Further Reading for Health Professionals - Parents’ Relationships

1. Albuquerque, S., Pereira, M., & Narciso, I. (2016). Couple’s Relationship After the Death of a Child: A Systematic Review. Journal of Child & Family Studies, 25(1), 30. doi:10.1007/s10826-015-0219-2

When a child dies, the parents must address the changes in their relationship as well as the way that these changes affect their individual adjustment. These two perspectives are addressed in this systematic review. Five databases were systematically searched for papers published in English between January 2000 and February 2014. Of the 646 publications, 24 papers met the inclusion criteria. The results suggest that a child’s death can cause cohesive as well as detrimental effects on a couple’s relationship. Variables that may produce differential outcomes for the marital relationship include situational factors, such as the cause and type of death and the child’s age at the time of death; dyad-level factors, such as surviving children, the pre-death characteristics of the relationship, communication and incongruent grieving; and individual-level factors, such as the family of origin’s processing of trauma, social support, religious affiliation and finding meaning. Aspects such as marital quality and the couple’s interdependence were found to influence each parent’s individual adjustment. Larger, prospective, ethically conducted studies should be implemented to consolidate these findings. Mental health professionals may benefit from a deeper understanding of the risk and protective factors regarding marital adjustment after a child’s death.

2. Joronen, K., Kaunonen, M., & Aho, A. L. (2015). Parental Relationship Satisfaction after the Death of a Child. Scandinavian Journal of Caring Sciences. doi: 10.1111/scs.12270

Nursing Science, School of Health Sciences, University of Tampere, Tampere, Finland

This study describes Finnish parents’ (n = 461) parental relationship satisfaction and examines factors associated with relationship satisfaction after the death of a child in the family. This reported study is part of a broader investigation concerning parents’ experiences after the death of a child. Most respondents were very (36%) or quite satisfied (49%) with their current relationship. Lower relationship satisfactio scores were reported by older respondents, people with poorer subjective health and people who had other living children. Causes of death other than stillbirth, need for marriage counselling and moderate or poor marital relationship of the respondents’ own parents in childhood were also related to lower relationship satisfaction.

3. Bolton, J. M., Au, W., Walld, R., Chateau, D., Martens, P. J., Leslie, W. D., ... & Sareen, J. (2014). Parental bereavement after the death of an offspring in a motor vehicle collision: a population-based study. American journal of epidemiology, 179(2), 177-185.

4. Salakari, A., Kaunonen, M., & Aho, A. L. (2014). Negative Changes in a Couple’s Relationship After a Child’s Death. Interpersona, 8(2), 193. [full text]

School of Health Sciences, Nursing Science, University of Tampere, Tampere, Finland

The purpose of this study was to describe negative changes in parents’ relationships following the death of their child. A request to join the study was presented to members of grief associations through email and websites. Additionally, data were gathered through closed internet-groups where parents who had experienced the death of their child were logged in (e.g. in Facebook). The study participants were mothers (n = 321) and fathers (n = 36) whose child had died. The data were analysed using inductive qualitative content analysis. As negative changes in their relationship following the death of their child, parents reported the following: problems caused by failing mental health, problems due to changes in identity, increased difficulty of emotional communication, and decreased sexual intimacy. In addition, decreased sense of togetherness, behaviour that damages the relationship, everyday life straining the relationship, and emotions straining the relationship. It is concluded that a child’s death brings many kinds of negative changes to the parents’ relationship. The changes manifest as problems in the parents’ interaction, their behaviour, and their emotional life. The results can be utilized in supporting the relationships of grieving parents, developing different kinds of support interventions, and in nursing education.

5. Umphrey, L. R., & Cacciatore, J. (2014). Love and Death: Relational Metaphors Following the Death of a Child. Journal of Relationships Research, 5, e4. doi: 10.1017/jrr.2014.4 [full text]

School of Communication, Northern Arizona University, Flagstaff, Arizona, USA

Recognised as one of the most painful human experiences, the purpose of this study was to uncover the relational and metaphorical themes embodied in bereaved parent narratives following the death of a child. Using a grounded approach, 420 narratives were analysed. Results of the study found (a) relational trajectory, (b) grief/coping, and (c) communication as prominent relational themes. In the present study, bereaved parents often described their conjugal relationship metaphorically as being in motion, as a living organism, and as on a journey. Grief was primarily described metaphorically as a type of journey. Communication was metaphorically described in terms of being open or closed. Discovering the experiences of bereaved parents adds to our knowledge about how the stress of child death impacts relational resiliency. Implications are discussed.

