How does bereavement affect child development

In Longest and Most Detailed Study of Pediatric Grief Following Parental Loss to Date, Department Researchers Find Increased Rates of Depression and Functional Impairment

The death of parent is an incredibly stressful event for a child, and one that can have profound consequences for the child’s future wellbeing. However, little is known about the specific long-term impact of parental loss because these types of studies are challenging to conduct. Pitt Department of Psychiatry researchers recently completed a seven-year prospective examination of pediatric grief following parental death, the longest and most detailed study to date. They found that the loss of a parent had an early and persistent negative impact on the academic and social functioning of the child that was in part due to the onset of depression within the first two years after the parent’s death. The results were published in the American Journal of Psychiatry.

“We found that kids who have lost a parent are more than twice as likely than nonbereaved kids to show impairments in functioning at school and at home, even 7 years later. Importantly, this finding held up even when we adjusted for risk factors such as a pre-existing psychiatric disorder in the child or parent,” said the study’s co-senior author, David Brent, MD, Endowed Chair in Suicide Studies and Professor of Psychiatry, Pediatrics, Epidemiology, and Clinical and Translational Science.

In a project that took more than a decade to complete, Dr. Brent and co-senior author Nadine Melhem, PhD, Associate Professor of Psychiatry, and colleagues examined pediatric bereavement for seven years following the sudden loss of a parent by suicide, accident, or natural death. They followed 216 children aged 7 to 17 and compared them to 172 demographically similar nonbereaved children. The children and their surviving parents were interviewed at five different time points across the seven years of the study.

The bereaved children had higher rates of depression than nonbereaved children for the first two years following the parent’s death, but not in subsequent years. Children who were less than 12 years old when their parent died were more likely to have depression than those who lost a parent in adolescence. Grieving children also had higher rates of post-traumatic stress disorder (PTSD) than nonbereaved children at all time points. 

“Subthreshold symptoms that do not meet the criteria for a psychiatric disorder can also profoundly affect a child’s quality of life, so in a first for pediatric grief studies, we also used a global scale of day-to-day academic and social functioning to better capture the true magnitude of the effects of bereavement,” said Dr. Melhem. The team found profound changes in daily functioning: children who had lost a parent showed higher rates of functional impairment than nonbereaved children across all time points of the study.

Another unique aspect of the study is that the repeated assessments of the bereaved children over a long period of time enabled the researchers to look at not just how problems unfolded, and when they occurred, but also what the some of the underlying mechanisms were.  

To examine the mechanisms responsible for the effects of bereavement on daily functioning, the researchers used a method of statistical analysis called structural equation modeling. They found that not only did pediatric bereavement have a direct effect on function, it also indirectly affected function by leading to both depression and an increased vulnerability to subsequent negative life events. In order to better understand the biological mechanisms by which parental death might increase the vulnerability of children to subsequent adversity, Dr. Melhem, in collaboration with Dr. Brent, is leading a new pediatric study that examines the impact of a parent’s cancer diagnosis and subsequent death on two key stress pathways, the hypothalamic-pituitary-adrenal (HPA) axis and inflammation.

“Findings from longitudinal studies like this one are exciting because they suggest when and how to intervene with children who have lost a parent,” wrote Kathryn Cullen, MD, of the University of Minnesota, in a commentary accompanying the article.

The current study demonstrates that the first two years after losing a parent are a high-risk period for developing depression. “Our results also show that kids who have lost a parent, especially before age 12, and are showing difficulties with daily functioning need to be evaluated and, if necessary, treated with evidence-based interventions such as the Family Bereavement Program, which teaches coping skills to the child and surviving parent. Early identification and intervention are the keys to protecting children against the effects of parental loss,” said Dr. Brent. 

The Burden of Bereavement: Early-Onset Depression and Impairment in Youths Bereaved by Sudden Parental Death in a 7-Year Prospective Study
Pham S, Porta G, Biemesser C, Walker Payne M, Iyengar S, Melhem N, Brent DA
Am J Psychiatry, 2018 175(9):887-896

Persistent Impairment: Life After Losing A Parent
Cullen K
Am J Psychiatry, 2018 175(9):820-821

Grief and Children

Grief and Children

No. 8; Updated June 2018

When a family member dies, children react differently from adults. Preschool children usually see death as temporary and reversible, a belief reinforced by cartoon characters who die and come to life again. Children between five and nine begin to think more like adults about death, yet they still believe it will never happen to them or anyone they know.

