In this Papers Podcast, Layla Rashid discusses her JCPP paper ‘Maternal experienced bereavement and offspring mental health in early adulthood: the role of modifiable parental factors’ (https://doi.org/10.1111/jcpp.13963). Layla is the first author of the paper.
There is an overview of the paper, methodology, key findings, and implications for practice.
Discussion points include:
- Bereavement prevalence rates and child outcomes.
- Importance of understanding the role of parental factors to target resources to mitigate the relationship between child bereavement and later psychopathology.
- Insight into the surprising findings from the study.
- The role of positive and negative parenting practices as it relates to bereavement and child and adolescent mental health.
- Implications of the results for child and adolescent mental health professionals.
- The need for further research into modifiable parental factors.
In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are The Journal of Child Psychology and Psychiatry (JCPP); The Child and Adolescent Mental Health (CAMH) journal; and JCPP Advances.
#ListenLearnLike
Subscribe to ACAMH mental health podcasts on your preferred streaming platform. Just search for ACAMH on; SoundCloud, Spotify, CastBox, Deezer, Google Podcasts, Podcastaddict, JioSaavn, Listen notes, Radio Public, and Radio.com (not available in the EU). Plus we are on Apple Podcasts visit the link or click on the icon, or scan the QR code.
Layla Rashid is a DPhil student in the Department of Experimental Psychology at the University of Oxford. Layla’s work is funded by the 1+3 ESRC Grand Union Doctoral Training Programme. Her work in the TOPIC Research Group and oRANGE lab focuses on exploring the relationship between child adversity and the impact this has on later psychopathology. Layla completed her MSc in Psychological Research at the University of Oxford and was awarded a distinction. Her thesis explored maternal experienced bereavement and early adulthood mental health, considering the role of modifiable parental factors.
Layla’s research integrates methods from social epidemiology, clinical and developmental psychology to guide and adapt treatment interventions by identifying protective factors that promote positive psychopathology among vulnerable and at-risk populations. Particularly, her DPhil is focused on developing a guided parent-led psychological intervention for refugee parents to help identify and meet the mental health needs of their young children. (Image and bio from University of Oxford).
Transcript
[00:00:10.000] Jo Carlowe: Hello, welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a Freelance Journalist with a specialism in psychology. In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are the Journal of Child Psychology and Psychiatry, commonly known as JCPP, the Child and Adolescent Mental Health, known as CAMH, and JCPP Advances.
Today, I’m interviewing DPhil student, Layla Rashid, of the Department of Experimental Psychology at the University of Oxford. Layla is the First Author of the Paper, “Maternal Experienced Bereavement and Offspring Mental Health in Early Adulthood: The Role of Modifiable Parental Factors,” recently published in the JCPP. This paper will be the focus of today’s podcast.
If you’re a fan of our Papers Podcast series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or review, and do share with friends and colleagues.
Layla, thanks for joining me, welcome. Can you start with an introduction about who you are and what you do?
[00:01:16.541] Layla Rashid: Thank you for having me. So, I’m an experimental psychology doctoral student at the University of Oxford and my work is funded by the ESRC and focuses on identifying protective factors that promote positive mental health among vulnerable and at-risk populations.
[00:01:33.263] Jo Carlowe: Thank you. So, today we are focusing on your JCPP paper. This is “Maternal Experienced Bereavement and Offspring Mental Health in Early Adulthood: The Role of Modifiable Parental Factors.” Layla, can you give us an overview of the paper? What did you look at and why?
[00:01:50.639] Layla Rashid: Of course. So, loss and bereavement are very much a part of being human and as such, are normal, if painful, life events. When it comes to child bereavement, by the age of 16-years, 78% of children are likely to have experienced the death of a close friend or family member. We also know that children from the most deprived households are five times more likely to be bereaved than those from the least deprived households. Now, in the short-term, evidence has linked bereavement during childhood with emotional, cognitive and social difficulties. There is also evidence that child bereavement is a potential risk factor for the development of psychiatric disorders in the long-term.
However, much of this research is focused on specific types of bereavement, such as losing a parent or a sibling, and so, very little is known about the impact of the wider experiences of bereavement that are very common for families, for instance, death of uncles, aunties or even friends of your parents that often play a role in your childhood. So, the aim of this study was to look at child outcomes when we consider bereavement in a more inclusive way and not just focusing on immediate family members. And this leaves us with another important question, which is, what are the possible factors that influence children’s resilience or vulnerability following bereavement? And identifying these children that are at risk of poor mental health outcomes post-bereavement and factors that might influence their outcomes, provide opportunities for early intervention.
