Complicated grief and associated risk factors among parents following a child's death in the pediatric intensive care unit

Objective: To investigate the extent of complicated grief symptoms and associated risk factors among parents whose child died in a pediatric intensive care unit. Design: Cross-sectional survey conducted by mail and telephone. Setting: Seven children's hospitals affiliated with the Collaborative Pediatric Critical Care Research Network from January 1, 2006, to June 30, 2008. Participants: Two hundred sixty-one parents from 872 families whose child died in a pediatric intensive care unit 6 months earlier. Main Exposure: Assessment of potential risk factors, including demographic and clinical variables, and parent psychosocial characteristics, such as attachment style, caregiving style, grief avoidance, and social support. Main Outcome Measure: Parent report of complicated grief symptoms using the Inventory of Complicated Grief. Total scale range is from 0 to 76; scores of 30 or higher suggest complicated grief. Results: Mean (SD) Inventory of Complicated Grief scores amongparents were 33.7 (14.1). Fifty-nine percent of parents (95% confidence interval, 53%-65%) had scores of 30orhigher. Variables independently associated with higher symptom scores in multivariable analysis included being the biological mother or female guardian, trauma as the cause of death, greater attachment-related anxiety and attachment-related avoidance, and greater grief avoidance. Conclusions: Parents who responded to our survey experienced a high level of complicated grief symptoms 6 months after their child's death in the pediatric intensive care unit. However, our estimate of the extent of complicated grief symptoms may be biased because of a high number of nonresponders. Better understanding of complicated grief and its risk factors among parents will allow those most vulnerable to receive professional bereavement support.