Adding to a child's shock and confusion at the death of a brother, sister, or parent is the unavailability of other family members, who may be so shaken by grief that they are not able to cope with the normal responsibility of childcare.

Parents should be aware of normal childhood responses to a death in the family, as well as signs when a child is having difficulty coping with grief. It is normal during the weeks following the death for some children to feel immediate grief or persist in the belief that the family member is still alive. However, long-term denial of the death or avoidance of grief can be emotionally unhealthy and can later lead to more severe problems.

A child who is frightened about attending a funeral should not be forced to go, but a plan to honor or remember the person in some way, such as lighting a candle, saying a prayer, making a scrapbook, reviewing photographs, or telling a story, may be helpful to your child's grief process. Children should be allowed to express feelings about their loss and grief in their own way.

Once children accept the death, they are likely to display their feelings of sadness on and off over a long period of time, especially around special times such as birthdays and holidays, but also at unexpected moments. The surviving relatives should spend as much time as possible with the child, making it clear that the child has permission to show his or her feelings openly or freely.

The person who has died was essential to the stability of the child's world, and anger is a natural reaction. The anger may be revealed in boisterous play, nightmares, irritability, or a variety of other behaviors. Often the child will show anger towards the surviving family members.

After a parent dies, many children will act younger than they are. The child may temporarily become more infantile, need attention and cuddling, make unreasonable demands for food, talk baby talk, and even start wetting their beds at night. Younger children frequently believe they are the cause of what happens around them. A young child may believe a parent, grandparent, brother, or sister died because he or she had once wished the person dead when they were angry. The child feels guilty or blames him or herself because the wish came true.

Children who are having serious problems with grief and loss may show one or more of these signs:

• an extended period of depression in which the child loses interest in daily activities and events
• inability to sleep, loss of appetite, prolonged fear of being alone
• acting much younger for an extended period
• excessively imitating the dead person
• believing they are talking to or seeing the deceased family member for an extended period of time
• repeated statements of wanting to join the dead person
• withdrawal from friends
• sharp drop in school performance or refusal to attend school

If these signs persist, professional help may be needed. A child and adolescent psychiatrist or other qualified mental health professional can help the child accept the death and assist the others in helping the child through the mourning process.

Perinatal losses: psychological aspects, specifics of mourning, forms of psychological assistance

I.V. Dobryakov , M. E. Bloch , L.M. Faerberg,
ORIGINAL RESEARCH 5 VOLUME LXIV ISSUE 3/2015

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg; Federal State Budgetary Scientific Institution "NII AGiR them. D.O.Otta, St. Petersburg; MU "Maternity Hospital No. 1 of the city of Kurgan", Kurgan.

The problem of perinatal losses is considered from the point of view of the features and dynamics of experiencing the stages of grief, the main forms of psychological assistance in a situation of perinatal loss. nine0008

Keywords: trophoblast; perinatal loss; psychological help; burning stages.

The problem of perinatal loss has received close attention in recent years both in the psychological and medical communities, but clearly formulated provisions in terms of psychological assistance and psychotherapy in our country are clearly not enough. As a rule, not psychologists, but obstetricians, gynecologists, doctors involved in ultrasound diagnostics, who do not have special training in the field of accompanying the loss, are forced to inform the woman and her relatives about the non-viability or death of the fetus [3, 5]. They use the empathy inherent in a person by nature, empathize with the grief of loss. At the same time, the doctor also has his own experiences, which can negatively affect his mental state. For some, the so-called burnout syndrome may occur. As a defense against deep feelings, some doctors may experience a kind of “emotional channel” block, which is manifested by a formal, cold, and sometimes cynical attitude towards bereaved women and their relatives. Such behavior of medical personnel is fraught with iatrogenics [2]. But the improvement of the quality of life of patients, the improvement of the quality of medical care, and the solution of the demographic problems facing society depend on the success of experiencing grief in a situation of loss. nine0008

