual's ability to access and obtain support from their network. All three of these
scales assess the individual’s capacity to use both problem and emotion focused coping
strategies. Means for these three subscales were calculated and used to indicate parent
coping for the structural equation analysis. For the regression analyses, 3 grand mean of

the three subscales was computed.

Table 7

E l '13 . [1111" 2. S! l

 

Scale ltems Mean SD Corrected
Item-Total
Correlations

l. Seeking information and advice from persons in other families 3.20 1.32 .39
who have faced the same or similar problems

 

 

 

2. Seeking assistance from community agencies and programs 2 62 1 28 .60
designed to help individuals in my situation
3. Seeking information and advice from the family doctor 2.45 1.35 .38
4. Seeking professional counseling and help with my difﬁculties. 2.85 1.37 .55
Alpha = .69
Table 8
Scale Items Mean SD Corrected Item-
Total Correlations
1. Attending church services 3.53 1.49 .85
2. Participating in church activities 3.21 1.41 .88
3. Seeking advice from a minister 2.73 1.36 .65
4. Having faith in God 4.37 1.09 .53

Alpha = .87

73

Table 9

EI'E'EE'E'IZ'Sll

 

 

 

Scale ltems Mean SD Corrected
Item-Total
Correlations

1. Watching television 3.93 1.1 1 .15

2. Knowing luck plays a big part in how well we are able to solve 4.04 .88 .35

family problems.

3. Feeling that no matter what 1 do to prepare, 1 will have 3.91 1.03 .12

difﬁculty handling problems.

4. Believing if I wait long enough. the problem will go away. 4.36 .99 .13

Alpha = .30

Table 10
S a1 1

Scale Items Mean SD Corrected Item-

Total
Correlations

1. Sharing my difﬁculties with relatives 3.25 1.34 .53

2. Seeking encouragement and support from ﬁ'iends 3.72 1.17 .48

3. Seeking advice ﬁ'om relatives 3.32 1.21 .60

4. Receiving gifts and favors from neighbors (e.g. food. taking 2.99 1.32 .52

in mail. etc.)

5. Asking neighbors for favors and assistance 2.58 1.31 .65

6. Sharing concerns with close friends 3.84 1.1 1 .48

7. Doing things with relatives (get-together. dinners. etc.) 3.65 1.1 1 .44

8. Asking relatives how they feel about problems 1 face 2.57 1.17 .37

9. Sharing problems with neighbors 2.19 1.23 .46

Alpha = .81

 

74

Table 1 l

Elm'E'EEﬁ'Z'Sll

 

 

Scale Items Mean SD Corrected Item-
Total
Correlations

1. Knowing I have the power to solve major problems 3.99 1.01 .70
2. Knowing that l have the strength within myself to solve my 4.01 .96 .71
problems.
3. Facing the problems “head-on” and trying to get solutions 3.93 .95 .52
right away.
4. Showing that I am strong. 3.91 .93 .59
5. Accepting stressful events as a fact of life. 3.99 .92 .61
6. Accepting that difﬁculties occur unexpectedly. 4.03 .92 .51
7. Believing I can handle my own problems. 3.66 1.13 .66
8. Deﬁning my problem in a more positive way so that I do not 3.89 .91 .49
become too discouraged.
Alpha = .86

Cl .1 l C .

The children who participated completed a modiﬁed version of the Kidcope
questionnaire (Spirito. Stark. & Williams. 1988) which consisted of 11 items concerning
coping strategies (e. g. I thought about something else; tried to forget it; and/or went and
did something like watch TV or play a game to get it out of my mind). Kidcope is
concerned with both the frequency of usage for each coping strategy and the efﬁcacy or
how helpful they found each coping strategy. However, this study just focused on the
efﬁcacy (i.e. how helpful did you ﬁnd that strategy) questions since norms for coping
strategies used by children have not been established (Knapp et al., 1993). Measuring

coping in this manner also reduces the biases regarding "appropriate" coping strategies

75

for children and evades problems linked to making assumptions about a strategy being
adaptive or maladaptive (Knapp et al.. 1993). The children answered the efficacy
questions using ﬁve possible responses where 0 = Not at all to 4 = Very Much. The
authors report adequate test retest reliability and concurrent validity for this measure
(Spirito. et al.. 1988). (Appendix H1)

WWW Since the Kidcope scale has not been
used extensively. a factor analysis was conducted on the Kidcope questionnaire. Results
indicated a two factor solution which accounted for 50% of the variance. The solution
may be somewhat unstable given the small N used to test for factors. Both these factors
focused on problem and emotion focused coping strategies and did not seem conceptually
different from each other. As a result. the whole scale was used to represent child coping.

For this study. the internal consistency of the efﬁcacy Kidcope scale was .68. The
reliability analysis led to the deletion of one item (I kept thinking and wishing this had
never happened and/or that I could change what happened) due to a low corrected item
total correlations. Table 12 contains the psychometric properties and internal consistency
of the total Kidcope scale. A total mean was computed and used in the regression

analyses.

76
Table 12

E l 'E . [Eff] Ill 51

 

Scale Items Mean SD Corrected Item-Total
Correlations

1. I thought about something else. 1.62 1.20 .30

2. I stayed away from people. 1.79 1.85 .32

3. I tried to see the good side ofthings and/or 2.19 1.58 .35

concentrated on something good that could come out
of the situation.

4. I realized 1 brought the problem on myself and 1.24 1.72 .44
blamed myself for causing it.

5. I realized that someone else caused the problem 1.56 2.10 .48
and blamed them for making me go through this.

6. I thought of ways to solve the problem. 1.82 1.80 .39
7. I talked to others to get more facts and information 1.99 2.38 .37
about the problem and/or tried to actually solve the

problem.

8. I talked about how 1 was feeling. 2.57 1.23 .30
9. Turned to my family. ﬁ'iends. or other adults to 2.71 1.27 .30

help me feel better

10. 1 just accepted the problem because I know 1 1.98 1.49 .32
couldn’t do anything about it.

Alpha = .68

 

77
W
To measure the progression through the grieving process, parents and children
completed the Response to Loss (RTL) scale developed by Schneider, Deutsch, and
McGovern (1992). This scale helped the researcher to determine approximately where the
bereaved was in the grieving process. This questionnaire consisted of seven scales
representing Schneider’s (1995) phases of the grieving process: holding on, letting go,
awareness, healing and perspective, integration, reformulation, and transformation. Each
subscale also contained measures which assess grief reactions in the following ﬁve areas:
behavioral, cognitive, emotional, physical, and spiritual. The Holding On and Letting Go
scales measured how a bereaved person coped with the loss. Holding On (e.g. I look at
reminders of my loss such as pictures and mementoes) measured if the person coped by
believing s/he would overcome or destroy the loss or the threat of one. Letting Go (e.g.
It ’ s easier when I can forget what happened) measured if the person coped by escaping or
avoiding the impact of the loss. Awareness (e.g. I am unable to ﬁnd anything to look
forward to.) measured active grieving (i.e. the pain, loneliness, helplessness, and
h0pelessness of grief). Healing and perspective (e.g. I think about the effects of this loss,
how I have changed. what is different) assessed a person’s ability to begin examining
What‘ 5 left after a loss. Integration (e.g. I understand why it’s important to have times of
Celebration and remembering before it’s too late) examined the person’s ability to
remember, restore, and recreate their memories as well as their curiosity, patience,
ﬁt'nll'iess, and forgiveness. Reformulation (e.g. I’ve changed in ways that would not have

happened otherwise) assessed the person’s ability to ﬁnd signiﬁcance in the loss.

78

Transformation (e.g. I know that things in my life can change and life can still be

meaningful) measured the person’s ability to endure and complete transitions (Schneider,
1994). The subscales on the split half versions of this scale had overall reliabilities
ranging from .90 to .96. The shortened version of the scales had the following

reliabilities: Holding on .89, Letting go .93, Awareness .95, Perspective .83, Integration

.92, Self-Empowerment .92, and Transforming Loss .82 (Breer, 1993).

The questions on the scales were in statement form, and participants assessed if
the statements were true for them now or in the past few days or weeks. They answered
the statements on a ﬁve point likert scale with O=this isn't accurate about my current
response to this loss to 4 = this deﬁnitely is accurate about my current responses to this
loss- The responses for the children’s version were changed slightly in order to decrease
confusion for the younger children. These responses were also on a ﬁve point likert scale
with O=this is never true to 4=this is always true. Also, two questions pertaining to
making love and sex were removed from the children’s version because the pilot
participants felt they were inappropriate for the age group. The wording on some
questions were also changed in order to make it more understandable for younger

participants.
Since the total RTL consists of 517 items and takes approximately 1-2 hours to

complete and since the families will be completing a number of measures, the parents
comDIveted the split half version of the scale (Appendix I), and the children completed a
Shortened version of the scale constructed for the purpose of this study (Appendix II).

This shortened version consisted of 158 statements. The transformation subscale

79
contained 10 statements while the other six subscales all contained 25 statements that had
the highest item—total correlations with the corresponding subscale on the total RTL.
The RTL is usually scored by obtaining percentage scores for each of the ﬁve
areas of grief reactions (emotional. behavioral, physical, spiritual, and cognitive) of each
subscale representing the three phases of grief (holding on, letting go, awareness, etc.).
an overall percentage score for each subscale, and an overall percentage score for each
area (emotional, behavioral, etc.). For example, a percentage score was calculated for the
overall scale of Holding On and for the emotional, behavioral, physical, spiritual, and
cognitive aspects of Holding On. The highest percentage scores of the seven subscales
indicate where the individual is in the grieving process. Once all of these scores are
cal culated, the researcher looks for patterns, variations, and balances in the scores. For
example, very low scores across all the physical scores in the subscales could indicate
that the individual had a physical disability.
mm A factor analysis was completed on the whole scale
to determine if it included one or more scales (holding on, letting go, etc..). This analysis
resulted in two factors for both the parent and the child. The ﬁrst factor represented the
early phases of the grieving process which focus more on coping with the loss. The
Second factor represented the later phases of the grieving process which concentrate more
on growing from the loss. The Holding On, Letting Go, and Awareness scales factored
into one scale for both groups with an internal consistency of .98 for the parents and .97
for the children. The three subscales used to comprise this scale represent the early

phases of the grieving process which focuses on coping with the death. As a result, this

80

scales was called Coping Grief. Combining these scales provided a mean coping grief
score for each child and parent. The Integration, Perspective, Self-Empowerment, and
Transforming scales also factored into one scale labelled Grief Growth for both groups
with an internal consistency of .97 for the parents and .97 for the children. The scales
used to develop the Grief Growth scale depict the later phases of the grieving process
which focus on gaining perspective and integrating the death into their life. The two
factors accounted for 82% of the variance in the whole scale. Table 13 contains the
varimax rotated factor loadings for both the parent and child versions of the RTL.
The two factors indicate where the bereaved are in their grieving process. Since
the three subscales composing the coping grief scale for both parents and children
represent the early phases of the grieving process, a high coping grief score indicates that
the individual tends to be in the early phases of the grieving process. The four subscales
comprising the grth grief scale for both parents and children represent the later phases
of the grieving process. A high grth grief score signiﬁes that the bereaved tends to be
in the later phases of the grieving process. In other words, if the coping grief score is
higher than the growth grief score, then the individual is probably in the earlier phases of
the grieving process. but if their grth grief score is higher than their coping score, then
they are probably in the later phases of their grief. It is not possible to have high scores
on both the coping and grief score, but it is possible to have medium (fairly equal) scores
on b0th. A mean score for each of the two scales was computed for both parents and
children and used as indicators to test the structural equation model. For the regression

analyses. a difference score for grief was computed both the parent and the child. This

81

difference score subtracted the coping score from the grth score. High scores mean the
individual is likely to be further along in the grieving process while low and negative

scores indicate that the individual is in the earlier phases of their grieving process.

IntemalsnnsisteneiesoﬂtheBILsumy. Internal consistencies were calculated

on each of the two grief scales to determine their reliabilities for this study. Examination
of the corrected item-total correlations resulted in the deletion of 40 items on the parent
scales and 15 items on the child scales due to corrected item total correlations below .30.
With the deletion of these items the internal consistencies of the scales were .81 (coping)
and .96 (growth) for the parents and .85 (coping) and .95 (growth) for the children. The
deleted items are identiﬁed in Appendix 13. Tables 13 through 17 contain the

psychometric properties and internal consistencies of these four scales.

Table 13

82

 

 

Scale

Parent Scale
Self-Empowerment
Integration
Perspective
Transformation
Letting Go
Awareness
Holding On

Child Scale

Transforming Loss
Perspective
Integration
Self-Empowerment
Awareness

Letting Go
Holding On

Factor 1:
Coping Grief

.943
.887
.879
.876
.128

.306
.230
.l 15

Factor 2:
Growth Grief

.1 10
.074
.030
.014
.924
.878
.854

.137
.198
.086
.271
.886
.884
.859

 

83

 

Table 14
P ' ' s f ' ' 1
Scale Items Mean SD Corrected Item-
Total
Correlations
1. I am smoking more. .74 1.41 .40
2. Taking care of others distracts me from thinking about my 2.43 1.22 .39
loss.
3. 1 want/need to tell others what happened. 1.99 1.34 .37
4. If 1 try hard enough. I can bring back what I lost .25 .71 .39
5. I'm looking for who made this loss happen. .21 .73 .35
6. 1 remain involved with my friends and family to stay 3.65 1.65 .42
connected with my loss.
7. I haven't given up the rituals and habits that connect me to 1.82 1.47 .31
my loss.

8- 1 don't believe that this loss really happened. 1.49 1.46 .32
9. I keep thinking something could be done to bring back .53 1.09 .35
what I lost.

I O- I try to ﬁgure out how it could have been different. 1.65 1.32 .54
l l - I try to ﬁgure out why this loss happened to me. 1.44 1.35 .50
l 2 - l f 1 don't concentrate on remembering what has 1.02 .40

happened. 1'11 forget it. .35
l 3 - If I'm good enough. nobody I love will ever die. .80 .53 .30
l 4 - l f 1 am good enough or perfect enough, what was lost .90 .59 .32
will come back.
1 5 - I think 1 am responsible for this loss. .70 .80 .40
I6- I wish things were the way they were before this loss 2.82 1.44 .30
o<><rurred.
1 7 . I'm scared to share what I've been thinking, feeling. 1.29 , 1.37 .69
and doing

1 8- My feelings are so unpredictable I wonder if 1 am crazy. .96 1.25 .76

I 9- I feel guilty just thinking about enjoying myself. 1.21 1.32 .67

20- My feelings are so intense I'm afraid of losing control. 1.00 1.35 .84

ﬂay to hold back the tears. 1.36 1.31 .66

 

84

Table 14 cont’d

22. Unless something happens to change this. 1 don't know if
1 can control myself.

23. 1 am afraid to think about anything else but my loss.

24. Nothing is going to rob me of my feelings about this loss.

25. l have trouble breathing.

26. 1 don't eat as much.

27. 1 am sleeping less.

28. I dream that something has happened to reverse my loss.
29. Life seems unfair.

30. I wonder if 1 really deserve what 1 have.

3 1. I avoid telling anyone what I'm thinking. feeling and/or
doing about this loss.

32. I'm less patient with people.

3 3 - I don’t see much of my old friends.
34. I've ben careless.
3 5 - I avoid getting involved in anything.

36- I've put away anything which could remind me of this
loss-

3 7- l have kept secret what really happened.

38- I can be verbally abusive when others remind me of this
loss-

39. l f 1 get too happy. something bad is bound to happen.
40. This loss is evidence that I have failed as a person.
4 1 . I deserve a better deal than 1 am getting.

42. Even if I could understand why it happened. it wouldn't
change anything.

43 - It's easier when I can forget what happened.
44~ Nobody really cares how this loss affects me.
45 - I‘ve rejected others' ideas about the loss.

46- 1 should eat. drink. and be memo for tomorrow may
&Vﬂc0me.

.50

.50
1.46
.58
1.19
1.88

1.22
1.40
.68
1.28
.74

.70
.70

.80
.70
1.14
2.54

.95

.95
1.50

1.41
1.70
1.39
1.48
1.39
1.29

1.24
1.45
1.07
1.39
1.36

.68
.68

l .07
.72

1 .29
1 .66

1.30
1.23
1.14
1.00

.63

..48
.40
.48
.40
.70
.47
.58
.40

.52
.65
.58
.62
.34

.32

.35

.51
.54
.68
.35

.45
.48
.39
.30

85

Table I4 cont’d
47. Don't rock the boat. You'll just get noticed.

48. Nobody cares about me. Why should I care about anyone
else?

49. Easy come. easy go.
50. Enjoy yourself now. Who cares about tomorrow?
51. If you're too happy. something bad is bound to happen.

52. It is the nail that stands out that gets hammered the
hardest.

53. I feel confused and disoriented.

54. I try not to let anything affect me.

55. I feel detached and separate from others.
56. I feel bored with life.
5 7. People irritate me easily.

5 8 -I feel frustrated.

5 9- If I let myself. I get so unhappy I can't stand it.
60- 1 get upset with myself for the way 1 have behaved.
6 I - I am revolted by the way people have responded.
62 - I don't want to be touched.

63 - I 'm more clumsy and accident prone.
64 - I have felt sick to my stomach.

65 - I exercise less.

66- I don't watch what 1 eat.

67 - I doubt that anything or anyone can give my life meaning
again.

68- I can't imagine anyone ever being as important to me.

6.9- I've given up believing that my life has any particular
s'gnifrcance.

70- It's hard for me to trust anybOdy'

7‘ - Nothing has really made any difference. so why do I
ther?

7 . , . .
_‘2-\lwonder If I m really a drsgustrng worthless person.

.55
.50

.40
.39

.53

1.19
1.22
1.47
.96
1.14
1.54
1.13
1.01
.90
.82
.72
.99
1.21
1.36
1.33

1 .94

.97 '

1.67
.53

.50

.96

.72
.80
1.20
1.07

1.31
1.09
1.44
1.18
1.17
1.31
1.29

1.25
1.32
1.15
1.34
1.60
1.44
1.43

1.64
1.27

1 .40
.90

.87

.36
.55

.39
.40
.49
.49

.79
.52
.68
.63
.69
.78
.79

.76

.62
.61
.68
.77
.55
.58
.78

.59
.76

.73

.57

86

Table 14 cont’d

73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.

1 dream that l destroyed who 1 lost.

I deserve to be taken care of after what's happened.
I am scattered and ineffective.

I forget to do routine. everyday tasks.

I never seem to know what to do with myself.

1 have very little to say.

1 do less of the things I enjoyed before.

I've not been interested in meeting anyone new.
I lack love. affection. and companionship.

I've lost friends.

My thinking has been slower than usual.

I am unable to ﬁnd anything to look forward to.
I forget how it used to be before this happened.

I'm struck by how other people seem to go on with their

lives while I cannot.

87. There's no way 1 can fully understand why it happened.

88.
89.

1 am aware of what is no longer a part of my life.

I think about what’s missing in my life.

90.The tears are hard to stop.

9 I
92
93
94
95
96
97

1 long for whom I've lost.

It's hard to express what I feel in words.

I miss feeling happy.

I feel a great deal of hurt or emotional pain.
I feel helpless.

I feel lonely and alone.

Being in certain places stirs up unexpected feelings.

98. Certain odors (e.g. perﬁimes. old houses) can trigger
feelings.

99.

I feel tense.

.60
.89
.90
.75
.81
1.03
1.38
1.88
1.71
1.14
1.28
1.04
.75
1.13

2.78
3.56
2.74
1.54
2.81
2.39
2.08
2.17
1.06

2.06 '

2.53
2.18

1.64

.81
1.24

1.54
.80

1.26
1.24
1.35
1.53
1.55
1.48
1.38
1.46
1.37
1.51

1.38

.48
.35

.62
.66
.74
.56

.61
.62
.73
.54
.77

.68
.72

.57
.48

.81

87

Table 14 cont’d

100. My body feels heavy.

101. I've had no energy to do anything.
102. I feel numb

103. 1 sigh.

104. 1 wake up feeling tense and achy. as if I'd been tense all
night.

105. 1 wake up during the night.
106. My dreams remind me of my loss.

107. When someone touches me. my feelings come to the
surface

108. My stomach really churns

109. I have aches and pains which remind me of my loss

1 10. I would rather die than go on experiencing this.

1 1 1. No amount of money could ever replace it

1 12. The future seems empty

1 13. What 1 value most in life has been destroyed.

I 14. 1 question the existence of the God I used to believe in
1 15. 1 cannot continue life the same way as before.

I 16. My life will never be totally ﬂee from pain and
suffering.

117. I will lose things and people important to me

1 18. Parts of me are missing.

119. I am no the loving. caring. trusting person I was.

120. When I'm convinced things can't get any worse they do.
121. I have lost my desire to live.

_AJpha =98

1.49
1.32
1.22
1.58
1.38

2.14
1.50
1.14

.89
.86

2.89
1.68
1.83
.70

2.22

2.07

2.06
2.22
.92
1 .21
.60

1.46
1.32
1.36
1.36
1.37

1.59
1.48
1.17

1.21
1.23
1.07
1.71
1.50
1.59
1.22
1.56
1.50

.71
.72
.80

.72

.61
.71
.40

.62

.54
.37

.52
.46
.54
.71

.50
.68
.69
.58

 

88

Table 15

II 'E '[IE EIJ'ESI

 

Scale Items Mean SD Corrected Item-
Total Correlations

1. Being by myself has been healing. 2.08 1.45 .30
2. Activities like getting a massage, painting or music are 1.99 1.61 .51
soothing.

3. Talking or writing about it gives me relief and release. 2.18 1.54 .40
4. I can let things turn out the way they will. 2.06 1.42 .43
5. I realize that I've lost a lot. but I haven't lost everything. 3.21 1.05 .56
6. I think about how 1 have changed, what is different. 2.72 1.19 .34
7. l have already passed the lowest point. 2.65 1.47 .50
8. My fears about dying are less. 2.10 1.62 .38
9. 1 am able to express my feelings about the loss. 2.90 1.06 .46
10. My feelings still catch me by surprise. but they don't last 2.42 1.31 .30
as long.

11. I'm not so sad. 2.26 1.38 .40
12. My disgust over what happened has lessened. 1.38 1.55 .43
13. I realize that sadness and peacefulness can co—exist. 2.74 1.34 .69
14. 1 can enjoy simple pleasures of life again. 2.79 1.26 .76
15. The aches and pains 1 used to have with this loss have 2.10 1.52 .43
lessened.

16. I enjoy being touched and held once again. 1.43 1.75 .48
17. It takes less energy to do things than it used to. 1.65 1.51 .52
I8. I notice how things smell and taste again. 1.96 1.62 .45
19. l have learned to accept that losses and changes are a 3.26 1.10 .51
part of life.

20. My life will continue. 3.58 i .78 .59
21. My dreams seem to help me understand and accept what 1.24 1.44 .43
happened.

22. My faith or spiritual understanding helped me with this 2.85 1.55 .34

experience.

 

89

Table 15 (cont’d)

23. My life does seem to have meaning.

24. Life seems more fragile and precious.
25. I've found ways to get back my integrity.

26. 1 don't depend as much on others.

27. I've remembered what 1 really want to remember about it.

28. I've ﬁnished things related to my loss as completely as I
can.

29. I've taken steps to forgive those involved.

30. I am making restitution fof my contribution to this loss.
31. I like being with people again.

32. Putting my thoughts into words has helped me recover.

33. 1'5 important to have times of celebration and
remembrance before it's too late.

34. My life has more to it.

35. I've felt all 1 can feel about this loss.

36. I've found effective ways to express my feelings.
37. I've experienced this loss in ways that were healing.
38. I've let go of the guilt.

39. I've let go of the anger.

40. I can make sense out of the messages from my body.
41. I don't push my body beyond limits.

42. I relax.

43. I sleep well.

44. 1 eat sensibly.

45. 1 can be sexually or romantically interested.

46. 1 know my life is important.

47. My dreams are restﬁil, playful and helpful.

48. I've restored or regained part of what 1 had lost.

49. I feel the presence of who I lost.

1.38
.69
2.39
2.36
3.01

1.75
1.56
2.47
2.43
1.68
2.11
1.79
2.15
2.19
2.21
2.07

1.42 .

3.31
1.53
1.32
1.94

1.28
1.1 1
1.63
1.34
1.42
1.46

1.60
1.34
1.47
1.46
1.40

.67
.39
.36
.31
.50
.52

.41
.30
.61
.52
.46

.53
.34
.58
.68
.36
.41
.66
.47
.57
.42
.36
.51
.61
.61
.46
.30

 

90

Table 15 (cont’d)
50. l have forgiven myself for what happened.
51. I have forgiven others for what happened.

52. 1 would not want my loss reversed if it meant giving up
all my growth from it.

53. I feel conﬁdent enough in myself to move on to other
things.

54. It takes less effort and thought to do what I need to do.
55. I'm nicer to myself.

56. I'm not as serious a person.

57. I'm able to take risks again.

58. I'm more self-disciplined.

59. 1 don't place limits in front of myself as readily as 1 did
before this loss.

60. I am more able to give to others.
61. l have time for my family and friends and time for me.
62. 1 can express myself in many ways.

63. 1 can appreciate the paradoxes and seeming
contradictions in my life.

64. I feel more conﬁdent.

65. I've grown.

66. I feel challenged to keep on going.

67. I trust my ways of thinking.

68. I don't avoid my feelings.

69. I've found new ways to express my feelings.

70. I feel loving and affectionate.

71. Sadness reminds me how important this loss was to me.

72. I am curious about many things.
73. I listen to what my body tells me.
74. I enjoy making love.

75. I feel strong.

1.15
1.10
.68

2.65

1.99
2.06
1.31
1.75
2.10
1.81

2.15
2.69
3.18
3.06
2.90
2.06
2.32

2.88 .

2.82
2.30
.92
2.38

1.54
1.52
1.31

1.31

1.45
1.34
1.27
1.42
1.40
1.38

1.39
1.16
1.36
1.46

1.43
1.30
1.07

.30
.36

.43
.63
.49
.56

.65
.51
.77
.70

 

91

Table 15 (cont’d)

76. 1 am active in caring for myself physically.
77. What I eat is healthy.

78. I feel warm all over.

79. 1 have what is meaningful within me.

80. I've learned to respect myself.

81. I feel like a whole person.

82. I've discovered that there is more to me than what meets
the eye.

83. My dreams make sense.

84. 1 live as fully as 1 can

85. I have fewer conditions on my love.
86. I feel lovable.

87. I've challenged and altered some of my most cherished
and long standing assumptions and beliefs.

88. I want other people in my life.

89. I want to share with others who have these life
experiences.

90. What I own isn't important.

91. The cycles of life have times of birth and death.
92. I am sometimes surprised by what 1 know and say.
93. I feel connected to the world and to nature.