Of course, based on previous research, we know that multiple factors can impact this trajectory, but many of those are things that we can’t control and we can’t modify, for instance, the child’s relationship to the deceased or the type of death, so whether it was an accident, a suicide or a natural death. But there are also factors that could be targets for change, particularly those that are linked to parents and their role and interactions with the child. And understanding the role of such parental factors could help us target our resources at aiming to mitigate the relationship between child bereavement and later psychopathology.
And so, in this paper, we address the following research questions. First, “Does maternal bereavement, up to the age of 11-years, predict offspring mental health outcomes at 18-years-old?” And “Is this relationship,” secondly, “moderated by aspects of parental mental health, such as parental depression, parental – maternal anxiety and aspects of parenting, including parental monitoring, positive parenting and negative parenting practices?” We hypothesised that maternal bereavement would be associated with increased risk of offspring psychological disorders in early adulthood and that such risk would be moderated by modifiable parental factors.
[00:04:31.451] Jo Carlowe: And Layla, how did you go about it? Can you tell us a little about the methodology that you used for this study?
[00:04:37.226] Layla Rashid: Of course. So, the study utilised a longitudinal cohort design, drawing on data from a large population-based sample, called the “Avon Longitudinal Study of Parents and Children,” “ALSPAC” for short. The sample included mothers who had experienced bereavement and their offspring, who were followed into early adulthood. And information on maternal bereavement, so whether the mother had lost a child, a partner or a family member and/or friend, was collected eight times, until the children were 11-years-old, through surveys. Now, information on parenting practices and parental mental health were collected either via parental report, adolescent report or an observation task where parent and child dyads were observed during an Etch-a-Sketch task.
Now, the mental health outcomes of the offspring at 18-years-old were assessed via the CIS-R. So, that’s a Clinical Interview Schedule-Revised, which is a structured diagnostic instrument that provides diagnosis and severity scores for common psychiatric symptoms and disorders. In terms of analysis, we used logistical regression models to examine the relationship between maternal bereavement, parenting practices and offspring mental health and controlled for a potential confounder, such as socioeconomic status, their prior mental health issues and other environmental factors.
Now, we also conducted a subgroup analysis of the three subgroups of bereavement. So, that’s whether the mother’s partner, the child’s siblings or the mother’s friend or relatives were bereaved, separately, to examine whether outcomes differed based on the nature of the relationship. And then, also, we assessed time of bereavement by looking at bereavement experience while the child was nil to five-years and between six and 11-years-of-age, on the outcome variable.
[00:06:22.788] Jo Carlowe: Right, sounds very comprehensive, and what key findings from the paper would you like to highlight?
[00:06:28.865] Layla Rashid: So, our findings indicated that bereavement experienced by the mother during childhood did not substantially increase children’s risk of a mental health diagnosis at 18-years-of-age, and there was also no evidence that this association was moderated by maternal mental health or parenting. However, there was a surprising finding in relation to positive parenting practices, in which non-bereaved, but not bereaved children, were more likely to show later mental health problems in the context of higher versus lower levels of positive parenting. However, this finding was not replicated in the unadjusted model or the imputed data analysis, and so, we’d say for it to be considered with caution.
[00:07:11.988] Jo Carlowe: Right. Do you want to say anything more about that, any – the fact that some of the findings were unexpected?
[00:07:17.466] Layla Rashid: Yeah, so the finding that bereaved children are not at increased risk of a mental health diagnosis at 18-years differs from a previous analysis using ALSPAC data, by Jones and Colleagues, conducted in 2013. So, they actually found children who experienced the loss of a family member at any age before 13-years had lower emotional wellbeing at age 13. Now, one potential explanation for these different results is our wider focus on bereavement experiences, which included mother-reported deaths of a partner, her child and her family and friends. And this was associated with 20,334 reported deaths by the time the children were aged 11-years-old, and that’s in contrast to 682 mother-reported deaths of child experienced bereavement of a parent or a family friend – member or friend by Jones and Colleagues in 2013.
Now, although it’s possible that a proportion of the mother-reported deaths in this study, particularly in the family or friends subgroup, may be of individuals that are not known by the child, more than half of the deaths in the family and friends category, so that’s over 10,000 deaths were described by the mother as affecting her a lot, or moderately, and so, the children may still be indirectly exposed. And so, it’s really, really important for future research to explore direct versus indirect impact of bereavement on children.
[00:08:41.468] Jo Carlowe: Thank you. You mentioned ‘positive’ and ‘negative parenting’. I want to just focus a bit more on that. What does the research suggest with regards to the role of positive and conversely, negative parenting practices, as it relates to bereavement and child and adolescent mental health?