Perinatal losses include situations of miscarriage, abortion, ectopic pregnancy, antenatal and intranatal death of the fetus, failure in in vitro fertilization, death of one of the fetuses during multiple pregnancy, death of a newborn child, in some countries and the death of an adopted infant, as well as incurable infertility . However, not only the death of a child, but also the detection of gross pathology of the fetus during an examination during pregnancy, the birth of a disabled child are perinatal losses, as parents (especially the mother) lose hope for the happiness of having a healthy child, raising him, rejoicing in his achievements and being proud them. nine0008

Perinatal loss is a psychic trauma, as it causes experiences that have a lasting effect on the human psyche. Psychic trauma as a consequence of stress is more severe than the stress itself, it can provoke self-destructive behavior. Reacting to a situation of mental trauma requires a certain amount of time. The stronger the trauma, the more time is needed to cope with it, the time during which a person grieves [1].

The situation of perinatal loss provokes the experience of grief and is a risk factor for dysfunction of the entire family system. Parents have a whole complex of physical and symbolic losses: the loss of an external object, the loss of a significant other, the loss of parenthood, the loss of the future, hope, dreams, part of themselves, existential loss. nine0008

Grief allows you to come to terms with the loss, to adapt to the new situation. Grief can be defined as a process of experiences extended over time, including many changes that are manifestations of psychological, behavioral, social and physical reactions to loss [4]. Grief is a difficult but natural feeling that needs to be experienced, and this requires a lot of strength and courage. Not its presence, namely the absence of grief, can indicate a deviation from the norm, be a sign of violations. Although people's reactions to loss are individual and everyone reacts to grief in their own way, general patterns of the dynamics of the process of mourning have been identified. There are 4 successive stages of this process, which differ in the nature of experiences and manifestations of grief. Knowing these features will help you understand that they are natural, reduce anxiety somewhat, deal constructively with surging feelings, and see the future. nine0008

Stage I - emotional shock and stupor.

II stage - melancholy and anger.

III stage - disorientation and suffering.

IV stage - reorganization and permission.

Stage I - emotional shock accompanied by stupor (stupor). The duration of this stage depends on many factors (personal characteristics, family situation, death period, etc.). It may vary, but, as a rule, does not exceed two weeks. At the same time, subjectively, time for those experiencing loss flows slowly. It is during this period that the maximum manifestations of grief are noted. When a woman learns about the fatal outcome of a pregnancy, about the forced need to have an abortion, or about the death of a child, it is difficult for her to believe in the reality of what is happening. After all, images, ideas, fantasies about a child are still fresh in my memory. With loss in late pregnancy and after childbirth, recent sensations of fetal movement are recalled. Particularly difficult experiences are experienced by a woman who is to give birth, knowing that the child has died. At this stage, in addition to the loss of a sense of time, contact with external reality may be disrupted: attention disorders, difficulties in assessing the situation and making decisions are noted. A woman may begin to feel that this is not happening to her, or that she is just having a nightmare, and awakening is possible. Often there is a feeling of a kind of blunting of emotions, accompanied by thoughts: “Strange, a terrible thing happened, but I am indifferent, I don’t feel anything . ..”, etc. This numbness is a manifestation of stupor, which is a protective reaction from experiencing an avalanche of negative emotions. When the numbness passes, the second stage of grief begins. nine0008

The main task of psychological support for those experiencing a loss at the stage of emotional shock is to help them realize and accept the reality of loss and understand its irreversibility.

Stage II - longing, searching for answers, anger. This stage can last from two weeks to three months. The transition to this stage is marked by violent external manifestations of feelings of anger, sadness and guilt that overwhelm a woman. A woman constantly thinks about the loss that has befallen her: “Why did this happen?”, “Why do I need this?”, “Why me?”. Intrusive expressions of condolences, as well as calls to "don't think about it", are annoying. They are not only useless, but also harmful, hurt, provoke conflicts. The search for the perpetrators may begin. Anger can be directed at oneself, at loved ones (spouse, other family members, friends) or at those who seem to have power and can control the situation (at doctors, medical staff, at the Lord God himself). Feeling your own guilt can be very difficult: “I must have done something wrong!” or "I did something I shouldn't have done." Self-directed anger often leads to depression. nine0008

At the stage of melancholy and anger, the task of helping is to alleviate the experience of emotional pain, to reduce and channel the manifestations of unconstructive anger.