94. Things in my life can change and life can still be
meaningful.

95. I am curious about what will happen after 1 die.
96. 1 can't live without loving myself.

97. I discovered some essential parts of me.

98. My life has times of joy.

Alpha = .97

2.57
2.44
1.33
2.49
2.58
2.17
2.60

1.31
2.68
1.43
2.25
1.56

2.90
3.00

2.42
3.43
2.38
2.50
2.94

1.16
1.12
1.33
1.31
1.26
1.42
1.30

1.35
1.05
1.49
1.38
1.39

1.38
1.10

1.18
1.14
1.33
1.30
1.17

1.41
1.53
1.48
1.10

.42

.41

.75
.73
.74
.52

.48
.66

.66
.43

.49
.30

.30
.45
.33
.62
.62

.38
.50
.67
.57

 

92

 

Table 16
P , . . '1 . . e
Scale Items Mean SD Corrected
Item-Total
Conelations
1. I’ve been working much harder. 1.99 1.26 .30
2. I look at reminders of my loss (pictures, mementoes). 2.56 1.1 1 .30
3. I go over the loss in my mind, trying to ﬁgure out how 1.88 1.53 .52
things could have been different.
4. I try to ﬁgure out why this loss happened to me. 1.86 1.57 .66
5. I ask myself: “Why did this happen to me?" 2.14 1.47 .58
6. This whole thing seems unreal. 2.07 1.43 .54
7. Sometimes I unexpectedly see or hear things that remind 2.49 1.33 .42
me of my parent.
8. l have hoped that 1 was dreaming and I’d wake up and ﬁnd 2.38 1.48 .51
out it never happened.
9. I feel that 1 should have done something to prevent this 1.19 1.34 .52
from happening
10. I’ve been angry 2.04 1.23 .52
l 1. I’ve been scared to share what I’ve been thinking. feeling. 1.49 1.33 .47
and doing.
12. I can’t express the feeling I have about what I did and/or 1.58 1.44 .53
didn’t do just before the loss happened.
13. I dream that it never happened. 1.64 1.52 .45
14. I’ve increased my exercise. 1.49 1.34 .30
15. I ignore the physical pain just to keep going. 1.38 1.35 .54
16. 1 dream that something has happened to reverse my loss. 1.24 1.41 .46
17. l have lost weight. 1.04 1.43 .32
18. It would help if someone could help me understand this. 1.35 1.32 .68
19. Life seems unfair. 2.36 1.44 .65
20. There are times when it feels like 1 am going through the 1.49 1.32 .63

same thing all over again.

21. 1 am not able to forgive those who contributed to this loss. .81 1.35 .36

 

93

Table 16 (cont’d)
22. I wonder if I really deserve what I have.

23. I avoid telling anyone what I’m thinking. feeling. and/or
doing. ,

24. I avoid people who remind me of this experience
25. I’ve been careless.

26. Something else is going to go wrong.

27. It’s easier when 1 can forget what happened.

28. This loss is evidence that 1 have failed as a person.
29. If I get too happy. something bad is bound to happen
30. If 1 don’t look out for myself, no one else will

31. I feel confused .

32. I feel detached and separate from others.

33. I feel dissatisﬁed with everything.

34. I feel overwhelmed.

35. People irritate me.

36. I don’t want to be touched.

37. 1 get hurt more.

38. 1 am sick 3 lot.

39. 1 wish 1 could be saved from having to deal with this
experience.

40. I doubt that anything or anyone can give my life meaning
again.

41. It’s hard for me to trust anybody.

42. Nothing has really made any difference. so why do I
bother?

43. Nobody cares how 1 am doing.

44. It’s been hard to concentrate.

45. I am less conﬁdent.

46. I’ve not been interested in meeting anyone new.

47. I have very little to say

1.67
1.54

.85
1.47
1.39
1.42
.50
1.10
1.31
1.97
1.58
1.25
1.64
1.85
.95
1.10
.85
2.18

.88

1.08
.75

.82
1.57
1.33
.79
1.13

1.38
1.29

1.17
1.10
1.21
1.23

1.20
1.10
1.44

1.19

1 .30
.95

1.14
1.16
1.24
1.03
1.13

.58
.38

.35
.55
.59
.30
.34
.50
.48
.71
.71
.63
.51
.49
.51
.61
.35
.58

.70

.62
.31

.69
.63
.51
.55

 

94

Table 16 (cont’d)

48. I’ve had no energy to do anything

49. 1 am scattered and ineffective

50. I am unable to ﬁnd anything to look forward to.
51. My thinking has been slower than usual.

52. 1 can’t imagine how things will get better.

53. It seem hopeless to try to understand what really
happened.

54. I feel empty. like a shell. like 1 amjust existing.
55. I feel lonely and alone

56. I long for whom I’ve lost.

57. The tears are hard to stop.

58. I miss expressing my love.

59. I feel restless.

60. I feel tense

61. I am exhausted by any effort

62. My body feels heavy

63. 1 wake up during the night.

64. The future seems empty.

65. It is easier to realize that someday I will die.
66. Everything else seems trivial and meaningless.
67. There is nothing positive or good about this loss.

Alpha = .97

1.10
.94
.82
.85
1.01
1.01

1.15
1.44
2.58
1.56
1.97
1.46
1.54
.80
.94
1.34
1.00
2.25
1.14
1.59

1.26
1.05
1.04
1.08
1.12
1.29

1.19
1.29
1.42

1.55
1.31
1.30
1.06
1.18
1.30
1.15
1.45
1.26
1.55

.58

.67
.68
.75
.71

.75
.76
.66
.67
.58

.68
.66
.67
.54
.67
.42
.61
.48

 

95

Table 17

El '13 '[121’115 IE'ESI

 

Scale Items Mean SD Corrected
Item-Total

Correlations

1. Hearing about other‘s experiences with similar losses helps 1.92 1.30 .41

2. Being by myself has been healing. 1.81 1.27 .32

3. Telling or writing my story about this experience gives me 1.90 1.44 .43

a feeling of relief and release.

4. It's easier to let myself just experience this loss. 1.61 1.27 .30

5. It helps to be with a friend who accepts me as I am 3.25 1.14 .38

6. I think about the effects of this loss. how I have changed. 2.68 1.06 .30

what is different.

7. 1 can take what comes 2.69 1.03 .51

8. I realize that I’ve lost a lot. but I haven’t lost everything. 2.97 1.00 .52

9. My feelings make sense when I think about them. 2.54 1.20 .46

10. I don't need to struggle to accept what has happened. 2.21 1.33 .38

1 1. 1 still hurt. but the pain has lessened. 2.43 1.30 .57

12. My feelings still catch me by surprise. but they don’t last 2.17 1.37 .53

as long.

13. I don’t feel as guilty as 1 used to. 1.96 1.60 .51

14. I can enjoy simple pleasures of life again. 2.90 1.13 .51

15. My body is healing from the stresses of this experience. 2.49 1.36 .57

16. The aches and pains I used to have with this loss have 2.54 1.32 .63

lessened.

17. 1 notice how things smell and taste again. 2.67 1.48 .55

18. I’m able to relax. 2.49 1.37 .61

I9. I realize that sadness and peacefulness can co—exist. 2.81 1.30 .60

20. Someone or something powerful and loving has helped 3.15 1.13 .68

me make it this far.

21. l have learned to accept that losses and changes are a part 3.03 1.00 .57

of life.

22. I believe there is some good in every person. 3.17 .96 .56

96

Table 17 (cont’d)

23. My faith or religious beliefs helped me with this
experience.

24. At least one person knows that I’ve forgiven myself.
25. I’ve found ways to get back my integrity
26. I’ve experienced this loss in ways that were healing.

27. I’ve said good-bye to my loss.

28. I realize how important it is to say good-by to who’s gone.

29. My life has more to it.
30. I know my life is important.

31. I have as good an understanding as I can right now about
what happened.

32. I understand why it’s important to have time of
celebration and remembering before it’s too late.

33. I’ve felt what I’ve needed to feel about this loss.

34. I no longer feel shame.

35. I’ve let go of the guilt.

36. I’ve let go of my sadness.

37. I’ve let go of my anger.

38. 1 can make sense out of the messages from my body
39. 1 have the energy I need.

40. 1 relax

41. I don’t neglect my body

42. I feel conﬁdent enough in myself to move on to other
things.

43. I have forgiven myself for what happened.
44. It’s time for me to get on with life.

45. This loss has opened me to bonds of love and friendship
with at least one person.

46. I have been forgiven for what I contributed to this loss.
47. I discovered what 1 want in life.

48. 1 can laugh at myself

2.47

1.90
1.78
2.39
2.24
2.76
2.49
3.18
2.99

3.07

2.47
2.35
2.40
1.81
2.07
2.15
2.76
2.79
2.64
2.96

2.46
2.61

2.97

1.94
2.17
2.54

1 .42

1.77
1.44
1.12
1.48
1.25
1.32
1.12
1.13

1.21

1.21
1.64
1.63
1.30
1.39
1.29
1.20
1.20
1.35
1.00

1.65
1.39
1.28

1.74
1.38
1.20

.40

.42
.43

.33
.34
.63
.67
.37

.50

.68
.51
.48
.58
.60
.58
.56
.63
.47
.62

.58
.56
.53

.45
.30

 

97

Table I7 (cont’d)

49. I’m more assertive

50. I feel more conﬁdent.

51. I’m more creative in my approach to life

52. I feel challenged to keep on going.

53. I enjoy dreaming as much as I do reaching for my dreams.

54. I’ve changed in ways that would not have happened
otherwise.

55. 1 am curious about a lot of things.

56. I feel like a whole person.

57. I feel loving and affectionate.

58. I’ve learned to respect myself.

59. I am not as hard on myself when I make mistakes.
60. I listen to what my body tells me

61. 1 am efﬁcient and creative at doing things.

62. I feel strong.

63. I am active in caring for myself physically.

64. I’ve discovered that there is more to me than what meets
the eye.

65. I trust my intuition. dreams. fantasies. or my inner sense to
let me know what 1 need to know.

66. I feel a part of something much bigger than me.
67. I live as fully as 1 can.

68. I can love and be devoted to another without losing
myself.

69. 1 have peaceful moments.

70. I’ve discovered that the most important parts of my loss
remain alive inside me.

71. I believe there is someone or something more powerful,
loving. lasting. and wiser then any single human being.

72. I feel connected to the world and to nature.

73. I know 1 am in the right place for me right now.

2.46
2.46
2.22
2.51
2.83
2.86

3.00
2.69
2.88
2.82
2.21
2.06
2.43
2.75
2.77
2.82

2.69

2.56
2.93
2.76

2.75
2.68

3.10

2.36
2.64

1.23
1.14
1.20
1.28
1.17
1.21

1.06
1.29
1.07
1.28
1.36
1.22
1.14

1.12
1.20

1.07

1.21
1.08
1.27

1.03
1.21

1 .29

1.18
1.30

.40

.63
.5 1
.63
.42

.45
.56
.60
.72
.62
.56
.40
.61
.57
.67

.47

.61
.65
.58

.57
.51

.63

.57

 

98

Table 17 (cont’d)
74. I realize that 1 can’t live without loving myself.

75. 1 know that things in my life can change and life can still
be meaningful.

76. My life has times ofjoy.
Alpha = .97

2.82
3.21

3 .46

1.23
1.09

.71

.62

.71

.62

 

99
Ell?"

Parents completed the Family Assessment Device (FAD) which determined the
family’s functioning (Appendix J). This measure consisted of 60 items regarding the
family’s functioning on a 4 point likert scale (Epstein, Baldwin, & Bishop, 1983). The
FAD included seven subscales based on the McMaster Model of Family Functioning and
an overall level of family functioning. The FAD responses were on a four point likert
scale with 1=Strong1y Agree and 4=Strongly Disagree. All items on the scale were
recoded to l=Strongly Disagree and 4=Strongly Agree so that high numbers would
represent high functioning and low numbers would signify low functioning. The seven
subscales were Problem Solving, Communication, Roles, Affective Responsiveness,
Affective Involvement. Behavior Control, and General Functioning (Epstein, et al.,
1983). Problem Solving was the family’s ability to settle difﬁculties while maintaining
effective family functioning. This subscale consisted of 6 items, such as we try to think
of different ways to solve problems. Communication involved determining whether
communication was clear in respect to content and whether the family members talked
directly with each other. For example, did family members talk directly with the person
for whom a message was intended, or did they leave the message with another family
member? The communication scale consisted of 9 questions, such as people come right
out and say things instead of hinting at them. The Roles scale centered on the existence
of organized patterns for family chores. This scale included 11 items, such as family
tasks don't get spread around enough. Affective Responsiveness determined whether the

family members exhibit appropriate responses to situations. This scale included 6 items.

100

such as we do not show our love for each other. Affective Involvement ascertained the
interest and values family members place on the activities and concerns of other family
members. This scale contained 7 items, such as we get involved with each other only
when something interests us. Behavior Control included 9 items and measured how the
family revealed and preserved behavior standards for family members using questions
like we can easily get away with breaking the rules. General Functioning, with 12 items,
gave an overall level of family functioning using questions similar to we don’t get along
together (Epstein. et al.. 1983). The internal consistency of the FAD subscales have
alphas ranging from .72 to .92 and test-retest reliabilities of .66 to .76 (Miller, Kabacoff,
Keitner. Epstein. & Bishop. 1986).

W This study produced internal consistencies ranging
from .76 to .86 for the family functioning subscales. Tables 18 through 24 contain the
psychometric properties and internal consistencies of the seven family functioning
subscales. Means for each of the seven subscales were calculated and used as indicators
of family functioning to test the structural equation model. Previous researchers using the
FAD tend to use the general functioning scale when looking at family functioning in
general (Miller, Keitner. Whisman. Ryan, Epstein, Bishop, 1992; Keitner, F odor, Ryan,
Miller, Epstein. & Bishop. 1991). As a result, a mean of the general ﬁmctioning scale
was calculated and used to test the regression analyses. High means indicate high

functioning while low means represent low functioning for the family.

101

Table I8

 

 

 

 

Scale Items Mean SD Corrected Item-
Total Correlations
I. We express tenderness. 3.1 l .64 .70
2. We cry openly. 2.86 .82 .43
3. We are reluctant to show our affection for each other. (R) 3.22 .80 .65
4. Some of us just don’t respond emotionally. (R) 2.44 .66 .43
5. We do not show our love for each other. (R) 3.30 .74 .42
6. Tenderness takes second place to other things in our 2.78 .78 .41
family. (R)
Alpha = .76 NOTE: (R) = Recoded
Table 19
El '13 '[3 1E "E!E511
Scale Items Mean SD Corrected Item-
Total Correlations
I. In times of crisis we can turn to each other for support. 3.45 .73 .61
2. Individuals are accepted for what they are. 3.21 .74 .58
3. We can express our feelings with each other. 2.98 .65 .52
4. We feel accepted for who we are. 3.32 .62 .65
5. We are able to make decisions about how to solve problems. 3.17 .60 .40
6. We conﬁde in each other. 3.09 .63 .63
7. Planning family activities is difficult because we 3.15 .87 .36
misunderstand each other. (R)
8. We cannot talk to each other about the sadness we feel. (R) 3.09 .82 .42
9. We avoid discussing our fears and concerns. (R) 2.89 .71 .69
10. There are lots of bad feelings in the family. (R) 3.32 .73 .48
1 1. Making decisions is a problem for our family. (R) 3.00 .75 .69

Alpha = .86 NOTE: (R) = recoded

 

102

 

 

 

Table 20
v v v 1
Scale Items Mean SD Corrected Item-
Total Correlations
1. You only get the interest of others when something is 2.73 .79 .39
important to them. (R)
2. We are too self-centered. (R) 2.95 .71 .46
3. We get involved with each other only when something 2.98 .79 .62
interests us. (R)
4. We show interest in each other when we can get 2.99 .75 .66
something out of it personally. (R)
5. Our family shows interest in each other only when they 3.18 .73 .71
can get something out of it personally. (R)
6. Even though we mean well. we intrude too much into each 3.04 .76 .39
other‘s lives. (R)
Alpha = .79 NOTE: (R)=Recoded
Table 21
E l . E . E 2 . . E l l: S 1
Scale Items Means SD Corrected Item-

Total Correlations

1. When someone is upset the others know why. 2.72 .59 .39
2. People come right out and say things instead of hinting at 2.80 .67 .57
them.

3. We talk to people directly rather than through go between. 2.94 .72 .41
4. We are frank with each other. 3.09 .47 .54
5. When we don’t like what someone has done. we tell them. 3.02 .54 .35
6. You can’t tell how a person is feeling from what they are 2.81 .82 .52
saying. (R)

7. It is difﬁcult to talk to each other about tender feelings. (R) 2.71 .73 .62
8. We often don’t say what we mean. (R) 2.87 .70 .67

Alpha=.79 NOTE: (R) = recoded

 

103

Table 22

El '13 "EEIISI'EIESI

 

 

 

Scale Items Mean SD Corrected Item-
Total Correlations
1. We resolve most everyday problems around the house. 3.35 .59 .41
2. We usually act on our decisions. 2.97 .64 .32
3. After our family tries to solve a problem. we usually discuss 2.64 .64 .31
whether it worked or not.
4. We resolve most emotional upsets that come up. 3.17 .48 .55
5. We confront problems about feelings. 2.96 .65 .47
6. We don’t talk to each other when we are angry. (R) 3.10 .57 .31
Alpha = .86 NOTE: (R)=Recoded
Table 23
El '2 '[EIV'EEESII
Scale Items Mean SD Corrected Item-
Total Correlations
I. We know what to do in an emergency. 3.14 .60 .59
2. There are rules about dangerous situations. 3.49 .56 .50
3. We don’t know what to do when an emergency comes up. (R) 3.35 .66 .49
4. We have no clear expectations about how we dress. (R) 3.01 .72 .54
5. We don’t hold any rules or standards. (R) 3.47 .56 .54
6. If the rules are broken, we don’t know what to expect. (R) 3.09 .64 .54
7. Anything goes in our family. (R) 3.48 .68 .54

Alpha = .80 NOTE: (R)=Recoded

104

 

 

Table 24
r r F e
Scale Items Mean SD Corrected Item-
Total Correlations
1. We make sure members meet their family responsibilities. 2.93 .71 .41
2. Each of us has particular duties and responsibilities. 2.96 .67 .61
3. We discuss who is to do household jobs. 2.90 .73 .58
4. When you ask someone to do something, you have to check 2.31 .79 .37
that they did it. (R)
5. Family tasks don't get spread around enough. (R) 2.43 .81 .62
6. There’s little time to explore personal interests. (R) 2.94 .74 .52
7. If people are asked to do something. they need reminding. (R) 2.29 .64 .55
8. We are generally dissatisﬁed with the family duties assigned 2.95 .67 .32
to us. (R)
Alpha = .79 NOTE: (R) = recoded
P_ilo_t

The measures in this study were piloted with 10 parents who had lost a child and 5
children who had lost a sibling. These families were recruited through a local support
group for families located in Lansing. The researcher asked these participants for any
comments they had concerning the social support and communication measures created
by the researcher. They were asked to determine if there was anything they thought
should be added. deleted. or changed on the measures. Parents timed themselves and
their children to see how long it took for everyone to complete all the measures. Both the

parents and the children recorded any reactions they had while completing the measures.

105

Once this data was collected and evaluated, all suggestions were noted and necessary
modiﬁcations were made.

The comments received from the pilot participants overwhelmingly stated that
both the social support surveys were redundant, too long, and boring to complete. As a
result. the researcher made extensive modiﬁcations on the social support measures, the
communication measures, and the Kidcope measure. The researcher incorporated the
feedback received from both parents and children by deleting inappropriate and redundant
items and rewording ambiguous items on the social support and communication measures

for both parents and children and the Kidcope measure.

Chapter 3

RESULTS

E . .

Of the 1 12 families that requested surveys, 72 (66%) completed and returned the
measures. The forty families that did not complete the questionnaires usually stated that
the children were unwilling to complete the surveys. The parents’ ages ranged from 30 to
68 years and the mean age was 45. The children ranged in age from 12 to 18 with a mean
age of 15. Sixty-eight (94%) parents identiﬁed their family’s ethnic background as
Caucasian, 2 (3%) as Native American, 1 (1%) Hispanic, and 1 (1%) multiple
backgrounds. Table 25 contains the other demographic information on the participants,
and Table 26 contains the means, standard deviations, minimums, and maximums of the
variables used in this study. Table 27 contains the intercorrelations among the variables
used in the regression analyses, and Table 28 contains the intercorrelations among the
variables used in the structural equation model.

Use of Time and Age as Covariates in Analyses
Since time since death and age possibly covary social support, coping, and grief,

the researcher planned to control for these two variables in all the analyses. To determine

106

107

 

 

Table 25
:1 . . [E . .
Characteristics N °/o
Family

Income
$0-%10.000 2 3
S 10.000-520999 I4 19
$2 1 .000-83 5.999 25 35
536,000-850,999 I3 18
Over $51,000 17 24

Type of Death
Sudden 47 65
Anticipated 25 35

Religion
Catholic 18 25
Protestant 35 49
Jewish 2 3
Mormon 1 1
No religious Afﬁliation 6 8
Other 10 I4

Cause of Death
Cancer 27 38
Heart Attack 12 17
Suicide 7 10
Accident 1 1 15
Chronic Disease 4 6
Homicide 1 l
Aneurysm/Hemorrhage 6 I 1
Other Health Problems 4 6

Time since Death
< 1 year 18 25
1-2 years 25 35
2-3 years 17 24
3-4 years 12 17

Number of Children
I 6 8
2 29 40
3 24 33
4 10 14
5 l l
6 2 3

 

108

Table 25 (cont’d)
Parents

Gender
Women
Men

In a New Relationship
Yes
No

Support Group/1' hernpy
Yes
No

Education Level Surviving Parent
High School/GED
Some College
College Degree
Masters Degree
Other

Change in Circle of Friends
No Change
Have Lost and Gained a Few
Lost All Friends and Gained a Few
Have all New Friends
Other

Children

Gender
Female
Male

Support Group/Therapy
Yes
No

Deceased Parent
Father
Mother

Change in Circle of Friends
No Change
Have Lost and Gained a Few
Lost All Friends and Gained a Few
Have all New Friends
Other

66

13
59

43
29

14
I9
22
12

Law
\Obawwu.

50
22

38
34

27
28

13

69
31

53
47

37
39

18

 

109

Table 26

 

 

Variables Mean SD Minimum Maximum
Nature of Death 1.35 .48 l 2
Time Since Death 2.32 1.03 I 4.00
Child Age 15.07 1.99 1 I 18
Parent Age 45 6.35 30 68
Parent Family Adequate SS 2.26 .57 l 3
Parent Friends Adequate SS 2.38 .63 I 3
Parent Functional Social Support 2.32 .48 1.19 3
Child Family SS 2.44 .51 1.4 3
Child Friends SS 2.36 .60 1 3
Child Functional Social Support 2.40 .41 1.36 3
Parent Structural Support 3.15 1.16 .33 5.33
Child Structural Support 3.57 1.21 1 6
Parent Coping Reframing 3.94 .68 1.88 5
Parent Coping Acquire SS 3.13 .77 1.33 4.56
Parent Coping Spiritual Support 3.43 1.16 1 5
Parent Coping: Grand Mean 3.50 .62 1.90 4.85
Child Coping Frequency .99 .52 .17 3
Child Coping Efﬁcacy 1.94 .86 0 5.50
Parent Communication 4.94 .80 3.3 6
Child Communication (Family) 4.74 .85 3.00 6.00
Parent Coping Grief 1.24 .71 .16 2.82
Parent Growth Grief 2.27 .67 . .73 3.61
Parent Grief 1.03 1.13 -1.83 3.11
Child Coping Grief 1.43 .72 .16 3.19
Child Growth Grief 2.57 .68 .89 3.74

Child Grief 1.14 1.13 -1.45 3.30

 

Table 26 (cont’d)

Fam. Fun. Affective Response
Fam. Fun Affective Involvement
Fam. Fun. Behavior

Fam. Fun. Roles & General Fun.

Fam. Fun. Communication &
Problem Solving

Family Functioning (General)

2.96
2.96
3.23
2.97
2.92

3.14

110

.50
.53
.42
.42

.34

1 .67
1.83
1.86
1.65
2.29

1.83

3.83

3.85
3.86

4.00

 

111

a. V a: ”no. V a.

 

 

.4~. .2. :R. .N. 5.. 8. .8. an. .5... 8.. 8.. 4o. 8. 4.. 45.. as: 2.54.. .2
:2. .54. :_4. 2. 5.- 8.. :8. n _. N..- .2..- .3- _ 7 8. 2. are 2.5 .2

-- 5.- 8. :54. 2 .- .2. 8. :8. 5.. 5. .- .8. _~.- 8. 8.- ....e 224.. .4.

-- :2“. a _ .- 5.. 8. .2... 5.- _ 7 e. .- 5.- 5. 8. n _. 5&5 :8... .2

-- _ T 8. 45. .8. 55.. 8.- 5. m _ .- 8.- 5.. 5. 8.58 2.5 .N.

-- 5. .. M. _. 8.- :54. 8. 8.- .8- a _ .- a _ .- : _ m.- 880 224.. .:

- 2 .. 8.- 5.. 8. _~. 8.- 4..- 5. 8.. .288 can. .6 .5.

-- 5. .2. 5.- .5? .2. .. _ n. o. .- e. .. .828 42.. a. .o

- 5. 4..- 2.. 5.- _N.- :.- 5. 55m 8m 2.5 .5

-- 5.- 8.- ...4.- 2 .- a _ .- .3- 98 8m 224.. s

- :2“. w..- .4~.- 8.. 5. 224.. a? .5

- 2.- n _ .- 5. ... _ .- 2.5 a? .n

- :8. 2. 2. .455“. 5.. .53.. .4

-- 2. 2. 355. E... 2.5 .n

I 3. £390 005m 05:. .N

I 569C ..c 9.582 .—

2 4. 2 2 _ _ 5. 5 a a 5 n 4 n N _ 324:;

 

 

em 03....-

112

 

 

4 _. 58. 8.. 85. 8. 8.. 8.. 8. .8. 5.. 55. 5. 8. 8 .. 55.5 5355 .u .5.
5.. .8.- 8.- 5.- 8..- .8. :.8.- ... 55.- 8. 85. :8.- ..8.- 8..- 8.585.508.
- :.8. 8.- 85.- 4..- ...4. 8..- 5.. 5.. ... .5.... 8... 5.. 8.. sac-5.525.. .4.
- 4..- 5..- N..- .8. ...8. 55. 5.- 8.- .8. 45.- :44. 5.. 5.55.85 .8.

.5.-.558

- ..8. :88. 85.- 55.- 8. 8.. .48. 8.- 8..- 55.- 8..- 2.6.5.8.

cam

- N5. 45.- 4..- ..44. :88. .8. 8.- .48. 45. .58.- 88 558.-....

..8. use-.3.

- 5.- 8... 4..- 5.. .8. 4..- .55. 5.- . 555.5 ... .5.

- 85.- 8 .. 5.. 5.. ..58. :8.- 4..- 85.- .525 2.5.5 .u .5

- 85.- 8.- 55.- 8. 8.. 8.. 8. 82.2.5... 2.5.5.0...

- .58. 8 .. 5. .- . .. .5.- 5. .- .52-.50 52.. .5.. 8

gm

- : . 8. 55.- 58. 8 . .- .58.- ...-.3... .52.... .5

gm

- 55. 8.. 55.- 8 . .- 8:55.. .52.... .8

- .8.- 8 .. 85.- 88.55 5a... .5 .4

- ... 8. ...-m 55...... 5..-C .8

- 8. ...-8 8.5.5.. 2.5 .8

- 532 .3 2:52 ._

4. 8. 8. _ . 5. 5 8 8 5 8 4 8 8 _ 85.545;

 

 

mm 033-

113

 

 

seem.

geom.

seam.

w_.

own.

5.0m.

55cm.

eemm.

ohm.
o.r

wet

as.

m_.

e_.

N..

b_.
eAVM.

emmr

5mm.

cc.

ehN.

.wN.

_~.

scamr

no.

m_.

we.

cc:

some.

ehmr

eehm.

sewn.

sum.

o_.

«acm-

me.

me.

c_.

0—.

we.

we.
9.;

N.(

4mm.

m_.

4cm.

NN.

eeNM.

n.-

mm:

mm.

m_.

co.

N_r

abNﬁ

w_.

comm.

~..

~_.
em.

eeva

w_.

0—.

w_.

me.

«mm.

e_r

c_.

v_r

n_r

cor

no.

ovmr
3c.

wer

om.

enm-

540m.

seem.

h_r

>5
5.585 .... .8

m8. 4% EEcQ ...“. .NN

:3..—
coC 2cm 8: ._N

.5320: an. .ON

83.
o>:oo.:< .....— .0—

..35 £3.55 ... .E
5.5.5 2.5.5 ... .8.

v.33 an 38......

