Children's Responses to Sibling Death in NICU/PICU in 3 Racial/Ethnic Groups

3 个种族/族裔群体的儿童对 NICU/PICU 中兄弟姐妹死亡的反应

• 批准号: 8074320
• 负责人: DOROTHY BROOTEN
• 金额: $ 50.75万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-29 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8074320
• 关键词: Children; Responses; Sibling; Death; NICU

DESCRIPTION (provided by applicant): Death of a sibling is a double loss for surviving siblings - loss of a playmate, confidante, friend, role model - and loss of parents whose grief leaves them with little to no emotional energy to reach out to their hurting surviving children. Approximately 2 million US children experience this each year, leaving 25% of them in need of clinical intervention and more than 50% with significant behavior problems. Many children respond to a sibling's death with anger, aggression, guilt, depression, suicidal thoughts and attempts, anxiety, poor school performance distance from parents, and confusion. Research in this area has changed from a focus on having children "get over the sibling's death" to calls for a more comprehensive approach to children's responses to sibling death within a family context. Current studies on responses of surviving siblings suffer from small and frequently biased samples, little to no minority or lower socioeconomic representation, and inclusion of newborn to adult sibling deaths in the same sample often conducted many years after the sibling's death. The purpose of this longitudinal, mixed methods study is to examine children's mental health, physical health, personal growth, and functioning from 2 to 13 months after death of a sibling in the PICU/NICU and identify factors related to these outcomes in White non-Hispanic, Black non-Hispanic, & Hispanic/Latino children. The proposed study's theoretical model posits that characteristics of the situation surrounding the death, characteristics of the surviving sibling, parent and family characteristics, and supportive resources affect surviving sibling grief. Sibling grief and supportive resources are posited to affect surviving children's mental health, physical health, personal growth, and functioning (aggressive behavior and school performance). Surviving siblings between 6 and 18 years old living with the deceased sibling's parent(s) will be included if they are in their age- appropriate grade in school + 1 year. Quantitative data will be obtained from both parents and children. Qualitative interviews with each surviving sibling will focus on the time around the deceased sibling's death, their thoughts and feelings about the death and life since the death, roles and relationships within their family since the death, and relationships/activities with friends and teachers/child care providers. Study findings will provide much needed information on factors that influence outcomes for surviving siblings. Study data will provide a much more comprehensive examination of sibling loss in the context of the family, so timely, culturally appropriate and effective interventions can be developed to promote health of both the surviving siblings and the family. PUBLIC HEALTH RELEVANCE: Approximately 2 million US children experience death of a sibling each year, leaving 1 in 4 in need of help from a health care professional and more than half of these children with significant behavior problems including anger, aggression, guilt, depression, suicidal thoughts, anxiety, and poor school performance. Unfortunately the research to guide care of these sibling survivors is outdated and weak in many areas. This study will identifying surviving siblings at risk for poor outcomes so that parents, family members and health care professionals can intervene to promote health and functioning of both the children and their families.

描述(申请人提供)：兄弟姐妹的死亡对幸存的兄弟姐妹来说是双重损失--失去玩伴、红颜知己、朋友和榜样--以及失去父母，他们的悲伤让他们几乎没有情感能量去帮助他们受伤的幸存子女。每年大约有200万美国儿童经历这种情况，其中25%的儿童需要临床干预，超过50%的儿童有严重的行为问题。许多孩子对兄弟姐妹的死亡反应是愤怒、攻击性、内疚、抑郁、自杀念头和企图、焦虑、学业成绩差、与父母的距离和困惑。这一领域的研究已从侧重于让孩子“克服兄弟姐妹的死亡”，转变为呼吁采取更全面的方法，在家庭背景下处理儿童对兄弟姐妹死亡的反应。目前关于幸存兄弟姐妹反应的研究样本少且经常有偏见，很少或没有少数群体或较低的社会经济代表性，以及将新生儿至成年兄弟姐妹的死亡纳入同一样本，通常是在兄弟姐妹死亡多年后进行的。这项纵向的混合方法研究的目的是检查PICU/NICU中兄弟姐妹死亡后2-13个月内儿童的心理健康、身体健康、个人成长和功能，并确定与这些结果相关的因素，包括非西班牙裔白人、非西班牙裔黑人和拉美裔/拉丁裔儿童。这项研究的理论模型假设，死亡周围环境的特征、幸存兄弟姐妹的特征、父母和家庭特征以及支持资源影响幸存兄弟姐妹的悲痛。兄弟姐妹的悲伤和支持资源被认为会影响幸存儿童的心理健康、身体健康、个人成长和功能(攻击性行为和学校表现)。尚存的6至18岁的兄弟姐妹与已故兄弟姐妹的父母(S)生活在一起，如果他们在学校达到适龄年级+1岁，将被包括在内。量化数据将从父母和孩子那里获得。对每个幸存兄弟姐妹的定性访谈将集中在已故兄弟姐妹去世前后的时间，他们对去世后的死亡和生活的想法和感受，死亡后他们在家庭中的角色和关系，以及与朋友和教师/儿童保育机构的关系/活动。研究结果将为影响幸存兄弟姐妹结局的因素提供亟需的信息。研究数据将在家庭背景下提供更全面的兄弟姐妹丧失情况检查，因此可以制定及时、文化上适当和有效的干预措施，以促进幸存兄弟姐妹和家庭的健康。 公共卫生相关性：每年约有200万美国儿童经历兄弟姐妹死亡，导致四分之一的儿童需要医疗保健专业人员的帮助，其中超过一半的儿童有严重的行为问题，包括愤怒、攻击性、内疚、抑郁、自杀念头、焦虑和学习成绩不佳。不幸的是，指导照顾这些兄弟姐妹幸存者的研究在许多领域都是过时和薄弱的。这项研究将确定幸存的兄弟姐妹面临不良结局的风险，以便父母、家庭成员和卫生保健专业人员能够进行干预，以促进儿童及其家庭的健康和功能。