Stage III - disorientation and suffering. This stage usually occurs between the fifth and ninth months after the loss, and may last a year or more. Its manifestations are associated with exhaustion resulting from physical and emotional trials: loss of strength, sleep disturbances, headaches, memory and attention impairment, increased fatigue, decreased activity and ability to work, avoidance of communication, despair. There comes an awareness of the reality of loss, and after it a feeling of emptiness and meaninglessness of existence. The feeling of one's own guilt, one's insolvency is aggravated ("could not conceive a healthy child", "could not save . ..", "inferior"). Often, women experiencing loss painfully recall the past, try to analyze it, look for mistakes (“If I had not gone to visit and had not caught a cold ...”, “If I had gone to the doctor in time, I would have told him about ...”), they reproach themselves for them, the feeling of guilt increases. Some are characterized by an obsessive desire to get pregnant again as soon as possible, to go for in vitro fertilization, as a rule, to forget and again go on the path to achieving their goal. However, it is preferable to endure time, allow the body to recover for a new pregnancy, and most importantly, allow the soul to find peace, since psychological comfort is an extremely important component of health. Before attempting to get pregnant, you should consult your doctor and preferably a psychologist or psychotherapist. You may need additional testing and treatment. It is desirable that the period between the death of a child and a new pregnancy be at least 2–2.5 years. Others, on the contrary, do not believe in the possibility of the next successful pregnancy, have a sharply negative attitude to conversations on this topic, and say that they never want to become pregnant again. In severe cases, it may seem to a woman that she feels the movement of the fetus, that she hears a baby crying. As a rule, she understands that these are false sensations, and there is a fear of going crazy. nine0008

At the stage of disorientation and suffering, support is effective if it helps to solve the main task: creating a new relationship with the lost child, accepting the world without him.

Stage IV - reorganization and resolution, overcoming the crisis. Occurs approximately between the eighteenth and twenty-fourth month after the loss. Strength is gradually restored. The fact of the death of a child is finally accepted, realized, but no longer occupies a central place in life. The pain of loss does not go away, but becomes tolerable, allows you to live on: return to household chores, profession. Return interest in life, the ability to rejoice, the desire to communicate. The feeling of sadness can come again, become aggravated, especially on those days when something important related to the baby was supposed to happen (the date of conception, childbirth, the anniversary of the death of the child, etc. ). Sadness can cover the holidays or at the sight of happy parents with strollers. However, this sadness is no longer felt as a sharp piercing pain. Improving the condition, returning to an active habitual way of life in some people causes fear that they have begun to forget about the disaster that happened, about the lost child, they may even feel guilty about this. However, quiet bright sadness will continue to remind you that the baby has settled in the soul forever, and life goes on. nine0008

At the final stage of reorganization and resolution, it is important to help a person find his place in the world, continue to live.

Of course, the successful course of the stages of experiencing loss depends on the state of health of the woman, the family situation, the timeliness and quality of psychological and medical assistance.

Forms of assistance for perinatal losses can be different, assistance can be provided by both specialists and close people, the most productive is a combination of various forms of assistance. nine0008

Information assistance

Lack of information gives rise to anxiety, does not allow a person to assess the situation, plan the future. Obtaining certain information about what is happening, behavioral patterns, and possible actions in a situation of losing a child help to adequately respond to grief and not later regret what was not done due to a lack of knowledge. It is necessary to provide new information in the form of a sincere conversation, and not in the form of moralizing, microlectures. Moreover, during the conversation, it is important to carefully monitor the reactions of a person experiencing the loss of a child. This will allow you to understand what resonates in the soul of the interlocutor, what he does not accept, to understand whether it is worth continuing the conversation on this topic, or whether it should be transferred to another, or even temporarily stopped. Often a person experiencing a loss needs time for the information received to be comprehended and accepted. In order for the information to help, and not exacerbate the difficult feelings associated with the loss, it should be:

• timely, that is, provided when they are ready to accept it;
• understandable, that is, provided in an accessible form in simple language, since incomprehensible medical, psychological terms frighten, irritate, cause a feeling of helplessness; • objective and truthful, since omissions, falsehood cause distrust and protest in a person experiencing loss, who intuitively feels them. Great harm can be caused by false information received from incompetent, prejudiced, mystical-minded people; nine0063
• of the optimal volume, since both the lack of information, which does not allow answering the questions that arise, and its excess, which generates new questions, can worsen the condition of those experiencing loss.