114

 

Table 28 (cont'd)

 

Variables 15 16 I7 18 19 20 21 22 23
16. C. Growth Grief -.30‘ -

17. P. Cope Grief .30‘ -.I4 -

18. P. Growth Grief -.29‘ .21 -.34” -

19. FF Affective Res .002 .15 -.07 -.004 -

20. FF Behavior -.11 .18 -.20 .22 .39” -

21. FF Role Gen Fun -.08 .23’ -.21 .15 .60” .68" -

22. FF Comm & PS -.07 .19 -.14 .21 .56“ .54” .81” -

23. FF Affective Int .15 .13 -.23‘ .10 .47” .46" .70" .59” -

 

115

the necessity of using these two covariates, the correlates of both time since death and age
and the predictors and outcomes in the planned analyses were examined. Since time
since loss and age of the parent were not signiﬁcantly correlated with any of the other
variables (see Tables 27 & 28), time and parent age were not included in the analyses.
Age of the child was only signiﬁcantly correlated with child grief. Since child age shares
a signiﬁcant relationship with child grief, the analyses concerning child grief controlled
for child age, and for all the other analyses child age was not included in the analyses.
I. 11111.15 1E .1111

The models (see Figures 1 & 2) were tested with structural equation modeling
(SEM) using LISREL VIII. Numerous indices of overall model ﬁt provided by LISREL
VIII were examined to determine the degree to which the model ﬁt the data. The model
ﬁt indices that are typically reported in the literature were used to determine model ﬁt.
The reported ﬁt indices were based on the results from the analyses using a
variance/covariance matrix.

For Model 1 (Figure l), the Chi-Square for goodness of ﬁt with 142 degrees of
freedom was equal to 246.95 (p<.01), and for Model 2 (Figure 2), the Chi-Square for
goodness of ﬁt with 265 degrees of freedom was equal to 439.20 (p<.01). Both Chi-
Squares indicated a signiﬁcant discrepancy between the observed and estimated
variance/covariance matrixes. However, the Chi-Square for goodness of ﬁt is not
necessarily a good indicator of ﬁt since it is heavily dependent on sample size. As a
result, other indices of ﬁt, such as the Goodness of Fit Index (GFI), the Adjusted

Goodness of Fit Index (AGFI), the Root Mean Square Residual (RMR), and the Normed

116

Fit Index (NFI) were used to determine the goodness of ﬁt for both Models 1 and 2.
Values equal to or greater than .90 are the normally accepted cutoffs for GFI, AGFI, and
the NFI. The RMR should be less than .1 for a good ﬁt. For Model I, the GFI equaled
.75. the AGF I equaled .66, the RMR equaled .l l, and the NF] equaled .51. Model 2's
GFI equaled .70. AGFI equaled .64, RMR equaled .15, and the NF] equaled .43. All of
these indices indicated a poor ﬁt for both Model 1 and Model 2.

Since testing the whole model with SEM did not work, the models were then
reduced. The ﬁrst half of the model was tested (nature of death to parent and child
coping) and then the second half of the model was tested (parent and child coping to
family functioning). Again these analysis resulted in bad ﬁts for both models. Fit indices
for half the model were extremely similar to the ﬁt indices of the whole model. The
changes in ﬁt indices represented differences of only .01.

I. 11111 '21? 1'

Since the SEM indicated a poor ﬁt, a simple path analysis, which examined only
the observed variables instead of the latent variables, was then conducted for Model 2. A
path analysis was conducted for Model 1, but the analysis did not converge and therefore,
could not produce a solution. This could be due to ill-conditioned matrices or
mathematical anomalies that cannot be ﬁxed which are more common in analyses with
small sample sizes. For Model 2 the Chi-Square goodness of ﬁt with 28 degrees of
freedom equaled 48.92 (p<.05 ). indicating a discrepancy between the observed and
estimated matrixes. The GF I = .87, AGFI = .75, RMR = .13, and the NFI was greater

than one which should not be possible (small sample size could produce coefﬁcients

117

greater than I which could produce indices greater than 1). Since the NFI indicated a

number larger than one, these analyses could not be trusted.

 

Since structural equation modeling and path analysis proved unsuccessful for
testing the model. the models were modiﬁed into three main models with parent coping
(see Figure 6), child coping (see Figure 10), and family functioning (see Figures 11 & 12)
as the outcome variables in the models. Regressions were used to test these modiﬁed
models as well as the predicted mediating and moderating hypotheses. Baron and
Kenny’s (1985) recommendations for using regressions to test mediating and moderating
relationships were followed to test these relationships in the models. An independent t-
test was used to test the hypothesis regarding the nature of the death’s impact on
adequacy of social support, and a correlation was reported for the hypothesis linking
parent coping to family communication as the dependent variable.

Baron and Kenny (1986) recommend that three regressions are performed to test
for mediation between independent variables and dependent variables. The ﬁrst
regression represents the relationship between the mediator and the independent variable,
the second between the independent variable and dependent variable, and the third
regresses the dependent variable on both the independent variable and mediator. For
mediation to occur the ﬁrst and second regression coefﬁcients must be signiﬁcant, and in
the third regression the mediation variable should signiﬁcantly impact the dependent
variable in the presence of the independent variable (Baron & Kenny, 1986). This third

criterion also includes seeing the regression coefﬁcient for the relationship between the

118

independent variable and dependent variable decrease when the mediator is also
represented in the equation.

Baron and Kenny (1986) recommended that when testing for moderators when the
independent variable is categorical and the moderator is a continuous variable a
regression should be performed including the independent variable, moderator variable,
and an interaction between the independent variable and moderator. A moderating
relationship exists when the interaction between the independent variable and moderator
is signiﬁcant.

Wm

Independent t-tests were performed to test the relationships between the nature of
the parent’s death and adequacy of social support for parents and children and between
participation in formal support and coping for parents and children. Hypotheses 1 and 6
proposed the following relationships: 1) parents and children who experience a sudden
death will be less likely to have their emotional and practical needs met by friends and
family than individuals who experience an anticipated death; and 6) parents and children
who participate in formal support will be more likely to cope more effectively than
parents and children who did not participate in formal support.

T-test results indicated that the nature of the death does impact adequacy of social
support for the parents, but not in the hypothesized direction. Parents whose spouse died
suddenly were signiﬁcantly more likely to have adequate social support (M=2.41) than
parents who anticipated their spouses’ death (M=2.15) (t=2.21, df=70, p<.05). For the

children. the nature of the death did not impact the adequacy of social support received

119

from family and ﬁiends.

T-test results also demonstrated that participation in formal support did impact
parent coping, but not in the hypothesized direction. Parents who did not participate in
formal support were more likely to be coping better (M=3.67) than parents who did
participate in formal support (M=3.39) (t=2.03, air-70, p<.05). For children participation
in formal support did not impact coping.

Modiﬁed Model 1: Parent Coping as the Dependent Variable
E 1' [E 2 .

. . hr 1 v .H . ”m ,.-' 5U . L.” A. .1. J” . "1.. . .
W A series of multiple regressions were used to test hypothesis
7 which states that functional social support (adequacy of social support) will either a)
mediate the parent's ability to cope or b) moderate the effect of the nature of death on the
parent's ability to cope. Figures 3 and 4 display the hypothesized relationships, and
Tables 29 and 30 contain the unstandardized and standardized regression coefﬁcients, t-
tests. R3. and F tests for the mediating and moderating analyses, respectively.

Functional support was found to be a partial mediator between the nature of the
death and parent coping. All three conditions were met for mediation. Nature of the
death negatively inﬂuence parent’s perceived adequacy of social support (functional
support) (B=—.26, p<.05). This indicates that parents whose spouse died suddenly are
more likely to receive adequate support from friends and family (M=l .35) than parents
who anticipated their spouse's death (M=2.32). Nature of the death also negatively

inﬂuences coping (B=-.31, p<.01) which indicates that parents who experienced a sudden

120

loss are coping better (M=3.50) than parents who experienced an anticipated loss

(M=1.35). When both nature of death and adequacy of social support are entered into the

equation, adequacy of social support inﬂuenced parent coping (B=.34, p<.01), and the

impact of nature of the death on parent coping did decrease (B=-.23, p<.05). This ﬁnding

indicates that adequacy of social support only partially mediates the relationship between

the nature of the death and parent coping since a signiﬁcant relationship continued to

exist between the nature of the death and parent coping with the presence of adequacy of

 

 

social support.
Table 29
s' 7 '
Outcome and Predictors B B t R2 F
Analysis 1:
Outcome: Adequacy of social support
Predictor: Nature of the Death -.26 -.26 -2.21* .06 4.89"I
Analysis 2:
Outcome: Parent Coping
Predictor: Nature of the Death -.41 -.31 -2.78" .10 7.65“
Analysis 3:
Outcome: Parent Coping
Predictor: Nature of the Death -.30 -.23 -2.05"' .20 8.86"
Adequacy of social support .43 .34 3.03”

‘p<.05. "p<.01

 

Hypothesis 7 part B theorized that adequacy of social support would moderate the

relationship between the nature of the death and coping for parents (see Figure 4). If

adequacy of social support moderates coping, then the interaction effect between

121

adequacy of social support and the nature of the death must be signiﬁcant when coping is
regressed on all three variables, nature of the death, adequacy of social support, and the
interaction term. While testing for moderation, the nature of the death was recoded into a
dummy variable where sudden death=0 and anticipated death=1. A new mean score for
adequacy of social support was calculated and used to test for moderation. The new score
was computed by subtracting the sample’s overall mean score of functional (adequacy)
social support from each participant’s mean score for ﬁinctional (adequacy) social
support. This new score along with the nature of the death dummy variable were used to
compute the interaction terms. This was done in order to avoid problems of multi-
collinearity. Speciﬁcally, interaction terms can be highly correlated with the independent
variables used to compute the interaction term which violates assumptions of multiple
regression (Aiken & West. 1991). Table 30 contains the standardized and unstandardized

regression coefﬁcients, t-tests. R2. and F test for parents.

Table 30

 

 

 

Outcome and Predictors B [3 t R2 F
Analysis 1:
Outcome: Parent Coping
Predictor: Nature of the Death -.23 -. l 8 -.36 .21 6.08”
Adequacy of social support .52 .40 2.89"
Interaction -.24 -.40 ' -.79

*p<.05. "p<.01

These ﬁndings indicate that adequacy of social support does not moderate the

effect that nature of the death has on coping for parents. The interaction term for parents

122

was nonsigniﬁcant (13:-.24, p<.05). Even though adequacy of social support (functional
support) does positively impact coping for parents (B=.40, p<.01), having adequate social
support does not decrease the impact of anticipated death on parent coping as the '
moderating hypothesis developed by Cohen and Wills (1985) suggests.
mmwmwmmm Hypothesis 3
speculated that structural social support (frequency of contact with support network) will
mediate/directly effect coping for parents regardless of the nature of the death (see Figure
5). Table 31 contains the standardized and unstandardized regression coefﬁcients, t-tests,

R3. and F test for parents ﬁom the multiple regression analyses.

 

 

Table 31
run-0r : ‘01! 'ie 0 u. r__r-. 0-: .u-Irukzt ‘r I.'.=_.r:10':rr ur°
Outcome and Predictors B B t R2 F
Analysis 1:
Outcome: Frequency Contact with Network
Predictor: Nature of the Death -.38 -.16 -l .32 .02 1.73
Analysis 2:
Outcome: Parent Coping
Predictor: Nature of the Death -.41 -.31 -2.77“ .10 7.65“
Analysis 3:
Outcome: Parent Coping
Predictor: Nature of the Death -.37 -.28 -2.43" .1 1 4.21 "

Frequency Contact with Network .08 .14 1.19
‘p<.05. "p<.01

The results indicate that structural support does not mediate the relationship

between the nature of the death and parent coping. Only one of the three needed

123

conditions are present. The nature of the death does not impact the parent’s frequency of
contact with their network (IF—.16), nor does parent frequency of contact with network
impact parent coping (13:. 14), even though nature of the death does inﬂuence parent
coping (13:-.31. p<.01). It appears that structural social support (frequency of contact
with the network) does not have a mediating effect on parent coping. Nature of the death
does directly impact coping for parents.

WW Multiple regression was used to
test these hypotheses, and Table 32 contains the unstandardized and standardized
regression coefﬁcients. t-tests- R3. and F tests for these analyses. The following analyses
tested the following ﬁve hypotheses: 2) Parents who experienced a sudden death will
have a more difﬁcult time coping than parents who experienced an anticipated death. 3)
Parents who have their emotional and practical needs met by friends and family will cope
better than those whose needs are unmet. 5) The child's ability to cope will inﬂuence the
parent's ability to cope. Hypothesis 4) Parents in frequent contact with their support
networks will cope better than parents who are not in frequent contact with their networks
was not included in this analyses since structural support (frequency of contact with
network) was not a predictor of parent coping (see Table 32).

These results support hypotheses 2 (opposite of the hypothesized direction) and 3
but do not support hypothesis 5. Nature of the death (hypothesis 2) and functional
(adequacy) social support (hypothesis 3) were signiﬁcant predictors of parent coping.
Child coping (hypothesis 5) did not inﬂuence parent coping in any way. Parent coping

seems to be impacted by the nature of the death and functional (adequacy) social support.

124

Parents whose spouse died suddenly were more likely to be coping better ([3=-.30; p<.05)
than parents who anticipated their spouse’s death. Parents who received adequate social

support ﬁ'om family

Table 32

 

 

 

Outcome and Predictors B p t R2 F
Analysis 1:
Outcome: Parent Coping
Predictor: Nature of the Death -.30 -.23 -2.05‘ .22 6.27”
Adequacy of Social Support .43 .34 303"
Child Coping -.08 -.1 1 -l .04

’p<.05. "p<.01

and friends also tended to cope better (B=.43, p<.05) than parents whose social support
was inadequate. These ﬁndings suggest that both the nature of the death and adequacy of
social support signiﬁcantly inﬂuence the parent’s ability to cope.

Summam, These ﬁndings indicate that the nature of the death and adequate social
support are important factors for parents coping with the death of a spouse. Nature of the
death and adequacy of social support both directly inﬂuence parent coping. These
ﬁndings suggest that parents whose spouses died suddenly were more likely to be coping
better and to receive adequate support from friends and family than parents who
anticipated their spouse’s death. Also, adequacy of social support only partially mediates
the impact that the nature of the death has on parent coping since a signiﬁcant

relationship continued to exist when parent coping was regressed onto adequacy of social

125

support and the nature of the death. This ﬁnding suggests that adequate social support
does inﬂuence parent coping regardless of the nature of the death, even though nature of
the death also impacts coping.

Modiﬁed Model 2: Child Coping as the Dependent Variable

E l' [2].”: .

‘. r° rm 1" '1-.. no. 0- «__ n-or rm. 0 o rut-rec. I o '9
coping, Multiple regressions were used to test hypothesis 7 which states that functional
social support (adequacy of social support) will either a) mediate the child's ability to
cope or b) moderate the effect of the nature of death on the child's ability to cope. Figures
7 and 8 display the hypothesized relationships and standardized regression coefficients,
and Tables 33 and 34 contain the unstandardized and standardized regression coefﬁcients,
t-tests. R3. and F tests for the mediating and moderating analyses.

Functional social support was not found to be a mediator of child coping. Only
one of the three conditions for mediation were met. The nature of the parent’s death did
not inﬂuence child’s perceived adequacy of social support ([3=.03; p<.67) nor child
coping (B=.05; p<.65). However, adequacy of social support did effect child coping
(13:.25; p<.05) when the nature of the death was also present in the equation. In other
words. adolescents who had adequate social support from friends and family (M=2.40)
tended to be coping well. This ﬁnding indicates that adequacy of social support seems to
be important to the adolescents’ ability to cope, and that the nature of the parent’s death

does not inﬂuence the children’s coping.

126

Table 33

 

 

 

Outcome and Predictors B I} t R2 F

Analysis 1:

Outcome: Adequacy of Social Support

Predictor: Nature of the Death .01 .03 .24 .001 .057

Analysis 2:

Outcome: Child Coping

Predictor: Nature of the Death .13 .05 .43 .003 .18

Analysis 3:

Outcome: Child Coping

Predictor: Nature of the Death .1 1 .04 .38 .07 2.45
Adequacy of Social Support 1.39 .25 2.17"

‘p<.05. “p<.01

 

Hypothesis 7 part B theorized that adequacy of social support would moderate the
relationship between the nature of the death and coping for children. If adequacy of
social support moderates coping, then the interaction effect between adequacy of social
support and the nature of the death must be signiﬁcant when coping is regressed on all
three variables. nature of the death, adequacy of social support, and the interaction term
(see Figure 8). Table 34 contains the standardized and unstandardized regression
coefﬁcients. t-tests. R2. and F test for children. These ﬁndings indicate that adequacy of
social support does not moderate the effect that nature of the death has on coping for

children. The interaction term for children was nonsigniﬁcant.

127

Table 34

 

 

 

Outcome and Predictors B 0 t R2 F
Analysis 1:
Outcome: Child Coping
Predictor: Nature of the Death .02 .01 .1 19 .10 2.53
Adequacy of social support .96 .29 213"
Interaction .24 .04 .30

‘p<.05. "p<.01

 

r° INA-1'1 ' -r- --r. o , MM L -. "‘0. c r ' Orr
Multiple regressions were used to hypothesis 8 which proposed that structural social
support (frequency of contact with support network) will mediate coping for children (see
Figure 9). Table 35 contains the standardized and unstandardized regression coefﬁcients,
t-tests. R3. and F test for the children. Results indicated that structural social support does
not mediate coping for children since none of the relationships needed to support a
mediation effect were present. Neither the nature of the death (p=.05; p<.66) nor
frequency of contact (B=.05; p<.68) inﬂuenced child coping in any way. Also, nature of

the death did not impact frequency of contact with the network (IF-.03; p<.83).

128

Table 35

 

 

 

Outcome and Predictors B [3 t R2 F

Analysis 1:

Outcome: Frequency of Contact

Predictor: Nature of the Death -.06 -.03 -.22 .001 .047

Analysis 2:

Outcome: Child Coping

Predictor: Nature of the Death .13 .05 .43 .003 .18

Analysis 3:

Outcome: Child Coping

Predictor: Nature of the Death .13 .05 .43 .005 .176
Frequency of Contact .05 .05 .41

‘p<.05. "p<.01

... ”m r i qt". m" _.' . .H "1., . L . . “...
Multiple regressions were used to examine hypothesis 11 which considered the possibility
of family communication mediating the relationship between parent and child coping.
Table 36 contains the standardized and unstandardized regression coefficients, t-tests, R3-
and F test for the children. The results indicate that family communication regarding the
death and deceased does not mediate child coping since parent coping did not impact
family communication (13:-.17; p<.l6) nor did it impact child coping (IF-.13; p<.27).
However. family communication did signiﬁcantly impact child coping (B=.29; p<.05).
Although family communication does not mediate the relationship between parent and
child coping it does have a direct effect on child coping. This ﬁnding implies that if a

child perceives their family communication surrounding the deceased parent and the

ID

lag]

011C

“and

129

death as open. honest, and good, they are more likely to have better coping abilities.

 

 

 

Table 36
e i ' i ti t i ' i n
Outcome and Predictors B [l t R2 F
Analysis 1:
Outcome: Family Communication
Predictor: Parent Coping -.23 -.1 7 -1 .42 .03 2.03
Analysis 2:
Outcome: Child Coping
Predictor: Parent Coping -.34 -.18 -1.51 .03 2.28
Analysis 3:
Outcome: Child Coping
Predictor: Parent Coping -.25 -.13 -1.12 .1 1 4.39‘
Family Communication .40 .29" 2.52‘
‘p<.05. ”p<.01
D. E 1. [C1 .1 1 C .

Multiple regressions were used to examine the direct predictors of child coping.

They regressed child coping onto child functional support (adequacy of social support)

and family communication. Nature of the death (Hypotheses 2), structural support

(Hypothesis 4). and parent coping (Hypothesis 5) are not included in this multiple

regression since previous regression results indicate that these variables have no impact

on child coping (see Tables 33, 35, and 36). These analyses tested the child sections of

hypotheses 3 and 10 (see Figure 10). Table 37 contains the unstandardized and

standardized regression coefficients. t-tests, R2. and F tests for these analyses.

W The following analyses tested the

130

direct impact of functional social support and family communication on child coping.
Hypothesis 3 predicted that children who have their emotional and practical needs met by
friends and family will cope better than those whose needs are unmet. Hypothesis 10
speculated that families who communicate openly about the death and the deceased will
have children who cope more effectively with the death than families who do not discuss
the death or deceased.

For the children, adequacy of social support (Hypothesis 3) and family
communication (Hypothesis 10) did impact child coping. These ﬁndings indicate that
children tend to cope more effectively when their emotional and practical (functional
support) needs are met by their family and friends (B=.23; p<.05) and when they live in a
family environment where they can openly communication about the death and deceased

((3:34; p<.05).

Table 37

 

 

 

Outcome and Predictors B B t R2 F

Outcome: Child Coping

Predictor: Adequacy of Social Support .89 .23 1.96‘ .12 4.55"
Family Communication .38 .28 2.36“

‘p<.05. “p<.01

 

W Nature of the death, frequency of contact with the network, parent
coping, and participation in formal support had no signiﬁcant role in child coping.

Structural social support (frequency of contact with the network) and functional social

131

support (adequacy of social support) neither mediated nor moderated the impact of the
nature of the death on child coping. The two important key factors that directly inﬂuence
child coping seem to be functional social support (adequacy of emotional and practical
support from family and friends) and open family communication regarding the death and

deceased parent.
Modiﬁed Model 3: Family Functioning and Grief

E '1 E . . 1 I2 1 If . 1 l

The following analyses examine parent and child grief and family functioning as
the dependent variables. They tested the relationships between coping and grief , grief and
family functioning, and grief as a mediator between coping and family functioning. Since
the child’s age is signiﬁcantly correlated with child grief (r:=-.30; p<.05), the child’s age
was included as a covariate in the analyses involving child grief. However. time and
parent age were not signiﬁcantly correlated with any of these variables (see Table 27). As
a result. time and parent age were not included in the analyses. Multiple regressions were
used to test all of these hypotheses.

- u ...-o .r‘, ' .1' r.-. o ”- .. ,I’ 1‘ o; u - I, ..1- - Hypothesis

13 speculated that families that have parents and children grieving more effectively will
function better as a family than those families whose members are not grieving effectively
(see Figure 11). Table 38 contains the unstandardized and standardized regression
coefﬁcients, t-tests. R2, and F tests for these analyses.

The ﬁndings from these analyses suggest that both parent and child grief do

inﬂuence family functioning. Parent grief positively impacts family functioning (l3=.27;

132

p<.05). This ﬁnding suggests that parents who are in the later phases of the grieving
process tend to have families that function better than parents who are in the early phases
of the grieving process. Child grief also positively effects family ﬁrnctioning ([3=.24;
p<.05). This result also implies that children who are in the later phases of their grieving
process tend to have families that function better than children who are in the early phases
of the grieving process. The positive correlations between grief and family functioning
signify that families function more effectively when both the parents and children tend to
be in the later phases of the grieving process. In other words, when family members are
still actively coping with their grief (early phases of grief) family functioning tends to be
low, yet when they reach the later phases of the grieving process, the family tends to

function more effectively.

Table 38

I'lllill'l [E'EE'IE"

 

 

Outcome and Predictors B B t R2 F

Analysis 1:

Outcome: Family Functioning

Predictor: Parent Grief .1 1 .27 * 2.36“ .07 5.57"
Child Grief .09 .24* 1.96“

‘p<.05. "p<.01

 

Hypothesis

 

12 stated that parents and children who cope effectively will grieve more effectively than

parents and children who have difﬁculty coping. Coping did inﬂuence grief for both

133

parents and children. For parents. coping positively affected grief (13:.49; p<.01).

Parents who were coping well tended to be in the later phases of the grieving process than
parents who were not coping well. For children, age of the child was covaried out using
hierarchical regression since it shared a signiﬁcant relationship with child grief. The
child’s coping (15:31; p<.01) and age (IF-.33; p<.05) inﬂuenced their grieving process.
Like their parents, children who were coping better also tended to be further along in their
grieving process. However. the age of the child negatively impacted the child’s grief
which indicates that younger children tended to be further along in their grieving process
than older children. Effective coping led to effective grieving for both children and
parents.

Hypothesis 14 speculated that parent and child grief will mediate the relationship
between parent and child coping and family functioning (see Figure 12). Table 38
contains the unstandardized and standardized regression coefﬁcients. t-tests, R3, and F
tests for these analyses. The results from the three regressions indicate that parent grief
does not mediate the relationship between parent coping and family functioning. Only
one of the three criteria for mediation was met. Parent coping does directly impact parent
grief (B=.49, p<.01). The other two conditions: parent coping impacting family
functioning and parent grief impacting family functioning with parent coping in the
equation do not exist. As a result parent grief does not mediate the relationship between
parent coping and family functioning. Instead, parent coping has a direct effect on parent
grief. and the direct relationship between parent grief and family functioning disappears

in the presence of coping which could be due to the strong correlations between coping

I34

and grief for both parents and children. Also with the small sample size, the direct
relationship between grief and family functioning does not appear to be strong enough to
withstand the addition of a new variable for either parents or children.

These analyses were repeated for the children in order to test for grief as a
mediator between child coping and family functioning. The ﬁndings from these analyses
show that for the children only one of the three criteria for mediation were met. Child
coping does impact child grief (13:3 1 . p<.01) which indicates that children coping
effectively are further along in their grieving process. However, child coping did not
impact family functioning, nor did grief impact family functioning when child coping was
also present. These ﬁndings suggest that grief does not act as a mediator between coping
and family functioning for either parents or children. However, they do show that coping
does directly affect grief for both parents and children.

Summary, These results indicate that parent and child coping impact parent and
child grief and that parent and child grief effects family functioning. Child age also
inﬂuences child grief. Grief does not mediate the impact that coping has on family
functioning for parents or children, since parent and child coping share no relationship
with family functioning. These ﬁndings imply that parents and children who are coping
well tend to grieve well and that parents and children who grieve effectively tend to have

high functioning families.

135

 

 

Table 39
‘r' a 103.1" 4'U"-..1 'i' o'er‘r arr r. r I" .1,.I':"..l 10 nan-“r Hr' -rt
E '1 E . .

Outcome and Predictors B B t R2 F

Analysis 1:

Outcome: Parent Grief

Predictor: Parent Coping .88 .49 4.69“ .24 22.02"

Analysis 2:

Outcome: Family Functioning

Predictor: Parent Coping . I4 .19 I .63 .04 2.66

Analysis 3:

Outcome: Family Functioning

Predictors: Parent Grief .05 .08 .58 .08 2.93
Parent Coping .09 .23 1.76

Analysis 1:

Outcome: Child Grief

Covariate: Child Age -.19 -.33 6.00"

Predictor: Child Coping .29 .31 2.79" .18 7.60"

Analysis 2:

Outcome: Family Functioning

Covariate: Child Age -.02 -.09 -.79

Predictor: Child Coping .06 .18 1.51 .04 1.35

Analysis 3:

Outcome: Family Functioning

Covariate: Child Age -.007 -.03 -.24

Predictors: Child Coping .05 .12 .97 .07 1.66
Child Grief .08 .19 1.50

*p<.05. "p<.01

Chapter 4

DISCUSSION

The primary purpose of the present study was to evaluate a conceptual model that
included both individual and family factors and their impact on individual grief and the
functioning of the family system. Its second purpose was to determine the relationships
among key variables, such as nature of the parent's death, social support, coping,
communication, grief, and family functioning. The results of this study supported several
ﬁndings from previous grief research which found evidence for the impact of family
communication on child coping (Bertman, 1984; DeSpelder, et al., 1987) and functional
(adequate) social support on both child (Harris, 1991; Silverman &Worden, 1992) and
parent coping (Dimond's et al., 1987; Malikson, I987) . Although pieces of the
conceptual model were conﬁrmed. the study did not support the overall proposed
conceptual model which could in part be due to small sample size and mutlicollinearity
among the independent variables.

