Developing a Family-Focused Treatment for Prolonged Grief for Parental Suicide Bereaved Families with Children

The suicide death of a parent is a major stressor, associated with increased risk for Prolonged Grief (PG) and long-lasting psychopathology in surviving parents and children. Our Pittsburgh team conducted the first longitudinal study characterizing children bereaved by parental suicide. Results indicated substantial rates of PG and/or impairing subthreshold symptoms, as well as incident psychiatric disorders and reduced developmental competencies that persisted for at least 7 years after the death. PG in the surviving parents predicted prolonged grief, depression, and impaired functioning in their children. The profound effect of parent's grief on child outcomes also underscores the importance of parent-child interactions. A positive parent-child interaction following parental bereavement has been consistently characterized as the single most consistently supported malleable mediator of the adjustment of parentally bereaved children; Our objectives are to develop a family-focused treatment for suicide bereaved families that address PG In children and parents and address the parent-child interaction. We propose a standard-linked grant including 2 sites with leaders in the field of childhood suicide bereavement from the University of Pittsburgh (PI: Dr. Nadine Melhem; co-I: David Brent), and adult prolonged grief treatment (PGT) from Columbia University (PI: Dr. Katherine Shear). We propose to work together to develop a family-focused treatment for prolonged grief. We plan to help parents and children deal with their loss and restore the family's capacity to thrive including optimizing their ability to communicate in a sensitive and effective manner by strengthening their reflective functioning. We propose to adapt and manualize our efficacious prolonged grief treatment for use with families (F-PGT), using a multi-level intervention reviewed and informed by qualitative interviews with child grief researchers (n=5) to obtain and incorporate their feedback in treatment development. F-PGT will include sessions for children alone, parents alone, and sessions with both parents and children. It will include loss-focused, restoration-focused, and reflective functioning components. We will also conduct qualitative interviews with stakeholders (parents, children, and grief therapists). We will conduct interviews with children (n=5) and parents (n=5), separately, and inquire about their experiences, struggles, beliefs, and perceived needs to get through parental suicide. For grief therapists, we will recruit child and adult grief therapists with experience working with suicide bereaved families (n=5) and conduct a focus group to discuss their experiences working with families bereaved by suicide and their needs. We will use this information in adapting F-PGT. We will also complete a pilot study of F-PGT to determine the feasibility of delivery of this therapy and its acceptability to suicide bereaved families with a parent and/or child with PG, and to provide preliminary evidence of potential efficacy. We will randomize 30 families (children, aged 8-12 years, and their parents) to either F-PGT or Wait-list. Wait-list participants will be offered open treatment after the study is completed. Primary outcomes will include clinical global improvement (CGI) scores, parent and child PG symptoms, and the feasibility and acceptability of the treatment. Our secondary outcomes include child and parent's functioning, as well as self-reported and observational measures of the parent-child interaction. A family-focused treatment for suicide bereaved families with PG would be a major step forward in both survivor interventions and in suicide prevention.