Psychological support

Psychological support is provided by close people (relatives, friends, co-workers, etc. ) and those who are nearby in a situation of grief and are ready to support a suffering person.

Often, ignorance of the stages of mourning, their duration leads to the fact that people around the grieving person provide support, pretending that nothing terrible has happened, urging the woman to stop grieving or, if it doesn’t work out, to restrain, not to show feelings. This is explained by the fact that they themselves are afraid to talk about death, they themselves do not have an intelligible answer to many questions that have become relevant. Practice shows that no matter how painful the feelings associated with the loss are, the state of the person experiencing it will recover faster and better if he allows himself to experience grief to the fullest. nine0008

Psychological support is effective if, at successive stages of experiencing loss, it solves different problems, highlighting the main ones. Unfortunately, often poorly chosen words and actions not only do not improve the state of the bereaved, but aggravate it. The following recommendations can help to avoid this: during the interaction, you should listen, honestly answer questions using a simple style of speech, do not hide your emotions, you need to say “I’m sorry”, “I wish it had ended differently”, “I don’t know what to say", "I'm sad", "I feel sorry for you", "Do you have any questions?", "We can talk about it again a little later." You should not use medical, psychological terminology, argue with parents, avoid questions, remain silent, leave, support attempts to find someone to blame. In no case should you say “It’s better this way”, “It could be worse”, “You can still have children”, “Time heals”, “It’s good that the child died while you are still not used to it.” nine0008

To support those experiencing perinatal loss, you can gently give them the following advice:

• Do not reject support and help when it is offered.
• Do not tolerate formal, intrusive, tactless expressions of sympathy "out of politeness" or because "you need to be strong. " Avoid them.
• Choose among those seeking to help a tactful, attentive, sensitive person with whom you can share your grief, trust him.
• Don't resist, allow yourself to feel pain and loss. Accept them. nine0063
• Do not be ashamed of your feelings, openly express them, allow yourself to cry.
• Take care of your appearance, physical well-being.
• Try to keep the usual daily routine, your basic lifestyle.
• Be tolerant of your loved ones, they also experience the pain of loss.
• Do something for other people. This may ease some of your pain.
• Know that the severity of emotions can subside, do not feel guilty about this before the child, do not resist it. nine0063
• Know that at times the strength of feelings, the sharpness of pain, can, for obvious or hidden reasons, become stronger. Don't be afraid of it, give yourself the opportunity to grieve.
• Take an active part in organizing and conducting mourning events, no matter how difficult and painful it is. • If you have begun to think about faith, and even more so if you are a believer, turn to a clergyman for spiritual help.
• Do not hesitate to seek professional help from a psychologist, psychotherapist, especially if you cannot cope with feelings of anger and guilt, move away from loved ones, lose interest in life. nine0063

Spiritual help

Psychological support of a person should be combined with spiritual help concerning important issues of worldview, the meaning of life. They become relevant for a person who is unsettled in everyday life by perinatal loss, which suddenly violated the usual ideas about the world around him, causing mental stress and anxiety. It is natural for a believer to seek spiritual help in a temple from a clergyman. An experienced clergyman, as a rule, finds ways to alleviate the suffering of believers experiencing perinatal loss. Not without reason, in some countries, health workers are required to take into account the religious beliefs of parents who have lost a child, and offer them the services of a clergyman. nine0008

Mourning events play an important role in providing spiritual assistance. Mourning is a form of public expression of grief in the form of rituals and rituals accepted in a given cultural society. The purpose of mourning ceremonies is to structure and complete the cycle of grief. It helps to perform rites and rituals. They provide a bewildered person experiencing a loss with a socially approved opportunity to perform certain actions together with loved ones that allow them to express grief, streamline personal and social behavior in a situation of loss, feel and realize community. Funeral ceremonies, accompanied by support and spiritual help, lead to relief of the state of a person experiencing a loss. nine0008