Even though the overall conceptual model was not supported by the ﬁndings, the
ﬁndings did conﬁrm the underlying purpose which was that both individual (social

support, coping and grief) and family (family communication and family functioning)

I36

137

level variables are important components to the family’s ability to cope and function after
the death of parent. The results also identify important relationships among the key
variables that researchers have noted in the past and a few relationships that contradict
previous ﬁndings.
1' . 1.1 1 l I

Contrary to previous research. time since death was not correlated to any of the
variables examined in this study which indicates that time since death does not impact
coping, social support, grief. or family functioning. These results imply that time does
not have a signiﬁcant impact on the grieving process or family functioning. This
indicates that other factors, such as coping and social support, play a more important role
for bereaved individuals and families than time since the death. Previous researchers
have linked time since death to grief reactions for both children and adults (Ball, 1977;
Elizur & Kaffrnan. 1982). However. this study examined the actual grieving process
which may account for the different ﬁndings. Future research needs to evaluate these
relationships more closely to determine the effects of time since death on the bereaved.
This ﬁnding also indicates that the bereaved could potentially need support from family,
friends, and professionals for years after the death of a loved one, yet in all likelihood the
support is not available for years following the death.

Age has also been considered an important variable fOr the bereaved. Previous
researchers have indicated that age can play a signiﬁcant role in reactions to the death of a
loved one (Ball, 1977; Elizur & Kaﬂtnan. 1982; Harris. 1991). However, for this study

age of the parent and child did not impact social support, coping. or family functioning.

138

Again. the previous studies examined grief reactions and not coping, social support,
family functioning, or the actual grieving process. Parent age did not share a relationship
with parent grief. However. for the children, age was signiﬁcantly correlated to their
grief. Findings indicated that younger children were more likely to be further along in
their grieving process than older children. Perhaps this result is a reﬂection of who these
adolescents turn to for support. Older adolescents are more likely to turn to their peers
for support, even though their peers may not be emotionally mature enough to provide the
support these older adolescents need (Gray, 1989; Harris, 1991). Younger adolescents
may tend to depend more on their families for support (Worden, 1996), and if the parent
is further along in the grieving process the child may also be further along in the grieving
process. Future research needs to examine the relationship between age and grief and
between age of children and parent and child grief more closely. If younger children do
depend more on their family for support and if parent grief inﬂuences child grief, then
professionals and researchers need to develop programs that focus on the family and that
promote progress through the grieving process for parents. If older adolescents depend
more on their social network for support, programs should be developed for both the
bereaved adolescents and their support network.
1 I [1: l l . S . 1 S l C .

Conclusions made from past research in the area of the nature of the death have
suggested that both sudden and anticipated deaths have detrimental inﬂuences on the
survivors’ reactions to the death of a loved one for various reasons (i.e. debilitating

shock, unﬁnished business, and difﬁculty letting go) (Bumell & Bumell, 1989;Rando,

139

1983; Sanders. 1982). However, this study produced three unexpected ﬁndings related to
the nature of the death. First. this study indicated that the nature of the death impacted
only parents and not children. For the surviving children, perhaps the nature of the death
does not inﬂuence their adequacy of social support and coping because they focus more
on the event and not on the process of how the event occurred. In other words, it may not
matter how mom or dad died. The child’s only concern may be that the parent died and
what the death means to her/him (Crase & Crase, 1989).

Second, sudden death tended to be associated with higher levels of functional
(adequate) social support in surviving parents. This relationship has not been examined
speciﬁcally in previous research. However, this effect could be due to the surviving
parents’ support network. Perhaps, with anticipated deaths, the social network wears out
supporting the family throughout the illness, and as a result, disappears after the death.
Whereas with sudden deaths. the family as well as the network are probably in shock, and
as a result, the network may tend to show great support to the family after the death has
occurred.

Third, sudden death also tended to be associated with the surviving parent’s
having better coping abilities which contradicts previous theories about anticipated deaths
(Cook & Oltjenbruns, 1989). This ﬁnding contradicts previous research which suggest
that anticipated deaths of intermediate lengths have less of an impact than sudden or long
terminal illness on surviving family members (Ludin, 1984; Rando, 1983). In other
words. previous researchers have concluded that when family members anticipate the

death for six months or less they tend to cope more effectively than family members who

140

experience a sudden loss or long chronic loss (Rando, 1983). This study suggests that
family members who experience a sudden loss cope more effectively than family
members who anticipate their loss. However. this study grouped all anticipated deaths
into one category since there were not enough cases to break down into < 6 months and >
6 months which could possibly account for this result. Perhaps, how the parent/spouse
actually dies (e.g. accident, suicide, homicide, cancer. AIDS, etc.) is more important for
coping and functional (adequacy) social support than whether the death was anticipated or
sudden. This study examined how the nature of the death (sudden/anticipated) affected
coping strategies and functional social support (adequate social support) of both parents
and children. while previous studies have focused on increases in somatic and psychiatric
illnesses (Ludin, 1984), poorer bereavement adjustments (Rando, 1983), physical
symptoms (Sanders, 1982), and general reactions to the death of a parent (Crase & Crase,
1989) as outcome variables. The different targeted outcome variables examined in these
studies may account for the difference in ﬁndings among the studies.

Future research should examine these relationships more carefully and determine
how a speciﬁc type of sudden death (accident, homicide, suicide, heart attack, etc) or
anticipated death (cancer. AIDS, diabetes, etc..) impacts the surviving parent. Future
research in this area should also examine the effects of the length of a terminal disease on
parent coping and functional (adequacy) social support. They should also evaluate if a
speciﬁc type of death would inﬂuence the children’s coping and frmctional (adequacy)
social support. While doing this, they could also discover the age at which the nature of

the death becomes an important variable for children, if at all.

141

The negative relationship between ﬁmctional social support and the nature of the
death indicate that parents whose spouse died suddenly were more likely to receive
adequate social support from friends and family than parents whose anticipated their
spouse’s death. This ﬁnding suggests that support networks need to provide support for
the parents throughout the grieving process as well as the illness. They also suggest that
professionals dealing with families in which a parent is dying should keep track of how
the well parent is coping with the illness and the changes in the family that result from the
illness and make sure that this parent is not overwhelmed with all the added
responsibilities thrust upon them. Future research should examine more fully the
relationship between the nature of the death and functional (adequate) social support.
They need to determine what aspects of both sudden and anticipated deaths are
detrimental and what aspects enhance the support received from family and ﬁiends.

S l I E i l S I C .

In the past. research has consistently highlighted the importance of social support
for bereaved individuals for both coping and grief (Dimond, et al., 1987; Gray, 1989;
Raphael & Nunn, 1988), and the ﬁndings of this study support this research. This study
found that the functional (adequate) support received from family and ﬁiends inﬂuenced
coping for both parents and children. For both parents and children, having their
emotional and practical support needs met (functional support) tends to increase their
coping abilities. Structural social support (frequency of contact with network), on the
other hand. did not impact coping for parents or children. This suggests that structural

support (frequency of contact with the network) may not be as important as the actual

142

support received when in touch with their network. Perhaps for parents and children, just
knowing that they can depend on someone within their network is more important than
how often they actually interact with members of their network (Malikson, 1987;
Worden, 1996). These ﬁndings strongly support the link between social support and
coping for parents and children that is highlighted in previous research (Gray. 1989;
Raphael, 1988).

These ﬁndings also reinforce the important and necessary role that social support
has for bereaved individuals on coping. These ﬁndings suggest that the provision of
social support is not as important to the bereaved as the extent to which the social support
provided meets the needs of the bereaved (Gray, 1989; Malikson, 1987; Silverman, 1988;
Worden. 1996). As a result, it is essential that researchers and professionals determine
the emotional and practical needs of the bereaved. Once a greater understanding of the
bereaved’s needs is reached, researchers and professionals can begin to educate the
bereaved's network to help their bereaved family and ﬁiends and help the family and
friends recognize their own limitations for providing support (i.e. practical versus
emotional). The bereaved also need to know who they can depend on in their networks
for the different types of support (practical or emotional) that they need at different times
during their grieving process, and if they cannot get what they need from their network,
they need to be able access community resources available to them.

The current study also found that parent coping and child coping share no
relationship. This is contradictory to systems theories, which imply that the family is a

unit and how one person in the family reacts affects everyone else in the family (Shapiro.

143

1994). Perhaps, this result is due to the age of the children. Maybe in families with
young and preadolescent children, parent coping would have a signiﬁcant impact on child
coping (Baker et al., 1992). The children participating in the study ranged in age from 12
to 18 years. They are at the point where they are beginning to gain independence ﬁ'om
the family, to explore who they are, and to rely more heavily on their peers for support
and acceptance (Harris, 1991). This could explain why parent and child coping share no
relationship in this study. Another explanation of this ﬁnding could be that parents and
children have completely different ways of coping and that one is not dependent on the
other. For example, parents may extemalize their feelings by talking with friends and
family while children internalize their feelings by keeping busy and thinking about other
things. More research needs to be done in this area to test this relationship. It is also
possible that the instrument used for measuring child coping could have affected this
relationship since its reliability was fairly low, and it only had eleven questions. The
instrument may not have tapped into the coping strategies that the children ﬁnd extremely
effective or that are more related to the parent coping strategies. Future research could
compare families with young and preadolescent children to families with adolescent
children in order to reexamine this relationship and the possible differences between
families with children in different age groups. Developing a good instrument to measure
child coping would also be beneﬁcial to future research. If this ﬁnding is replicated,
professionals who work with the bereaved, especially families, need to be aware of the
fact that parent and child coping abilities do not share a relationship which could alter

how they deal with families.

144
E l S 1 Cl '1 I C .

It was predicted that formal support would positively impact coping for both
parents and children. For children, participation in formal support did not inﬂuence
coping which contradicts previous ﬁndings (Masterman & Reams, 1988). However,
previous research in this area did not examine coping as an outcome. Instead they tended
to evaluate behavior changes and mood (Masterman & Reams, 1988; Zambelli et al.,
1988) which could account for the different ﬁndings. For the children, perhaps the
support received from formal support was no better or no different than the support
received from ﬁiends and family, or maybe the children did not feel that attending formal
support helped them cope with their experience. They may have attended under duress.
and therefore. did not make the effort to actively participate or gain anything from this
experience. This group of children may have found the information and experiences
gained ﬁ'om formal support to be ineffective for coping with the death of their parent.
However, participation in formal support may have been effective in other areas, such as
feeling less angry and having fewer behavior changes or problems as previous research
has shown (Masterman & Reams, 1988). or perhaps these formal support programs were
ineffective for these adolescents and just didn’t meet their needs. Future research needs
to evaluate this relationship in closer detail in order to determine the actual impact of
participating in formal support for children and adolescents. This research should include
measuring actual coping strategies. behaviors. and grief for children as well as examining
the effectiveness of formal support. Age of the child may have also affected the impact

of participation in formal support on the child’s coping. Perhaps younger children ﬁnd

145

more comfort from the family while older adolescents may beneﬁt more from the support
groups since they depend more heavily on their peers for support (Gray, 1989; Worden,
1996). This is another area that future researchers need to explore more fully.

These ﬁndings contradict previous research which found that children who
participate in formal support tend to experience less anger and fewer behavioral problems
after attending a support group (Masterman & Reams, 1988). Support groups often
reduce misconceptions about death, make the death less confusing for children, and
normalize reactions to the death. and on the family level, they often promote
communication about death in the family (Masterman & Reams, 1988; York &
Weinstein, 1981; Zambelli & DeRosa, 1992). However, these studies focused on
emotional and behavioral reactions as the outcome variables. They did not examine
coping strategies which may explain the different ﬁndings.
Wallis

Parents in this study who participated in formal support tended to be coping less
effectively than parents not participating in formal support which may be the reason
parents initially sought help from formal sources instead of family and ﬁiends. Perhaps
formal support resources sought by the parents in this study did not impact coping. but
instead focused on providing emotional support for the participants.

Parents who participated in formal support were also less likely to have their
functional support (adequacy of emotional and practical needs) needs met by their family
and ﬁiends. This ﬁnding may indicate that participating in formal support may make

parents more aware of what they need emotionally and practically ﬁ'om family and ﬁiends

146

and that their family and friends are not meeting those needs or that the parents attending
formal support programs may be more needy than parents who do not seek these
resources. Future research involving formal support resources for the bereaved needs to
examine why people seek these resources. how well they are coping before and after
attending. the adequacy of support received from family and friends before and after
attending. and the effectiveness of these formal resources. Future research also needs to
determine the differences between people who seek formal support resources and people
who do not seek formal support resources. and should also use longitudinal studies to
examine individuals and families attending formal support resources in order to ascertain
if attending formal support improves coping and functional support over time.

The study did not separate the type of formal support (support group, counseling,
therapy. or clergy) received by the participants. Perhaps one type of formal support is
more effective than another (i.e. support group over therapy) for different types of
resources (i.e. sharing experiences and problems). The length of time the participants
attend the formal support may also have impacted these results (Black &
Urbanowicz,l987). Perhaps the bereaved have to attend for a certain period of time
before formal support positively impacts coping, and this sample had not yet reached that
point. Or maybe formal support does not impact coping at all, but instead affects family
communication and grief like previous researchers have suggested (Masterman & Reams,
1988; York & Weinstein, 1981; Zambelli & DeRosa, 1992) and could ultimately impact
family functioning instead of coping. More research should be performed that examines

formal support in detail. This research should include type of formal support, length of

147
time participated in formal support, coping of participants, satisfaction with support
received, family communication, grief. reactions to the death, and family functioning and
should be performed longitudinally. Developing and evaluating interventions for the
bereaved individuals and families is also a critical area that needs to be examined in
detail. Speciﬁcally, researchers need to determine what types of support services (i.e.
support groups. individual counseling. family counseling) are the most effective for
families and individuals. what the focus of the interventions should be, why the bereaved
seek support resources, do these resources work more effectively for some families over
others, and if so, how these families differ on coping. social support, nature of the death,
family functioning and demographic characteristics.
5 . l S l l l l l I I.

Although results regarding social support reinforce the importance of adequate
social support for bereaved individuals. social support in this study tended to have only
direct relationships with other variables. Functional (adequacy) social support did not
moderate the relationship between nature of the death and coping for parents or children.
For children. this probably resulted because the nature of the death was not linked to
social support or coping. For parents. this result may be a product of the strong direct
relationship that both nature of the death and functional social support have with coping.

Both structural (frequency of contact with network) and functional (adequacy of
social support) social support were examined as mediators between the nature of the
death and coping. Structural support (frequency of contact with the network) did not

mediate the relationship between the nature of the death and coping for either children or

148

parents. For children, nature of the death was not significantly linked to either frequency
of contact with network or coping which accounts for the lack of results. As discussed
earlier, frequency of contact with network just may not be as important to coping as the
support they get when they are in touch with their network, and how their parent died may
not matter as much as how the event affects them. Also, no change in frequency of
contact may have occurred as a result of the death. This could especially be true for
children since they still live at home and are in contact with their families every day and
they see their friends at school every day also.

Structural support did not mediate the relationship between the nature of the death
and coping for parents either. Nature of the death did not impact frequency of contact
with the network. Perhaps the parents in this study experienced no changes in their
contact with their support network. In today’s society most families have two working
parents. and if the surviving parent’s coworkers are also close friends, the frequency of
contact is not affected since they see their coworkers everyday at work. Or maybe
functional support is more important to bereaved parents than structural support. In other
words, perhaps the quality of the interaction is more important for parents than the
number of interactions.

Functional support partially mediated the relationship between parent coping and
the nature of the death. This ﬁnding indicates that adequacy'of social support impacts
coping regardless of the nature of the death. Functional support is a partial mediator due
to the signiﬁcant relationship between the nature of the death and coping when adequacy

of support was added to the equation. This indicates that other factors that were not

149

accounted for in this analysis may be involved in this relationship or that the nature of the
death has both an indirect and direct effect on coping. Other possible factors not
accounted for may consist of emotional reactions to the death, such as anger, guilt, blame
and a lack of control (e.g. not having control over the events that lead to or are associated
with the death that may have prevented the death) (Cook & Otljenbruns, 1989). Future
research should further examine these relationships in order to determine what other
factors may be playing a role in these relationships.

In this study, parent coping did not inﬂuence family communication in any way.
It was hypothesized that parents who were coping more effectively would be more likely
to have families open to communication regarding the death and the deceased parent;
however. this hypothesis did not hold true for this study. Perhaps, parent coping did not
affect family communication because the family was in crisis and this upset their normal
communication patterns. or maybe parent coping has no impact on the family’s
communication pattern regarding the death and the deceased parent.

Even though parent coping shared no relationship with family communication.
family communication did impact child coping which supports previous research
(Bertman. 1984; DeSpelder. et al., 1987). The strong relationship between family
communication and child coping indicates that children ﬁnd ‘open communication in the
family to be very important to their coping. Parents, on the other hand, do not seem to be
affected by family communication since these two variables did not share a relationship.

This could be a result of the way family communication was measured. The family

150

communication scale really considered the child’s perception and feelings of being able to
ask questions and express their emotions. Since previous research indicated that family
communication was important for the children (DeSpelder, et al., 1987; Olowu, 1990),
the family communication survey did not ask questions regarding the parent’s ability to
share their feelings with the family. This is something to consider for future research.
This study reinforces the importance of family communication for children. As a result,
parents need to understand the importance of being open about what happened with their
children. Parents of bereaved children need to be educated about the importance of being
open and honest about the death and the deceased parent and how to talk about these
subjects with their children. Future research should include developing interventions that
promote family communication about death, dying and grief among family members
before and after death occurs in the family. Community education regarding talking
about death and feelings associated with a deceased loved one would be a good place to
start.

C . 5 . E l E '1 E . .

It was hypothesized that coping effectively would predict grieving for both parents
and children. The ﬁndings of this study support this hypothesis. For both parents and
children. high coping was positively linked to grief. This suggests that if a parent or child
were coping effectively they also tended to be in the later phases of the grieving process.
This ﬁnding indicates that coping is an important aspect of the grieving process and tends
to impact the grieving process. It is also important to note that time since the death did

not impact coping or the grieving process for either parents or children which indicates

151

that time is not a factor for the grieving process for the participants in this study. This
knowledge should be utilized by the professional community when developing programs
and working with the bereaved. Programs should evaluate the coping skills of the
participants and help to enhance effective coping strategies for participants who are
having a difficult time coping with their loss. Since time does not impact the grieving
process. programs should be available and designed to help all grieving individuals and
families no matter how long it has been since the death occurred. Although grief did not
serve as a mediator between coping and family functioning for parents or children, it did
directly affect family functioning. The results showed that families with children and
parents in the later phases of the grieving process function better as a family which
indicates that having family members in the later phases of the grieving process beneﬁts
family functioning while having family members in the early phase may prove to be
detrimental to family functioning. Perhaps being in the early (coping) phase of the grief
process is so consuming that family members cannot concentrate on what is happening
within the family. Maybe they are so busy dealing with their own grief and the daily
needs of the family that they may not have the energy or awareness of what is happening
in the family (Schneider, 1994). These ﬁndings indicate the importance of effective
grieving on family ﬁmctioning. Evidently, while in the early phases of the grieving
process, family members are very self involved with trying to deal with their feelings and
reactions to the death. As a result, the family is affected and does not function well.
However, once members enter the later phases (i.e. growth phases) of the grieving

process. family functioning improves. Future research needs to further examine this

152

relationship in greater detail and concentrate on developing programs that help families
deal effectively with their grief which may lead to better family functioning for bereaved
families. These relationships indicate the important impact these individual and family
level variables have on the family. and support the idea that death affects family members
on both an individual and family level.

Summary, Although all the hypotheses in this study were not supported and the
proposed models were not conﬁrmed. the results advance our understanding of the impact
of the death of a family member on individual variables and family functioning. For the
most part. the individual level variables for parents and children had similar relationships.
For example. effective coping was associated with effective grieving for both the parents
and the children. Most of the differences in the ﬁndings between the parents and the
children occurred when examining the mediational relationships proposed in the model
and the impact of the nature of the death on coping and adequacy of social support. The
ﬁndings indicate that for both parents and children: I) adequacy of social support
positively impacts coping; 2) effective coping positively inﬂuences grieving; and 3)
dealing effectively with their grief and progressing through the grieving process
inﬂuences family functioning. Further testing of a modiﬁed model with a larger sample
size should be considered for future research. Some of the relationships in the original
model that were consistently nonexistent could be removed (i.e. link between parent
coping and family communication, and links between nature of the death and child
coping and satisfaction with support). A larger sample size could extract relationships

that may exist but were not strong enough to be found with this small sample. Doing this

153

would provide us with a much clearer picture of what happens to both the family and
individuals within the family when the death of a parent occurs. See Figure 13 for a ﬁnal
model that illustrates the relationships demonstrated in this study.

This study shares two shortcomings of past research that has focused on grief,
recruiting difficulties and sampling bias. Recruiting bereaved families, especially
families with children, has always been a tall order for researchers, and getting a large
sample where both the parent and the child or children (especially teenagers) in the family
agree to participate has proven to be even more difﬁcult. Studies have usually relied on
support groups. funeral homes, hospitals, obituaries, and churches for recruitment
purposes which may access a lot of families (Stroebe & Stroebe, I989; Zambelli et al.,
1988; Black & Urbanowicz 1987), but not all families attend support groups, or access
the same hospitals. churches, or place obituaries in the newspaper the researchers are
using for recruitment. Sampling from support groups and churches is very problematic
because not all families have access to support resources or attend churches and families
(and individual members of families) choose to access these resources (Stroebe &
Stroebe, 1989). The current study accessed similar resources for recruitment. The
participants responded to notices in small circulation community newspapers and support
groups. Although support groups were not good resources to acquire participants, the
community newspapers proved to be an excellent resource for participants. Although
some of the newspapers served large urban areas, most of these newspapers were in small

rural towns in the Midwest. This raises the concern of the differences between people

154

who live in urban areas and rural areas, and the resources available or not available to
each. Also, the people who read these community newspapers may be different from
people who choose not to read these papers. Therefore, the results may be biased towards
families who have access to the papers, who live in certain geographical areas, who are
interested and/or are involved in community events, and who may have educated parents.
As a result, conclusions drawn from the current research may not be generalizable to all
bereaved families.

Difﬁculties in recruitment leads to another limitation the present study faced,
small sample size. This research consisted of only 72 families. Small sample size may
adversely affect the Goodness of Fit Indices in structural equation modeling. In other
words. small sample size (under 250) may cause some of the ﬁt indices, such as GP] and
NFI, to be underestimated indicating that the model does not ﬁt when in actuality it does
(Hu & Bentler, 1995). The small sample also placed this study at an increased risk for
statistical error and low power which may account for some of the difficulty faced in
analyzing the data (Hu & Bentler, 1995).

Another potential limitation of this study were some of the instruments used by
the researcher. More research needs to be done on developing and reﬁning measures that
assess the variables looked at in this study. A better coping measure for the children
should have been used. The KidCope scale had low reliability and few items. Since the
children in this study were adolescents, perhaps a more sophisticated instrument could
have been used. The family communication scale in this study had never been used

before and so had no test retest reliability. Questions were added by the researcher to the

155

functional social support measure. These questions had not been previously tested with
the bereaved either. While the other scales used in this study had been previously tested,
most of them had not been used to assess the bereaved, Bereaved individuals may face
some unique social support, coping, or family functioning needs that are not important to
other populations tested with these measurements.

Multicollinearity was another concern the study faced. The independent variables
were highly correlated with each other and most were correlated with the dependent
variables. Multicollinearity among the independent variables may produce unstable
partial regression coefﬁcients. This instability may cause the coefficients to change
considerably in magnitude and even in sign (negative/positive) (Shavelson, 1988). As a
result. the ﬁndings of this study may have been affected by the high number of
intercorrelations among the observed variables. Perhaps, if the independent variables
were less correlated with each other, more of the mediation and direct effects may have
been signiﬁcant.

Another limitation was the lack of variance in the sample population. Most of the
participants were Caucasian (94%), earned more than $21,000/year (77%), and 92% of
the families had lost a father/husband. To truly understand the impact that the death of a
parent has on family functioning, future research needs to focus and build on the
importance of the relationships between social support, coping, family communication,
grief, and family functioning found in this study. In order to do this, research needs to
evaluate these relationships by collecting information from a sample representative of our

population. Researchers in this area need to actively recruit families across racial/ethnic

156

and rural/urban backgrounds as well as across income levels to determine the differences
among the different ethnic or cultural groups, who functions best aﬁer the death, and if
what they are doing right is applicable to the other groups and the special needs of each
population. It would be interesting to understand the differences that may exist between
these groups of people, and if what proves effective for one group could be taught to the
other groups and be just as effective. It would also be fascinating to ascertain if rural and
urban families differ in regards to support, available resources, coping, grief, and family
functioning. Future researchers also need to evaluate the differences that may exist
between families that lose a mother versus a father and the special needs that each family
has.

The ﬁnal limitation of the current study was that it was not longitudinal,
especially since very little is known about the long-term effects the death of a parent has
on children as they develop and become adults. At this point, researchers have very little
knowledge of how the loss of a parent in childhood or adolescence affect these children
throughout their lifetimes. Researchers know that the loss is felt throughout life because
of anniversary reactions during special life events and developmental stages (graduations,
weddings, holidays, etc.) (Baker, et al., 1992), but not how it affects their development,
their relationships with ﬁiends, family and partners, their parenting skills, and how they
deal with everyday life events. Other areas of interest for longitudinal studies could
include how losing a parent at different ages or developmental stages inﬂuences
children’s development and how they may differ from children who have never

experienced the death of a parent as adults. Also, since data was cross sectional, the

157

researcher had no way to know how well the family was supported, coping,
communicating, and functioning before the death, and as a result, could not compare the
families over time. A better way to truly determine the effects that the death of a parent
has on family functioning would be to study the family in a non crisis mode (preferably
before the death occurred) as well as after. But, this is virtually impossible to do since we
do not know when we will die, and even families with a terminally ill parent are not in a
non crisis mode since they are dealing with a dying family member. Of course,
researchers could ask families about coping, social support, family communication, and
family functioning retrospectively. However, an objective view of these variables would
probably be difficult to obtain since the family members’ perception may be tainted by
their experience.
lmnﬁgatignifQLEumﬂth

The present study both supports and contradicts previous research done in the
grief area but also, makes an important contribution to the research. More importantly,
these ﬁndings strengthen our understanding of how the death of a parent impacts a family
on both individual and family levels. The present study takes a further step to portray the
relationships between key variables that have been identiﬁed as important to bereaved
individuals. These ﬁndings have implications for future intervention design and
implementation.

