Adolescent adjustment before and after HIV-related parental death
Study Question: What is the impact of parental death on the adjustment of
adolescents living with a parent with HIV (PWH)?
Study Participants: The 414 adolescents in this study were children of PWH
receiving comprehensive case management services from the New York City (NYC)
Division of AIDS Services and also participating in a randomized controlled study in
which families in the intervention group received a 31-session program on family
communication.
Study Methods:
 | Adolescents were interviewed at the beginning of the study, every 3 months
for two years, and every six months until six years. They routinely completed
the Brief Symptom Inventory which measures emotional distress and the
Dealing-With-Illness Questionnaire which assesses coping style and reports on
stressful life events. Problem behaviors including smoking, unprotected sex,
contact with the criminal justice system, and school problems were also
monitored. |
 |
| During the six years about half of the PWH died. Youth were categorized as
bereaved or non-bereaved. |
|
Study Findings:
| Bereaved adolescents reported significantly higher levels of distress prior
to bereavement, with lower levels following bereavement. Their adjustment,
compared to non-bereaved youth, was different and worse only prior to parental
death. |
|
| Bereaved adolescents had significantly more emotional distress, negative life
events, and contact with the criminal justice system than non-bereaved youths;
these behaviors did not remain significantly higher after parental death. |
|
| Depressive symptoms and passive problem-solving increased soon after parental
death, as compared with non-bereaved adolescents. One year subsequent to
parental death, depression and passive problem-solving were similar to the
levels of non-bereaved peers. Only sexual risk behaviors increased following
parental death. |
|
Limitations: The youth and families were only from NYC, although the authors
note that a third of PWH in the U.S. live in NYC. However, adolescents' adjustment
in locations with fewer social services and different stressors might be different.
The families were part of an intervention trial, and the intervention might have
reduced the potential impact of bereavement.
Lessons Learned:
| Contrary to what the authors expected, the overall impact of parental death
on the bereaved adolescents was not dramatic compared to non-bereaved youth.
Youths' emotional distress declined over the year prior to their parent death.
The authors speculate that this might have been because they focused more on the
necessary tasks of caretaking or because they may have received increased
medical and social services and social support that helped to protect the
adolescent. |
|
| The study's results suggest the importance of early family intervention soon
after parental HIV diagnosis, prior to parental death, and sustained over time.
Developmentally sensitive interventions are needed that promote parenting
skills, family communication, and positive coping for both parents and young
people. |
|
Source: Rotheram-Borus MJ, Weiss R, Alber S, Lester P. Adolescent adjustment
before and after HIV-related parental death. J Consult Clin Psychol. 2005
Apr;73(2):221-8.
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