adjustment outcomes following paternal loss among adolescents

8/10/2019 adjustment outcomes following paternal loss among adolescents

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ADJUSTMENT OUTCOMES FOLLOWING PATERNAL

LOSS AMONG ADOLESCENTS

A THESIS IN

Psychology

Presented to the Faculty of the University

of Missouri-Kansas City in partial fulfillment of

the requirements for the degree

MASTER

OF

ARTS

By

ERIN M ICHELLE MCINERNEY-ERNST

B.A., University of Texas at Austin, 2003

Kansas C ity, Missouri

2008


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UMI Number: 1455678

Copyright 2008 by

Mclnerney-Ernst, Erin Michelle

All rights reserved.

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2008

ERIN MICHELLE MCINERNEY-ERNST

ALL RIGHTS RESERVED


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ADJUSTMENT OUTCOMES FOLLOWING PATERNAL LOSS

AMONG ADOLESCENTS

Erin Michelle Mclnerney-Ernst, Candidate for the Masters of Arts Degree

University of M issouri-Kansas City, 2008

ABSTRACT

Previous research regarding the effects of traumatic loss on adolescent adjustment has

produced conflicting

results.

This study compared psychological outcomes of 702

demographically matched adolescents who experienced paternal death, parental divorce,

or resided in intact families. Adolescents were evaluated on levels of depression,self-

esteem, somatic complaints, and delinquency/aggression. For bereaved adolescents,

potential predictors of gender, age, time since death and quality of maternal relationship

were evaluated. Results indicated that females, regardless of family background,

endorsed higher levels of depression and somatic complaints; males reported higher

levels of self-esteem and delinquency/aggression. Only adolescents who experienced

parental divorce had significantly higher levels of delinquency/aggression. Bereaved

females reported higher levels of depression and somatic complaints and less

delinquency/aggression. Quality of the ado lescent's relationship with their mother

predicted lower levels of all outcomes except somatic complaints. Findings from this

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study indicate that parental death does not unequivocally lead to negative psychological

adjustment for adolescents.

This abstract of

150

words is approved as to foimand content.

Tamera Murdock, Ph.D.

Professor of Psychology

College of Arts and Sciences

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The undersigned, appointed by the Dean of the College of Arts and Sc iences have

examined a thesis titled Adjustment Outcomes Following Paternal Loss among

Adolesc ents, presented by Erin Michelle Mc lnerney-Ernst, candidate for the Master of

Arts degree, hereby certify that in their opinion it is worthy of ac ceptance .

ate

7

Tamera Murdock, Ph.D. Dat

Department of Psychology

MA^v 111(2-1 (ft

Kathy Gog gin, Ph .D. Datfc '


^ ^ ^ ^ c ^ ^ 7 ^ ^ r )

H/ISL

on

Maine Sherman, Ph.D. Date



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CONTENTS

ABSTRACT ii

LIST OF TABLES vii

ACKNOWLEDGEMENTS viii

Chapter

1. INTRODUCTION 1

Depression and Anxiety 2

Self-Esteem 13

Somatic Complaints 18

Delinquency and Aggression 25

Summary and Critique 33

Current Study 35

2. METHODS 37

Participants 37

Measures 40

Analysis 43

3.

RESULTS 47

MANOVA 47

Regression 51

4. DISCUSSION 59

Depression and Anxiety 60

Self-esteem 63

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Somatic Complaints 65

Delinquency and Aggression 69

Limitations and Future Directions 71

REFERENCE LIST 75

VITA 82

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TABLES

Table Page

1.

Biological Sex 38

2.Grade in School 38

3.

Ethnicity 39

4.IQ Level 39

5.M other's Education Level 40

6. Intercorrelations between Dependent Variable Scales 44

7. Univariate Analysis of Variance for Family Type 48

8. Mean s and Standard Deviations for Delinquency/Aggression 49

9. Univariate Analysis of Variance for Gender 50

10.Me ans and Standard Deviations for Gender 51

11 .Summary for Hierarchical Regression Analysis for Variables

Predicting Depression/Anxiety levels in Paternally

Bereaved Adolescents 53

12.Summ ary for Hierarchical Regression An alysis for V ariables

Predicting Self-Esteem levels in Paternally


13.Sum mary for Hierarchical Regression A nalysis for V ariables

Predicting Somatic Com plaints in Paternally


14.Summ ary for Hierarchical Regression A nalysis for V ariables

Predicting Delinquency/Aggression in Paternally


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ACKNOWLEDGEMENTS

This work would not have been possible without the support of my committee.

Thank you to Kathy Goggin, Ph.D. and M arne Sherman,

Ph.D.

for the tim e you invested in

this project and your helpful feedback and suggestions. I would also like to extend a special

thank you to my committee chair, Tamera Murdock, Ph.D. whose enthusiasm and

encouragement throughout the project helped me continue forward.

Additionally, I would also like to thank the Grief Support Network board members

who enthusiastically accepted me into their group and whose empathy for grieving families

provided much of the inspiration for this project. I would also like to thank my parents,

Michael and Laurie M clnerney, and my family, Larry and Vicki Ernst, Becky and Jim

Jewell, and all of my friends, especially Janet Pike and Jen Van Alstyne, for providing

encouragement to me along the way. I would like to extend a final thank you to my

husband, Corey Ernst, whose support and continued encouragement has helped me achieve

the first steps to accomplishing my dream. It is to them that I dedicate this work.

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CHAPTER 1

INTRODUCTION

Approximately 3.5% of American children experience the death of a parent by the

age of

18

(H aine, Ayers, Sandler, Wolchik, & Weyer, 2003). The loss of a parent during

childhood or adolescence can be especially detrimental because it occurs during a time of

intense psychological growth and development. Parental loss is often accompanied by

substantial immediate and stressful lifestyle disruptions, such as relocation to a different

home or school, reduction in family income, changes in caregivers and loss of friends

(Lin, Sandler, Ayers, Wolchick, & Luecken, 2004). Currently, very little research has

been conducted regarding children 's psychological and behavioral adjustment following

the loss of a parent and substantially less is known about this topic as it applies to

adolescents (Kuntz, 1989).

The effects of parental loss on children 's and adolescents' mental health and

behavioral adjustment have emerged as a topic of research during the past few decades.

Outcomes on which researchers in this field have focused include internalizing

symptomology (anxiety and depression), self-esteem, somatic complaints, and

externalizing behaviors (delinquency and aggression). However, studies that consider the

mental and behavioral outcomes of children and adolescents who have experienced

parental loss have produced conflicting results. Furthermore, this body of literature is

plagued w ith methodological limitations such as small sample sizes, the use of clinical

populations, the lack of control groups, and a reliance on the surviving parent's report of

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the ch ild's or adolescent's internal and external adjustment following the loss. More

studies that address these limitations are needed to better assess the effects of parental

loss on children and adolescents. Using a nationally representative data source, this study

will compare the adjustment of adolescents who have experienced the death of their

father withtwodemographically matched control groups: adolescents living in an intact

family and adolescents who reside w ith their mother as a result of parental divorce. Four

adjustment indicators will be examined: depression/anxiety, self-esteem, somatic

complaints, and delinquency/aggression. In addition, gender differences on the four

adjustment indicators will also be examined.