W The current study illuminates the importance of perceived
adequacy of social support for bereaved individuals, and past research has illustrated how

the lack of support can be detrimental to bereaved individuals (Malikson, 1987). But in a

158

society that sees death as a taboo subject and most work settings provide three days leave
when facing the death of an immediate family member, good social support may be
difficult to acquire for many bereaved individuals. The rise of violent (homicide) and
stigmatized deaths (AIDS) may not only increase the chances of complicated grief for the
survivors (Rando. 1983) but could potentially decrease adequacy of social support.
Interventions should not only focus on the bereaved, but on their support networks also.
Community and high school education may be a good place to lay the groundwork for a
greater understanding of what bereaved individuals and families face (Weeks & Johnson,
1992). Support networks (i.e. people of all ages) could be educated about the grieving
process and what their family members and ﬁiends face as a result of losing a loved one.
and in cases of terminal illness, support needs to be provided beyond the illness and into
the grieving process (Silverman. 1988). Ultimately, this education could also beneﬁt the
support networks. since it could prepare them for what they may face in the ﬁrture.
Findings from this study also indicate that family communication regarding the
death and the deceased parent is instrumental to the child’s coping abilities. Interventions
for bereaved parents should include an educational component on how to talk with
children about death and the deceased parent. The ﬁndings also imply that coping
abilities impact both grief and family functioning so increasing coping capabilities for the
bereaved should also be a key component of interventions for families. Grief was also
identiﬁed as an important component for family functioning. In fact, the focus should be

on helping families to progress to the grth phase of grief since this phase is what

159

positively inﬂuences family functioning. Interventions need to ﬁnd appropriate ways to
facilitate the grieving process for families.
Conclusion

Although the results from the current study did not support the hypothesized
models, they did prove that both individual and family level variables impact the family
after the death of a parent. These ﬁndings support Kissane and Bloch’s (1994) belief that
grief is both an individual and shared experience. The results from this study indicate
that the death of a parent does impact both parents and children at the individual level as
well as the family level, and these levels interact with each other. Thus far, researchers
have tended to focus on the individual level and have all but ignored the possible
inﬂuence that the family may have on the individual when facing the death of a loved one
(Kissane & Bloch. 1994). In the future, research needs to consider not only individual

level factors but also family level variables when working with a grieving population.

APPENDICES

APPENDIX A

APPENDIX A

RECRUITMENT MATERIALS
A]: LETTER TO THE EDITOR
Grieving Families

My name is Lynn Breer, and I am a Ph.D. candidate in psychology at Michigan
State University. For my dissertation I would like to collect information from families
who have experienced the death of a parent. My interest in this ﬁeld stems from personal
experience. Nine years ago my life changed forever when my father died suddenly from a
brain aneurysm. I was seventeen, confused, angry, and in pain. I felt there was no one I
could turn to for help. My family was also in pain and I didn't want to upset them more
than I had to and there were no community resources available for me in the small town
where I lived. I never really talked with my friends about my father’s death and how I felt
because I didn't know how they would react, and I wouldn't have known what to do if this
happened to one of them instead of me. As a result of my experience, I have decided to
devote my life to helping families who have lost a loved one.

Most communities don’t provide us with effective information, support, or
resources when we are grieving. So my long term goal is to develop effective resources
for grieving families. In order to do so, I need to know what helps grieving families and
what grieving families need. Currently, I am working on a project that focuses on families
who have lost a parent within the last four years with at least one child between the ages
of 12 and 18. If you or someone you know has experienced this loss and would be willing
to complete some mailed surveys, please contact me at 1-800-765-7542, or e-mail me at
lbreer@aol.com. I really need your help. Everything you do will be greatly appreciated
and could potentially help numerous other families who will experience the death of a
parent.

Lynn Breer

160

161

A2: COVER LETTER TO THE EDITOR

April ,1996
M. Lynn Breer
3021 Beau Jardin #305

Lansing MI 48910
(517) 393-6665

Dear Editor:

I am a graduate student at Michigan State University, and I am working on my
dissertation and need information from a lot of people. I do not have the resources to
advertise, so I thought this would be a good way of getting the word out. If you can’t use
this or ﬁt it in as a letter to the editor, would you please consider using it as a news
worthy item in some other form. I am willing to provide you with any other information
you would need. If need more information or decide to print it, please contact me at my 1-
800-765-7542 number or e-mail address lbreer@aol.com.

Sincerely,

M. Lynn Breer, M.A.

162

A3: INFORMATION SHEET

Family Grief Study

Information Sheet

My name is Lynn Breer, and I am a psychology graduate student at Michigan State
University. For my dissertation, I am examining factors, such as coping, social support,
communication, and grief, that inﬂuence how a family adapts alter the death of a parent.
My interest in this area stems from my own experience of losing my father at the age of
seventeen. As a result of my experience, I want to help others who are experiencing
similar losses.

My intent in conducting this study is gathering information about how families deal and
adapt effectively with the crisis of losing a parent. I want to ﬁnd out what determines how
well a family adapts and functions after the death of a parent. The material gathered in
this study may provide the needed information to develop effective interventions and
support resources for families experiencing the loss of a parent.

Various strategies will be used to protect the identities of all participants. I will be the
only one who is aware of your participation in the study. All the information you provide
will be kept strictly conﬁdential. You name and the information you give will not be
linked in any way.

If you have lost a spouse or parent within the last four years and have at least one child
between 12 and 18, your participation in this study may make a valuable contribution to
our understanding of these issues. So if you are interested or know of anyone who may
be, please contact Lynn Breer at 1-800-765-7542 or e-mail me at lbreer@aol.com.

APPENDIX B

APPENDIX B

ENTRANCE INTERVIEW

Hello, this is Lynn Breer. I am calling (or returning your call) about the Family Grief
Study. 1 am a graduate student in psychology at Michigan State University. I am
interested in working with families who have experienced a signiﬁcant loss through
death. My interest in the area stems from a personal experience. My father died when I
was seventeen. and I remember how much it affected my family and how hard it's been to
deal with my father's death for everyone in my family. Do you have any questions you
would like to ask me at this point? Did you call to get more information about the study?
What do you know about the study and what would you like to know about the study? Do
you have any questions or concerns about participating in the project?

Let me explain the options you have for completing the surveys, and then if you have any
other questions, please feel free to ask them. First, I need to ask you if you live in the
Lansing area? If you live in the Lansing area, you and your child have several options for
completing the surveys. I can mail the surveys to you and your child, and you can
complete them and return them in a self-addressed stamped envelope to me through the
mail, or I could pick them up. I could come to your home and wait and while you and
your child complete the surveys, or we could meet somewhere neutral, like an office on
campus, my ofﬁce at VNS, or a restaurant, and you and your child could complete the
surveys. Which option would you and your child be most comfortable with?

OUT OF TOWN OR MAILING OPTION FOR LOCALS: If you do not live in the
Lansing area or do live locally and want to receive the surveys through the mail, I will
explain the process. I will be mailing a packet to you in the mail. The packet will contain
two packets of surveys marked one marked parent and one marked child and two self-
addressed stamped envelopes. Both packets will contain the appropriate surveys for you
and your child along with an instruction sheet, a consent form, and a mailing checklist. I
want you and your child to complete the forms in separate rooms and then seal them in
the envelope as soon as you complete ALL the forms and then drop them in the mail. You
do not have to complete all the surveys in one day. Take a few days to complete them if
that works best for you and your child. Please return the completed surveys within a week
of receiving them.

164

Do you have any questions at this point? Let me assure you that all the information you
give me will be kept strictly conﬁdential. I will be the only person who knows that you
are participating in the study. Your name will not be linked with the information or the
study in any way or form. Any questions? Would you and your family like to participate
in the study?

If yes, I need to ask you a few questions okay?

If no. is it okay if I ask you ﬁve questions?
1. How old are you?

Could you give me the ﬁrst name and ages of all your
children?

 

 

 

 

2. What was the relationship you shared with the deceased?
a. Wife
b. Husband
c. Ex-wife
d. Ex-husband

3. When did your spouse die? (Date/Month/Year)

 

4. What was the cause of death?

 

5. Was the loss:
a. Sudden/unexpected
b. Anticipated for 1-6 months
c. Anticipated for longer than 6 months

Non Participants: Thank you for your interest in the study. I enjoyed talking with you.

Now we will select the child who will participate in the study. I will randomly select one
of your children between 12 and 18 to participate in the study. (Pick the name of the child
by putting their names in a hat and picking one.) I have selected . Is
available? Could I speak to him/her? Hello, my name is
Lynn, and I am studying psychology at Michigan State University. I am interested in
working with you and your mom/dad. I would like you and your mom/dad to answer
some questions for me about your experiences since the death of your parent. Do you
have any questions you would like to ask me? I just want to let you know that your
answers will be kept conﬁdential. I will send you an envelope to put all the surveys in

 

 

165

when they are done and you can seal it. You don't have to show anyone your answers.
Your name will not be connected to the study in any way. Do you have any questions?
Would you like to complete the surveys I will be sending you and your mom/dad? If yes,
great could I speak with your mom/dad again? If no, okay could I speak with your
mom/dad again? (If no randomly select another child and ask the new child to
participate.)

Now I will need your name and address.

Name:

 

Address:

 

 

 

MAILED SURVEYS: I will be sending you the surveys in the next few days. Remember
to be sure to sign the consent form, read the instruction sheet, and read all the directions
carefully before completing the surveys. Please return the surveys within a week of
receiving them. Thank you so much for your interest and participation.

LOCAL SURVEYS NOT MAILED: You chose to complete the surveys by:

1. allowing me to come to your home. Could I get directions and could we schedule
a date and time to meet?

2. meeting in a neutral place: Where would you like to meet? When would you like
to meet?

Thank you so much for agreeing to participate in my study. Remember if you have any
questions, please feel free to call me anytime at 1-800-765-7542 (local 393-6665). Thank

you.

APPENDD( C

APPENDD( C

INSTRUCTION PACKET

Cl: PARENT INSTRUCTION SHEET

Parent Instruction Sheet

Please read the following directions carefully before completing your questionnaires.

I just want to make sure that you know that all the information you and your child provides will be kept
strictly conﬁdential. Your names will not be linked to any information you provide in any way or form.
PLEASE MAKE SURE BOTH YOU AND YOUR CHILD READ AND SIGN THE APPROPRIATE
CONSENT FORM BEFORE COMPLETING THE SURVEYS!

Enclosed with this envelope you will ﬁnd two self-addressed stamped envelopes, one with a questionnaire
packet for you marked PARENT PACKET, and one with a packet for your child marked CHILD PACKET.
When completing the questionnaires, make sure that you and your child are in separate rooms, and
please do not discuss the questions with each other while completing the surveys because it could
inﬂuence how the questions are answered. Once the surveys are ﬁnished, please complete your
questionnaire and seal it in the envelope when you have ﬁnished. Please have your child complete his/her
questionnaires and have him/her seal them in the designated envelope. When you have both completed
these questionnaires, please drop them both in the mail at the same time.

The questionnaires you will complete are basically the same questionnaires that your child will complete.
There are some minor variations in wording and questions on most of the measures, but overall they are the
same.

Completing these questionnaires should take approximately 2 hours, and you do not have to do it all in one
night. Please take a few days to complete them if that works best for you. Just be sure to return the
completed questionnaires within one week of receiving them.

Be sure to tell your child to read all the directions carefully. If your child has any questions regarding
directions or answering questions. please have them phone me at 1-800- or e-mail me at
breermar@pilot.msu.edu. I will be checking my messages daily and will respond promptly. If your child
decides not to participate, please call me immediately so I can randomly select another child in your
family to participate. If you have only one other child between 12 and 18 who wants to participate,
then go ahead and let that child complete the surveys. If you have more than one child between 12
and 18, please call me now.

After completing the questionnaires, if you have any concerns, questions, or nwd to debrief, please call me
at l-800-765-7542, or e-mail me at breermar@pilot.msu.edu. Talk with your child also. Ask him/her if s/he
has anything s/he wants to talk about regarding the surveys or anything else.

BEFORE SEALING THE ENVELOPE MAKE SURE YOU HAVE ALL THE SURVEYS IN IT
AND MAKE SURE YOU ENCLOSE YOUR SIGNED CONSENT FORM.

I66

167

C2: CHILD INSTRUCTION SHEET

Child Instruction Sheet

Please read the following directions carefully before completing your questions.

I just want to remind you to make sure you read and sign the consent form before you
begin answering the questions. Also you should know that all the information you
provide will be kept strictly conﬁdential. Conﬁdential means that I will never use your
name when I talk about what I ﬁnd in my study. It also means that all the information you
give me will be looked at with all the other information I get ﬁ'om everyone who
completes the surveys. So there will be no way that your name or the information you
give me can be linked to you. It also means that your parent will not look at your answers.
Your answers are private. To make sure your parent doesn't see your answers, put the
surveys in your envelope and seal it when you are ﬁnished with all of the questions.

You have your own survey packet and your own self-addressed stamped envelope. When
you ﬁnish ALL your questions put them in the envelope and seal it. BEFORE
SEALING THE ENVELOPE MAKE SURE YOU HAVE ALL THE SURVEYS IN
THE ENVELOPE AND YOU ALSO HAVE THE CONSENT FORM IN THE

ENVELOPE ALSO. Then give the sealed envelope to your parent to mail.

Please complete all the questions as best you can. Completing the surveys will take you
about 2 hours, and you do not have to do it all in one night. Take a couple of nights to
complete them if that works best for you. If the directions or some of the statements don’t
make sense, or you don’t understand a word in the question, please contact me at 1-800-
765-7542 or e-mail me at breermar@pilot.msu.edu. and I will answer any questions you
have as soon as I receive your message. Be sure to let me know a good time to contact
you. Be sure to complete the surveys in a separate room from your parent.

If you need to talk with someone after you complete the questions, please feel free to talk
with me by calling or writing me. You may also want to talk with your parent about you
experience after you both have completed the surveys.

168

C3: PARENT MAILING CHECKLIST
Mailing Checklist (Parent)
Before sealing your envelope make sure you have:

Signed and dated your consent form.

Enclosed the signed and dated consent form.

Enclosed the completed Social Support Survey
Enclosed the Coping Survey.

Enclosed the Family Communication Survey

Enclosed the Response to Loss Survey (grief survey)
Enclosed the Family Assessment Device (parents only).

NP‘V‘PP’NT‘

If you have enclosed all of these forms please seal the envelope and drop it in the mail.

169

C4: CHILD MAILING CHECKLIST
Mailing Checklist (Child)
Before sealing your envelope make sure you have:

Signed and dated your consent form.

Enclosed the signed and dated consent form.
Enclosed the completed Social Support Survey
Enclosed the Coping Survey.

Enclosed the Family Communication Survey
Enclosed the Response to Loss Survey (grief survey)

QMPWNT"

If you have enclosed all of these forms please seal the envelope and give it to your parent
to mail.

APPENDIX D

APPENDD( D

CONSENT FORMS
Parent Consent Form

I have freely consented to take part in a study being conducted by M. Lynn Breer,
a graduate student at Michigan State University.

I have freely consented to allow my minor child to take part in this study if he or
she wishes to participate.

I understand that this research involves me and my child completing surveys about
our loss experience, our grief, our social support system, our family
communication. our coping abilities, and our family functioning.

I understand that the surveys will take approximately 2 hours to complete.

I understand that if my child or I need more intense help we can call the researcher
and receive ways we can contact resources within our community.

I understand that my child and I are free to refuse to participate in the study at any
time and that we are free to choose NOT to answer any or all of the questions
without penalty.

I understand that all details about my participation in the study, including answers
I give to questions and questions I choose not to answer are conﬁdential. I
understand that in any report of the research ﬁndings, information from all
surveys will be included together, and that I will remain anonymous. Results of
the study will be made available at my request.

I have been given the name and phone number of a contact person in case I have
any questions or concerns after or during my participation in the study.

Signature:

 

Date:

 

170

171

D]: CHILD CONSENT FORMS
Child Consent Form

I know that I will be participating in a study and will be answering questions
about my experiences since the death of my parent.

I understand that I do not have to answer questions if I don’t want to.

I understand that I can drop out of the study and not complete the surveys.

I understand that all my answers will be kept conﬁdential. My name will not be
connected with any information I give on the surveys. I do not have to discuss my
answers with anyone unless I want to.

I have been given a name and phone number in case I have questions.

Signature:

 

Date:

 

APPENDIX E

APPENDIX E

DEMOGRAPHIC SURVEY

PARENT SURVEY

What is your family’s religious afﬁliation?
a. Catholic

b. Protestant

c. Jewish

d. Mormon

e. Lutheran

f. Baptist

g. No religious afﬁliation

h. Other (Specify)
What is your family’s annual income?

a. SO-Sl0.000

b. S] LOGO-$20,999

c. $2 I DOG-$35,999

d. 336,000-350,999

e. Over $51,000

What is your family’s ethnic background?
a. Caucasian

b. African American

c. Native American

d. Hispanic

e. Indian

f. Asian

g. Multiple Backgrounds (Specify)
h. Other (Specify)
What is your education level?
a. Some High School

b. High School Diploma/GED
c. Some College

(I. College Diploma

e. Master's Degree

f. Ph.D.

g. Other (Specify)
What was your spouse’s education level?
a. Some High School

b. High School Diploma/GED

c. Some College

d. College Diploma

e. Master‘s Degree

f. Ph.D.

g. Other (Specify)

 

 

 

 

172

10.

ll.

12.

l3.

I4.

15.

I6.

173

How many deaths has your family experienced in the last three years? Please specify the
relationships with the deceased. (Includes grandparents, aunts, uncles, friends, cousins, spouse, and
children)

 

Are you currently in a new relationship?
Yes No

What grief support services are available in your community?

As a result of your loss, have you or any of your children attended counseling or therapy?
Yes No

As a result of your loss. have you or any of your children attended a support group?
Yes No

If yes to questions 9 and/or 10, please list everyone in your family who attended.

 

 

If you attended a support group or therapy, how long did you go?

 

How old are you?
Please give the ﬁrst name and ages of all your children.

 

 

When did your spouse die? (Month/date/year)

 

What was the cause of death?

 

Was the loss:

A. Sudden/unexpected

B. Anticipated for l-6 months

C. Anticipated for longer than 6 months

174

El: CHILD SURVEY

AC9. As a result of your loss, have you attended counseling or therapy?
Yes No

AC 1 0. As a result of you loss have you attended a support group?
Yes No

AC 1 3. How old are you?

 

APPENDIX F

APPENDIX F

SOCIAL SUPPORT SURVEYS

STRUCTURAL SOCIAL SUPPORT (PARENT)

When answering the following questions, please think about the how you feel in response
to each of these questions since the death of your spouse. Please read each question
carefully and give or circle the answer that best describes your experience.

1.

Since the death of your spouse, how many family members really help you when
you have a problem and really listen to you and talk with you?

 

Since the death of your spouse, how often do you talk with the family members
who really help you when you have a problem and who really listen to you and
talk with you?

A. Never

B. Less than One time per Month
B. One time per month

C. 2-3 times per month

D. Weekly

E. Daily

Since the death of your spouse, how many friends really help you when you have
a problem and who really listen to you and talk to you?

 

Since the death of your spouse, how often do you talk with the friends who really
help you when you have a problem and who really listen to you and talk to you?

A. Never

B. Less than One time per Month
B. One time per month

C. 2-3 times per month

D. Weekly

E. Daily

175

176

To what extent has your circle of ﬁiends changed since the death of your spouse?

A. Not at all (Still have all the same friends)

B. Have lost a few and gained a few

C. Have lost all ﬁiends and gained a few new friends
D. Have all new ﬁiends

E. Other (Please explain)

Have you ever attended a support group or sought professional help ﬁ'om a
counselor, therapist, minister, or doctor to help you deal with the loss of your
spouse?

Yes No
If yes, please answer questions 7 and 8. If no, please go to next survey.

Since the death of your spouse, how many members of your support group or
professional people (counselor, therapist, minister, or doctor) have really helped
you when you have a problem and really listen to you and talk to you?

Since the death of your spouse, how often do you talk with members of your
support group or professional people (counselor, therapist, minister, or doctor)
who have really helped you when you have a problem and really listen to you and
talk to you?

A. Never

B. Less than One time per Month
B. One time per month

C. 2-3 times per month

D. Weekly

E. Daily

177

F l: STRUCTURAL SOCIAL SUPPORT (CHILD)

When answering the following questions, please think about the how you feel in response
to each of these questions since the death of your parent. Please read each question
carefully and give or circle the answer that best describes your experience.

I.

Since the death of your parent, how many family members really help you when
you have a problem and really listen to you and talk to you?

 

Since the death of your parent, how often do you talk with the family members
who really help you when you have a problem and really listen to you and talk to
you?

A. Never

B. Less than One time per Month
B. One time per month

C. 2-3 times per month

D. Weekly

E. Daily

Since the death of your parent, how many ﬁiends really help you when you have a
problem and really listen to you and talk to you? ?

Since the death of your parent, how often do you talk with the friends who really
help you when you have a problem.

A. Never

B. Less than One time per Month
B. One time per month

C. 2-3 times per month

D. Weekly

E. Daily

To what extent has your circle of friends changed since the death of your parent?

A. Not at all (Still have all the same ﬁiends)

B. Have lost a few and gained a few

C. Have lost all friends and gained a few new friends
D. Have all new friends

B. Other (Please explain)

178

Have you ever attended a support group or sought professional help from a
counselor, therapist, minister, or doctor to help you deal with the loss of your

parent?
Yes No
If yes, please answer questions 7 and 8. If no, please go to next survey.

Since the death of your parent, how many members of your support group or
professional people (counselor, therapist, minister, or doctor) have really helped
you when you have a problem and really listen to you and talk to you?

Since the death of your parent, how often do you talk with members of your
support group or professional people (counselor, therapist, minister, or doctor)
who have really helped you when you have a problem and really listen to you and
talk to you?

A. Never

B. Less than One time per Month
B. One time per month

C. 2-3 times per month

D. Weekly

E. Daily

179

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.96. .00.. .5.:
m N _ v m N _ 8.0:. £00.. £50.: .50» 003 5:0 Be: .0259. Se» ..0 5000 0:. 00:5 N
.8380... £50.. .23 00.5% 000.0000: .50» 530
m N _ v m N _ 09500.: .50» $0.98 :0» on :23 so: .0253 50» ..o 500—. 05 005m .0
N033» .50» :0 500.0 0:. 530 3.500.. :5» 0:50:03:
m N _ v m N _ £00.. £50.: .50.: 0000 5:0 30: .0309. so» be 5000 05 02.5 .n
$000: :0» 00:00:33.. EB tow—=00
m N _ v n N _ 05 :0» 03m 5:5 .50» 0000 5:0 30: .3080 .50» .«o 5000 0:. 00.5 .v
280:0m 5 so» .3
m N _ v n N _ 030.533. :00: £80.: .50» 0.0: :33 Be: .0253 So.» .3 500.0 0:. 02.5 .n
N038.“
008000.. So» 530 03: :0» 2:00:00 .5 ems—00.: 530 £80.. =5»
m N _ v m N _ .8 £095.: E 00:50 :0» 0—0 5:0 30: .0309. :5» ..0 £000 0:. 002% .N
$800.50 0:0 0.50320 .50» teams—0:: 2 .9 0:0 :0»
n N _ v n N _ 2 :03: 3.00.. £80.: .50» 0.020 5.00 so: .0380 .50» mo 500.0 0:. 005m ._
EmE 5:0 5:0 @332 008:
7.3 0.00.— 0.5.2 :33: 5:0 -0Eom 00>0Z
”:5
on 2 E05 c005 0.6: 2:03 _ 5:0 >6: "ﬂag a 32.0 9.35:. 0.23 25:02:. mite—.8 0:. 00323.

 

0:528 000:0 00.0. 0:: 5 so» 9 002%? .00: 00:: 00305.. 0:: $526

B 0.080% 9.235 so: :5:— SE. 035 E s .zPEe

mmmd .Zm—EO EKG—2 redeem £5 00:: 0>0: 2:03 :0» 050:3 003020 :ZOUHm .m :wseﬁ N 0:628 5 so» 9 00:30 .05
00:800.. 0:. 950:0 .3 :0» “00:25.5 0>0: 0.30m mo 95.—w 005302 0:. Zm—EO 3O: 030:0 Ema—h 0550:: C3.—. .0328
E0: :000 Sm €003 So» .3 500—0 0:: 0050 so» 3 toga m£E>En :00: 020: “:98 0:3 0302. no 095% 0:20:30 000:0 9 00.00
0.83003 0: m. 030% So» :0 £000 0:. 0050 no» 2 030—226 05: so» ton—9a 0:0 20: .«o .050. 0:: 50:0 0.830020 088 000 320m

AHZmM<mV PMOnEDm xix—00m 12,205,023”. ”Nu

 

180

 

 

 

00:003. b0> E0 _ .0
00:39. 3:32:00. E0 _ .0.
00:00:05. 3:30:50 E: . .N
00:02.02: b0> E0 . ..
...»..E0. 50» E0: 00:000.. 02.: :0» .8003 0:. 5.3 :0» 0.0 00.00.30. 30: .00.:000 50.. ..0 :.000 0:. 00:5 ....
m N _ .000: :0» mm:.:. .050 5.3 0.0... .0.
m N _ .0000: 0.00 0::0 5.3 0.0: .m.
m N . 00.000: 5..—3:000:00. :.05 0.0... .0.

 

«00:0: 0:. 0:00... 0:00 3:2. w:_..0w 3.80:0m

 

 

m N _ ..0 .355 m:.x_.. .m0._0:0 m: :03 20:00.30: .50» w:.w0:0:. 000: :0» 0.0... .m.
m N _ .000: :0» 00300 0:: 0.0: 305:... .N.
m N . .000: :0» 00300 0:: 0.0: .03: .. .

 

30:. .0m :0» 00 :0:0 30:
0.0:EOE 3.50.. .50.. .3 00.0....0 0.00030 ..0 00:... 0:. 50:: w:...:.:. 302

 

...mE0.:0.=...
m N _ 50.: 5.3 .000 0. 30: .0 00.95.00 00 3.:5. 50.. 00: :0» :00 :0:0 .50: .o.

 

$5030.... 50.. 0>.0m
m N _ 0. 30: 50:0 00300 :0» 03.. .0 0:0..0000 50» 0030:: 0:. 00 5:0 .50: .0

 

 

 

 

 

wa:.:. 0:8 50:: w:..0:::0 .0 00:03:...0. .3 2:030... .00»
m N _ ...0 05.: 50» 00.0. 0. b. 0:. 00 5:0 30: 00:00... 50:0 :.000 0:. 085 .w

 

 

 

 

 

 

181

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0 0 _ 0. 0 N _ 008.. .50 8.0... 08 0.2. .0230... .00

0 N _ 0 0 0 _ 008.. .5. 3.0.0 05 22. .003 .00

0:. .0m 00.0 00

0000 30: 0000.0 .00» .00 00.0.00 ..00000 ..0 000... 0:. .0000 00.0.0.5 302

0080.020 .00»

m N . v m N . 5.3 .000 0. 30: ..0 00.00.0000 00 0000.... .00» 000 00» 000 0000 30: .0N

0050.00... .00.. 0.0.00 0.

m N . v n N . 30: .0000 00.>00 00.0 0...» .0 0000000.. .00» .03000 00:. 00 0000 30: .nN

0000.5 .050 .0000 w0..0..0:0 .0 08.0.. 05:0. .00 05030.0 .00» .00

n N _ v n N . 00.6 .00» 00.0. 0. b. 00:. 00 0000 30: .000000 .00» ..0 :.000 0:. 000.m .vN

00000.... 5.3 000000 00000000 .00» .0000

n N _ v m N . 0w0..00.. .00» 000.0..0 00» 00 0000 30: 000000 .00.. ..0 :.000 0:. 000.m ..N

0000000 .00.. ..0 :.000 0:. .0000 000000.. .00» 000.0.0000

m N . v m N . 0:00. 0000.... .00.. 00 0000 30: .000000 .000 ..0 :.000 0:. 30% .NN

0000: 00.0 0000.00000. 000 00.88

m N . v m N . 0:. 00.. 0>.w 0000.0 .00» 00 0000 30: .000000 .00» ..0 :.000 0:. 000.m ..N

...—0.000» 0. 00.30 0>...00000

m N . 0 m N _ 0000 0000.... .00» 03.: 0000 30: .000000 .00» ..0 :.000 0:. 000.m .0N

0000000 00000000 .00.. .0000 03.: 00.0 0E00000 .0 0w:._00.. .0000 0000....

m N . v m N . .00» 0. 000000 00.0 00 0000 30: .000000 .00.. ..0 :.000 0:. 000.m .0.