[00:08:57.695] Layla Rashid: Positive parenting has previously been shown to be the single most effective protective factor that’s associated with adaptation in children who are bereaved and is characterised by parents’ provision of a structured and nurturing environment, including a warm, responsive relationship and consistent discipline. Now, an association between positive parenting and lower mental health problems among parentally bereaved children has been evidenced in several studies, both directly and indirectly, with positive parenting hypothesised to promote the use of effective child coping strategies, social and problem-solving skills.
Now, negative parenting practices, characterised by hostility, such as intrusive, critical or aggressive behaviours, a lack of parent-child communication and over-control, have also been widely associated with children’s mental health generally and among bereaved children specifically. Now, when you think about bereaved caregivers, they may be distressed and/or experience task overload, which may lead to less patience and more negative interactions with their children.
However, contrary to our hypothesis, we did not find a robust and/or consistent moderating effect of positive and negative parenting practices on the association between bereavement experiences and mental health outcomes in this study. Now, although previous studies have found parenting practices and mental health to be associated with child mental health outcomes, these studies have been largely cross-sectional by design, where they investigated parental bereavement only or assessed short-term mental health outcomes of bereavement. Studies that did use or assess lifetime disorder prevalence required participants to recall negative parenting practices and bereavement, which may have resulted in recall bias and shared method variance.
Now, this may account for some of the inconsistency in the findings and it’s also really important for me to note that rates of negative parenting practices were very low and rates of parental monitoring were very high in this sample, which may have influenced our ability to identify moderating effects, too.
[00:11:01.052] Jo Carlowe: Layla, is there anything else in the paper that you would like to highlight?
[00:11:05.024] Layla Rashid: Yeah. So, in our exploratory analysis, we explored whether cumulative deaths, so that’s the overall number of deaths experienced by the mother, was associated with the increased risk of poor mental health outcomes among offspring in early adulthood. And our findings suggest that although a singular death may not be associated with increased risk of mental health disorders, cumulative deaths may be, suggesting a possible dose-response relationship.
[00:11:31.639] Jo Carlowe: And what are the implications of your findings for CAMH professionals?
[00:11:36.844] Layla Rashid: So, the findings highlight that a substantial number of children are directly or indirectly bereaved, and the results from this study suggest that the majority of children bereaved, with wider experiences of bereavement, do not go on to develop clinical levels of mental health problems in early adulthood. However, our exploratory analysis do highlight that those children that experience multiple deaths may be at greater risk of poorer mental health outcomes.
[00:12:02.671] Jo Carlowe: Is there any message for CAMH professionals around the modifiable parental factors?
[00:12:09.426] Layla Rashid: So, in terms of the modifiable parental factors, we definitely need a lot more research on this. So, we need to identify which children are particularly vulnerable and how to help them, as well as further research to understand the role of positive parenting and other factors that promote good adjustment following bereavement. But we also suggest several methodological considerations for future research. So, when we’re designing bereavement research, it’s important to consider who reports bereavement, as this may cause underestimates of the extent to which children are exposed to bereavement. And future research also needs to be equipped to disaggregate direct impact versus indirect impact of bereavement on children.
And the focus of child bereavement studies so far has mostly been the loss of parents, or in a few cases, siblings and family members. Yet, multigenerational and extended household structures are super prevalent, particularly so for racial minority youth and disadvantaged or lone parenthood families, which may influence the effect of bereavement on child mental health and may not have been evidenced in this study sample, which lacked diversity.
[00:13:13.108] Jo Carlowe: Are you planning any follow-up research, or is there anything else in the pipeline that you would like to share with us?
[00:13:19.351] Layla Rashid: Since this work, I’ve actually narrowed my focus on a particular group of children and young people, that are refugees and asylum seekers, who experience really high rates of bereavement and also, other traumatic events. So, last year, we saw 108.4 million people forcibly displaced from their homes and half of the world’s refugees are children. So, children exposed to traumatic events are at a higher risk of developing psychiatric disorders and behavioural problems, but often experience many barriers in accessing mental health services. And given these challenges, there’s the growing recognitions of the need for innovative approaches to addressing the mental health needs of refugee children. So, my doctoral work, specifically, is focused on investigating how we can best support refugee and asylum seeking parents that resettle in the UK, with their children’s mental health.
[00:14:07.853] Jo Carlowe: And finally, Layla, what is your take home message for our listeners?
[00:14:11.895] Layla Rashid: So, our findings suggest that maternal bereavement does not necessarily lead to severe and enduring mental health difficulties for children generally, which may help to alleviate parental concern. In terms of research, much more needs to be done to identify which children are particularly vulnerable and how we can also best support them.
[00:14:33.155] Jo Carlowe: Brilliant. Thank you ever so much. For more details on Layla Rashid, please visit the ACAMH website, www.acamh.org, and Twitter @ACAMH. ACAMH is spelt A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.
