title: The Indirect Effect of Positive Parenting on the Relationship Between Parent and Sibling Bereavement Outcomes After the Death of a Child.
abstract: BACKGROUND
  Families are referred to pediatric palliative care (PPC) programs when a child is diagnosed with a medical condition associated with less than a full life expectancy. When a child dies, PPC programs typically offer a range of bereavement interventions to these families, often focusing on parents. Currently, it is unclear which factors increase the likelihood that bereaved siblings will experience negative outcomes, limiting the development of empirically supported interventions that can be delivered in PPC programs.
  
  
  OBJECTIVE
  The present study explored the relationship between parents' and surviving sibling's mental health symptoms (i.e., post-traumatic stress disorder [PTSD], prolonged grief disorder (PGD), and depression symptoms) after a child's death. Additionally, the extent to which parent functioning indirectly impacted sibling functioning through parenting behaviors (i.e., positive parenting and parent involvement) was also examined, with a specific focus on differences based on parent gender.
  
  
  METHODS
  Sixty bereaved parents and siblings (aged 8-18) who enrolled in a PPC program from 2008 to 2013 completed measures of PTSD, PGD, and depression related to the loss of a child/sibling. Siblings also completed a measure of general parenting behaviors.
  
  
  RESULTS
  Maternal, but not paternal, symptoms of PTSD and PGD were directly associated with sibling outcomes. Paternal symptoms were associated with sibling symptoms indirectly, through parenting behaviors (i.e., via decreasing positive parenting).
  
  
  CONCLUSIONS
  These results underscore the importance of examining both maternal and paternal influences after the death of a child, demonstrate differential impact of maternal vs. paternal symptoms on siblings, and stress the importance of addressing postloss symptoms from a family systems perspective.
authors.affiliation: Division of Child and Adolescent Psychiatry, Johns Hopkins Medicine, Baltimore, Maryland, USA. Electronic address: amorri54@jhmi.edu.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Morris
authors.affiliation: Department of Psychology, Middlesex Community College, Edison, New Jersey, USA.
authors.forename: Crystal
authors.initials: C
authors.lastname: Gabert-Quillen
authors.affiliation: Akron Children's Hospital, Akron, Ohio, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Friebert
authors.affiliation: Akron Children's Hospital, Akron, Ohio, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Carst
authors.affiliation: Department of Psychology, Kent State University, Kent, Ohio, USA; Department of Psychology and Psychiatry, Northeastern Ohio Medical University (NEOMED), Rootstown, Ohio, USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Delahanty
mesh_terms: D000293:Adolescent; D001601:Bereavement; D002648:Child; D003643:Death; D003863:Depression; D005260:Female; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D016487:Parenting / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D035781:Siblings / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic
keywords: Bereavement; family focused care; parent distress; positive parenting