000.0003 000 £00.00... .00» 0080.000: 0. b. 000 00»

m N _ v m N _ 0. 00.0.. 0:00. 0000.... .000 00 0000 30: .000000 .00» ..0 :.000 0:. 0005 .0.

.:w.0 0000 0000 0.0032 005..

.00.. 0000 0.03. 0.0003 0000 -080m .962

00. "0000300000000

00 0. .00.... 00.... 0.6: 0.003 . 0000 30: an" .00.: .0000 00.0.0.0. 0:03 002.0000 00.32.00 0:. .0300<

 

 

 

 

182

0000000 b0> E0 . 0
0000000 .0:30E00 E0 . .m
000000000 .0:30E00 E0 _ N
000000000 b0> E0 _ .

 

 

 

00000.... .00» E0... 00>.000. 0>0: 00.. ..00000 0:. :..3 00» 0.0 00000000 30: .000000 .00» ..0 :.000 0:. 000.m .mm
m N . 00000 00.. 000.0. .050 :..3 0.0.. .Nm
0 a _ 0008.. 28 220 0.3 0.00 ..0
m N _ 000000 :0..0..00000.. :..3 0.0... .cm

 

 

 

 

 

00000: 0:. 0000.0 0000 0w0.:. 00.0% 3.0.000w .0
m N . .0002. w:...... .00.0:0 00 :000 0.0:0000: .00.. w0.w000E 0000 00.. 0.0: .0N

 

 

 

 

 

 

183

 

000.6.
.00.. 00» 000E »..00. »..E00 .00» 0000 0000 300 400.00 .00» ..0 0.000 00. 0005 . 0

 

.0.00E0E »..E0.. 003 .0200 00000000 .00»
.0000 0w0..00.. .00» 0020.8 00» 00 0000 300 .0200 .00» ..0 0.000 00. 000.m .0

 

0.00.00
00» ..0 0.000 00. 000.0 0w0..00.. .00» 05.0.0000 »_.E0.. .00» 0000 0000 30: .n

 

00000 00» 0000.00000. 000
..00E00 00. 00» 03» »..E0.. .00» 0000 0000 300 ..00.00 ..00» ..0 0.000 00. 000.m .v

 

0.0.000» 0. 00»
..0 0>0.00000 0000 »..E0.. .00» 000 0000 300 ..00.00 .00» ..0 0.000 00. 0005 .m

 

0.00.00 00000000 .00» .0000 0>00 00» 0E00000 .0 30:00.. .0000 »..E0..
.00» ..0 0.00E0E 0. 000000 00» 00 0000 300 000.00 .00» ..0 0.000 00. 0005 .N

 

m

N

0

N

00E00000 000 0E0.00.0 .00» 000.0.0000 0. ».. 000
00» 0. 00.0.. »_.00. »..E0.. .00» 0000 0000 300 000.00 .00» ..0 0.000 0.0 000% ..

 

0.0.0
.00..

 

0000
0000

 

500
0.03.

0»03_<
»__000D

 

COCO

 

00E0
-0E0m

 

.0>0Z

 

 

0.0

00 0. E00. 00.... 0>00 0.003 .

 

0000 30..

 

80000.05
0.003.503.0000» 0.2... 0.0.0.00 0.0.; 2508.... 0.0.6:... 20 .0305

 

0080.00 00.0. .00_ 00. 0. 00» 0. 000000 .000 .00. .03000 00. 30000 »0 0.0000 00 002w 00. E0... FED—~— hma. m<>> .5 ..0 .ZHEO
mmmd .ZHEO ”mu—OS. ..00000 0.0. 00.... 0>0... 0.003 00» .00.003 .03000 :ZOUHm .m 0w00.0. N 00E0.00 0. 00» 0. 000000 .00.
0000000. 00. w0..0..0 »0 00» 00000000 0>00 0.0000 00 002m 0000000. 00. ZHEO >90: .03000 Fwd—..— .00000000 95,—. .03000
E00 0000 .00 ..00000 .00» ..0 0.000 00. 000.0 00» 0. ..00000 w0.0.>0.0 0000 0>00 .030. 003 0.0000 .00 0000.w 2.0.00.0 00.0. 0. .000.
0000000.. 00 H ..00.00 .00» ..0 0.000 00. 000.0 00» 0. 0.00..0>0 0>0: 00» ..00000 000 0.00 ..0 00... 00. .0000 0000000.. 0E00 0.0 30.00

ASA—10.0.0000Dm u.<.UOm 13020200230. Hm”.

 

184

3:35. bo> Eu _ .v
cocmzum .230—=8 Eu _ .m
3:385 «23058 Eu _ .N
8:33.... b9, Eu _ ._

 

 

 

 

 

 

 

 

 

 

 

Nazca» 5% Eat 3382 92 so» tong—a on. 5:» :0» 2a 02.3.8 3o; ...—Eng So» .3 ﬁuuv 2.. 3:5 .2
2:28
N m N .50» .8 58v 2: 825 you: so» 852% 2: 0332 3» on coco So: .0.
“Mu—BE .23 So 95.. .mtoocoo 8 839: 9 on .3..on Ami
N m N mu :2; .36 2.23 So» 9.83 Ev so» want: 05 on 2 .0» sex on coco >6: .2
N m N m: new: so» can: AzEﬁ So» 89: 3:9: .0» so» on coco Bo: .E
N m N w: too: :0» 5:3 ghoBoEo; So» 5:: Bo; 3w :0» on cuco 3c: .N_
N m N 255 Bu: :0» 5:3 cm 2 E95 so» 383 9 82. 6w :0» ca coco 3o: .N_
N m N NEE: wow: :0» 5:3 3:328 .028 2 wow: «ow .5» cu coco Bo: ._ _
«mp—832a
N m N So» FEB .8“. 2 So; 3 moi—:88 mm €25 So» em: :0» 58 Ste So: .2
$50305 :5»
N m N 928 9 Bo; Scan 833 :0» 91m 5 22526 So» 5325 35 av coco Bo: .o
Rum—:5 550 Sean mctozmzu .o muxoq w=_=2 3 $5396
N m N :5» to 3:: So» 8.8 2 b. 55 an coco Be; .223 5030 Snob 2: 35m .w

 

 

 

 

 

 

 

 

185

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0505 300:

n N _ v m N _ :0» :23 3:05 805 cm 0. :53 :0» 0000.: 0. 002.. :0m :0» 3 :050 30: .NN

NEoﬁ

m N _ v m N _ .000: :0» :23 3:05 E05 003330: 30:00. 0. 0.02.. .0» :0» 3 :050 30: SN

03030::

n N _ v n N _ 50» 5:5 .03 0. 30: ..0 00.0830 0.: 3:05 5% 00: :0» :8 :050 30: .oN

0050320 .50» 028 0. 30:

m N . v m N _ Son: 0330 :0» 03m :0 30:00:: .50» 0030:: 3:05 .50» 3 :050 30: ..N

03:2. .050 50:: 3:00.20 ..0 000.3. m:_=0. .3 3.032: .50» to 35E

n N _ v m N _ .50» 00.8 0. E: 3:05 SPA 03 5:0 30: .220: 0:0» ..0 503 0:. 085 .N

3:05 5:: E20: 300.0003 .50»

n N _ v m N _ 50:: $5.00.: 0:0» 8230 :0» 3 :050 30: E20: 50» ..0 5:3 05 08% .MN

2:200

m N _ v m N _ :0» 50 £03 0:. 00:7. $5.00.. 5% 35.23:: 3:05 0:0» 03 :050 30: .NN

.300: :0» 082332 3:: 205.00

m N _ v m N _ 05 :0» 02m 3:05 .50» 03 :050 30: .5200 50» 50 £003 0.: 005m ..N

220:0w :_ :0» ..0

n N _ v m N _ 03:03:: :00: 3:05 0:0» 0>0: :050 30: .2200 .50» .50 £003 0:. 005m .oN

2:20: 303003 50» 30:0 0>0: :0» 0:.—00:00 :0 03:00.. 50::

m N _ v m N _ 3:05 0:0» :_ 05:00 :0» 3 :050 30: .220: .50» 50 5:03 0:. 00:5 .0—

mmE00:00 0:: 2:032: .50» 35323:: 0: b: 3:: :2? :0»

n N _ v m N _ 0. :20: 2.02 3:05 0:0» 3 :050 30: .2200 5% 50 £03 0:. 005m .2

EwE :0¢O 5:0 983?. 0.0:...

.03 0.0.0: 202 £03.: :050 -060w .032

ME: 3 g

0. E05 300.: 0>0: 2:03 _ :050 30: Hang .50» 30:: ”:35... 0.33 30:02:. 3.30—.05 0.: :0tu:<

 

 

 

 

186

30538 »:0> E: _
30:38 6:32:00. E: _
30:33:: 8:32:00 E: _
305303: »._0> E: _

éNdé

53:05 ._:0» 805 302002 0>0: :0» 20.33 05 .23 :0» 2: 30532 30: .220: 2:0»..0 £003 0:. 085 ..m

 

2:200 .50» 50 5003
m N _ 0:. 00:? 3:05 605 300: :0» 00:3_:w 05 03002 :0» 03 :050 30: .cm

 

 

 

 

 

m N _ E 300: :0» :05: 303080.. ::0» FEB 20: .0w :0» 03 :050 30: .0N

 

 

 

 

 

 

187
F4: ITEMS DELETED FORM CHILD’S FUNCTIONAL SUPPORT SCALE

Family:

1. Since the death of your parent, how often do they try to take your mind off your
problems by telling jokes or chattering about other things?

2. How oﬁen do you get help with your homework when you need it?

3. How often do you get money from your family when you need it?

Friends:

1. How often do you get rides to school activities from friends when you need them?

2. How often do you get rides to places you want to go from friends when you need
them?

3. How often do you get help with your homework when you need it?

APPENDIX G

 

.528
3030003 :05 50:: 0:5 0: 53:5 »5 08.5005 .0: 03 _ .w

 

.528 3800003
:05 50:0 3058:: 0523.30 »5 2030:: 5.00:0: _ N

 

.528 3800003 :05 .5..
00:20: 3.0505 :0 .205: 05 :_ 328528 523.20 »$_ 3

 

.528 3030003 :05 50:: 30500:: 05 «.00 5053.20 »2 .n

 

.528 3300003 :05 50:0 ...8 0. 52.3.20 »5 08.5005 . .0

 

.528
3030003 :05 50:0 30:00:: 05 x8 :05: 223.20 »2 .n

 

3

v

m

.553? :05 223:0 5.8»5
5:5 528 3030003 :05 50:0 0.0.3505 205.: 523.50 »S_ .N

 

e

v

m

.528 30000003 :05 50:0 05 5:5 0:5 »_005 523.20 »_2 ._

 

 

02w<
»_w:0.:m

 

02w<

 

02w<
555058

 

023:5
853058

 

00585

 

00.585
»_w:05m

 

 

 

.555 50» 3:0 :0» 0052033 30: 55 .0330 05 20:0 3:0 »__:5200 3053:: 5:50:05 05 50 :000 3:2 030E

szm<mv ZO_H<U_ZDEEOU 5:32“—

>m>~5m ZOF<BZDEEOU

O van—295::

188

189

 

503:0 05 050:0
_ .528 :05 ..0 5003 05 50:0 0:0. €25.20 »5 8:3 .3

 

5.00»5 :05 ..050 0.808 505
00:0 :28 :2: 32. 32.0 00:5 :5 0.5.: 250.20 :2 .0.

 

3:3 0:3 528
:05 50:0 :0. 0: 503 »05 :53 523.50 »E 0. :20: _ .N_

 

.303 528 :05 30: 50:0
0>0: »05 30300:: »:0 0.00 0. 525.50 »5 0w0..:00:0 _ ._ _

 

.528 30000003 :05 »5 53:0. 205 _ 3:0 5.3.50 »_2 .c.

 

 

 

 

 

 

 

 

.528 :05 ..0 5003
05 50:0 05 53 05:00.. :05 0029.0 »_005 525.50 »2 .0

 

 

190

 

.003—.0
0:. 00mc0:0 A..50. A5 .30.3 0:3 .028 A5 50:0 ...0. 0. .003 . 00:3 .3.

 

.A._50.. A5 .0 0.0:505
.0: 000 0:3 0.800.. 50.... 30.3 528 A5 30: 50:0 0w:_:. 50 3:00.. _ .m.

 

30.3 0:3 528 A5 50:0 ...0. 0. 503 . 00:3 05 0. 000.0: A_.50.. A2 .N_

 

30.3 .028 A5 30: ..0 5003 50:0
0>0: . 002.00.... A00 0.00 0. A..50.. A5 .0 20:505 A: 30m050000 E0 . .. _

 

30.3 0:3 528 A5 50:0 900:0. 03.02. A._50.. A.). .o.

 

.A._50. A5 .0 0.05505 5.3 .028 A5 50:0 0m0..00.. A5 00298 A702. _ .0

 

30.3 0:3 .028 A5 50:0 ...0. 0. 05 08.50000 .0: 0003 A._50.. A2 .w

 

.3028: 3203000 20 30.3 0:3 528 A5 50:0 ..00 _ 002.0000 0:.. .0

 

30.3 0:3 .028 A5 00.. 0003.00 5.5505 ..0 .0005... 0:. 0. 30.86.08 _ .0

 

30.3 0:3 528 A5 50:0 000500.... A._E0.. A5 ...00 _ ,m

 

 

30.3
0:3 528 A5 50:0 ...0. 0. A..50.. A5 .0 20:50.5 A: 30w050000 50 _ .0

 

30.3 0:3 .028 A5 50:0 00050000 A..50._ A5 0.00 .030: . .m

 

c

m

.A..50.. A5 ..0 05:50.: 5.3 528 30000003 A5 50:0 00.00505 20:0 . .N

 

0..

m

m

.A._E0.. A5 ..0 0:0:505 5.3 .028 30000003 A5 50:0 :.0. A52. _ ..

 

 

02w<
A3055

 

02w<
5:30500

 

02w<

 

00300.3
5:3050m

020.00.:

 

 

00300.0.
A3000:

 

 

.3020

300 0.050.: 0.0.0.0. A..50.. 50A 00:...0003 .00: .05 003000 0:. 0.2.0 300 A:=,.200 002.0000 w:.30=0.. 0:. ..0 :000 302 0000.0.

REED. ZOE.<U.ZD.>:>.OU >:.$.<n. ..O

 

191

62: ITEMS DELETED FROM PARENT COMMUNICATION SURVEY

My children participated in the funeral or memorial services for their deceased
parent.

I do not encourage my chidlren to talk about their deceased parent.

My children found out things about how their parent died from people other than
myself.

When my children talk about the death of their parent, I change the subject.

Items Deleted from the Child Communication Survey
I participated in the funeral or memorial services for my parent who died.
My family avoids talking about my parent who died.

I found out things about how my parent died from people who are not members of
my family.

APPENDIX H

 

n v m N _ .0503 A..50.. 0:. 50.. 00.>30 3:0 00:05.05. w:.:00m .0

 

 

 

 

 

 

 

 

 

 

0. v n N . .20 ...05 0. w:...0. .300. .w.0. 0.0::w.0: 50... 0.9.0.. 300 05m m:.>.000~. ...

n v n N . 050.:0... A5 0200 0. ...00A5 0.5.3 59.2.0 0:. 0>0: . .05 9:305. N

00:03.0 A5 ... 0.0:3.>.3:.

n v ... N _ 8.0: 0. 305.003 05030.0 300 00.0:0m0 A..:=5500 50... 0000.0.000 m:...00w .0

n v m N . 0015.0. 50... 00.>30 w:...00w .n

050.:08 .0..5.0 .0 0500

n 0 m N _ 05 3000. 0>0: 0:3 002.50.. .050 0. 0:00.00 50.... 00.>30 3:0 00:05.05. m:...00m ...

n v m N . 050.:0... .055 0>.00 0. .038 0:. 0>0: . 8.305. .m

n 0 m N . 0300.... 50.. 08.50 300 5050350000 w:...00m .N

0 v 0 N _ 02.0.2 ...? 00285.0 .5 05.20 ._
02w< 02m< 02w00.3 .0: 0290.3 005005 2
A.m:0..m 320.030.). 02%. .0552 A.0.0.030$_ A3025, 3.: A250. A5 0. 00...:0E.3 .0 053:0... 000.. . .000000 A5..0 :.003 0:. 005.0. mu.

 

 

 

 

 

 

 

0000002 50A 50:0 50520.0 0:. 5.3 00500.3 .0 02% 00A :005 30: 0.00.30. 0. v .0 .m

.N .0:5:: 0.00.00 :05 .0233 0500 0. 000802 50A 00:..0003 50520.0 05 0. $5100.20 55201.5 00A .05 m:..00.3:. . 5:50: 0.2.0 :05
...0 .0 000802 50A 05.0003 .0: 0003 50520.0 0:.... £5.00. .5020sz 00A .05 m:..00.3:. m .0:5.5 0:. 0.0..0 00:. ...03 A.0> 00:800. .00A
00:..0003 50520.0 0:. .. 00:50:05 .0 05050... 0. 000802 :. .0.>0:0: 3:0 0030....0 50A 00:..0003 50520.0 :000 :03 30: 03.000 “000.525

OZEOU ...Zmyzn. ...

m>m>~5w 02.0.00

I X52950.

193

 

.50 5 5.0. 05:: .00

 

0.0.3300 5.3 05030.0 w0.00:m .0N

 

S030 0w ...3 5030.0 0:. 59.000 w00. ..03 ... m0.>0..0m. .wN

 

.0.0.0.5 0 50.. 00.30 00.0.08 ...N

 

05030.0
M0300: b.00E.3 0>0: ...3 . 0.0020 0. 03 . .0:3 .0005 00 .05 M0..00... .eN

 

000. . 05030.0 5030 .00. »05 30: 00>..0.0. w0.0.0< .mN

 

3090:0003
00. 05000: .00 03 . .05 00 A03 0>...000 0.05 0 0. 5030.0 .05 M05000. ..VN

 

00...>..00 50.50 0. 05.00.2000 .nN

 

05030.0 030 .05 0.300: 000 . w0.>0..00 .NN

 

00...:0E.3 »5 5.3 0.0: 300 m0..000:00 .000.000.0.0 M0305 ..N

 

.30 .0.000.3 ..0:.0w0.-.0w. 0035.0. 5.3 30.5 M030. .oN

 

0.3300050: .0000 00...:0.....3 .05 M0..0000< .0.

 

COB—.9. BUD—ya. 3:5 ... .Aaﬁ 0. £050.... £23 “ﬁshnet”.— .m—

 

05030... .....50. 0:00 0. 030 0.0 03 :03 30: 0. ..00 m... 0 0.00.0 0.0... M0305. N.

 

0300... 000.0 5.3 00.00000 w:..0:m .0.

 

0... .0 .00. 0 00 0.00>0 3.00050 m0..0000< .m.

 

000.>.00 :0.=:0 00.3032 .3

 

M0050 50 . .05 w0.30:m .m.

 

00.0.>0.0. @0305? .N_ .

 

 

»030 .:m.. 00050.00 .00 0. wEb. 300 ..00.300:.. 05030.0 0... M0500 .. .

 

 

 

 

 

 

 

 

 

 

0000.0.000 300 0.03.. .0. 0.0::w.00 M0...0< .0.

 

  

194

 

0. 52... 00.35

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3 m N . 0 n N . 0 03 ..03...00 . 300.. . 000000: 5030.0 0:. 30.00000 .00.: .. .
02.0:
0 0 0 . o 0 n _ 0 .8. 2.. ...2. 2 0.30.. .20.. a .008... 5.0a. .... 2 02...; ....
3000000: .003 09.000 3.000 .
v 0 N _ c ... N _ 0 a... .205 8:05.... .22. 02. 0.... 0:00.; ...... 05...... as. _ .0
v ... N . o m N . 0 00:00. 003 . 30: .0000 300:0. . .0
5030.0 0:. 0300 ...—00.00 0. 30... .0300 5030.0
0 n N . 0 m N _ 0 0:. .0000 02.05.05. 300 0.00.. 0.05 .0m 0. 0.050 0. 38:0. . .0
5030.0 05 0300 ...—00.00
0. 30... .0300 5030.0 0:. 5000 00.55.05. 300 0.00.. 0.05
3 m N . 0 m N . 0 .0m 0. 0.050 0. 30...... ”5030.0 0:. 0300 0. 03.3 .0 59.05 . .0
0.5 09.0.5 cm 05 5.0.05 .0. 505
v n N . 0 m N . 0 30503 300 5030.0 0.... 300000 00.0 0000500 .05 300:3. . .n
... 00.0000 .0.
v 0 N _ o 0 N _ o :8? Bee. 0503...: .5 02...... 2.. 20.5... _ 08:3. _ ...
00:03.0 0:. .0 50 0500 3.000 .05 300w 5.50500
3 n N . o m N . 0 00 30.0.5303 .0300 000.5 .0 03.0 300m 0:. 000 0. 30... . .m
.. 0 N . 0 0 N _ 0 2.8.. 52. .03.. 0:30 _ .0
.. 0 N _ o 0 N _ 0 0% 05.0058 .8... £08... _ ..
:005 :005 005.. 0...: =0 05.. 0:. .0 05.. 0:. 005.. ..0
~00> 3.0.0 -0500 < .0 .02 ..0 .005_< .0 .0. < -0500 .0 .02
00.0.. .. 3.3 :005 30.. 00.... 03 =0» 3.3 00:0 30..

 

 

 

 

 

..03000 .000 0:. w0:0..0 .50... :000
.0 .:w.. 0:. 0. 002.00.... 50: .03000 00: ... .3000 ... 00.30.. 300.0000 0:. 0.5.3. 000.:0 :0. :3 0.0..0 300 50.. :000 300. 0000.0 6202.0: Ehz.

02.000 01:20 H.2

APPENDIX 1

APPENDIX 1

GRIEF SURVEYS
Response to Loss
Questionnaire Instruction
Parent Inventory

This is an inventory of ways people respond to losses in their lives. All of the

questions reflect the normal process of grieving, although of course, no one reacts in all
of these ways to any given loss. You may ﬁnd responding to this questionnaire difﬁth
because some questions may bring up memories or feelings which are painful. If you may
ﬁnd completing this inventory to be painful, put it aside for a while and return to it later.

Since this inventory asks you W, you may ﬁnd that you

have changed from how you would have responded even a few days or a few
months ago.

It might be helpful to discuss your reactions with someone. You are invited to
note your thoughts about taking the inventory at the end of your answer sheets.
As you read each question ask yourself if the statement is true about you ﬁght
WWW. You can indicate the degree to which you
are having these responses according to the following scheme.

0 ﬁhis isn't accurate about my current response to the loss of my spouse.

1 =occasionally this is true about my current responses to the loss of my spouse.
2 =some of the time this is true about my current responses to the loss of my
spouse.

3 most of the time this is true about my current responses to the loss of my
spouse.

4 =this deﬁnitely is accurate about my current responses to the loss of my spouse.

NOTE: IF A STATEMENT IS NOT A RESPONSE TO THIS LOSS, PLEASE

LEAVE IT BLANK.
Please read all questions, even if you leave some of them blank. You may ﬁnd it

helpful to take some breaks while ﬁlling out the questionnaire. If ﬁlling out this inventory
provokes strong feelings, you may wish to postpone ﬁlling out this questionnaire.

ANSWER EACH ITEM IN THE SPACE NEXT TO THE ITEM.

195

196

0 = this isn't accurate about my current response to the loss.

1 = occasionally this is true about my current responses to the loss.

2 = some of the time this is true about my current responses to the loss.
3 = most of the time this is true about my current responses to the loss.
4 = this deﬁnitely is accurate about my current responses to the loss

Since the time of my loss,

I keep active and busy.

I am smoking more.

Taking care of others distracts me from thinking about my loss.

I want/need to tell others what happened.

If I try hard enough, I can bring back what I lost.

I'm looking for who made this loss happen.

I remain involved with my ﬁ'iends and family to stay connected with my
loss.

I haven't given up the rituals and habits that connect me to my loss.
I look just as good as I always did.

I've found someone or something to replace who I lost.

NP‘P'PP’N?‘

09°

0‘
o 0

Since the time of this loss, I have thought

1 l I don't believe that this loss really happened.

12 I keep thinking something could be done to bring back what I lost.

13 I try to ﬁgure out how it could have been different.

14 I try to ﬁgure out why this loss happened to me.

15 If I don't concentrate on remembering what has happened, I'll forget it.
16 If I'm good enough, nobody I love will ever die.

17 It will all work out in the long run.

18 Every cloud has a silver lining.

19. People get the respect they deserve in this world.

20. The show must go on.

2] Idle hands are the devil's workbench.

22 If I am good enough or perfect enough, what was lost will come back.
23 I think I am responsible for this loss.

24 I wish things were the way they were before this loss occurred.

25 I'm scared to share what I've been thinking, feeling, and doing.

26 My feelings are so unpredictable I wonder if I am crazy.

27 I feel guilty just thinking about enjoying myself.

28 My feelings are so intense I'm afraid of losing control.

29 I try to hold back the tears.

30. Unless something happens to change this, I don't know if I can control

myself.

197

O = this isn't accurate about my current response to the loss.

1 = occasionally this is true about my current responses to the loss.

2 = some of the time this is true about my current responses to the loss.
3 = most of the time this is true about my current responses to the loss.
4 = this deﬁnitely is accurate about my current responses to the loss

In the time since this loss,

I am afraid to think about anything else but my loss.
Nothing is going to rob me of my feelings about this loss.
I've increased my exercise.

Sex gets my mind off the loss.

I don't feel like I am a sexual creature.

I have trouble breathing.

I don't eat as much.

I am sleeping less.

I dream that something has happened to reverse my loss.
Life seems unfair.

I believe something good will happen.

I can outlast any intruder.

I can still ﬁnd meaningful and supportive relationships.

I know I will not be tested beyond my capacity to endure.
I wonder if I really deserve what I have.

Athbhbwwwwwwwww
m wN—oxoooqomrswwy—

Since this loss occurred,

46 I know I won't give up.

47 I am determined to make those responsible pay for this.

48 This loss must be changed.

49. I avoid telling anyone what I'm thinking, feeling and/or doing about this
loss.
I'm less patient with people.

I don't see much of my old friends.

I've ben careless.

I avoid getting involved in anything.

I use drugs to forget my loss.

I've put away anything which could remind me of this loss.
I have kept secret what really happened.

I can be verbally abusive when others remind me of this loss.
I've had more sex with more people.

If I get too happy, something bad is bound to happen.

This loss is evidence that I have failed as a person.

I deserve a better deal than I am getting.

OngiUiUiUonL/uuummm
- soooxraman—o

198

O = this isn't accurate about my current response to the loss

1 = occasionally this is true about current my responses to the loss

2 = some of the time this is true about my current responses to the loss
3 = most of the time this is true about my current responses to the loss
4 = this deﬁnitely is accurate about my current responses to the loss

Since the time of this loss, I have thought

62. I'm better off without him/her.

63. No matter what I do, what will happen will happen.

64. Even if I could understand why it happened, it wouldn't change anything.
65. It's easier when I can forget what happened.

66. Nobody really cares how this loss affects me.

67. I've rejected others' ideas about the loss.

68. I should eat, drink, and be merry, for tomorrow may never come.
69. Don't rock the boat. You'll just get noticed.

70. Nobody cares about me. Why should I care about anyone else?
71. Easy come, easy go.

72. The good die young.

73. What the eye doesn't see, the heart doesn't remember.

74. Enjoy yourself now. Who cares about tomorrow?

75. If you're too happy, something bad is bound to happen.

76. It is the nail that stands out that gets hammered the hardest.
Since this loss happened.

77. I feel confused and disoriented.

78. I try not to let anything affect me.

79. I feel detached and separate from others.

80. I feel bored with life.

81. People irritate me easily.

82. I feel frustrated.

83. If I let myself, I get so unhappy I can't stand it.

84. I get upset with myself for the way I have behaved.

85. I am revolted by the way people have responded.

86. I don't want to be touched.

87. I'm more clumsy and accident prone.

88. I have felt sick to my stomach.

89. 1 exercise less.

