title: Follow-up study of complicated grief among parents eighteen months after a child's death in the pediatric intensive care unit.
abstract: OBJECTIVE
  We previously demonstrated that parents whose children die in a pediatric intensive care unit (PICU) have a high level of complicated grief symptoms 6 months after the death. In this study, we investigate the change in the extent of complicated grief symptoms among these parents between 6 and 18 months postdeath and identify factors predicting improvement.
  
  
  METHODS
  One hundred thirty-eight parents of 106 children completed surveys at 6 and 18 months. Surveys included the Inventory of Complicated Grief (ICG), measures of grief avoidance, attachment, caregiving and social support, and demographics. Multivariable analysis was performed using generalized estimating equations to identify characteristics independently associated with improvement in ICG score.
  
  
  RESULTS
  ICG scores were 33.4 ± 13.6 at 6 months and 28.0 ± 13.5 at 18 months, representing an improvement in ICG score of 5.4 + 8.0 (95% confidence interval [CI] 4.1-6.8, p < 0.001). Variables independently associated with greater improvement in ICG score included traumatic death and greater grief avoidance. Variables independently associated with less improvement included being the biological parent and having more responsive caregiving. Parents with one or two surviving children had more improvement in ICG score than those with no surviving children whereas parents with three or more surviving children had less improvement.
  
  
  CONCLUSIONS
  Complicated grief symptoms decrease among parents between 6 and 18 months after their child's death in the PICU; however, high symptom levels persists for some. Better understanding of the trajectory of complicated grief will allow parents at risk for persistent distress to receive professional support.
authors.affiliation: Children's Hospital of Michigan, Detroit, Michigan, USA. kmeert@med.wayne.edu
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Meert
authors.forename: Katherine
authors.initials: K
authors.lastname: Shear
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Newth
authors.forename: Rick
authors.initials: R
authors.lastname: Harrison
authors.forename: John
authors.initials: J
authors.lastname: Berger
authors.forename: Jerry
authors.initials: J
authors.lastname: Zimmerman
authors.forename: K J S
authors.initials: KJ
authors.lastname: Anand
authors.forename: Joseph
authors.initials: J
authors.lastname: Carcillo
authors.forename: Amy E
authors.initials: AE
authors.lastname: Donaldson
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Willson
authors.forename: Carol
authors.initials: C
authors.lastname: Nicholson
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006117:Grief; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010290:Parents / Q000523:psychology*