6. Williams, E. M. (2014). Death of a child to Tay-Sachs or other progressive neurological disorders: Long-term impact on parents’ emotional and personal lives (Doctoral dissertation, Brandeis University). [full text]

7. Avelin, P., Rådestad, I., Säflund, K., Wredling, R., & Erlandsson, K. (2013). Parental Grief and Relationships after the Loss of a Stillborn Baby. Midwifery, 29(6), 668–673. doi: 10.1016/j.midw.2012.06.007

Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden

OBJECTIVES: to describe the grief of mothers and fathers and its influence on their relationships after the loss of a stillborn baby. DESIGN: a postal questionnaire at three months, one year and two years after stillbirth. SETTING: a study of mothers and fathers of babies stillborn during a one-year period in the Stockholm region of Sweden. PARTICIPANTS: 55 parents, 33 mothers and 22 fathers. FINDINGS: mothers and fathers stated that they became closer after the loss, and that the feeling deepened over the course of the following year. The parents said that they began grieving immediately as a gradual process, both as individuals, and together as a couple. During this grieving process their expectations, expressions and personal and joint needs might have threatened their relationship as a couple, in that they individually felt alone at this time of withdrawal. While some mothers and fathers had similar grieving styles, the intensity and expression of grief varied, and the effects were profound and unique for each individual. KEY CONCLUSIONS: experiences following a loss are complex, with each partner attempting to come to terms with the loss and the resultant effect on the relationship with their partner. IMPLICATIONS FOR PRACTICE: anticipating and being able to acknowledge the different aspects of grief will enable professionals to implement more effective intervention in helping couples grieve both individually and together.

8. Essakow, K. L., & Miller, M. M. (2013). Piecing Together the Shattered Heirloom: Parents’ Experiences of Relationship Resilience After the Violent Death of a Child. The American Journal of Family Therapy, 41(4), 299-310. doi:10.1080/01926187.2012.701590

The purpose of this phenomenological study is to understand eight heterosexual individual parents’ lived experiences of relationship resiliency in the midst of sudden violent death bereavement for a child. Relationship resiliency is defined as the experience of the relationship with one’s spouse as a protective factor and secure base from which to grieve and heal from trauma. Moustakas’ (1994) transcendental phenomenological approach was employed. The essence of relationship resilience was the bereaved parent’s experience of the marriage as: (1) safe, secure, and protected; (2) mutually understanding; and (3) able to reintegrate and reorganize their relationship.

9. Lyngstad, T. H. (2013). Bereavement and Divorce: Does the Death of a Child Affect Parents’ Marital Stability? Family Science, 4(1), 79-86. Doi: 10.1080/19424620.2013.821762

What effect does the death of a child have on parents’ rate of divorce? This study answers this and related research questions on parental bereavement and divorce. In addition to estimating an excess risk of divorce for bereaved parents, I test whether there are differences in the bereavement effect on divorce risk by family size, time since bereavement, and whether the couple has had another child. Detailed longitudinal data on first marriages taken from administrative registers covering the entire population of Norway and discrete-time hazard models are used to estimate effects of a child’s death on divorce risk. Results show that bereaved parents have higher divorce rates than other parents. This difference is observed across several family sizes and strengthens somewhat over time. Post-bereavement fertility does not affect the increase in divorce risk.

10. Stroebe, M., Finkenauer, C., Wijngaards-de Meij, L., Schut, H., van den Bout, J., & Stroebe, W. (2013). Partner-Oriented Self-Regulation Among Bereaved Parents The Costs of Holding in Grief for the Partner’s Sake. Psychological Science, 24(4), 395-402. doi: 10.1177/0956797612457383 [full text]