90. I don't watch what 1 eat.

91. I doubt that anything or anyone can give my life meaning again.
92. I can't imagine anyone ever being as important to me.

93. I've given up believing that my life has any particular signiﬁcance.

100.
191.
103.
103
1114
105

10';
101
111‘

I 77
S3

124.

199

O = this isn't accurate about my current response to the loss

1 = occasionally this is true about my current responses to the loss

2 = some of the time this is true about my current responses to the loss
3 = most of the time this is true about my current responses to the loss
4 = this deﬁnitely is accurate about my current responses to the loss

Since this loss happened,

94 It's hard for me to trust anybody.

95 Nothing has really made any difference, so why do I bother?
96 I've realized that nothing could have prevented it.
97 I wonder if I'm really a disgusting worthless person.
98 I don't remember my dreams.

99. I dream that l destroyed who I lost.

100. No one can blame me for the way it turned out.
101. I deserve to be taken care of after what's happened.
102. I am scattered and ineffective.

103. I forget to do routine, everyday tasks.

104. I never seem to know what to do with myself.

105. I have very little to say.

106. I do less of the things I enjoyed before.

107. I've not been interested in meeting anyone new.
108. I lack love, affection, and companionship.

109. I've lost friends.

In the time since this loss,

110. My thinking has been slower than usual.
111. I am unable to ﬁnd anything to look forward to.

112. I forget how it used to be before this happened.

1 13. I'm struck by how other people seem to go on with their lives while I
cannot.

l 14. I know I cannot bring it back

1 15. There's no way I can fully understand why it happened.

l 16. I am aware of what is no longer a part of my life.

1 17. I think about what’s missing in my life.

1 18. The tears are hard to stop.

1 19. I long for whom I've lost.

120. It's hard to express what I feel in words.

121. I miss feeling happy.

122. I feel a great deal of hurt or emotional pain.

123. I feel helpless.

124. I feel lonely and alone.

 

200

O = this isn't accurate about my current response to the loss

1 = occasionally this is true about my current responses to the loss

2 = some of the time this is true about my current responses to the loss
3 = most of the time this is true about my current responses to the loss
4 = this deﬁnitely is accurate about my current responses to the loss

Since this loss happened,

125. Being in certain places stirs up unexpected feelings.

126. Certain odors (e.g. perfumes, old houses) can trigger feelings.
127. I feel tense.

128. My body feels heavy.

129. I've had no energy to do anything.

130. I feel numb

131. I sigh.

132. I wake up feeling tense and achy, as if I'd been tense all night.
133. I wake up during the night.

134. My dreams remind me of my loss.

135. I lack a sex life.

136. When someone touches me, my feelings come to the surface
137. My stomach really churns

138. I have aches and pains which remind me of my loss

139. I would rather die than go on experiencing this.

140. No amount of money could ever replace it

141. The future seems empty

142. What I value most in life has been destroyed.

143. I question the existence of the God I used to believe in

144. I cannot continue life the same way as before.

145. My life will never be totally free from pain and suffering.
146. I will lose things and people important to me

147. Parts of me are missing.

148. I am no the loving, caring, trusting person I was.

149. When I'm convinced things can't get any worse they do.

150. I have lost my desire to live.

151. Hearing about other's experiences with similar losses helps.
152. There is at least one person I can count on for support.

153. Being by myself has been healing.

154. I take long walks and just daydream.

155. Activities like getting a massage, painting or music are soothing.
156. Talking or writing about it gives me relief and release.

157. I can let things turn out the way they will.

158. I realize that I've lost a lot, but I haven't lost everything.

159. I think about how I have changed, what is different.

201

O = this isn't accurate about my current response to the loss

1 = occasionally this is true about my current responses to the loss

2 = some of the time this is true about my current responses to the loss
3 = most of the time this is true about my current responses to the loss
4 = this deﬁnitely is accurate about my current responses to the loss

160. I'm not as responsible as I thought I was for what happened.

161. I have already passed the lowest point.

162. My fears about dying are less.

163. I am able to express my feelings about the loss.

164. My feelings still catch me by surprise, but they don't last as long.

165. My guilt has lessened.

166. I'm not so sad.

167. My disgust over what happened has lessened.

168. I realize that sadness and peacefulness can co-exist.

I69. I can enjoy simple pleasures of life again.

170. The aches and pains I used to have with this loss have lessened.

172. I enjoy being touched and held once again.

173. It takes less energy to do things than it used to.

174. I notice how things smell and taste again.

175. I have learned to accept that losses and changes are a part of life.

176. My life will continue.

177. My dreams seem to help me understand and accept what happened.

178. My faith or spiritual understanding helped me with this experience.

179. My life does seem to have meaning.

I80. Whatever I contributed to this loss, I did not want it to happen.

Since this loss happened,

181. Life seems more fragile and precious.

182. My past will always be a part of me.

183. The fond memories are there along with the painful ones.

184. I've found ways to get back my integrity.

185. I don't depend as much on others.

186. I've remembered what I really want to remember about it.

187. I've ﬁnished things related to my loss as completely as I can.

188. I've taken steps to forgive those involved.

189. I am making restitution for my contribution to this loss.

190. I like being with people again.

191. Putting my thoughts into words has helped me recover.

192. 1's important to have times of celebration and remembrance before it's too
late.

193. My life has more to it.

 

202

0 = this isn't accurate about my current response to the loss

1 = occasionally this is true about my current responses to the loss

2 = some of the time this is true about my current responses to the loss
3 = most of the time this is true about my current responses to the loss
4 = this deﬁnitely is accurate about my current responses to the loss

Since this loss happened,

194. I've felt all I can feel about this loss.

195. I've found effective ways to express my feelings.

196. I've experienced this loss in ways that were healing.

197. I've let go of the guilt.

198. I've let go of the anger.

199. I can make sense out of the messages from my body.

200. I don't push my body beyond limits.

201. I relax.

202. I sleep well.

203. I eat sensibly.

204. I can be sexually or romantically interested.

205. I know my life is important.

206. My dreams are restful, playful and helpful.

207. I've restored or regained part of what I had lost.

208. I feel the presence of who I lost.

209. I have forgiven myself for what happened.

210. I have forgiven others for what happened.

21 1. I would not want my loss reversed if it meant giving up all my growth
ﬁom it.

212. I feel conﬁdent enough in myself to move on to other things.

213. It takes less effort and thought to do what I need to do.

214. I enjoy being alone.

215. I'm nicer to myself.

216. I'm not as serious a person.

217. I'm able to take risks again.

218. I'm more self-disciplined.

219. I don't place limits in front of myself as readily as I did before this loss.

220. I am more able to give to others.

221. I have time for my family and friends and time for me.

222. I can express myself in many ways.

223. I can appreciate the paradoxes and seeming contradictions in my life.

224. I feel more conﬁdent.

225. I've grown.

226. I see the past as just as important as what is happening now.

227. Past, present and future are equally important.

203

0 = this isn't accurate about my current response to the loss

1 = occasionally this is true about my current responses to the loss

2 = some of the time this is true about my current responses to the loss
3 = most of the time this is true about my current responses to the loss
4 = this deﬁnitely is accurate about my current responses to the loss

228. I feel challenged to keep on going.

229. I trust my ways of thinking.

230. I don't avoid my feelings.

231. I've found new ways to express my feelings.

232. I feel loving and affectionate.

233. Sadness reminds me how important this loss was to me.

234. I am curious about many things.

235. I listen to what my body tells me.

236. I enjoy making love.

237. I feel strong.

238. I am active in caring for myself physically.

239. What 1 eat is healthy.

240. I feel warm all over.

241. I have what is meaningful within me.

242. I've learned to respect myself.

243. I feel like a whole person.

244. I've discovered that there is more to me than what meets the eye.

245. My dreams make sense.

246. I live as fully as I can

247. What is important to me has changed.

248. I have fewer conditions on my love.

249. I realize I can do destructive things.

250. I feel lovable.

251. I've challenged and altered some of my most cherished and long standing
assumptions and beliefs.

252. I want other people in my life.

253. I want to share with others who have these life experiences.

254. What I own isn't important.

255. The cycles of life have times of birth and death.

256. I am sometimes surprised by what I know and say.

257. I feel connected to the world and to nature. '

258. Things in my life can change and life can still be meaningful.

259. I am curious about what will happen after I die.

260. I can't live without loving myself.

261 . I discovered some essential parts of me.

262. My life has times of joy.

qus
ohh

mm
the

Non
PLEA

11¢]pr
131010]
ANS“

Elﬁn If

204

11: CHILD GRIEF SURVEY

Response to Loss
Questionnaire Instruction
Child Inventory

This is an inventory of ways people respond to losses in their lives. All of the
questions reﬂect the normal process of grieving, although of course, no one reacts in all
of these ways to any given loss. You may ﬁnd responding to this questionnaire difﬁcult
because some questions may bring up memories or feelings which are painful. If you ﬁnd
that completing this part of the surveys is painful, put the survey down and return to it
when you feel refreshed.

° Since this inventory asks you WW you may ﬁnd that you
have changed from how you would have responded even a few days or a few
months ago.

0 It might be helpful to discuss your reactions with someone. You are invited to

note your thoughts about taking the inventory at the end of your answer sheets.

0 As you read each question, ask yourself if the statement is true about you ﬁght

WW. You can indicate the degree to which you

are having these responses according to the following scheme:

0 = this is never true

1 = once in a while this is true
2 = some of the time this is true
3 = most of the time this is true.
4 = this is always true

NOTE: IF A STATEMENT IS TRUE, BUT IS NOT A RESPONSE TO THIS LOSS,
PLEASE LEAVE IT BLANK.

Please read all questions, even if you leave some of them blank. You may ﬁnd it
helpful to take some breaks while ﬁlling out the questionnaire. If ﬁlling out this inventory
provokes strong feelings, you may wish to postpone ﬁlling out this questionnaire.

ANSWER EACH ITEM IN THE SPACE NEXT TO THE ITEM.

Some questions may seem like they are the same questions. Please answer these questions
even if it seems like you have already answered a question like it.

205

Please select the response that best describes your current response to the questions since
the death of your parent. Right now or in the past few weeks how accurate do these
statements describe your current responses to the death of your parent.

0 = this is never true

1 = once in a while this is true
2 = some of the time this is true
3 = most of the time this is true
4 = this is always true

In the time since my parent died.

9999191“

—‘-‘\OOO\I
~o...

llllllll llll ll"! Wlll

u—tt—ih—ID—d
LII-AWN

h—lh—IO—iI—I
\OOOQO"

NNNN
{AN—to

NM
3"?

I look just as good as I always do.

I ﬁnd myself talking or acting as if nothing has changed.

keeping active and busy helps me feel less troubled about this loss.

I’ve been working much harder.

I look at reminders of my loss (pictures, mementoes).

I go over the loss in my mind, trying to ﬁgure out how things could have
been different.

I try to ﬁgure out why this loss happened to me.

I ask myself: “Why did this happen to me?”

This whole thing seems unreal.

Sometimes I unexpectedly see or hear things that remind me of my parent.
I have hoped that I was dreaming and I’d wake up and ﬁnd out it never
happened.

I feel that I should have done something to prevent this from happening.
I’ve been angry

I’ve been scared to share what I’ve been thinking, feeling, and doing.

I can’t express the feeling I have about what I did and/or didn’t do just
before the loss happened.

I dream that it never happened.

I’ve increased my exercise.

I ignore the physical pain just to keep going.

I dream that something has happened to reverse my loss.

I have lost weight. -

It would help if someone could help me understand this.

Life seems unfair.

There are times when it feels like I am going through the same thing all
over again.

1 am not able to forgive those who contributed to this loss.

I wonder if I really deserve what I have.

206

Right now or in the past few weeks how accurate do these statements describe your
current responses to the death of your parent.

0 = this is never true

1 = once in a while this is true
2 = some of the time this is true
3 = most of the time this is true
4 = this is always true

Since the death of my parent.

26.
27.
28.
29.
30.
31.
32.
33.

lllllIllllllll'I'l'l'l'l’llllll

mmmmmmmmhbb-ﬁb Abka-wwwwww
ﬁGMbWN—oowuomth—ocmqama.

58-

I avoid telling anyone what I’m thinking, feeling, and/or doing.
I avoid people who remind me of this experience

I’ve been careless.

I have never told anyone what really happened.

I act as though this doesn’t really matter to me.

Something else is going to go wrong.

It’s easier when I can forget what happened.

This loss is evidence that I have failed as a person.

If I get too happy. something bad is bound to happen

If I don’t look out for myself, no one else will

I feel confused .

I feel detached and separate from others.

I feel dissatisﬁed with everything.

I feel overwhelmed.

People irritate me.

I don’t want to be touched.

I get hurt more.

I dream that I destroyed who I lost.

I am sick a lot.

I wish I could be saved from having to deal with this experience.
I doubt that anything or anyone can give my life meaning again.
It’s hard for me to trust anybody.

Nothing has really made any difference, so why do I bother?
Nobody cares how I am doing.

It’s been hard to concentrate.

I am less conﬁdent.

I’ve not been interested in meeting anyone new.

I have very little to say

I’ve had no energy to do anything

I am scattered and ineffective

I am unable to ﬁnd anything to look forward to.

My thinking has been slower than usual.

I can’t imagine how things will get better.

207

Right now or in the past few weeks how accurate do these statements describe your
current responses to the death of your parent.

0 = this is never true

1 = once in a while this is true
2 = some of the time this is true
3 = most of the time this is true
4 = this is always true

Since the death of my parent.

1t seem hopeless to try to understand what really happened.
I feel empty, like a shell, like I am just existing.
I feel lonely and alone

I long for whom I’ve lost.

The tears are hard to stop.

I miss expressing my love.

I feel restless.

I feel tense

I am exhausted by any effort

My body feels heavy

I wake up during the night.

The future seems empty.

It is easier to realize that someday I will die.
Everything else seems trivial and meaningless.
I’ve lost my fear of dying.

\INQNC‘O‘O‘QO‘ O‘C‘O‘ M
9N799¢NQM$WN—gp

74. There is nothing positive or good about this loss.

75 Hearing about other’s experiences with similar losses helps

76. Being by myself has been healing.

77. Telling or writing my story about this experience gives me a feeling of
relief and release.

78 It’s easier to let myself just experience this loss.

79. It helps to be with a friend who accepts me as I am

80. I think about the effects of this loss. how I have changed, what is different.

81 I can take what comes

82. I realize that I’ve lost a lot, but I haven’t lost everything.

83 There are some things I will never understand' about this.

84. I’m not as responsible as I thought I was for what happened.

85 My feelings make sense when I think about them.

86. I don’t need to struggle to accept what has happened.

87. I still hurt, but the pain has lessened.

88 My feelings still catch me by surprise, but they don’t last as long.

89. 1 don’t feel as guilty as I used to.

208

Right now or in the past few weeks how accurate do these statements describe your
current responses to the death of your parent.

0 = this is never true

1 = once in a while this is true
2 = some of the time this is true
3 = most of the time this is true
4 = this is always true

In the time since my parent died

90. I can enjoy simple pleasures of life again.

91. My body is healing from the stresses of this experience.

92. The aches and pains I used to have with this loss have lessened.

93. I notice how things smell and taste again.

94 I’m able to relax.

95 I realize that sadness and peacefulness can co-exist.

96 Someone or something powerful and loving has helped me make it this
far.

97 I have learned to accept that losses and changes are a part of life.

98 I believe there is some good in every person.

99. My faith or religious beliefs helped me with this experience.

100. At least one person knows that I’ve forgiven myself.

101. I’ve found ways to get back my integrity

102. I’ve changed

103. I’ve experienced this loss in ways that were healing.

104. I’ve said good-bye to my loss.

105. I realize how important it is to say good-by to who’s gone.

106. My life has more to it.

107. I know my life is important.

108. l have as good an understanding as I can right now about what happened.

109. I understand why it’s important to have time of celebration and
remembering before it’s too late.

1 10. I’ve felt what I’ve needed to feel about this loss.

1 l 1. I no longer feel shame.

I 12. I’ve let go of the guilt.

I 13. I’ve let go of my sadness.

I 14. I’ve let go of my anger.

l 15. I can make sense out of the messages from my body

1 16. I have the energy I need.

1 17. I relax

I 18. I don’t neglect my body

1 19. I sleep well.

209

Right now or in the past few weeks how accurate do these statements describe your
current responses to the death of your parent.

0 = this is never true

1 = once in a while this is true
2 = some of the time this is true
3 = most of the time this is true
4 = this is always true

As a result of the death of my parent.

120.
121.
122.
123.

124.
125.
126.
127.
128.
129.
130.
131.
132.
133.
134.
135.
136.
137.
138.
139.
140.
141.
142.
143.
144.
145.

146.
147.
148.
149.

HH Hllllllllllllllllllll ll'll

I feel conﬁdent enough in myself to move on to other things.

I have forgiven myself for what happened.

It’s time for me to get on with life.

This loss has opened me to bonds of love and friendship with at least one
person.

I have been forgiven for what I contributed to this loss.

I’m more self-disciplined

I enjoy being alone.

I discovered what I want in life.

I can laugh at myself

I’m more assertive

I feel more conﬁdent.

I’m more creative in my approach to life

I feel challenged to keep on going.

I enjoy dreaming as much as I do reaching for my dreams.

I’ve changed in ways that would not have happened otherwise.
I am curious about a lot of things.

I feel like a whole person.

I feel loving and affectionate.

I’ve learned to respect myself.

I am not as hard on myself when I make mistakes.

I listen to what my body tells me

I am efﬁcient and creative at doing things.

I feel strong.

I am active in caring for myself physically.

I’ve discovered that there is more to me than what meets the eye.
I trust my intuition, dreams, fantasies, or my inner sense to let me know
what I need to know.

I feel a part of something much bigger than me.

I live as fully as I can.

I can love and be devoted to another without losing myself.

I have peaceful moments.

210

Right now or in the past few weeks how accurate do these statements describe your
current responses to the death of your parent.

0 = this is never true

1 = once in a while this is true
2 = some of the time this is true
3 = most of the time this is true
4 = this is always true

150. I am sometimes surprised by what I know and say.

151. I’ve discovered that the most important parts of my loss remain alive
inside me.

152. I can get along with less than I have needed in the past

153. I believe there is someone or something more powerful, loving, lasting,
and wiser then any single human being.

154. I feel connected to the world and to nature.

155. I know I am in the right place for me right now.

156. I realize that I can't live without loving myself.

157. I know that things in my life can change and life can still be meaningful.

158. My life has times of joy.

99°89‘999’Nf"

AWWWWWWWWWWNNNNNNNNNN—H—du—tpun—au—o-d—‘u—n
PpwsowawwrPpwsowawwropwsowéwwro

211

13: ITEMS DELETED FROM PARENT SCALE

1 keep active and busy.
I look just as good as I always did
I've found someone or something to replace who I lost
It will all work out in the long run
Every cloud has a silver lining
People get the respect they deserve in this world,
The show must go on
Idle hands are the devil's workbench
I've increased my exercise
Sex gets my mind off the loss
I don't feel like I am a sexual creature
I believe something good will happen
I can outlast any intruder
I can still ﬁnd meaningful and supportive relationships
I know I won't give up
I am determined to make those responsible pay for this
This loss must be changed
I use drugs to forget my loss
I've had more sex with more people
I'm better off without him/her
No matter what I do, what will happen will happen
The good die young
What the eye doesn't see, the heart doesn't remember
I've realized that nothing could have prevented it
I don't remember my dreams
No one can blame me for the way it turned out
I know I cannot bring it back
I lack a sex life
Hearing about other's experiences with similar losses helps,
There is at least one person I can count on for support.
I'm not as responsible as I thought I was for what happened
My guilt has lessened
Whatever I contributed to this loss, I did not want it to happen
My past will always be a part of me
The fond memories are there along with the painful ones
I enjoy being alone.
I see the past as just as important as what is happening now
Past, present and future are equally important
What is important to me has changed
I realize I can do destructive things.

“SQV'PP‘NZ‘

u—ou—au—au—au—nu—tc
.V'F‘PJPr‘O'

212

14: ITEMS DELETED FROM CHILD SCALE

1 look just as good as I always do

I ﬁnd myself talking or acting as if nothing has changed
keeping active and busy helps me feel less troubled about this loss
I have never told anyone what really happened

I act as though this doesn't really matter to me,

I dream that I destroyed who I lost

I’ve lost my fear of dying on the Coping Scale

There are some things I will never understand about this
I’m not as responsible as I thought I was for what happened
I’ve changed

I sleep well

I’m more self—disciplined

I enjoy being alone

I am sometimes surprised by what I know and say

I can get along with less than I have needed in the past

APPENDIX .1

APPENDIX .1

FAMILY ASSESSMENT DEVICE
On the following pages, there are a number of statement about families. Please
read each statement carefully, and consider how much it describes your family anhe

We. you should answer according to how you see your family now.

For each statement there are four possible responses.

RESPONSE CHOICES:
1 2 3 4
Strongly Agree Agree Disagree Strongly Disagree

For each statement, circle one of the numbers to the right.

Circle 1 Strongly Agree if you feel that the statement describes your family
W

Circle 2 Agree if you feel that the statement describes your family
foLthesztnan

Circle 3 Disagree if you feel that the statement m describe your
family {anthem

Circle 4 Strongly Disagree if you feel that the statement @5119! describe your
family

Try not to spend too much time drinking about each statement. Answer with your initial
reaction.

213

214

 

.mEooSu 93 may: :5 9.52.3.5 2o: 93 ..N

 

..chwon 5 E o: 2 3:3 305— 93 .cu

 

53:28.5 enema": race 5% m: ..o quw .o.

 

.Eu:. 3 mes—:50 9"an $55 38 :5 =5 Em: 0E8 Bacon. .5

 

.m0.:.. 0:. 9.38.: ::3 .33.: .0» 37.3 :8 =o> .2

 

.93 39:. 3:3 .5.: 3588 03 22.239: .2

 

.:m=eco ESP—a 32% SM ..coe 5.3. szan. .n.

 

.sznm 0.8 3:: 3:3 :5: $58.. m_ 528 a 3e: =8 ..58 =o> .3

 

.Eu:. 9 Eatoag m_ wEEqum 5:3 29:8 .3 $23.: 9:. .ow bee =o> .m—

 

mcoﬁﬁue :5 co .8 »:aam: 93 .N_

 

:8: 03 9.2.92 9:. 50:: 5:8 :03 o. :.3 5:58 03 ._ _

 

.moEzemcoamB 5:5: :95 “ouE EBEuE 2% SEE 03 .e.

 

5:8 :98 .5: 85¢? 5c 3e:m o. 2.32:9. 2a 35 .o

 

€59: 03 5..—3L0 «:0 c3.— moEZOEGm 93 .w

 

d: .888 35925 cm 5:3 on 9 5:3 32:. race a? .n

 

€2.97, 5.. 8:8 :23 3 E3 :8 .43 mars .3 3E: :— .o

 

.3335 cc. 0808: 29:8 0:. 93:2. 5 m_ econ—=3 .: .n

 

.: E: 3:. 3:. :85 c. .33: sex .mEEoEcm a: o. 9.595% :3 :9: 5:3 .v

 

2:3 32.: 39:8 0:. 53: m_ oceoEom 5:3 .n

 

v

.345: 9:. .2593 mes—:95 $9026 36.: 3.82 o? .N

 

v

m

3:5 :28 3332.:sz “.3 3:89: «.356 3 323:8 »:EE wEEaE ._

 

 

unawama waEm

 

gammy. E

 

uuhw<

 

ouam< waEm

 

 

 

215

 

8:8 :28 :..3 :5... Pa 03 .3

 

5.28:2. ....o :8 wE:.uEOm 8w :3 8:. 8:3 .28 8:8 :88 E .888. m3o:m 3.88.. .50 Ne

 

8:8... :8 8.. 82:98 a m. 80.80.. mExa—z ......

 

BE. 28:88: on o. m. 0:3 v.88... 83 .9.

 

.....E... :8 E &E:. 8:8 8. 8...: 8:88 8:... 38:88:"; .2”

 

...: 2:8 3:. 23d: ...:E8Eo .moE 9:98.. 83 ...M

 

58:88.. ._ .8 =8 wE:8Eom .uw :3 03 8:3 8:8 :83 E .888. 397. 93 Km

 

.2: 83 0:3 8.. .8898: .8. 03 .cm

 

.58.: 03 8:3 .5. ..8: 8.8 83 .mn

 

.5888. 3:38.. 88.98 8. .8: 8...: 3.8:: in

 

.m: 3888. wE:.8ECm 8:3 3:0 8:8 :38 :._3 88283:. 8m 35 .mm

 

8.98: MEE: 86:: 8:: 9...: 83 .Nm

 

.....EE 8:. E &EEE em: .8 m8. 2.. 88:... ..m

 

33:28:88.. 8:: 8.8: 8.23.8: an: m: .8 :83. .2“

 

.m:83.u:-ew :mzoE. 5:. 8:8. .288... 2:02. o. ...... 83 .oN

 

8:8 :28 8.. 88. :8 3o:m 8: on 83 .mm

 

:88 .33 3e: 88:: 82.58%“. 88.8 o: 83.: 83 ...N

 

8:8 :28 :..3 me_8.. :8 988.8 :8 a? ..N

 

.UO..D~CUOJ=Um g. ”..N 03 .WN

 

.8: .8 .8483 .. 8:8:3 $33.... 3.83 83 82:08 a "3.3 e. 8.... »:EE :8 8..< .vm

 

i=5 :8 MEBuE 2:8... 26: .53 .2.

 

 

 

 

 

 

88:88.. 8.8.... 88:: 8.8 :88 o. ...... o. ..zoE... m. .. .NN

 

 

216

 

.2538... 3.8 8. $33 .58.....8..8 ..E:. 8. b. 83 .88

 

...8:. =8. 83 8:88 3: 8:888 ...:3 8.... ..:88 83 5:? .on

 

82:88:88.. 2:888. 8. .88: 83.: ..:88 83 8:88: 888.8 8.2% 2:88.. 83.: 83 .w...

 

8.588 .08 83 Km

 

8:8 :88 E 88:58 8.... 8m

 

88.82... £88888 88:8 8.... 8... 885. .mn

 

.83. 98:8 :88 8E. :88E .8. 888...: 83 ...83 :3... 83 :w.8:. 53.. .3.

 

.m: 8. 88:98: 8.88 ...E... 8:. :..3 82.88328 ......85w 8... 8.5 .mm

 

.bwcm 8... 83 5:3 8:8 :88 8. ...... ..:88 83 .Nm

 

8:88. :83 was... .DM ..:88 25 ..n

 

.....mEEu. 88:: 2:28... 82,888 8? dm

 

.mmuE885. $8.58 8.5 .89

 

..:88. .88 E 3% w:.:.z:< .wv

 

.88....» 8. 8:3 385. ..:88 83 .58.: ...... 8.... 8:. .. .5

 

...—:28... 2...... 8. 38: 88:: 28.2888 828E 8. 2:: 8.: 25 8..

 

.wE8EEu. 888: 8:. .w:.:.uE8¢. 88 8. 88...... 88 2:82.... .3.

 

 

 

 

 

 

.m8...8::.m .8 m2... .5. 8.8: ..:88 83 .3.

 

 

APPENDIX K

 

APPENDIX K

FIGURES

217

218

....S.

 

 

.8885 .288
\ ......8

 

 

 

82:0

..... .

_ 88.88.8883. _ ...
_ 2.88“. _ 5.80.8 0.8.82 _

IIIII ... + , IIIIII_

9:880
.58..

.35 ,
8_.:U
. — 8.880

 

 

 

 

 

..2.0 .58..

