GRIEF AMONG PARENTALLY BEREAVED
ADOLESCENT GIRLS IN SOUTH AFRICA:
ADVERSITY AND RESILIENCE
REPSSI PSYCHOSOCIAL FORUM
SEPTEMBER, 2015
Tonya R. Thurman, MPH, PhD
Associate Professor, Tulane University
Director, Highly Vulnerable Children Research Center
Country Director, Tulane International, LLC South Africa
Orphans and Bereavement

1 in 5 children in South Africa have lost a parent

Evidence is lacking about:
Grief reactions
 Effective mental health interventions

“Future interventions might focus on provision for mental health
support for children around grief and loss and providing
systematic tools and measurement to improve the evidence base.”
- Sherr & Mueller. (2008). Where is the evidence base? Mental health issues
surrounding bereavement and HIV in children.
Our Study: Coping with Loss


Baseline data from a Randomized Control Trial
evaluating Abangane (Friends) Grief Groups for
adolescent girls in Free State South Africa
School-based 9th grade girls reporting loss and
interest in participating in a related support group
 From

11 schools in three areas: two rural, one urban
Data collected January-March 2015
 Follow-up
data in November 2015
Our Study: Coping with Loss




Ethical approval obtained from
University of Free State in RSA
and Tulane University in USA
All participants provided with a
collection of stories from Africa
about dealing with loss
By Heather Ferris and Corianna Heise
Cognitive interviews conducted to select & adapt grief measures
Descriptive analysis of experiences and multivariate models to
examine predictors of complicated grief, intrusive thoughts and
personal growth
Adolescent Girls:
Baseline Sample Characteristics (n = 416)
Age range: 12-18 years (12-16: 93%, 17-18: 7%) Mean: 14.5
38% were single orphans and 12% were double orphans
30% were maternal orphans and 33% were paternal orphans
50% cared for by a biological parent
23% cared for by a grandparent
19% live with an HIV positive caregiver
Adolescent Girls’ Experiences of Loss
Circumstances of loss
44% experienced more than one loss (range 2-10, average = 2)
44% reported parent as loss that affected them the most
o 55% cited her mother
o 45% cited her father
26% reported grandparent as loss that affected them the most
Average of 4.5 years since ‘most affected loss’
o Parentally Bereaved: 6.0 years
o Non-Parentally Bereaved: 3.4 years
Adverse Grief Reactions
70
63
60
50
40
30
45
Parentally
Bereaved
Non-Parentally
Bereaved
35
26
22
16
20
10
0
Self-reported
Debilitating Grief
Complicated Grief
Intrusive Thoughts
Complicated Grief
of Parentally Bereaved Adolescent Girls
Inventory of Complicated Grief (at least once per day)
50% miss loved one
47% could not believe loved one had passed
45% shocked at passing
27% felt lonely over passing
30% saw the world differently because of passing
42% cannot accept that loved one passed
6 items, Alpha=0.90
Complicated Grief among Parentally
Bereaved by Caregiver Risk Factor (%)
63
Total sample
72
Verbally
Abusive
Caregiver
79
Caregiver
Complicated
Grief
87
100
Chronically Ill Verbal Abuse,
Caregiver Chronic Illness,
Complicated
Grief
Intrusive Thoughts
of Parentally Bereaved Adolescent Girls
Intrusive Thoughts (at least once per day)
31% thought about the death of the deceased
25% had thoughts about the deceased even when they didn’t
want to
17% could not do regular things because they were thinking
about the deceased
14% had nightmares about the deceased
39% thought things were better before the deceased passed
9 items, Alpha=0.89
Risk Factors for Intrusive Thoughts
among Parentally Bereaved

Higher IGTS scores were associated with:
 More
recent loss
 Increased levels of grief among caregivers
 Poorer caregiver-adolescent relationship
 Scored
higher on a scale of negative caregiver-adolescent
connection
 Higher levels of perceived caregiving burden by the
caregiver
 Living
with a chronically ill caregiver
Risk vs. Resilience


Research often focuses on pathways to risk, rather than the
social, psychological pathways to improved mental health,
resilience and coping
Two reviews on mental health of HIV-affected children and
resilience concluded that rigorous research is lacking
(Skovdal 2012; Betancourt 2013)
A continued focus on the pathology of HIV-affected children
may influence how society and communities see, and describe,
their problems and impact on how they seek support and expect
recovery.
Skovdal 2013
Resilience among Parentally Bereaved
Adolescent Girls: Personal Growth


Hogan Grief Reaction Checklist used to measure Personal
Growth due to the death of a loved one (Alpha=0.82)
It includes 11 questions about how the death changed the
adolescent’s

Empathy:
 You are more aware of others feelings (64%)

Treatment of other people:
 You try to be kinder to other people (73%)

Growth:
 You feel as though you are a better person (60%)
(% answering mostly or completely true)
Factors predicting Resilience among
Parentally Bereaved Adolescent Girls

Higher personal growth was associated with:
 Better
positive caregiver-adolescent connection
 History of bereavement support
 Received
help for their bereavement through confiding in
another person, talking with other people who have
experienced a loss, and talking about the loss with family
members
 Number
of years since death was not significant, nor
were caregiver grief, burden, or illness

Personal growth was not correlated with adverse
grief– they are separate issues
Program Implications

Psychosocial support has the potential to help promote
resilience among parentally bereaved girls



More is needed to address adverse grief
Resilience is still possible among adolescents with adverse
grief reactions and challenging circumstances
Caregiver focused efforts could further improve children’s
grief outcomes
Addressing caregiver-adolescent relationship has the potential
to positively influence both grief and resilience
 Caregiver physical and emotional wellbeing are important
factors associated with children’s adverse grief responses

Acknowledgements
Tulane Contributors
Brian Luckett
Alex Spyrelis
Tory Taylor
Funding Support
PEPFAR
USAID Southern Africa
Anita Sampson
Program Partners
Child Welfare Bloemfontein & Childline Free State
Emma Francis
Team of wonderful social workers
Khululeka Grief Support Program
Deborah Diedericks
Research Partner: Epi Centre
Most importantly we appreciate the adolescents and caregivers who
shared intimate details of their lives to aid our understanding of their
circumstances. We hope they and other families facing bereavement
are the ultimate beneficiaries of these and similar research efforts.
Thank You!
Questions and Comments?
Website: http://hvc-tulane.org