Department of Clinical Psychology, Utrecht University, Utrecht,, The Netherlands

Bereavement research has focused on individual rather than interdependent processes in coping with loss. Yet bereavement takes place in a social context, and relationship partners are likely to influence each other’s grieving process. We examined the impact of a dynamic, interpersonal phenomenon, partner-oriented self-regulation (POSR): the avoidance of talking about loss and remaining strong in the partner’s presence to protect the partner. Two hundred nineteen couples who had lost a child participated 6, 13, and 20 months after their loss. Consistent with predictions, results showed that one partner’s POSR was associated not only with an increase in his or her own grief, but also with an increase in the other partner’s grief. These relationships persisted over time: Self-reported and partner-reported POSR predicted later grief. These results are paradoxical: Although parents try to protect their partners through POSR, this effort has the opposite of the desired outcome. These findings underline the importance of further investigating interpersonal dynamics of coping with bereavement.

11. Stroebe, M., Schut, H., & Finkenauer, C. (2013). Parents Coping with the Death of their Child: From Individual to Interpersonal to Interactive Perspectives. Family Science, 4(1), 28-36. doi:10.1080/19424620.2013.819229

Department of Clinical Psychology, Utrecht University, Utrecht,, The Netherlands

Scientific research on the impact of the death of a child on parents is reviewed. A major aim is to extend coverage from individual to social – in particular interactive – perspectives. We not only illustrate how such approaches complement each other, but also how different conclusions can be reached when interactive phenomena are examined. Intrapersonal studies are first reviewed, covering grief reactions as well as the range of health consequences and risk factors, including intrapersonal coping processes. Results attest to the severe impact of this type of loss across multiple dimensions of parents’ lives. More social approaches are then reviewed. The impact of a child’s death has been shown across diverse social phenomena (which also affect individual grief and grieving), including informal and professional support patterns, effects on the couple’s relationship and on couple coping and communication. Finally, attention is focused on one social dimension in particular, namely, interactive coping processes. We describe our own initial research within this domain, on a phenomenon identified as partner-oriented self regulation (POSR; holding in grief for the partner’s sake). The paradoxical results on POSR (its negative consequences for the partner as well as self) highlight the inherent social – as well as personal – nature of grief and bereavement. Implications for future research are outlined.

12. Barr, P. (2012). Negative self-conscious emotion and grief: an actor-partner analysis in couples bereaved by stillbirth or neonatal death. Psychology and Psychotherapy, 85(3), 310–326. doi: 10.1111/j.2044-8341.2011.02034.x

Department of Neonatology, Royal Alexandra Hospital for Children, Sydney, Australia

OBJECTIVES: The purpose of the present study was to examine the intrapersonal (actor) and interpersonal (partner) relationships of personality proneness to negative self-conscious emotion (shame and guilt) to grief in couples 13 months after a perinatal death. DESIGN: A cohort study using self-report questionnaire measures of grief, shame, and guilt. METHODS: The participants were 63 Australian couples bereaved by stillbirth (N= 31) or neonatal death (N= 32). The actor and partner relationships of chronic shame (Personal Feelings Questionnaire-2), situational shame (Test of Self-Conscious Affect-2), and survivor guilt and omnipotence guilt (Interpersonal Guilt Questionnaire-67) to grief (Perinatal Grief Scale-33) were explored using the Actor-Partner Interdependence Model (APIM) method of dyadic analysis. RESULTS: The correlations between the self-conscious emotions and grief were invariably larger in men compared with women. Chronic shame had a significant actor relationship with grief in women and men and a non-significant partner relationship in both sexes. Situational shame and survivor guilt had significant actor relationships with grief in men and significant partner relationships in women. Omnipotence guilt had a significant linear actor relationship with grief in men and a significant U-shaped quadratic actor relationship in women. CONCLUSIONS: Negative self-conscious emotions had intrapersonal relationship with grief in men and both intrapersonal and interpersonal relationships with grief in women. A moderate level of omnipotence guilt was associated with lower grief in women. APIM dyadic analysis furthers understanding of the relationship between personality and parental grief following a perinatal death.