 

 

 

.8896 ....88m ,
.58..

 

 

8.80 :8 88...”... 88.5 8 mm .835 .288 H. .8883.
. 8.8m...

219

_ €22.25...
_ €55.

.llll

 

 

.25
2:6

 

_ :o..ao_=:EEoU ..

 

 

..o..O
.53..

.. lllllll . e
/ w...qu
.53..

 

 

 

9.300
......U

 

 

 

roam—am 3.3m
_ .2232... ......U

 

_ ...aon. ..o 2:32 _

rlll'l.

 

 

 

 

\\

_ toaaam Boom

 

.2285... .53..

 

w:...oU ..o 5.80.82 a ma tongsm ....oom ”N .032

N 8%....

220

Figure 3

Functional Support as a Mediator of Parent Coping

 

 

Functional Social Supportj

 

p = -26. p = .34“

 

| Nature of the Death I ' Parent Coping

 

t. ______ J

 

B = -23:-

Figure 4

Functional Support as a Moderator of Parent Coping

 

Functional Social Support

 

 

 

 

Parent Coping

 

 

“ p<.05, “p<.0l

22]

Figure 5

Structural Social Support as a Mediator of Parent Coping

 

Structural Social Support

 

 

 

 

 

I Z, I Parent Coping

 

 

“ p<.05, " p<.Ol

' p<.os, “p<.0l

222

Figure 6

Parent Coping as the Dependent Variable

 

 

 

Functional Social Support

 

 

 

 

 

B = ,34.
r- —————— “I
I Nature of the Death I ’ Parent Coping
‘- ------ -’ B = -23:-
p = —.1 1

 

 

l Child Coping

‘p<.05, " p<.Ol

223

Figure 7

Functional Social Support as a Mediator of Child Coping

 

Functional Social Support

B=.03/ \B=.25‘

 

 

 

 

Child Coping

 

 

Figure 8

Functional Social Support as a Moderator of Child Coping

 

Functional Social Support

 

 

 

13:.03

----- t

F . .
I Nature of Death I ’ Child Coping
————— J B = .01

3:.04

 

 

 

 

 

*p<.05. " p<.Ol

224

Figure 9

Structural Social Support as a Mediator of Child Coping

 

Structural Social Support

 

 

 

 

I
| Nature ofthe Death | + Child Coping

 

 

 

’p<.05. "p<.Ol

225

Figure 10

Child Coping as the Dependent Variable

 

 

------- 1
Functional Social Support {-Family Communication |

 

 

B = '23‘ B = .28-v

 

 

 

Child Coping

 

‘p<.05, ”p<.Ol

226

Figure ll

Grief Predicting Family Functioning

 

 

Parent Grief B = '27‘

 

l ------ 't
I Family Functioning |

----—-‘

 

 

Child Grief /B-2:

 

 

‘p<.05, ”p<.OI

227

Figure 12

Parent and Child Grief as Mediators of Coping on Family Functioning

 

Parent Grief

 

 

B = .49"

 

 

Parent Coping

 

 

 

‘ * I Family Functioning l
| I
, , 7 . ______

 

LChild Coping B = .19

 

 

 

Child Grief

 

B:.3llt

 

 

*p<.05. "p<.0l

 

 

 

tonnam Boom
\ 2:6

 

 

 

..o...O
......U
- $.qu
220
8 _ m=.Mo..o::.. _ .. lllll _
n _ l. :85... i. _ :o..au.::EEoU _ ... lllll I.
l l I I 3.5.... _ ...aon. ..o 2352 .

 

.

iiiiiu _
m:...oU
.53..

 

 

..o..0 .53..

 

\

 

 

tong—5 .305 i
.58..

 

.082 :2: 8582

2 23w;

REFERENCES

Aiken, L. S. & West. S. G. (1991). Multiple regression: Testing and
interpreting interactions. Newbury Park, CA: Sage.

Altschul, S. & Beiser, H. (I984). The effect of parent loss by death in early
childhood on the function of Parenting. In R. S. Cohen, B ..J Cohler, and S. H. Weissman

(EdS) BanemhMJstchodxnamiLBmpestixe New York: Guilford Press

Bailey. D. Wolfe, D. M. & Wolfe, C. R. (1993). With a little help from our
friends: Social support as a source of well- being and of coping with stress. W

W 127-152

Baker, J .E.. Sedney. M.A., Gross, E. (1992). Psychological tasks for bereaved
children. MW 62, 105-116

Balk. D. (I983). Effects of sibling death on teenagers. WW
Hm, i2. 14‘18.

Balk. D.E.. Tyson-Rawson. D.. & Colletti-Wetzel, J. (1993). Social support as an
intervention with bereaved college students. W, 11, 427-450.

Barrett. C.J. (1977). Women in widowhood. .[cmmal {Kl/omen in Culture and
Society. 2, 856-363-

Barrett, C ..l. (1978). Effectiveness of widows' groups in facilitating change.

W 553 20-31
Barrett, C.J. (1981). Intimacy in widowhood. WW, 5,

473-487.

Baron, R. M. & Kenny, D. A. (1986). The moderator-mediator variable distinction
in social psychological research: Conceptual, strategic, and statistical considerations.

WM 51 1173- 1182

229

230

Ben-Sira. Z. (1983). Loss, stress and readjustment: The structure of coping with

bereavement and disability. WW, )1, 1619-1632.

Berado. DH. (1988). Bereavement and Mourning. In H. Wass, F.M. Berardo, &

R.A. Neimeyer (Eds). W (pp.279-300). New York: Hemisphere
Publishing Corporation.

Berlinsky. E.B. & Biller, H.B. (1982).Ear:1m1_ﬂeath_and_ﬁsy§hglggi§a1

Development (pp. 21, 107-127). Toronto, Canada: Lexington Books D.C. Heath and
Company.

Bertman. S. (1984). Helping children cope with death. In H. C. Hansen & T. T.

Frantz (Eds..) me. 48-60). Rockville, MD. Aspen Systems

Corporation.

Billings. A. G.. & Moos, R. H. (1981). The role of coping responses and social
resources in attenuating the stress of life events. MW, 5, 139-
157.

Black. D. & Urbanowicz. M. A. (1987). Family intervention with bereaved

children Ihelcumamfﬁhiliﬂmhelmdlimhim 28 467-476

Bowling, A. (1988). Who dies after widow(er)hood?: A discriminant analysis.
Qmega. 12. 135-153.

Breer. M.L. (1993). Social support and the bereaved widow: A needs assessment.
Unpublished Masters Thesis.

Bumell, G.M. & Bumell, AL. (1989). W
WW (1113- 513-67)- New York. New York: Human

Sciences Press. Inc.

Camper. FA. (1982). Children's reactions to the death of a parent: Maintaining
the inner world. 189-202.

 

Cleiren. M. (1993). g - . ' .
AW. Washington D. C. :Hemisphere Publishing Corporation

Cohen. J. (1977). WWW

Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers.

Cohen, S.. & Wills. T.A. (1985). Stress, social support, and the buffering
hYPOthesis W 28 310-357

231

Cook, A.S. & Otljenbruns, K.A. (1989). [bring and Quexing: lifespan & Emily
W. New York: Holt, Rinehart. and Winston Inc.

Crase, D.R. & Crase. D. (1989). Single-child families and death. W
Edmatinn, 153-156.

Crook, T. & Eliot. J. (1980). Parental death during childhood and adult
depression: A critical review of the literature. Esycholngmﬂmmm, 81, 252-259.

DeSpelder L-A & Stl'iCkland A L (1987) W

anilh'mg (pp. 235- 259). Mountain View CA: Mayfield Publishing Company.

Dimond. M., Lund, D.A.. & Caserta, MS. (1987). The role of social support in
the ﬁrst tow years of bereavement in an elderly sample. Qemnmlngist, 21, 599-604.

Dohrenwend. B. S. (1978). Social stress and community psychology. Ameﬁgan

WMIM

Elder, S. (1990). Impact of major life transitions on adolescent development. In J.

Morgan (Ed). Wm! Teenager (PP~ 90-97)- Philadelphia: Charles

Press.

Elizur. E. & Kaffman. M. (1982). Children's bereavement reactions following

death of the father: 11. MW Academxnfﬂhilﬂmhim 21, 474-
480.

Elizur, E. & Kaffman. M. (1983). Factors inﬂuencing the severity of childhood
bereavement reactions. Ameriganlqnmalgf W, 51, 668-676,

Epstein, N. B. Baldwin, L. M., & Bishop. D. S. (1983). The McMaster family

assessment devnce lQumalnﬂMatitalandﬂmilLIhemx 2 171- 189

Fleishman. J. A. (1984). Personality characteristics and coping patterns. W
Healthmdﬁmialﬁehamr 25 229-244

Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in a middle aged
community sample. MW 21 219-239

Folkman. S.. Lazaurs. R.S., Pimley, S., & Novacek, J. (1987). Age differences in
stress and coping processes. WW, 2, 171-184.

Fox. SS. (1985). Children's anniversary reactions to the death of a family
member. Qmega, 15, 291-305.

"

 

 

232

Furman, E. (1984). Children's patterns in mourning the death of a loved one. In H.

Wass & C .A. Corr (Eds). Childhm andﬂeath (pp 185-203). Washington DC:
Hemisphere Publishing Corporation.

Garber, B. (1983). Some thoughts on normal adolescents who lost a parent by
death. loumaloﬂouthandAdQIescence, 12. 175-183.

Gersten. J. C.. Beals. J. & Kallgren. C. A. (1991). Epidemiology and preventive
interventions: Parental death 11 childhood a case example. W

Communimﬁmhologx 12 481 500.

Glass. J. C. (1991). Death, loss, and grref among middle school children:

Implications for the school counselor. Elementary Wing, 2.6
1 39-148.

Gordon. A. (1986). Adolescents and death: Contemporary interactions. In C.Corr
and J. McNeil (Eds). Adglgsggngg animal] (pp. l6-31). New York: Sphinger.

Gottlieb, B.H. (1983). SOcial support as a focus for integrative research in
Psychology- Ameumﬂmhologist 3.8, 278-287.

Gray. R. E. (1989). Adolescents' perceptions of social support after the death of a
Parent MW 2 127-144

Hanson, B.S. & Ostergren. P0. (1997). Different social network and social
support characteristics, nervous problems and insomnia: Theoretical and methodological
aspects on some results from the population study 'Men born 1n 1914', Malmo, Sweden.

mm: 2.3 849- 859.

Harris. E. S. (1991). Adolescent bereavement following the death of a parent: An
CXPloratory study Chiliﬁsxchiamdﬂnman Mailman! 21, 267-281

Hauser, M. J. (1983). Bereavement outcome for widows. .LQumal Qf PsychQsQQial
NursingandMemalHealthSerxices 21. 22-31.

Heller, K., Price, R..,H Reinharz, S., Riger, S. Wandersman,A., &D',Aunno

TA (1984) WWW Paciﬁc
Grove. CA: Brooks/Cole Publishing Co.

Hirsch, B. J. (1980). Natural support systems and coping with major life changes.

WW 8 159-172.

Hirsch. B. J. (1985). Adolescent coping and support across multiple social

environments MW 13 381 -392

233

Hopmeyer, E., & Werk, A. (1994). A comparative study of family bereavement
gTOUPS- Deathﬁhrdies. 18. 243-256.

Hogan. N. S. & DeSantis. L. (1994). Things that help and hinder adolescent sibling
bereavement MW 16 132-153

Holmes. J..H & Rahe. RH. (1967). The social readjustment ratrng scale. Jgumal
ofﬁsxchosomausﬁesearch 11. 213- 218.

House. J .. & Kahn, R. (1985). Measures and concepts of social support. In S.
Cohen & S.L. Syme (Eds). Wm (pp. 83-108). Orlando, FL:

Academic Press.

Hu. L. T. & Bentler. P. M. (1995). Evaluating model ﬁt. In R. Hoyle (Ed),

WWW (PD 76-99) Thousand
Oaks, CA: SAGE Publication lnc.

Johnson. P.A. & Rosenblatt. PC. (1981). Grief following childhood loss of a
Parent. Amencanioumalofﬂsxchothmpx. 35, 419-425.

Johnson. RA. (1982). After a child's parent has died. Child Bmhiaﬂand
Humanllexelonmem. 12. 160-170.

Kalish. RA. (1985). IleathﬁneLanannngBelatronshm Montcrey. CA:
Brooks/Cole Publishing Company.

Keitner. G...l Fodor, J. Ryan, C. E. Miller, 1..,W Epstein, N. B., & Bishop, D. S.
(1991). Cross-cultural study of major depression and family functioning. Canadian

mm 3.6. 254-258

Kelly, J. (1966). Ecological constraints on mental health services. Ameﬁgan
W 21, 535-539.

Kincaid. S. B. & Caldwell. R. A. (19). Initiator status, family support, and
adjustment to marital separation: A test of an interactions hypothesis. Jgnmaigf

MW 12 79-88

Kissane. D.W. & Bloch. S. (1994). Family grief. WM gills/shim,
164, 728-740.

Kitson. G. C. & Zyzanski, S. J. (1987). Gnef 1n widowhood and divorce. In S.

Zisook (Ed) WWDP 369-386) Philadelphia W
B. Saunders Company.

 

234

Knapp, L.G., Stark, L...J Kurkjian, J. A., & Spirito, A. (1991). Assessing coprng 1n

children and adolescents: Research and Practice. Wm, 3, 309-
334.

Kosciulek, J. F. (1994). Relationship of family coping with head 1njury to family
adaptation MW 39 215— 231

Krupnick. J .L. & Solomon. F. (1987). Death of a parent or sibling during
childhood. In J. Bloom-Feshback, S. Bloom-Feshback, & Associates (eds). Ihe

WW5 (pp. 345-371 ). San Francisco: Jossey-Bass
Publishers.

Kubler-Ross. E. (1969). Qn Death and m. London: The McMillan Company.

Lazarus. R.S., & Folkman. S. (1984).§t1;e§s._AnnmsaLand_Cgmng. New York:
Springer.

Lehman. D.R.. Lang. E.L.. Wortrnan. C.B., & Sorenson, SB. (1989). Long-term
effects of sudden bereavement: Marital and parent-child relationships and children's

reactions. IoumaImZEamily. Psychology. 2. 344-367.

Levine M & Perkins DV (1987) BrineinlesoﬂCommuniﬂsxchologx;
W. New York. Oxford University Press.

Levine, M. (1988). Ananalysis of mutual assistance. W
Communimlimhologx 16.167-188

Levy. L. H. Derby. J. F., & Martindowski, K. S. (1993). Effects of membership in
bereavement support groups on adaptation to conjugal bereavement. W

Communimﬂsxcholoex 21. 361 -381.

Lieberman. S. (1978). Nineteen cases of morbid grief. Bdtishlmalgf
Esxchim. 132,159-163-

Lohnes, K.L., & Kalter. N. (1994). Preventive intervention groups for parentally
bereaved children. Americmloumamﬂthstxchim (a. 594-603.

Lopata. H. Z. (1986). Becoming and being a Widow: Reconstruction of the self
and tittpport Systems Wm 12 203-214

Ludin, T. (1984). Morbidity following sudden and unexpected bereavement.
Britishlnumamiﬁmhim 1:111, 84-88.

Lund, D.A., Caserta, M.S., Van Pelt, J ., & Gass, K.A. (1990). Stability of social
support networks after later life spousal bereavement. W, 14, 53-73.

235

Lund, D.A., & Caserta. MS. (1992). Older bereaved spouses' participation in self-
help groups. Omega. 25, 47-61.

Malikson. R. (1987). Helping and being helped: The support paradox. M
m, 1.1.9 205'219.

Masterman, S.H. & Reams, R. (1988). Support groups for bereaved preschool and
school-age children. AmericanJoumalnf W. 58. 562-570.

Matheny, K. B., Aycock. D. W., & McCarthy, C ..J (1993). Stress 1n school-aged
Children and youth Wm 5 109-134

Mayers. E. (1986). W. New York: Penguin Books.

McCubbin, H. 1., Olson. D. H., & Larsen, A. S. (1994). Family crisis oriented
personal evaluation scales. In J. Fischer & K. Corcoran (Eds) W
W (2nd ed. ). New York: The Free Press.

Middleton, W., Raphael, B.. Martinek, N., & Misso, V. (1993). Pathological grief
reactions. In M.S. Stroebe, W. Stroebe, and RD. Hansson (Eds). Handhnnkgf
W andlntemzntion (pp- 44-61)- New York: Cambridge

University Press.

Miller. I..W. Kabacoff. R.I.. Keitner, G.1., Epstein, N. B., & Bishop, D. S. (1986).

Family functioning 1n the families of psychiatric patients. W, 21,
302- 312.

Miller. l.W., Keitner, G.I., Whisman. M.A., Ryan, C.E., Epstein, N.B., & Bishop,
D.S. (1992). Depressed patients with dysfunctional families: Description and course of

illness. immaLoﬁAhnonnalﬁsxchologx. 191. 636-646.

Minuchin, P. (1985). Families and individual development: Provocations from the
field of family therapy. Chiliﬂeyﬂgnmgnt, 56, 289-302.

Mireault, G. C. & Bond, L. A. (1992). Parental death 1n childhood. Perceived

vulnerability, and adult depression and anxiety. WW, ﬂ,
517-524.

Mitchell, R.E., & Trickett. E.J. (1980). Social networks as mediators of social
support: An analysis of the effects and determinants of social networks. Community

MentaLHealtthumal. 1.6, 27-44.

Moos, R. H. & Schaefer, J. A. (1993). Coping resources and processes: Current
concepts and measures. In L. Goldberger & S. Breznitz (Eds), WM

WWQM ed., pp. 234-257). New York: Free Press.

236

Murphy, PA. (1986). Parental death in childhood and loneliness in young adults.
Omega. 11, 219-228.

Murphy. RA. (1991). Parental divorce in childhood and loneliness in young
adults. Qmsga. 2.3. 25-35.

Nelson. G. (1990). Women's life strains, social support, coping, and positive and
negative affect: Cross-sectional and longitudinal tests of the two-factor theory of

emotional well-being. WM, 18, 239-263.

Olowu, AA. (1990). Helping children cope with death. W Deyglgpmem
mm. 6.1. 119-123-

Osterweis, M;., Solomon, R., & Green, M. (1984). W Reagtinns
W. Washington DC: National Academy Press.

Owen, G.. Fulton, F., & Markusen, E. (1982-83). Death at a distance: A study of
family survivors. ngga, 18, 191-225.

Pearlin, L. & Schooler. C. (1978). The structure of coping. WW
Socialﬂehaxiot 19. 2-21.

Pearson, J. E. (1986). The definition and measurement of social support. .LQumaLQf
Counsehnaandﬂexelonmem (ﬂ, 390-395.

Plotkin, D. R. (1983). Children's anniversary reactions following the death of a
family member CanadianMentaLHealth lune 13-15

Ragan. R. V. & McGlashan, T. H. (1986). Childhood parental death and adult
PsychOPathology. Americanloumalﬂmhiany 143 153-157.

Rando, T. A. (1983). Investigation of grief and adaptation 1n parents whose
children have died from cancer. W W, 8, 3- 20.

Rando TA (1984) WWW
Champagne IL: Research Press. (Chapter 3 pages 43- 58.

Rando, T.A. (1992). The increasing prevalence of complicated mourning: The
onslaught is just beginning. Omega, 28, 43-59.

Raphael. B. (1977). Preventive intervention with the recently bereaved. Amhixes

W. 3.4.. 450-454.

237
Raphael. B. (1983). I11: Anatnmy Qfmyamgnt. New York: Basic Books.

Raphael. B. & Nunn. K. (1988). Counseling the bereaved. lgmmal QLSmial
Issues. 4.4.. 191-206.

Rognlie, C. (1989). Perceived short-and long term effects of bereaved support
group participation at the hospice of Petaluma. WW, 5, 39—53.

Rosen. H. (1985). Prohibitions against mourning in childhood sibling loss
Qmaga. 15, 307-316.

Rosen. H. (1986). When a sibling dies LntgmatinnaLJgnmﬂ W,
1, 389-396.

Rosenblatt. PC. (1988). Grief: The social context of private feelings. .[mimal nf
5mm Issues. .451. 67-78.

Rosenthal. N. (1986). death education: developing a course of study for
adolescents. In C.Corr and J. McNeil (Eds). Agiglasgang; animath. New York:
Sphinger. (PP. 202-214).

Roth. S.. & Cohen. L..J (1986). Approach, avoidance. and coping with stress

Ameﬁcartﬁmhologist _1 813- 819
Roy. P F. & Sumpter. H. (1983). Support group for the bereaved.

Saler. L. & Skolnick, N. (1992). Childhood parental death and depression in
adulthood: Roles of surviving parent and family environment. Amariganlmimaigf

Qtthonsxchim. 52. 504-516.

Sanders. C .M. (1979-80). A comparison of adult bereavement in the death of a
spouse, child. and parent. ngga, 19, 303-322.

Sanders. CM. (1982). Effects of sudden vs. chronic illness death on bereavement
outcome. ngga, 18. 227-241.

Sanders. C .M. (1989). QWWMNI
W. New York: John Wiley & Sons.

Sandler. I.N.. West, S.G.. Baca, L., Pillow, D.R., Gersten, J .C., Rogosch, F.,
Virdin, L.. Beals. J.. Reynolds K. D. Kallgren. C., Tein, J. Y., Kriege, G., Cole, E., &
Ramirez, R. (1992). Linking empirically based theory and evaluation: The family

bereavement Fragrant Amedcanioumalnfﬂnmmnniﬂmholm 211. 491 -521

Sekaer, C. (1987). Toward a deﬁnition of childhood mourning. mm
oﬂﬁmhotherapx. .41. 201-219.

238
Schneider. J. (1984). 3.11:5: Lang and ﬁnial”. Maryland: University Park Press.

Schneider. J .M., McGovern, T.. Deutsch, D., & Morgan, C. (1992).
Understanding the transformative potential of grief: Construct validation of the response
to loss inventory (RTL). Unpublished manuscript.

Schneider. J .M. (1996). W. Colfax, WI: Seasons Press.

Schuchter. S. R. & Zisook. S. (1988). Widowhood: The continuing relationship
with the dead spouse. Bulimia of the. Manning: Qlinig, 52, 269-279.

Schumacher. J .D. (1984). Helping children cope with a sibling's death. In H.C.

Hansen & T.T. Frantz (Eds). W 11111111111111! (pp. 82-94). Rockville, MD:
Aspen Systems Corporation.

Schwartz- Borden, G. (1986). Grief work: Prevention and intervention. Social
Caseworklheloumalofﬁomemmm Smalﬂork 499-505.

Shapiro. E. (1994). ngﬂasaﬁamilﬂm. The Guilford Press: New York.

Shavelsom RJ- (1988151atistioameasomngfonmsﬂehaxiomlﬁoionoes2ndﬂ
(pp 588-589). Allyn and Bacon. Inc: Boston; MA.

Siegel. K.. Mesagno. F .P.. & Christ, G. (1990). A revention program for bereaved
children. Americanloumalof W. 69. 168-175.

Silverman. P. R. (1969). The widow-to-widow program. Mantal Hygigna, 58,
333-337.

Silverman. PR. (1970). The Widow as a caregiver in a program of preventive
intervention With other Widows. Mgntal Hygigng. i4, 540-547.

Silverman, P. R. (1972). Widowhood and preventive intervention. Ihe Family
Coordinator. 21. 95-102-

Silverman, PR. (1974). Anticipatory grief from the perspective of widowhood. In
B. Schoenberg (ed.). AntiQinatnnLQﬁaf (pp. 320-330). New York: Columbia University
Press.

Silverman. S.M. & Silverman. PR. (1979). Parent-child communication in

widowed families. Amenoanloumalof Emhothetapx. 3.5, 428-441.

Silverman, P. R. (1988). In search of new selves: Accommodating to Widowhood.
In L. A. Bond & B. M. Wagner (Eds). Families in Iransition: Rummy Emotion

239

Brograms that M115. Beverly Hills. CA: Sage.

Silverman. P.R. & Worden, W. (1992). Children's reactions in the early months
after the death of a parent. Ammjaanjmimal 91121111925311.1311!- 62, 93-104.

Spirito, A. Stark, L. J.. & Tyc. V. L. 91994). Stressors and coping strategies
described during hospitalization by chronically ill children. W

Rsxohologx 23. 314- 322.

Stroebe. M.S. & Stroebe. W. (1989). Who participates in bereavement research?
A review and empirical study. Omega. 29, 1-29.

Stroebe. M. S.. Stroebe, W. ,& Hansson, R..O (1988). Bereavement Research: An
historical introduction. MW, 42, 1- 18.

Vachon. M. L. S.. Lyall, W. A. L. Rogers. J.. Freedman-Letofsky, K., & Freeman,
S. J. J. (1980). A controlled study of self-help intervention for widows Ameﬁganionmal

otﬂmhiatu 132 1380-1384.

Vachon. M. L. S. & Stylianos. S. K. (1988). The role of social support in
bereavement. WW, 4:1, 175-190.

Van Eerdewegh. M.M., Bieri, M.D., Parrilla, R.H., & Clayton, P.J. (1982). The
bereaved child. Britishloumaloﬂﬂsxohiany 149. 23-29.

Walsh, F. & McGoldrick, M. (1991). W. New York: Norton.

Wass. H. & Stillion. J. M. (1988). Death in the lives of children and adolescents.

In H. Wass. F. M. Berardo, & RA. Ne1meyer (Eds) W.
Philadelphia. Hemisphere Publishing Corporation.

Weeks. D & Johnson, C. (1992). A second decade of high school death education.
Ileathimdies. 16. 269-279.

West. S. G. Sandler,1., Pillow. D. R.. Baca L., & Gersten, J. C. (1991). The use of
structural equation modeling 1n generative research: Toward the design of a preventive

intervention for bereaved children. MW, 12, 459-
480.

Windholz, M. J.. Marmar, C. R., & Horowitz, M. J. ,.(1985) A review of the
research on conjugal bereavement: Impact on health and efﬁcacy of 1ntervention.

Wm 26 433-447

240

Wineﬁeld, H. R. Wineﬁeld. A. H. & Tiggemann. M. (1994). Multidimensional

support scale. In J. Fischer & K. Corcoran (Eds) WA
Sam-gem (2nd ed. ). New York: The Free Press.

Wittrock, D. A. Larson. L. S., & Sandgren, A. K. (1994). When a child is
diagnosed with cancer. 11. Parental coping, psychological adjustment, and relationships

with medical Personnel loumaloﬂﬂmhosooialﬂnoologx 12 17- 32

Worden. JW. (1982). WWW
Mentalﬂealthﬁtaotiﬁonet. New York: Springer

Worden. J .W. (1996). Childmnandﬂﬁgﬂ New York: The Guilford Press.

York, J.B. & Weinstein, SA. (1981). The effect of a videotape about death on
bereaved children in family therapy. Omega, 11, 355-361.

Zambelli, G.C., Clark, E.J., Barile, L., & de Jong, A. (1988). An interdisciplinary
approach to clinical intervention for childhood bereavement. W, 12, 41 -50.

Zambelli, G. C. & DeRosa. A. P. (1992). Bereavement support groups for school-
age children: Theory, intervention. and case example. Amarimlgmnalgf

Wm 62. 484-493

Zisook. S. & DeVaul, RA. (1983). Grief. unresolved grief, and depression.
Bsxohosomatios, 2.4.. 247-256.

Zisook, S.. Shuchter, S. R., & Lyons, L. W. (1987). Predictors of psychological
reactions during the early stages of widowhood. In S. Zisook (Ed. ), In; Emhiatn'c
Clinigs 91151th Amatioa. Philadelphia. W. B. Saunders Company.

HICHIGRN STQTE UNIV. LIBRRRIES
lllllllllllllllllllllIllllllllllllllllllllllllllllll
31293017804794