Depression and Anxiety

The largest group of studies examining children and adolescents' psychological

outcomes related to parental loss focus on depressive and anxious symptoms. Some of

these studies indicate that bereaved children dem onstrate significantly more depressive

and anxious symptoms than their non-bereaved peers, according to the criteria outlined in

the Diagnostic and Statistical Manual of Mental Disorders (DSM ). For example,

Kranzler, Shaffer, Wasserman, and Davies (1990), incorporated

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Child Behavior

Checklist (CBCL; Achenbach

Eldelbrock, 1983) items into scales that reflected the

DSM -III-R (1987) diagnostic category for depressive disorder and asked children directly

about their

experiences.

The researchers then compared the scores of 26 parentally

bereaved children (ages 3-6), who had lost a parent 6 months prior, to scores from a

group of non-bereaved peers. The bereaved children reported significantly more

depressive symptomology than their non-bereaved peers.

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Through telephone interviews with

4,023

adolescents aged

12

to

17

years old, researchers

asked yes/no questions regarding DSM-IV depression symptoms, and collected other

demographic information as well. A total of36.1%of the adolescents reported the death

of a relative w ithin a year prior to the study. Results indicate that girls, mem bers of lower

income households, and African American adolescents were all more likely to report the

death of a family member. Prevalence of major depressive episodes in the past 6 m onths

was 7.4% for boys and 13.9% for girls. However, no significant relationship was found

between major depressive episodes and past year death of a family member. It is

important to note that it is possible that there may have been sub-clinical differences

between the two groups of adolescents that were not assessed due to the design of the

study.

Harris (1991) conducted a longitudinal study to examine adolescents' level of

depression at six week, seven month, and thirteen month intervals following parental

death. A total of

11

adolescents (ages

13

to 18) completed the Children's Depression

Inventory (CDI) to assess depressive symptomology. Although the adolescents

acknowledged experiencing difficulties in sleeping and concentration levels, the overall

scores on the CDI were low and mimicked those of the general population. Furthermore,

these symptoms seemed to decrease significantly after a year had passed following the

death.

In addition to dem onstrating similar levels of depression and anxiety as their non-

bereaved peers, bereaved children and adolescents have also been found to report fewer

depressive symptoms than inpatient peers diagnosed with depression. For example, in a

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study conducted by Weller, Weller, Fristad, and Bowes (1991), 38 children, aged5to 12

years old, who had experienced the death of a parent3to12weeks prior, were compared

to a group of demographically matched children hospitalized for depression. The

researchers conducted interviews with both the child and the surviving parent and used

DSM-III criteria to establish the presence or absence of psychiatric diagnoses. Results

indicated that children endorsed a greater number of depressive symptoms than their

parents reported and a depressive episode diagnosis was three times more likely when

only considering the children's reports. In both cases, parent reports of the child's

symptomology seemed to minimize the number of manifestations. However, bereaved

children reported fewer incidences of depressive symptoms than their inpatient peers.

Similarly, parental reports for both groups confirmed that bereaved children expressed

depressive symptomology less often than those children diagnosed as depressed in an

inpatient setting.

A study by Fristad, Jedel, Weller Weller (1993) also suggests that bereaved

children do not manifest clinically significant depressive symptoms. Researchers

compared 38 parentally bereaved children (ages 5-12) who had experienced parental

death

3

to

12

weeks prior, to a group of demographically matched controls and depressed

inpatients. Results indicated that scores of the bereaved children on the CDI did not differ

from their non-bereaved

controls.

Moreover, bereaved children had fewer problems

related to interest in and behavior during school, peer involvement/enjoyment andself-

esteem levels than their inpatient peers diagnosed as suffering from depression and

appeared comparable to their non-depressed peers on each of these aspects.

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Overall, research regarding depression levels of bereaved children and

adolescents has resulted in conflicting findings. A few studies found that, according to

accepted diagnostic criteria, bereaved children exhibit significantly more depressive

symptomology in comparison to their non-bereaved

peers.

Also, females manifest more

depressive symptoms than their male bereaved peers after one year following the loss,

regardless of

age.

On the other hand, some studies have failed to find significant

differences between depression levels of bereaved and non-bereaved children and

adolescents. In fact, these studies have found self-reported scores on depression

inventories to mimic those of the general population, with any differences decreasing

significantly after one year following the death. Furthermore, in addition to reporting a

similar number of depressive symptoms as their non-bereaved

peers,

bereaved children

and adolescents report fewer symptoms than inpatient peers diagnosed with depression.

Research has also examined the effects of parental death on children's level of

anxiety. Some studies have indicated that parentally bereaved children manifest a greater

number of anxious symptoms than their non-bereaved peers (Cerel, Fristad, Weller &

Weller, 1999; Kranzler et al., 1990). For example, in a study by Abdelnoor and Hollins

(2004),

researchers asked73school-age boys and girls, who had experienced parental

death, to complete the Spielberger State Trait Anxiety Scale for Children (Spielberger,

1973) and compared their scores to a group of demographically matched controls.

Parentally bereaved children scored a statistically significant three to four points higher

on this measure of state anxiety than

the

control group. Additionally, children who had

experienced parental death before the age of 5 or after 12years of age and those who

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shared the same gender as their deceased parent demonstrated lower grade level

proficiency than their older bereaved

peers.

However, the effect of these characteristics

on their level of anxiety was not assessed by the researchers.

Another study asked surviving parents of 40 parentally bereaved children aged 2

to

16

years, who had experienced parental death

3

to

12

m onths prior, to complete the

CBCL to assess the relationship between children's anxiety levels and the death of a

parent. Parental report indicated that

63%

of the bereaved children scored higher on the

internalizing scale of the CBCL, which includes the anxiety-depression scale, than the

scores obtained from the normative sample of the measure. However, there were no

significant differences between the scores of bereaved boys and g irls on

this

scale.

Teachers a lso reported that bereaved children had significantly higher internalizing

problem scores than their control group, suggesting that bereaved children demonstrated

higher levels of anxiety and depression than their non-bereaved peers (Dowdney, et al.,

1999).

One of the earliest studies on bereavement and anxiety was conducted by

Kaffman and Elizer in 1979 as a descriptive analysis of 24 children aged

1

to

10

years

that assessed their anxiety levels1 and 6 months after paternal death due to war. The

researchers found that there was a marked increase in the incidence of fears after the

death of a father. Before the death occurred, 9% of the child exhibited anxious behaviors,

as reported by the ch ild's mother. This number rose to42%of the children after the loss.

The ch ildren's fears ranged from fear of being left alone by the mother, to fear of loud

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noises, war, death and imaginary creatures. Nearly half of the preschoolers were found to

manifest anxiety most often through sleep troubles and night fears.

In contrast, many studies have found no difference in anxiety levels between

children who have experienced the death of a parent and their non-bereaved

peers.

