There is a substantial literature on the burden, coping and adaptation of families whose relative has a mental disorder. One aspect of families’ adjustment about which less is known relates to loss and grief. Indeed, studies on this topic are few and typically sampled parents of adult offspring. There is a dearth of research on parents’ loss and grief in the specific context of youth mental illness. The implications of this knowledge gap are multifold. Foremost, parents’ loss and grief is rarely addressed in child and adolescent mental health services’ (CAMHS) provision of care. Parental grief is likely to be overlooked or pathologised by practitioners, which may impede the family’s treatment process. The aim of the thesis was to bridge this knowledge gap. Broadly, we intended to (a) explore parents’ loss and grief when their youth has a mental illness, (b) explore vulnerability factors for parents’ grief and (c) identify avenues through which services may support parents’ experience. Chapter 1 elaborated on the rationale for this program of research, and provided an overview to the thesis.
Chapter 2 comprised a review of the literature on family members’ loss and grief when their relative has a mental illness. It highlighted both the propensity for earlier studies to sample parents of adult offspring with major psychopathology (e.g., Schizophrenia), and the subsequent lack of research targeting youth mental health consumers’ parents. A second review was presented in Chapter 3; we considered the research on parents’ loss and grief when their youth has any chronic condition. Collectively, these reviews established the need for research on parents’ loss and grief in the context of youth mental illness.
Contextualised by the literatures discussed in Chapters 2 and 3, we conducted a series of four studies that each sampled parents of youth attending a CAMHS. The first of these (presented in Chapter 4) qualitatively explored parents’ loss and grief, and identified their support needs. Fifteen parents completed semi-structured interviews. An inductive thematic analysis indicated that parents incurred losses as a result of their youth’s condition, to which they reacted with ongoing grief. Parents’ coping strategies varied; they experienced significant caregiving difficulties and waning support. Participants offered insight into how CAMHS may support parents’ loss and grieving.
We expanded upon this qualitative research in Chapter 5. The study involved the completion of validated self-report measures by a larger parent sample (N = 103). From this data, we substantiated parents’ problematic loss cognitions, grief, prolonged grief (PG) symptoms and distress. Parents’ current grief appeared more pronounced than their grief when their youth was first diagnosed. Thirty-one per cent of parents cited elevated PG symptoms, seven of whom met criteria for diagnosable PG. Close to one-third (31%) of parents reported at least high levels of distress. There were positive correlations between parents’ problematic loss cognitions, grief, PG symptoms and distress.
Chapter 6 reported on a study that examined vulnerability factors for parents’ grief and PG symptoms. A parent sample (N = 103) completed questionnaires. Two hierarchical regressions confirmed that parents’ grief and PG symptoms were uniquely predicted by perceived social support, stigma, maladaptive coping, subjective internalised strain (SIS) and, for PG symptoms only, maintenance of dysfunctional loss cognitions.
Chapter 7 detailed the final research piece, the broad aim of which was to apply the knowledge gained from the preceding three studies. This study developed and piloted a parental loss and grief-based supportive group therapy. The 6-session program was intended to be piloted to parents of youth attending a partial hospitalisation program within the CAMHS. However, the clinical status of potential families resulted in the pilot being implemented with a grandparent couple whose 14-year-old grandson has depression, attention-deficit/hyperactivity disorder (ADHD) and learning difficulties. Whilst further research is needed, preliminary data suggested that the program may be beneficial and acceptable to parents engaged with the service.
In Chapter 8, thesis findings were discussed as a whole. Collectively, this research verified that parents incur profound losses when their youth develops psychopathology, for which they continue to grieve post-diagnosis. Parents’ loss and grief largely converges with that of adult mental health consumers’ family caregivers. Parents who perceive less support and more stigma, who adopt maladaptive coping behaviours, experience SIS and maintain unhelpful beliefs appear vulnerable to problematic grief. We inferred from these findings avenues through which services may support parents’ loss and grieving; the benefit and acceptability of a parental loss and grief-based support program was explored. The limitations of the thesis are noted, and future research directions outlined. It is concluded that parents’ loss and grief in the case of youth mental illness is an important research avenue to purse, and one that has key practice implications. Certainly, by supporting parents’ loss and grief process, clinicians are in a better position to implement positive change for the child, and their family.