In most confessions, there are rites of baptism and funerals, prayers, funerals, which have a powerful spiritual impact on a person. To part with the dead, you need to say goodbye to him. To forgive means to receive forgiveness both from him and from him. In the event of a perinatal loss, the infant is forgiven for everything that causes a feeling of guilt (“they didn’t save . .. they couldn’t ...”), he is forgiven for the pain that his death brought. Holding religious events allows you to gradually receive forgiveness and forgive, after which you experience great relief. nine0008

Unfortunately, parents often do not have the opportunity to say goodbye to a dead baby, sometimes even to see him. This significantly worsens the course of the mourning process, increases its duration, since there is no pronounced phenomenon of the absence of the one who lived, and therefore there is no signal of loss, the recognition and existence of the fact of loss is difficult (“The one who, as it were, was not there yet”) . In many countries, medical workers are required to offer parents to see, hold their dead child in their arms, and say goodbye to him. At the same time, failed parents should feel sympathy and empathy for grief from the medical staff who surround them and thereby provide spiritual assistance. Doctors, midwives, nurses encourage parents to overcome the fear of the unknown, touch the child, turn to him and utter words of love and sorrow. Such events are natural and very important. Combining them with permissible religious practices enhances the effectiveness. nine0008

Psychological counseling

This type of psychological assistance is provided through specially organized by the consultant communication with the client in the course of 1-3 conversations. As a rule, each consultation does not require a mandatory continuation, that is, it must be complete. Such consultations in case of perinatal loss are necessary in cases where people experiencing it do not have obvious neuropsychiatric disorders, but the informational and spiritual assistance received, and psychological support are clearly insufficient. nine0008

The psychological counseling of loss takes into account that the manifestations of grief are individual and can vary greatly from person to person. A counseling psychologist is able to distinguish between normal forms of experiencing perinatal loss (uncomplicated grief) and pathological (complicated grief), can differentiate, taking into account individual characteristics, to build his work.

Signs of uncomplicated grief are:

1. The presence of dynamics in the state of the bereaved, which is expressed in a gradual decrease in the intensity of experiences, sadness. nine0063
2. The ability to periodically switch to topics not related to loss, to show interest in everyday life.
3. Return within the first 6 months after perinatal loss of the ability to experience occasional positive emotions.

The psychologist, without grossly interfering during the natural process of mourning and not seeking to interrupt it, reveals and actualizes the personal resources of the grieving person, contributing to the dynamics of uncomplicated mourning.

Psychological counseling available for perinatal loss:

• a woman who has lost a child;
• of her relatives (husband, parents, children, etc.).

At the same time, a woman, as a rule, does not seek advice, is immersed in her grief and does not want help. First of all, the consultant needs to establish a trusting contact with her, or at least persuade her to listen to recommendations based on the experience of helping with perinatal losses. Relatives, as a rule, willingly take advantage of the opportunity to get a consultation with a psychologist, they are interested in how they can alleviate the condition of a woman, how to properly build relationships with her, what to talk about. nine0008

In the process of counseling, a bereaved woman receives important information that she cannot get from her close environment, with friendly support, but which is possessed by a professional psychologist. Of great importance are the recommendations of the perinatal psychologist-consultant on the organization of farewell to the deceased newborn. If it is physically possible, the woman should be given the opportunity to see the child, hold him, say goodbye to him, collect memorial materials that will subsequently confirm his existence, and all the hopes and dreams associated with this baby. nine0008

Parents are encouraged to:

• Be alone with your child. Hold, consider, shake it, without holding back emotions. Allow yourself to behave as you want: cry, stroke the child, rock him . ..
• If possible, bathe the baby, comb his hair, dress him as if he were born alive.
• Even if the child was born with developmental disabilities, deformities, violation of the skin and the mother is afraid to pick up a dead body, you can ask to cover obvious violations with a diaper or blanket or bring the child later. Otherwise, in the future, fantasies about how the child could look like may turn out to be more terrible and destructive than what they really are. nine0063
• Give the child a name. It may be the name that was supposed to be given to him during pregnancy, it may be another that seems appropriate. Having thus recognized him as a real person, it is easier to accept the reality of what he was. The name is very important for a person to preserve the memory of him. It is important, when thinking about him, talking about him with relatives and other people, to call him by name.
• Keep copies of hospital records, child records, death certificate, hospital tags, and wristbands. nine0063

