Psychological adjustment among bereaved parents: individual and interpersonal predictors

Bereaved parents are a highly vulnerable group. Nevertheless, considerable individual differences exist between parents who have lost their child. The aim of this thesis was to identify factors that can predict which parents will be at particularly elevated risk for problematic adjustment after the loss of their child. I focused on three types of factors: (1) characteristics of parents, the child and circumstances of the death (2) attachment styles (psychological adjustment of insecurely attached parents, both avoidant and anxious attached) and (3) interpersonal processes (i.e., the impact of the convergence or divergence of partners' coping styles on their adjustment; marital satisfaction). A longitudinal study was conducted with 219 couples, who participated at 6, 13 and 20 months post-loss. Adjustment was studied in terms of both grief and depression. Use of multilevel regression analyses enabled assessment of the impact of several predictors and facilitated analysis of factors that were either shared by parents or that were individual ones. Furthermore, the use of the Actor Partner Interdependence Model enabled assessment of both actor as well as partner effects, and permitted differentiating according to gender of the parent. Several factors were found to contribute significantly to the prediction of grief and depression symptoms. Of the objective characteristics, grief was predicted mainly by factors that were equal for both parents: child's age, cause and unexpectedness of death, and number of remaining children in the family. By contrast, depression was predicted by individual parent factors: gender, religious affiliation, and professional help-seeking. Importantly, the feeling of having had said goodbye to the child and presenting the body for viewing at home were associated with lower levels of parents' grief. Results of the study on the relation between avoidant attachment and psychological adjustment of were contrary to previous research, and challenge the notion that this group is resilient. In the interpersonal context, results indicated that for men, having a female partner high in restoration-oriented coping was related to positive adjustment. Conclusions: A broad range of factors have been found to predict individual differences within the psychological adjustment processes of bereaved parents. Among these predictors were characteristics of the child, circumstances of the death, and insecure attachment styles of the parents. A clear distinction appeared in predicting depression and grief: Grief was mainly predicted by bereavement related factors, while depression was only predicted by individual factors of the parent. The main findings of these studies are published in five journal articles

Predicting the Effectiveness of Work-focused Treatment of Common Mental Disorders: The Influence of Baseline Self-efficacy, Depression and Anxiety

Purpose This study examined who benefits most from a cognitive behavioural therapy (CBT)-based intervention that aims to enhance return to work (RTW) among employees who are absent due to common mental disorders (CMDs) (e.g., depression, anxiety, or adjustment disorder). We researched the influence of baseline work-related self-efficacy and mental health (depressive complaints and anxiety) on treatment outcomes of two psychotherapeutic interventions. Methods Using a quasi-experimental design, 12-month follow-up data of 168 employees were collected. Participants either received work-focused cognitive behavioural therapy (W-CBT) that integrated work aspects early into the treatment (n = 89) or regular cognitive behavioural therapy (R-CBT) without a focus on work (n = 79). Results Compared with R-CBT, W-CBT resulted in a faster partial RTW, irrespective of baseline self-efficacy. Among individuals with high self-efficacy, W-CBT also resulted in faster full RTW. The effectiveness of W-CBT on RTW did not depend on baseline depressive complaints or anxiety. The decline of mental health complaints did not differ between the two interventions, nor depended on baseline self-efficacy or mental health. Conclusions Considering the benefits of W-CBT for partial RTW, we recommend this intervention as a preferred method for employees with CMDs, irrespective of baseline self-efficacy, depression and anxiety. For individuals with high baseline self-efficacy, this intervention also results in higher full RTW. For those with low self-efficacy, extra exercises or components may be needed to promote full RTW

Parenting group composition does not impact program effects on children's conduct problems

Many established parenting programs for children's conduct problems are delivered in groups. Various, and at times conflicting, beliefs exist about whether families fare better in groups with parents that are more similar to them, or in groups that are more diverse. We set out to test these beliefs empirically. We integrated data from four trials of the Incredible Years parenting program in the Netherlands, including 452 families (children age 2-10 years) participating in 44 parenting groups. We used multilevel regression to test whether families benefit more (or less) when they participate in a group with parents that are more similar to them in terms of ethnic background, educational level, and children's baseline conduct problems, Attention Deficit/Hyperactivity Disorder (ADHD) symptoms, and emotional problems. In addition, we tested whether relative group position effects were stronger for some families than for others (e.g., whether especially ethnic minority families benefit from groups that are more ethnically diverse). Families with more severe conduct problems benefited more, but they did not fare better (or worse) in groups where other families were more similar to them. Regarding the other group characteristics, families' relative group position did not predict parenting program effects on children's conduct problems. Our findings held across families with different sociodemographic backgrounds and different levels of children's ADHD symptoms and emotional problems. We found no evidence that parenting group composition impacts the effectiveness of the Incredible Years parenting program for children's conduct problems

Patterns of attachment and parents' adjustment to the death of their child

The impact of adult attachment on psychological adjustment among bereaved parents and the mediating effect of relationship satisfaction were examined among a sample of 219 couples of parents. Data collection took place 6, 13, and 20 months after loss. Use of the actor partner interdependence model in multilevel regression analysis enabled exploration of both individual as well as partner attachment as predictors of grief and depression. Results indicated that the more insecurely attached parents were (on both avoidance and anxiety attachment), the higher the symptoms of grief and depression. Neither the attachment pattern of the partner nor similarity of attachment within the couple had any influence on psychological adjustment of the parent. Marital satisfaction partially mediated the association of anxious attachment with symptomatology. Contrary to previous research findings, avoidant attachment was associated with high grief intensity. These findings challenge the notion that the avoidantly attached are resilient

Neuroticism and attachment insecurity as predictors of bereavement outcome

Adult attachment dimensions as well as the personality trait neuroticism have been shown to be related to psychological adjustment after bereavement. No investigations so far have studied the relative contribution of these constructs to grief and depression. In our study of 219 bereaved parents, the two adult attachment dimensions, attachment anxiety and attachment avoidance, were compared to the personality trait neuroticism in predicting psychological adjustment. The attachment dimensions explained a unique part over and above neuroticism, but contrary to expectations, neuroticism explained more variance than attachment dimensions. Implications are discussed

Parenting group composition does not impact program effects on children's conduct problems

Many established parenting programs for children's conduct problems are delivered in groups. Various, and at times conflicting, beliefs exist about whether families fare better in groups with parents that are more similar to them, or in groups that are more diverse. We set out to test these beliefs empirically. We integrated data from four trials of the Incredible Years parenting program in the Netherlands, including 452 families (children age 2-10 years) participating in 44 parenting groups. We used multilevel regression to test whether families benefit more (or less) when they participate in a group with parents that are more similar to them in terms of ethnic background, educational level, and children's baseline conduct problems, Attention Deficit/Hyperactivity Disorder (ADHD) symptoms, and emotional problems. In addition, we tested whether relative group position effects were stronger for some families than for others (e.g., whether especially ethnic minority families benefit from groups that are more ethnically diverse). Families with more severe conduct problems benefited more, but they did not fare better (or worse) in groups where other families were more similar to them. Regarding the other group characteristics, families' relative group position did not predict parenting program effects on children's conduct problems. Our findings held across families with different sociodemographic backgrounds and different levels of children's ADHD symptoms and emotional problems. We found no evidence that parenting group composition impacts the effectiveness of the Incredible Years parenting program for children's conduct problems