For

instance, Sanchez, Fristad, Weller, Weller, and Moye (1994) compared anxiety

symptoms of 38 bereaved children to 38 children hospitalized for depression and

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non-

bereaved non-depressed peers. Children were asked to complete a Grief Interview

between

3

to

12

w eeks after experiencing parental death, and their answers indicated that

the average number of symptoms they endorsed was fairly low. Overall, the bereaved

group of ch ildren endorsed slightly m ore anxiety symptoms than their non-bereaved, non-

depressed

peers;

however, there was no significant difference in the endorsements.

Furthermore, bereaved children endorsed significantly fewer anxiety symptoms than their

inpatient peers who were hospitalized for depression. Interestingly, both bereaved and

depressed children endorsed significantly more anxiety symptoms than their parents

reported.

Comparisons between bereaved children of different age groups also demonstrate

no difference in anxiety and depression levels compared to non-bereaved peers. In the

initial analysis of a longitudinal study, researchers assessed depression and anxiety levels

of 40 children who had experienced the death of a parent8to 35 months prior. The

researchers of this study divided the participants into four groups based on gender and

age. They compared the children's scores on the internalizing scale of the CBCL as

reported by their parents. The children were asked to complete the Revised Children's

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Only one known study examined the differences between children and

adolescents who have lost a parent

to

death and those who have experienced parental

divorce. This comparison aids in identifying the specific effects caused by various

traumas. Anxiety and depression levels of 69 adolescents who had experienced parental

death 2 to18m onths prior were compared to those who had experienced parental divorce

during the same time period and a control group of peers from intact families.

Adolescents who had experienced parental death and divorce demonstrated higher

depression scores than their peers from intact families. However, scores for adolescents

who had experienced either type of parental loss did not differ from each other.

Furthermore, females in both the parental death and divorce groups, regardless of their

age,

experienced the highest level of depression and anxiety (Servaty & H ayslip, 2001).

A study conducted by Raveis et al. (1999) sought to identify the factors that

predict anxiety and depression w ithin a population of youth who have lost a parent.

Specifically, among

83

adolescents, ages 6 to 16 and who had experienced parental death

between

3

to

14

months prior, lower levels of depression were associated with a high

quality of comm unication w ith the surviving parent. Also, younger bereaved children

reported higher levels of state anxiety, regardless of the child 's gender. As children and

adolescents felt that their quality of communication with the surviving parent improved

over time, their level of state anxiety also decreased.

Another study also found a similar relationship between the quality of the

adolescent's relationship with their surviving parent and their depression levels. He

examined the responses of 50 participants between the ages of

12

and

19

on the Beck

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Depression Inventory(BDI).The adolescents included in this study had lost a parent 6

months to 5 years prior and results indicated that the quality of the adolescents'

relationship with their surviving parent influenced their level of depression. Adolescents

who reported having good relationships with their surviving parent prior to the death

demonstrated less depressive symptomology than peers who had also experienced

parental death but who lacked a close relationship to their surviving parent. Additionally,

when a poor relationship was combined with a sudden death of the parent, adolescents

demonstrated higher levels of depression. Adolescents who possessed personality styles

that were balanced between independent and dependent or passive and aggressive

characteristics were likely to be less depressed following the parental death than

adolescents who lack a supportive social network or those who possess

aggressive/independent or passive/dependent personality styles (Gray, 1987).

Finally, many studies fail to indicate a relationship between child and adolescent

depression and anxiety levels and age of the child or adolescent, suddenness of the death,

gender of the participant, or type of parental death: either suicide or non-suicide (Cerel et

al., 1999;

Pfeffer, Karus, Siegel, & Jiang, 2000). Additionally, adolescents who endorse

spiritual or religious beliefs manifest less depressive symptoms, than their peers who do

not hold similar beliefs (Gray, 1987). Older children typically endorse a greater number

of guilty symptoms and children experience more depressive symptoms when the mother

is the surviving parent, there was a history of depression in the family, the child had pre

existing, untreated psychiatric disorders, or when the family is considered to be of high

socioeconomic status (Weller etal.,1991). Finally, when the parental death is sudden,

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children and adolescents experience significantly more depression and a higher level of

anxiety (Saldinger, Cain, Kalter

Lohnes, 1999).

Similar to findings regarding depression, research examining differences in

anxiety levels between bereaved and non-bereaved children and adolescents also produce

conflicting results. Some studies have indicated that bereaved children exhibit a higher

number of anxious symptoms when compared to non-bereaved peers, with parental and

teacher reports often endorsing this pattern. A lternatively, other studies have indicated

that the anxiety and depression scores of bereaved children often mimic those of their

non-bereaved peers, with any differences failing to reach significance. Finally, bereaved

children have been found to endorse significantly less anxious symptoms than peers

hospitalized for depression.

Findings regarding possible influences on child and adolescent anxiety and

depression following parental death have also produced conflicting conclusions.

Investigations into the effects of both the age and gender of the child or adolescent have

produced the most notable controversy. W hile some studies have indicated differences in

anxiety levels between age groups or gender according to parental report, the same

studies have failed to demonstrate a similar pattern when examining child or adolescent

self-reported anxiety levels. Alternatively, some studies indicate that females experience

higher levels of anxiety and depression, regardless of their age or the identity of the

participant; either the adolescent or their

parent.

Furthermore, younger bereaved children

have been found to report higher levels of state anxiety, regardless of gender.

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The amount of time following the loss has also produced contradictory results in

previous research. For instance, children 's level of anxiety and depression have been

found to be stable in the initial time period following the death but increase after tw o

years following the loss, especially for pre-adolescent girls.Onthe other hand, other

studies have found that the effects of parental loss on adjustment decrease as more time

passes following the death.

Finally, studies have found that adolescents who report having a good relationship

with their surviving parent prior

to

the death manifest fewer depressive symptom s. Also,

adolescents who lack a supportive social network or possess aggressive/independent or

passive/dependent personality styles experience the highest amount of depression and

anxiety. Additionally, adolescents who endorse spiritual or religious beliefs manifest less

depressive symptoms than their peers who do not hold similar beliefs. Finally, when the

parental death is sudden, children and adolescents experience significantly more

depression and a higher level of anxiety. However, it is important to note that many of

these findings are based on the outcomes of single studies; therefore, further research on

the topic is imperative in order to confirm these conclusions.

Self-Esteem

The effects of parental death on child and adolescent self-esteem levels also

remain inconclusive. Some studies indicate that parental death negatively impacts

self-

esteem levels in bereaved children and adolescents. For example, Servaty & Hayslip

(2001) asked 317 adolescents ages

13

to

19

years, who had experienced the death of a

parent 2 m onths to

18

years prior, to complete the Interpersonal Sensitivity subscale of

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the Hopkins Symptoms Checklist (HSCL; Derogatis, Lipman, Rickels, Uhlenhuth &

Covi, 1974). This scale asked how adolescents felt about social interactions, specifically,

feelings of inadequacy and inferiority when dealing with peers. The study found that

those adolescents who experienced the death of a parent indicated a greater number of

intense feelings of inadequacy and inferiority in social interactions compared to a control

group of their peers. The researchers postulate that parental death leads to a heightened

sensitivity in bereaved adolescents and a concern that they may be perceived as different

from their peers which

may,

in

turn,

lead to further negative outcomes on their level of

self-esteem.