13. Dyregrov, A., & Gjestad, R. (2012). Losing a child: the impact on parental sexual activity. Bereavement Care, 31(1), 18-24. doi:10.1080/02682621.2012.654689

Center for Crisis Psychology, Norway

Few studies have been conducted into the impact on parents’ sexual activity following the death of a child. In this study, 285 bereaved parents representing 175 couples completed a questionnaire and ten couples took part in detailed face-to-face interviews. The majority of parents reported reduced frequency of sexual activity, at least initially, although most resumed sexual relations within three months. There were clear gender differences. Women were more likely than men to report reduced sexual activity and loss of sexual desire, primarily linked to feelings of guilt, sadness, depression and exhaustion. A primary reason for recommencing sexual activity was to conceive another child, which could of itself be a cause of complex and mixed feelings. The findings suggest a need for health professionals to pay more attention to these issues when offering structured follow-up to bereaved parents.

14. Rellias, B. O. (2011). Trauma of the Sudden Death of a Child: The Impact on Couple Relationship. Ph. D. Thesis, Loma Linda University. [full text]

A traumatic life event such as the death of a child can be very devastating and confusing for many couples and people tend to respond in different ways to such trauma due to different factors such as gender differences. Research studies have traditionally focused on the personal effects of trauma on individual family members, whereas less attention centered on the systemic outcomes and consequences that trauma has on family functioning especially from the couples’ perspective. Previous research has indicated that parents who lost their children to sudden death are likely to have serious mental distress and some disruption in functioning. However, there remains an important gap in the current literature regarding the causes and outcomes of interpersonal and relational issues that confront a couple dealing with such trauma. The purpose of this qualitative study is to examine the adjustments that may occur in couple relationships following the sudden death of a child. Findings from this study revealed that strategies used by participants (individually and as couples) when dealing with the sudden death of a child contributed to their relationships becoming stronger or deteriorating following the loss. These findings would be an important contribution not only to the existing literature but in conceptualizing, diagnosing, and implementing interventions with bereaved parents.

15. Hague-Dewes, C. (2006). An Investigation of Bereaved Parents: Coping Strategies and Effects on the Marital Relationship. Ph.D. Thesis, St. Mary’s University, San Antonia, TX, USA.

The present study is a qualitative phenomenological investigation of married couples that have experienced the death of a child (defined as birth to 18 years of age). Specifically, it examines coping strategies of bereaved parents and the effects of a child’s death has on the marital relationship. Limited research has been done to explore the marital relationship in the wake of a child’s death and to understand the lived experience of affect married couples. The researcher conducted in-depth interviews with 7 married couples who had lost children within the past 3 years. The interviews were recorded, transcribed, and thoroughly analyzed for thematic content according to the phenomenological approach as outlined by Lemon and Taylor and Giorgi. Eleven major themes emerged that were common to the study participants: 1) commitment to the marriage, 2) respect for individual grieving patterns, 3) faith in God or a higher power, 4) creating a memorial, 5) mutual/community impact of the child’s life/death, 6) need to parent surviving children, having subsequent children, and effects on other children within the family, 7) outside support, 8) paradoxical disconnections and expectations from others, 9) questioning, 10) guilt and blame, and 11) acceptance. This research sought to understand the needs and complications of bereaved parents, so that counselors may better assist in coping and survival in the midst of tragic adversity

16. Vance, J. C., Boyle, F. M., Najman, J. M., & Thearle, M. J. (2002). Couple Distress after Sudden Infant or Perinatal Death: A 30-month follow up. Journal of Paediatrics and Child Health, 38(4), 368–372.

Department of Paediatrics and Child Health, University of Queensland, St Lucia, Queensland, Australia

OBJECTIVE: To examine, using a 30-month prospective study, patterns of anxiety, depression and alcohol use in couples following stillbirth, neonatal death or sudden infant death syndrome. METHODOLOGY: One hundred and thirty-eight bereaved and 156 non-bereaved couples completed standardized interviews at 2, 8, 15 and 30 months post-loss. RESULTS: At all interviews, bereaved couples were significantly more likely than non-bereaved couples to have at least one distressed partner. Rarely were both partners distressed in either group. For bereaved couples, ‘mother only’ distress declined from 21% to 10% during the study. ‘Father only’ distress ranged from 7% to 15%, peaking at 30 months. Bereaved mothers who were distressed at 2 months reported significantly lower marital satisfaction at 30 months. CONCLUSIONS: At the couple level, the experience of a baby’s death is multifaceted. Gender differences are common and partners’ needs may change over time. Early recognition of these differences may facilitate longer-term adjustment for both partners.

Last reviewed: 19/5/24