In the process of experiencing their grief, parents will have to face the ambiguous question: what to do with a dead fetus? The maternity hospital may offer parents to carry out the burial process on their own, but sometimes they are deprived of such a choice. From the standpoint of psychology, even in cases of short gestation periods, a choice must be given. This is due to the fact that the psychological component of the gestational dominant in a woman is still preserved and the image-representation of the child is preserved. The image of a child, formed over many days of imaginings and fantasies, continues to exist in the mental sphere of both women and men. Therefore, the process of burial, as a traditional ritual, contributes to the gradual stage of "farewell" to the internal image of the child, which is necessary for the process of natural grief and successful adaptation. Relatives, clergymen of the corresponding denomination may be involved in the discussion of the organization of farewell, burial, cremation, all procedures related to burial and commemoration. In this case, the rules existing in the medical institution must be taken into account. It is recommended to organize a burial after the woman is discharged from the hospital, so that she can attend the funeral and say goodbye again. Violation of the process of parting with the internal image of the child can lead to phantom sensations of fetal movement, to severe and prolonged emotional experiences of loss. In the future, it can lead to the development of prolonged and severe depression. nine0008

At first glance, such recommendations aimed at preventing the complications of the process of mourning may seem inappropriate, and even blasphemous, to cause protest, but those who allowed themselves to follow them subsequently greatly appreciated everything they managed to do.

It is wrong to believe that you can not think about the disaster that happened, forget and not remember it. It is necessary to prepare for the fact that the experiences will be strong and painful for a long time to come. The pain of loss is certainly strong, but the full experience of this pain allows you to eventually find its appropriate place in the soul. An attempt to drown it out artificially, to pretend that it does not exist, will only stretch out difficult experiences in time, complicate their course. nine0008

Perinatal counseling psychologist can notice in time that grief is taking on complicated forms and motivate bereaved to receive psychotherapeutic help.

Psychotherapy

Psychotherapy is commonly referred to as a therapeutic effect on the psyche and through the psyche on the human body. In the case of perinatal loss, psychotherapy is necessary when the course of grief becomes complicated. The process takes a pathological course in the case, as Z. Freud wrote, when the “work of sorrow” is unsuccessful or not completed. The pathological course is delayed for several years, may be accompanied by the development of severe depression, psychosomatic illnesses, personality changes that violate social adaptation. nine0008

Signs of complicated grief include the absence of emotional dynamics. With complicated grief, the background of a person’s mood is constantly reduced, he constantly thinks about what happened, indulges in sorrowful thoughts, and it is difficult to return to normal life. The task of the psychotherapist is not to help the bereaved forget about grief, but to facilitate its inclusion in everyday life (integrate) in such a way that it does not replace it and does not interfere with it, that is, so that the process of mourning proceeds in a natural, uncomplicated version. nine0008

With effective psychotherapy, the experiences of grief cease to be so acute that a person who has suffered a perinatal loss successfully restores relationships with others, returns to his usual activities.

Drug therapy

The purpose of drug therapy is not to remove, but to reduce the intensity of anxiety and depressive experiences in order to be more receptive to other forms of help (informational, psychological support, spiritual, psychological counseling, psychotherapy). In addition, the experience of loss can cause an exacerbation or the emergence of a somatic disease, while many in a state of grief are not inclined to pay attention to their ailments, to consult a doctor. It is important to motivate them to seek qualified help from a specialist. nine0008

Article submitted by E.K. Ailamazyan, Federal State Budgetary Scientific Institution “NII AGiR named after A.I. D.O.Otta, St. Petersburg

Literature

1. Volkan V., Zintl E. Life after loss. The psychology of grief. Translation from English. 2nd ed.M.: Kogito-Center; 2014.
2. Dobryakov I.V. Perinatal psychology. St. Petersburg: Peter; 2010.
3. Dobryakov I.V., Kolesnikov I.A. Psychological and psychotherapeutic aspects of perinatal and neonatal losses. In the book: Reproductive Health of Society: Sat. materials of the international congress. St. Petersburg: IPTP Publishing House; 2006: 156–9.
4. Izard K. Human emotions. M.: Moscow State University; 1980.
5. Kosterina E.M. Psychological support of perinatal losses. Perinatal psychology and psychology of parenthood. 2004; 4.