Similarly, Worden and Silverman (1996) found that after2years following

parental death, their sample of

125

bereaved children (ages

8

years and older) considered

themselves to perform worse socially in comparison to a control group of peers,

demonstrated significantly lower scores on the global measure of self-worth, and reported

nearly significant lower scholastic perceptions of themselves in comparison to their peers.

In contrast, other studies have failed to demonstrate a significant relationship

between self-esteem levels and the loss of a parent during childhood and adolescence. For

instance, Abdelnoor and Hollins (2004) compared73school aged girls and boys who had

lost a parent in the United Kingdom with demographically matched peers in order to

discover how parental loss affected their level of global self-esteem. Their findings

indicated no discernible difference in self-esteem levels between those children who had

experienced the death of a parent and their peers who had not experienced this type of

loss.

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Cerel et

al.

(1999) compared self-esteem levels of 26 suicide-bereaved children

(ages 5 to17years) to 332 bereaved children who had experienced parental death due to

natural causes. At 6 months following parental loss, suicide-bereaved children reported a

significantly lower overall self-esteem level than their non-suicide bereaved peers.

However, there were no differences in self-esteem scores between the two groups at 1,

13,or25months following parental death.

The lack of impact of parental death on children's and adolescents' self-esteem

levels can also be seen when comparing bereaved children to a group of inpatient peers.

The self-esteem scores of 38 parentally bereaved children (ages5 to12years), who had

experienced parental death

3

to

12

weeks prior to assessment, were compared to a group

of demographically m atched controls and depressed inpatients. Self-esteem scores for

bereaved children did not differ from their non-bereaved controls. However, bereaved

children were found to have higher self-esteem scores than inpatient peers diagnosed as

depressed. Although not significantly different, lower self-esteem was associated with

death of a father rather than the loss of a

mother.

The results of this study suggest that

children who have lost a parent do not exhibit impaired self-esteem (Fristad et al., 1993).

Self-esteem levels were found to be equal among bereaved and non-bereaved

children when assessed across multiple domains: physical ability, maternal acceptance,

cognitive ability, and peer acceptance (Kranzler et al., 1990). Responses from 26

parentally bereaved children (ages 3-6) were compared to non-bereaved peers at1and 6

month intervals following parental death. Results indicated that parental loss in childhood

did not affect the children 's level of self-esteem in any of the four domains, as was

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evident by no significant difference between the scores of bereaved and non-bereaved

children.

Finally, a study of self-esteem as a possible stress-moderator or stress-mediator on

bereaved children's and adolescent's mental health outcomes suggest a possible function

of the construct (Haine et

al.,

2003). Participants in this study were 26 children between

the ages of 8 and16years, who had experienced parental death 4 to 34 months prior to

assessment. Self-esteem was not found to be a stress-moderator of the relationship

between children 's internal and external manifestations of behavioral problems and the

stress of parental loss. In other words, self-esteem failed to reduce or increase the effects

of stress on children's mental health problems. How ever, self-esteem was found to be a

significant stress-mediator of this relationship, indicating that, according to the study

authors, self-esteem is a plausible mechanism through which stress may affect mental

health.

Studies regarding self-esteem levels of children and adolescents following

parental death are few in number and have also resulted in contradictory findings. For

instance, one study indicated that parental death negatively impacts self-esteem levels in

bereaved children and adolescents by increasing the number of intense feelings of

inadequacy and inferiority in social interactions. Another study found that the negative

effects of parental suicide on bereaved children's self-esteem levels significantly decrease

after a year has passed following the loss. On the other hand, studies have also indicated

that self-esteem scores for bereaved children mimic that of non-bereaved peers and are

higher than those from inpatient peers diagnosed w ith depression. Also, although not

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significantly different, one study found that lower self-esteem was associated with death

of a father rather than the loss of a mother.

Furthermore, one study indicated that bereaved adolescents considered

themselves to have fewer social skills than their non-bereaved peers, demonstrated

significantly lower scores on the global measure of self-worth, and reported nearly

significant lower scholastic perceptions of themselves in comparison to their peers.

However, other researchers have concluded that there are no discernable differences

of

self-esteem levels between bereaved and non-bereaved children and adolescents.

Similarly, results of another study considered four separate domains of children's

self-

esteem and failed to find any significant differences between bereaved children and their

peers on any of the individual domains.

Finally,inone study, self-esteem has not been found to reduceorincrease the

effects of stress on children's m ental health problems.

On

the other hand, the construct

was found to beasignificant stress-mediator of this relationship, indicating thatself-

esteem may be a pathway through which stress can affect the mental health of bereaved

children. Once again, many of the findings from studies regarding the relationship

between parental death and self-esteem have been indicated by single investigations and

posit conflicting results.

It

is important that more research be devoted to this topic

in

order to more accurately examine the consequences, if any, of parental death onself-

esteem levels in bereaved children and adolescents.

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Somatic Complaints

The relationship between parental death and childhood somatic complaints has

been investigated by a variety of professionals in the medical field and has been a topic of

debate for many years. One study of 26 children ages 6 to

17

years found that bereaved

children manifest more somatic complaints than their non-bereaved peers after 4 ,1 2 , and

24 months following parental loss (Silverman

Worden, 1992). However, most studies

fail to find high levels of somatic complaints in bereaved children and adolescents, with

results differing depending on the identity of the participant reporting the outcome.

Dowdney et

al.

(1999) asked the surviving parents of 40 parentally bereaved

children and adolescents aged 2 to 16 years to complete the Child Behavior Checklist

(CBCL). The children had all experienced the death of their parent between3to 12

months prior to assessment. Both the scores for the children's parents and teacher w ere

compared to a randomly selected control group of their peers who had not experienced

parental death. Parent scores indicated that

63%

of the bereaved children had more

internalizing problems than non-bereaved children, including a greater number of somatic

complaints. Responses from the teacher form of the CBCL also indicated a significant

difference between bereaved children and their non-bereaved peers on num ber of

internalizing symptoms. However, when the researchers considered only the incidence of

somatic complaints, rather than the complete internalizing scale of the measure, there was

no significant difference between the somatic scale scores of parentally bereaved children

and those scores of their

peers,

according to either report.

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Somatic complaints are infrequent in children and adolescents in the subsequent

weeks following parental death. Sood, Weller, Weller, Fristad, & Bowes (1992) focused

solely on the somatic complaints of 38 children aged

5

to

12

years, who had experienced

parental death3to8weeks priortoassessment. Somatic manifestations indicated on the

parent and child form of

The Diagnostic

Interview for

Children

and

Adolescents DICA)

(Reich, Herjanic, Welner, & Gandhy, 1982) were compared between the 38 bereaved

children, 38 age- and sex-matched depressed control children, and19age- matched

control children. Results indicated that there w as no significant difference between the

average number of symptoms between the three groups of children and that, in fact, the

overall

frequency

of these symptoms was relatively low. For those children w ho were

manifesting somatic complaints, headaches and gastrointestinal pain were the m ost

common

issues.

Further, researchers found that parents reported their children

manifesting fewer symptoms than the children themselves endorsed. Recurrent

abdominal pain (RAP) and/or headaches were reported more often in children who had

anticipated the death of a parent but age and sex of the child or gender of the surviving

parent were not found to be significantly related to either RAP or headache symptoms.

