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      Resilience as a predictive factor towards a healthy adjustment to grief after the loss of a child to cancer

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          Abstract

          Introduction

          Grief among bereaved parents is known to cause psychological distress and physical illness, but knowledge concerning factors that can contribute to health promotion after bereavement is scarce. Childhood cancer remains the most common non-accidental cause of death among children in Norway. The aim of the present study was to explore if resilience factors among cancer-bereaved parents could predict whether they will be able to come to terms with their grief 2–8 years following the loss.

          Methods

          A Norwegian cross-sectional national survey was conducted among 161 cancer-bereaved parents using a study-specific questionnaire. Logistic regression was used to explore whether resilience factors predicted parents’ grief outcome 2–8 years after their loss.

          Results

          On the Resilience Scale for Adults (RSA), three of the resilience factors contributed significantly in predicting whether the parents in the present study would come to terms with their grief 2–8 years after the loss their child: “ Perception of self “(OR 2.08, p = .048), “Social resources” (OR 2.83, p = .008) and “Family cohesion” (OR .41, p = .025). The results showed a negative relationship between time since loss (2–6 years) and whether the parents answered that they had come to terms with their grief ( p = < .05). The loss of a parent (OR .30, p = .030) combined with the loss of their child had a negative and significant effect on whether they indicated that they had processed their grief.

          Conclusion

          The total score of RSA and three of the six resilient factors contributed significantly in predicting whether cancer-bereaved parents in the present study indicated that they had come to terms with their grief to a great extent. The present study supports hypotheses that regard resilience as an important contribution in predicting healthy outcomes in people exposed to adverse life events.

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          Most cited references48

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          Ordinary magic. Resilience processes in development.

          The study of resilience in development has overturned many negative assumptions and deficit-focused models about children growing up under the threat of disadvantage and adversity. The most surprising conclusion emerging from studies of these children is the ordinariness of resilience. An examination of converging findings from variable-focused and person-focused investigations of these phenomena suggests that resilience is common and that it usually arises from the normative functions of human adaptational systems, with the greatest threats to human development being those that compromise these protective systems. The conclusion that resilience is made of ordinary rather than extraordinary processes offers a more positive outlook on human development and adaptation, as well as direction for policy and practice aimed at enhancing the development of children at risk for problems and psychopathology.
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            Children in poverty: resilience despite risk.

            N Garmezy (1993)
            Two objectives provided the focus for the Conference on Community Violence and Children's Development that was jointly sponsored by the National Institute of Mental Health and the John D. and Catherine T. MacArthur Foundation. One was to examine the evidence for deficit behaviors that characterized children reared in poverty; the second was to identify the characteristics of children who sustained their competencies despite being reared in comparable environments. These dual objectives took this form: "What can we conclude from studies of children, their families, and environments about characteristics that predispose children to maladjustment following exposure to violence, and about characteristics that protect children from such adjustment problems following, or in the midst of, violence exposure?"
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              Mortality in parents after death of a child in Denmark: a nationwide follow-up study.

              Little is known about the effect of parental bereavement on physical health. We investigated whether the death of a child increased mortality in parents. We undertook a follow-up study based on national registers. From 1980 to 1996, we enrolled 21062 parents in Denmark who had a child who had died (exposed cohort), and 293745 controls--ie, parents whose children were alive, and whose family structure matched that of the exposed cohort. Natural deaths were defined with ICD8 codes 0000-7969 and ICD10 codes A00-R99, and unnatural deaths with codes 8000-9999 and V01-Y98. We used Cox's proportional-hazards regression models to assess the mortality rate of parents up to 18 years after bereavement. We observed an increased overall mortality rate in mothers whose child had died (hazards ratio 1.43, 95% CI 1.24-1.64; p<0.0001). An excess mortality from natural causes (1.44, 1.15-1.78; p<0.0001) was noted in mothers only during the 10th-18th year of follow-up. Mothers had increased mortality rates from unnatural causes throughout follow-up, with the highest rate recorded during the first 3 years (3.84, 2.48-5.88; p<0.0001). Bereaved fathers had only an early excess mortality from unnatural causes (1.57, 1.06-2.32; p=0.04). Mothers who lost a child due to an unnatural death or an unexpected death had a hazard ratio of 1.72 (1.38-2.15; p=0.0040) and 1.67 (1.37-2.03; p=0.0037), respectively. The death of a child is associated with an overall increased mortality from both natural and unnatural causes in mothers, and an early increased mortality from unnatural causes in fathers.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ValidationRole: VisualizationRole: Writing – original draft
                Role: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Funding acquisitionRole: SupervisionRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: Formal analysisRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                21 March 2019
                2019
                : 14
                : 3
                : e0214138
                Affiliations
                [1 ] Department of Public Health and Nursing, Centre for Health Promotion Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
                [2 ] Department of Psychology, NTNU Norwegian University of Science and Technology, Trondheim, Norway
                [3 ] School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
                Harvard TH Chan School of Public Health, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ These authors also contributed equally to this work.

                Author information
                http://orcid.org/0000-0002-4043-9697
                Article
                PONE-D-18-28206
                10.1371/journal.pone.0214138
                6428287
                30897157
                17634376-95fd-49f6-b286-df0563ee8cd4
                © 2019 Vegsund et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 30 September 2018
                : 7 March 2019
                Page count
                Figures: 0, Tables: 3, Pages: 15
                Funding
                This study was funded by: 1. The Research Council of Norway, grant number 238331, “Health Promotion – Worthwhile? Reorienting the Community Health Care Services”, https://www.forskningsradet.no/no/Forsiden/1173185591033; 2. NTNU Norwegian University of Science and Technology, https://www.ntnu.no/; 3. The Norwegian Children’s Cancer Foundation, https://www.barnekreftforeningen.no/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Computer and Information Sciences
                Network Analysis
                Network Resilience
                Social Sciences
                Sociology
                Human Families
                Research and Analysis Methods
                Research Design
                Survey Research
                Questionnaires
                People and Places
                Population Groupings
                Ethnicities
                European People
                Norwegian People
                Medicine and Health Sciences
                Mental Health and Psychiatry
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                People and Places
                Geographical Locations
                Europe
                Norway
                Medicine and Health Sciences
                Pediatrics
                Child Health
                Medicine and Health Sciences
                Public and Occupational Health
                Child Health
                Custom metadata
                Because the researchers did not receive permission from participants to publicize their data, even if anonymized, the datasets analyzed during the study are not publicly available. Data may be made available by request, either to the project leader ( gorill.haugan@ 123456ntnu.no ) or the corresponding author ( hilde.k.vegsund@ 123456ntnu.no ), both at NTNU Norwegian University of Science and Technology.

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