The impact of divorce on the development of children

Divorce, according to psychologists, is a stressful situation that threatens the mental balance of one or both partners, and especially children. The situation of divorce in the family causes great harm to the mental health of the child, for whom there is not and cannot be a divorce from either the father or the mother. Parents cannot become strangers to him if they really do not want it. 5-7-year-old children, and especially boys, react especially painfully to divorce, while girls are especially acutely experiencing separation from their father at the age of 2 to 5 years. nine0004 According to doctors, every fifth child with neurosis experienced separation from his father in childhood.
The consequences of a parent's divorce can have a negative impact on the child's entire subsequent life. The "battle" of parents in the pre-divorce and post-divorce period leads to the fact that

• 37.7% of children have reduced academic performance,
• 19.6% suffer from discipline at home,
• 17.4% require special attention,
• 8.7% run away from home,
• 6.5% have conflicts with friends. nine0063

At the same time, some psychologists believe that sometimes divorce can be regarded as a blessing if it changes for the better the conditions for the formation of the child's personality, puts an end to the negative impact on his psyche of marital conflicts. But in most cases, the separation of parents has a traumatic effect on the child. Moreover, it is not the divorce itself that causes great psychological trauma, but the situation in the family that precedes it.

Joint research by psychologists and physicians has shown that even in infancy, a child is able to acutely experience the psychological trauma that a mother experiences during or as a result of a divorce. The result of a response to a depressive post-divorce state of the mother may even be the death of a baby. This happens because newborns are in symbiosis with their mother, remain part of her body. In an unfavorable situation in the family, the attention of the mother is concentrated on conflicts and disputes with her husband, and the child is deprived of her care. In addition, when a young mother is in a conflicting pre-divorce or difficult post-divorce situation for a long time, the breastfeeding process that is so necessary for the baby almost always stops before the deadline, since the mother usually loses milk due to nervous tension. nine0008

There are also opposite situations, when a stressed mother surrounds the child with excessive care, literally does not let him go, so that her emotional state is transmitted to him in direct contact.

But a particularly difficult situation arises when, for some reason, the mother is forced, even temporarily, to separate from the baby, to give it into the wrong hands.

Family breakup is equally difficult for preschool children. Studies by foreign psychologists have shown that for a preschool child, the divorce of parents is a breakdown of a stable family structure, habitual relationships with parents, a conflict between attachment to father and mother. Specialists studied the reactions of preschool children to the breakup of the family in the pre-divorce period, during the period of divorce, and a few months after the divorce. They were interested in changes in children's behavior in the game, their relationships with peers, emotional manifestations, the nature and degree of awareness of conflicts experienced in the family

Children 2.5-3.5 years old reacted to the breakup of the family by crying, sleep disturbance, increased fearfulness, cognitive decline, untidiness, addiction to their own things and toys. They parted with their mother with great difficulty. The game created a fictional world inhabited by hungry, aggressive animals. Negative symptoms were relieved if parents restored care and physical care for them.

Children aged 3.5-4.5 years showed increased anger, aggressiveness, experiencing a sense of loss, anxiety. Extroverts became withdrawn and silent. Some children showed a regression of play forms, they were characterized by the manifestation of a sense of guilt for the breakup of the family. nine0008

In children aged 5-6 years, increased aggression and anxiety, irritability, restlessness, and anger were also observed. Children in this age group have a fairly clear idea of ​​the changes in their lives caused by divorce. They are able to talk about their experiences, longing for their father, the desire to restore a family, the children did not show pronounced developmental delays or a decrease in self-esteem, but the most vulnerable were disturbed by sleep and appetite.

According to research data, the only child is the most vulnerable in the event of family breakdown. nine0005 Those who have brothers and sisters experience a divorce much easier: children in such situations take out aggression or anxiety on each other, which significantly reduces emotional stress and reduces the likelihood of nervous breakdowns.