In 1996, Worden and Silverman conducted a quantitative analysis of the data

collected through the Harvard child bereavement study at three time periods after the

death of a

parent.

Results

from

he sample of

125

children (ages 8 years and older)

indicated that 4 months,1 year, and 2 years after the death of parent, there were no

significant differences in the somatic complaints scores between those children who had

experienced the death of a parent and their peers who had

not.

These results persisted

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even when considering gender differences between the two groups. N either boys nor girls

who had experienced the death of a parent were found to have a significantly higher

somatic complaints scale score on the CBCL than their peers who had not lost a parent

(Worden

Silverman, 1996). Unfortunately, the authors do not provide any information

about the ethnicity of the participants in this study; therefore it remains unclear if the

findings can be generalized to bereaved children of different cultures.

The type of parental death influences the number of somatic complaints

manifested by the child. Cerel etal.(1999) compared health outcomes of 26 suicide-

bereaved children to 332 children who had experienced death of a parent not caused by

suicide at

ime

periods of at 1, 6 ,1 3, and

25

months after the death. The researchers used

two measures that gathered information about the child's physical health that were

completed by the child's teacher and physician. At13months and25months after the

death of a parent, suicide-bereaved children had significantly fewer doctor visits than

non-suicide bereaved children. Also, at

25

months after the death of a parent, suicide-

bereaved children missed fewer days of school than their non-suicide bereaved peers, as

indicated by parent and teacher report.

Differences in children who have experienced parental death due to suicide and

more anticipated death due to physical illness are minimal. For example, Pfeffer et al.

(2000) compared scores on the Somatic complaints scale of the CBCL between 16

children who had experienced the death of a parent by suicide 1.5 years prior and their 64

peers who had experienced the death of a parent due to cancer 3-14 months prior. The

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to their peers. However, this finding was not supported for either age group of girls when

specifically considering somatic complaints. Finally, the study concluded that the gender

of the deceased parent affected the number of somatic complaints manifested by the

child, with death of a father more likely to result in a higher number of com plaints,

according to maternal report.

Children with a higher number of actual health problems 4 months after

experiencing parental death are younger in age , experience maternal death, and are more

concerned about the surviving parent's own health and safety (Silverman

Worden,

1992,1993). Lin et

al.

(2004) found that higher levels of caregiver warmth and greater

personal efficacy in coping in children were associated with less frequency of mental

health problems.

Only one known study compared adolescents who had experienced parental death

to those who had experienced parental divorce and a control group of their peers. Servaty

& H ayslip (2001) analyzed the responses of 317 adolescents ages

13

to

19

years who had

experienced the death of a parent 2 months to 18 years prior on the Somatization subscale

of the Hopkins Symptoms Checklist (HSCL; Derogatis et

al.,

1974). Results indicated

that females in the parental death or the parental divorce group scored higher on the

somatic complaints factor than both their controls and m ales in either of the loss groups.

Furthermore, a main effect for gender was found, indicating that females consistently

scored higher than m ales on the factor. Finally, a significant main effect for parental loss

was also found. While there were no significant differences between the scores of

adolescents who had experienced parental death compared to their peers who had

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Suicide-bereaved children have been found to have significantly fewer doctor

visits and missed fewer days of school than their non-suicide bereaved peers, according

to parental and teacher report in one study. However, it is important to note that these two

variables may not be accurate measures of somatic complaints, but may instead indicate

parental concern for social stigmatization of their children or adolescents following this

type of death. Other studies have indicated similar findings for number of m ental health

related appointments and hospitalizations of bereaved children over time.

Types of somatic complaints endorsed vary between studies. For instance, some

studies have indicated that only certain types of somatic complaints are significantly

different between bereaved and non-bereaved children. Also, younger and older bereaved

boys have been found to manifest a significantly higher number of somatic com plaints in

comparison to their non-bereaved peers, although this finding has not been found to apply

to females. Furthermore, the death of a father has been found, in one study, to result in a

higher number of somatic complaints, according to parental report. On the other hand,

another study indicated that after four months following parental death, younger children

and those who lost a mother exhibit the highest number of somatic com plaints and are

more concerned about the health and safety of the surviving parent.

Other factors that have been postulated to result in fewer somatic complaints

include higher levels of caregiver warmth and greater personal efficacy in bereaved

children's coping styles. Finally, females who have experienced either a parental death or

divorce manifest more somatic complaints than their non-bereaved peers or males who

had experienced either type of

loss.

In conclusion, while the majority of the studies have

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failed to indicate a relationship between parental death and somatic com plaints, it is

important to note that many of these studies have included both children and adolescent

participants from a variety of different age ranges. Due to differences in cognitive

development between children and adolescents, particularly regarding concepts

associated with death, it is likely that the significance of the relationship between parental

death and somatic complaints is minimized in existing research due to study design.

Delinquency and Aggression

Previous research has also examined a possible relationship between parental loss

and levels of delinquency and aggression in children and adolescents. Aggression is

commonly referred to as behavior that is intended to and actually harms another person

(Coie & Dodge, 1998). Delinquency, on the other hand, is conceptualized as actions that

are prohibited by law, including theft, burglary, violence, drug use, robbery, and

vandalism (Farrington, 2004). Many of these studies use the Child Behavior Checklist

(CBCL) in order to measure the number of problems that children experience that may be

indicative of under-control problems (Kalter et al., 2002). The externalizing scale of

the CBCL has been used in many different studies to examine disruptive, delinquent or

aggressive behaviors exhibited by children and adolescents. The majority of studies

indicate that parental loss leads to higher levels of delinquency and aggression in

bereaved children and adolescents.

Kranzler et

al.

(1990) used the externalizing scale of the CBCL and found that

according to parental report, bereaved children dem onstrated a significantly higher rate of

disturbance than their non-bereaved peers. Specifically, bereaved boys scored

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significantly higher on the externalizing scale than the non-bereaved control group, while

bereaved girls scored similar to their non-bereaved peers. The researchers also

incorporated 29 CBCL items into scales that reflected the DSM-III-R diagnostic category

for disruptive behavior disorders such as conduct, attention deficit, and oppositional

defiant disorders. They then compared the scores of 26 parentally bereaved children (ages

3-6), whose parent had passed away within the previous six months, with scores of their

non-bereaved

peers.

Findings indicated that bereaved boys manifested more disruptive

behavior symptoms than their non-bereaved peers. However, similar to the findings

regarding the externalizing scale scores, bereaved g irls manifested similar numbers of

disruptive behavioral symptoms to their non-bereaved peers.

Differences in ratings of delinquency and aggression levels occur depending on

the identity of the person reporting the information: the parent, teacher, or adolescents

themselves. Scores obtained from parents on the CBCL and from a total of 80

adolescents ages 9 to17,who had lost a parent between 4 to 24 months prior, on the

Youth Self-Report (YSR) version of the same measure were compared to scores from

non-bereaved peers in order to measure potential differences in adolescents' level of

externalizing behaviors. Results indicated that there were no significant differences

between the bereaved adolescents and their non-bereaved

peers,

according to

self-

reported responses regarding externalizing problems on the YSR. However, the CBCL

scores completed by the parents suggested that adolescents in the bereaved group

manifested a higher number of symptoms on the externalizing scale of the measure. Also,

according to the scores reported by the adolescents on the YSR, there was no significant

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difference between the bereaved and non-bereaved groups on clinical or borderline

clinical scores, which would indicate clinical distress. However, according to the parental

reports on the CBCL, bereaved adolescents were three times more likely to score in the

borderline clinical range on externalizing behaviors. Furthermore, there were no

interactive effects found for the YSR scores and race, sex, or

age.

On the CBCL, on the

other hand, analyses indicated that, according to parental report, girls scored significantly

higher than boys on the externalizing scale. Also, minority bereaved youth scored slightly

higher on the externalizing scale than their controls but non-minority adolescents who

were bereaved scored significantly higher than non-bereaved controls on the

externalizing score (Thompson etal., 1998).

Dowdney et

al.

(1999) compared the parent report CBCL externalizing scale

scores of 40 parentally bereaved children aged 2 to16years who lost a parent 3-12

months prior. Both scores from the children's parents and teacher were compared to a

randomly selected control group of non-bereaved

peers.

According to parental report,

58%of the bereaved children scored higher on the externalizing scale of the CBCL than

non-bereaved children. Furthermore, parents rated bereaved boys significantly more

likely to engage in delinquent and aggressive behaviors than their bereaved female peers.

Similarly, according to teacher reports of the CBCL, bereaved children had significantly

higher rates of aggressive and delinquent behavior in comparison to the control group of

non-bereaved peers.

In a more recent study, a total of 40 children who had experienced the death of a

parent

8

to 35 months prior were divided into four groups based on gender and age.

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Parental scores on the extemalization scale of the CBCL were compared to each group

and to normative scores. According to the CBCL scale scores reported by parents, older

bereaved boys experienced higher scores on the externalizing scale than both their

bereaved peers and the normative sample, indicating a higher level of delinquency and

aggressive behavior. However, according to parental report, younger boys and older g irls

who had experienced the death of a parent actually scored lower on the ex ternalizing

scale of the CBCL than their non-bereaved peers. Although this difference was not

statistically significant, the authors conclude that that parents may often report that

younger bereaved boys and older bereaved girls actually dem onstrate a slightly better

than average level of adjustment. Also, older girls' scores on the Children 's Depression

Inventory were found to be positively, though not significantly, related to externalizing

problems. (Kalter et

al.,

2002).

In the second phase of a study conducted by Silverman and Worden (1993), data

were collected on 125 bereaved children (ages 6 to

17

years) at

4

months and

1

year

intervals following parental death. Results indicated that at the 4 month period following

parental death, children demonstrated elevated scores on both the aggressive and

delinquent clinical scales of the CBCL. Also, 24% of the children and adolescents had T

scores higher than65on one or more of the broadband scales, indicating a higher level of

distress in comparison to the normative population.

During a one year follow-up to the above study, results indicated that bereaved

children demonstrated significantly higher levels of disturbance indicated by scores on

the CBCL Externalizing scale after two years following parental death. However, there

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were no significant differences in the scores at only one year following the death. When

considering the scores of pre-adolescent, adolescent

boys,

and adolescent g irls separately

on the delinquent and aggressive behavior scales, these groups of children were not

significantly different than their matched controls. However, pre-adolescent girls

demonstrated more aggressive behaviors than the normative population after two years

had passed since parental death (Worden & Silverman, 1996).

The amount of time since death may be related to the level of delinquency and

aggression manifested by children and adolescents. For example, one descriptive study,

11 children (ages

13

to 18) completed the Achenbach Youth Self-Report (YSR) at 6

weeks, 7 m onths, and

13

month time intervals following the death of a

parent.

After 6

months had passed since the death of the parent, seven adolescents reported the onset of

alcohol abuse, delinquency, and nearly failing school.Onthe other hand, the self-report

YSR scores in this study were low and reflected the scores found in a standard population

of adolescents, indicating no significant difference between the scores of bereaved

adolescents and non-bereaved peers. Furthermore, these symptoms seemed to decrease

significantly after a year following the death (Harris, 1991).

Furthermore, anticipation of the parental death often leads to higher levels of

delinquency and aggression, according to parental and teacher

report.

Saldinger et al.

(1999) examined this issue with scores on the CBCL from the parents of 41 children

(ages 6 to16years) who had experienced parental death8to 36 months prior. Scores

were compared between children who anticipated the death of a parent and those who

experienced sudden death, not including suicides. The study found that, according to the

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child's parent or teacher, higher levels of delinquency and aggression were associated

with anticipated deaths. The researchers concluded that when there is a lengthy

anticipation of the parental death, the child manifests greater delinquent and aggressive

behaviors.

However, a study by Pfeffer et al. (2000) failed to find a relationship between the

type of parental death and delinquency and aggression. Scores on the externalizing scale

of the CBCL were compared between children (ages 6 to 13) who had experienced the

death of a parent by suicide (1.5 years prior) and their peers who had experienced the

death of a parent due to cancer(3to14months prior). Results indicated that there were

no significant differences in levels of delinquency and aggression between the two groups

of children and , in fact, their scores were similartothose of the normative sam ple.

Thompson, K aslow, Price, Williams, and Kingree (1998) compared the scores of

26 adolescents ages 9 to

17

who had experienced paternal death due to homicide, 45 who

had lost either a mother or a father due to natural causes, and a group of 45 non-bereaved

peers were compared on both parental report on the CBCL and adolescent completion of

the Youth Self-Report (YSR). Results indicated that according to parental report on the

CBCL, the death of a parent to homicide was related to higher levels of externalizing

behavior. However, YSR scores were not found to be significantly different between the

control group, and the two groups involving the different types of parental loss.

Finally, Worden, Davies, & McCowen (1999) compared the scores of

125

school-

aged children who had experienced either parental or sibling death on the externalizing

scale of the CBCL at 4 months,

1

year and 2 year time periods. The study found no

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significant difference between either boys or girls who had lost a parent on their

externalizing scale score of the CBCL.

Overall, research focusing on the effects of parental death on children 's and

adolescents' levels of delinquency and aggression remains contradictory. Specifically,

differences in ratings of delinquency and aggression occur depending on the identity of

the participants reporting the behaviors: the parent, teacher, or child and adolescents

themselves. Results from a few studies indicate that, according to parental report,

bereaved boys demonstrate higher levels of delinquency and aggression than their non-

bereaved peers. Some studies indicate that bereaved girls manifest the same number of

delinquent or aggressive behaviors as their non-bereaved peers, while others suggest that

they manifest higher levels of delinquency and aggression than bereaved

boys.

One study

suggested that younger

boys

and older bereaved girls actually demonstrate lower levels of

delinquency and aggression than their non-bereaved peers. Conversely, information

gathered directly from the adolescent often suggests no differences between delinquency

and aggression levels of bereaved children and their non-bereaved peers, and no

interactive effects on the child or adolescen ts' gender, ethnicity, or age.

Other studies have suggested that the time since the parental death affects the

bereaved child or adolescent's level of delinquency and aggression. For instance, one

study found that after four m oths had passed following parental death, bereaved children

demonstrated higher levels of externalizing behavior than their non-bereaved peers,

according to parental report. The same study indicated that bereaved children

demonstrated significantly higher levels of delinquency and aggression after two years

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following the parental death. However, there were no significant differences in the scores

at only one year following the death. When considering the scores of pre-adolescent,

adolescent

boys,

and adolescent girls separately on delinquent and aggressive behavior

scales, these groups of children were not significantly different than their matched

controls. However, pre-adolescent girls demonstrated more aggressive behaviors than the

normative population aftertwoyears had past since parental death. On the other hand,

another study suggested minimal but non-significant differences between bereaved and

non-bereaved adolescents after six months following the loss.

In this

study, any increase

in delinquent or aggressive behaviors, according to self-report, decreased significantly

after a year following the death.

Finally, type of parental death has been investigated as possibly affecting the

delinquency and aggression level of bereaved children and adolescents. For instance, one

study found that, according to the ch ild's parent or teacher, higher levels of delinquency

and aggression were associated with anticipated deaths. On the other hand, another study

failed to find significant differences on delinquency and aggression levels between

children who had experienced parental suicide and those who lost a parent to cancer. In

fact, in this study, the bereaved children's scores were similar to those of non-bereaved

peers. Similarly conflicting, according to parental report, parental death due to homicide

was related to higher levels of externalizing behavior, however, this finding was not

corroborated by self-report information.

In conclusion, studies focusing on the effects of parental loss on child and

adolescent delinquency and aggression levels are limited in number and often rely on

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parental and teacher reports from the Child Behavior Checklist

(CBCL).

Although it is

important to gather information about the bereaved child or adolescent's behavior from

this perspective, it is likely that also incorporating self-reported information and using a

greater variety of instruments would increase the accuracy of research findings. Similar

to the research findings of other mental health outcomes, interpretation of the existing

literature must be done with caution due to small sample sizes and the inclusion of

participants from a wide range of

ages.

Summary and Critique

In summary, studies that focus on the internal and external reactions of children

and adolescents who have experienced parental loss are limited in number and have

produced contradictory

results.

This area of research is relatively new, beginning only in

the past few

decades,

and remains largely unexplored by the field of psychology. Also,

the current research that exists is plagued with various methodological issues.

One common limitation in the current literature involves small sample size. Of the

studies reviewed, 44.4% had a sample size of 50 or fewer participants. Understandably, it

remains difficult to recruit participants into studies that examine the effects of parental

death due to the emotionally charged nature of the topic. However, small sample sizes

remain detrimental to the ability to generalize study findings. Additionally, the inclusion

of only a small number of participants restricts the types and strengths of statistical

analyses.

Additionally, 59.2% of the reviewed studies failed to include a comparison group

in their

analysis.

Of the studies that included comparison groups, 29.6% of them lacked

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equal or nearly equal numbers of participants in each category, leading to in accurate

findings due to lack of independence between tests for main effects and interactions

(Tabachnick & Fidell, 2007). Many of the studies only examined the differences in the

mental health outcomes of bereaved children and adolescents, rather than considering

possible differences between bereaved children and their non-bereaved

peers.

A few of

the studies compared children and adolescents who have experienced parental suicide to

those who had experienced natural parental death. In fact, deaths involving both homicide

and suicide are often excluded from samples because many researchers in the field

consider these particular types of loss to be special cases that often are accompanied by

traumatic grief responses (Cerel, Fristad, W eller, & Weller, 2000; Graber, 2004; Jacobs,

Mazure, & Prigerson, 2000). In these studies, any differences found regarding the

emotional responses of these children may have been influenced by the nature of the

parental deathitself.

Furthermore, 22.2% of the reviewed studies relied solely on the surviving parent's

report of the ch ild's or adolescent's internal and external reactions to the loss. This

situation is especially detrimental, given that research has confirmed that while the parent

and teacher ratings of the ch ild's mental health are often correlated, a different outcome

emerges when the child com pletes the questionnaire themselves. Most often, there is a

substantial difference between the child's self-assessment and their parent's and teacher's

assessment of their reactions to the loss (Kalter et a l., 2002). Reliance on the surviving

parent's report may also be influenced by their own emotional reaction to the death of

their spouse.

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It is hypothesized that adolescents who have experienced the death of a father will

manifest significantly higher levels of internalizing symptomology (depression and

anxiety), somatic complaints, and externalizing behaviors (delinquency and aggression),

as well as significantly lower levels of self-esteem than their peers who have lost a father

to divorce and adolescents from intact families. A lso, it is predicted that female

adolescents will demonstrate higher depression levels and manifest a higher number of

somatic complaints. Males, on the other

hand,

are predicted to demonstrate higherself-

esteem levels and a more delinquent and aggressive behaviors than female adolescents. It

is also expected that the gender of the adolescent, the time since the death, age of the

adolescent and current relationship with the surviving m other will predict the

adolescents' mental health outcomes.

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Table 1

Biological Sex

Group Male Female

Paternal death 102 132

Divorced 104 130

Intact 102 132

Table 2

Grade in School

Group 7

m

and8

m

9

tn

and l0

m

1

r a n d 12

Paternal death 60 86 88

Divorced 66 84 84

Intact 63 88 83

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Table 3

Ethnicity

Group Caucasian African Native Asian Other Missing

Am Am

Paternal death 108 93 5 10 17 1

Divorced 112 96 4 6 16 0

Intact 109 92 4 11 18 0

Table 4

IQ Level

Group Deficits Borderline Average Above Gifted Missing

Average

Paternal death 6 36

Divorced 5 25

Intact 4 33

164 15 2 11

189 14 0 1

176 18 3 0

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Table 5

Mother s

Education Level

Group N oH .S . GED/H.S. Som eed. College Post-grad Missing

beyond H .S.

Paternal death 48 62 46 25 10 43

Divorced 39 75 73 29 18 0

Intact 49 75 61 33 16 0

Measures

Depression and Anxiety

The Feelings Scale, a self-report measurement of symptoms of depression, was

developed by researchers from the Center for Epidemiological Research (CES-D).

Evaluation of the scale resulted in high construct validity, demonstrates correlation w ith

other scales measuring distress, and has been found to be reliable across different

populations (Radloff & Locke, 1986). The instrument included a total of19items that

were measured on a four point Likert scale. Participants were asked how frequently in the

previous seven days they experienced various emotions and were given the following

response options: 0 for never or rarely, 1 for sometimes, 2 for a lot of the time, and

3 for most of the time or all of the time. Four of the items in this scale were reverse

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coded. A Cronbach alpha level of .87 suggests high internal consistency reliability of the

measure. Many of the items on this measure appeared to assess both depression and

anxiety. Therefore, for the purposes of this study, the Feelings Scale was used to indicate

both depression and anxiety levels of the participants due to continued debate in the field

of psychology regarding the conceptualization of the two em otions as independent

constructs (Graber, 2004).

Self-Esteem

This scale was constructed by averaging the scores on six items from the Add

Health dataset and dem onstrated a Cronbach alpha level of.86,suggesting high reliability

for this scale. The items included on this scale asked the participants questions regarding

their perception of feeling loved and w anted, socially accepted, and satisfaction with their

personal qualities. The content of the items are similar to other known m easures ofself-

esteem, such as the Rosenberg Self-Esteem Scale (Rosenberg, 1965). These six items

were combined to create the Self-Concept Scale used in previous research by Anderman

(2002) to measure adolescent self-esteem levels. Items were originally scored using a

five-point Likert scale where

1=strongly agree

and

5=stronglydisagree.

In order to

allow larger values on the scale to indicate higher self-esteem levels, the six items were

reverse coded.

Somatic Com plaints Scale

The measure of Somatic Complaints consisted of an average

of

14

items chosen from the Add Health General Health questionnaire, based on previous

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work by Chapman (2005), and demonstrated a Cronbach 's alpha level of

.81.

Participants were asked about the frequency of bodily reactions, such as cold sweats,

feeling physically weak, dizziness, and chest pains, during the previous 12 months that

were scored on a five-point Likert scale with 0 indicating never and 4 indicating

everyday.

Delinquency and Aggression

These constructs were based on a scale derived in previous research from an

average of15items (Cota-Robles, Neiss, & Rowe, 2002). All items were taken from the

Delinquency Scale- Audios CASI from the Add Health dataset. Eleven items were

considered to assess nonviolent problem behavior and four items were considered to be

indicative of violent

behavior.

The questions asked the participant

to

rate the frequency of

having engaged in certain activities during the previous

12

months. Questions were

scored on a four-point Likert scale with 0 indicating never and

3

indicating 5 or more

times. This measure, with the

15

items combined, demonstrated a Cronbach alpha level

of.83,indicating high reliability.

Quality of current relationship with surviving mother

This construct was measured using a single item which asked the adolescents how

close they felt to their biological mother. Responses were rated on a five-point Likert

scale ranging from

1

indicating not close at

all

to 5, extremely close .

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Analysis

The first hypothesis of this study is that adolescents who have experienced the

death of a father will manifest significantly higher levels of internalizing symptomology

(depression and anxiety), somatic complaints, and externalizing behaviors (delinquency

and aggression), as well as significantly lower levels of self-esteem than their peers who

have lost a father to divorce and adolescents from intact families. Also , females are

predicted to exhibit higher levels of depression and somatic complaints. Males, on the

other hand are expected to exhibit higher levels of self-esteem and a greater number of

delinquent and aggressive behaviors.

In order to examine potential differences between the three groups of adolescents,

the initial analysis will consist of a Multivariate Analysis of Variance (MANOVA) with

the four scales combined into a single dependent variable, adolescent adjustment.

Provided that the initial MANOVA analysis results in significant findings at the .05 level,

follow-up Univariate Analysis of Variance tests will also be examined for significant

differences between the groups of adolescents for each individual adjustment outcome:

depression/anxiety, somatic complaints, self-esteem, and delinquency/aggression. The

four dependent variables are each significantly correlated with each other, suggesting that

they are all related measures of adjustment (Table 6). However, each separate variable

will be included in the analysis due to both theoretical and logical reasoning as well as

low correlation coefficients. In order to minimize the increased risk of Type

1

error when

interpreting the results, all statistical analyses will be evaluated using a significant alpha

level of .01 (Tabachnik Fidell,

2007).

Preliminary analyses revealed adequate power

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for detecting significant differences between the groups. Based on the proposed sample

size of 702 adolescents, using an alpha level of

.05

and establishing pow er at the .80

level, a minimal effect size of

.031

is detectable through the MANOVA analysis.

Furthermore, for the ANOVA analyses, this sample size is sufficient to detect a minimal

effect size of

.161,

using an alpha level of

.01

and establishing power at the .80 level.

Table 6

Intercorrelations between Dependent Variable Scales

Variable 1 2 3 4

1. Depression/ ~^Z -.495** .504** .234**

Anxiety

2.

Self-Esteem -.272** -.222**

3.

Somatic Complaints .218**

4.Delinquency/

Aggression

** Correlation is significant atthe0.01level (2-tailed).

The second hypothesis of the study postulates that the gender of the adolescent,

the time since the death, age of the adolescent and the quality of the current relationship

with their surviving mother will predict the adolescent's mental health outcomes:

depression/anxiety, somatic complaints, self-esteem, and delinquency/aggression.

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Specifically, it is hypothesized that bereaved females will have higher levels of

depression/anxiety and somatic comp laints and lower levels of self-esteem. On the other

hand, it is hypothesized that bereaved males will demonstrate a higher level of

delinquency and aggression. As both the time since the paternal death and the age of the

adolescent increa ses, it is hypothesized that their levels of depression/anxiety, somatic

com plaints, and delinquency and aggression w ill decrease. Further, as mo re time since

the death passes and the adolescent ages, it is hypothesized that they will also manifest

higher levels of self-esteem. Finally, it is predicted that as the adolescents' perception of

the quality of their relationship with their surviving mother increases, they w ill

dem onstrate higher self-esteem levels and lower levels of depression/anxiety, somatic

complaints, and delinquency and aggression.

Four m ultiple regression analyses will be used to test this hypothesis on the g roup

of bereaved ado lescents. Due to the number of tests being performed, as stated

previously, a more conservative alpha of.01will be used to reduce the risk o f Type 1

error (Tabachnik & Fidell, 2007). Because previous research has established distinct

gender differences between adolescents on adjustment, sex of the participant will be

entered into step1in order to control for these differences. Time since death will be

entered in step 2, followed by age entered in step 3, and the quality of the current

relationship w ith mother w ill be entered into step 4. This order of entry was selected

because time since death and age are both logically and empirically co rrelated with one

another. G iven that time since death is the factor that is most conceptually related to

adjustment, it is being entered before age. Due to the conceptual overlap between time

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since death and age, the residuals of age will be entered in step

3

in order to include

variance in the construct that is not accounted for in time since the death. Finally, initial

analyses revealed that the sample size was sufficient to detect the four predictors on

bereaved adolescent's mental health outcomes. Based on the proposed sam ple size of 702

adolescents, using an alpha level of

.01

and establishing power a t the .80 level, a minimal

effect size of

.025

is detectable through the regression analyses.

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CHAPTER 3

RESULTS

Data were screened and all outliers were deleted

from

he dataset. Due to

moderate positive skew and kurtosis of the data, square root transformations were

performed on the Depression/Anxiety, Somatic Complaints, and Delinquency/Aggression

scales. However, no transformations w ere made to the Self-Esteem Scale because the

assumption of normality w as upheld for this measure.

MANOVA

First, a two-way M ANOVA was conducted to determine the effect of gender and

family type on adolescent adjustment, specifically: depression/anxiety, self-esteem,

somatic com plaints, and delinquency/aggression. Results were interpreted using Pillai's

Trace due to a significant Box Test, suggesting that the assumption of homogeneity of

variance-covariance matrices was violated (Mertler

Vannatta, 2005). MANOVA

results indicated that both family type (Pillai's Trace = .027, F(g, i386)= 2.38,p

=

.015,n

2

= .0 14 ) and gender (Pillai's Trace = .077,F

{4

,

69 2

)= 14.47,p

adjustment outcomes following paternal loss among adolescents

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