American Journal of Orthopsychiatry, 61(2), April 1991
Initial and residual grief reactions were assessed in a group of 220 adults, aged 35 60, who had experienced the death of a parent one to five years previously. Reactions to the loss were found to have sustained effects on social and emotional functioning, with lack of filial autonomy in the adult parent child relationship and unexpectedness of the parent's death emerging as the strongest predictors of unresolved grief. Theoretical implications are considered and directions for further research are proposed.
Increased evidence regarding the psychological import of adult parent child relationships (Barnett, Kibria, Baruch, & Pleck, 1988; Scharlach, 1987; Steindel & Rabin, 1982; Weishaus, 1979) has led a number of authors to speculate regarding the possible significance of a parent's death for an adult's mental health and psychological development (Bowlby, 1980; Hagestad, 1988; Moss & Moss, 1983 84; Weiss, 1982). Horowitz and colleagues (1981), for example, have described the death of a parent as "a serious life event leading to measurable symptomatic distress," while reports of reactions to parental death have cited profound feelings of loss, concerns regarding personal mortality, changes in self perceived psychological autonomy, and changes in family roles and relationships (Angel, 1987; Myers, 1986; Rosenfeld, 1977; Viorst, 1986). Little is known, however, regarding the factors associated with unresolved filial grief.
Previous research on grief reactions and their resolution has identified a number of factors apt to be associated with residual psychological and social impairment, including: the nature of the death (Lundin, 1984; Zisook, Schucter, & Lyons, 1987), previous experiences with loss (Sanders, 1979; Zisook, Schucter, & Schuckit, 1985); availability of adequate social support (Maddison & Walker, 1967; Vachon & Stylianos, 1988), and demographic characteristics such as age, gender, and socioeconomic status (Arens, 1982 83; Stroebe & Stroebe, 1983; Zisook et al. 1987). Attachment theorists (Bowlby, 1979; Parkes & Weiss, 1983; Weiss, 1982) have hypothesized that resolution of the grief process will be more difficult when a relationship has been marked by ambivalence, dependency, and other indicators of anxious attachment, and when the bereaved person's early childhood included experiences of parental separation or loss (Bowlby, 1980; Parkes, 1972; Sanders, 1979 80). Empirical investigations of spousal bereavement have provided some support for the former hypothesis (Maddison & Viola 1968; Parkes & Weiss, 1983; Sable 1986), but little for the latter (Hazan & Shaver, 1987; Willner, 1989).
The study reported here is an investigation of the impact of parental death in midlife and the factors associated with the extent and resolution of filial grief reactions. Particular attention is given to attachment theory predictions that a parent child relationship marked by anxious attachment and a history of childhood separation will contribute significantly to the extent of unresolved filial grief following the parent's death.
Participants consisted of 220 respondents to a notice in the Los Angeles Times, soliciting individuals who had lost a parent between one and five years previously. Participants ranged in age from 35 to 60 (median = 47) years, and were predominantly female (86%). The median time since the parent's death was two years, and the median parental age at death was 74 years. This convenience sample was approximately evenly distributed among persons who had lost both parents (31.8%), fathers only (32.3%), and mothers only (35.9%). The first parent to die was as apt to be the mother (46.8%) as the father (45.5%), with the parents dying at about the same time in 7.79 of the cases. All participants completed a mailed questionnaire designed to assess the extent of unresolved filial grief as well as a number of potential predictors.
Filial grief. Distress associated with the parent's death was assessed utilizing the Texas Revised Inventory of Grief (Faschingbauer, Devaul, & Zisook, 1977), containing eight items measuring grief reactions immediately following death and 13 items measuring the current level of residual grief.
Filial relationship. A Filial Relationship Scale developed specifically for this study included 22 items pertaining to the respondent's adult relationship with the deceased parent prior to any knowledge of impending death. Principal components factor analysis with Varimax rotation yielded the three-factor solution shown in TABLE 1. The first subscale, Attachment, assessed the extent to which the filial relationship was harmonious and free of conflict or discomfort. The second subscale, Autonomy, pertained to the respondent's independence from the need for parental approval and emotional reassurance. The third subscale, Assistance, assessed the extent to which the respondent provided more assistance to the parent than the respondent received.
Other predictors. Respondents rated how often they usually saw and how often they spoke by telephone with the parent prior to the time that they knew that the parent was going to die. In addition, respondents were asked about the occurrence of significant disruptions in their relationship with the parent during childhood. Also assessed were the respondent's age, education, gender, and ethnicity; the parent's age at death; length of time since the death; whether this was the first or second of a respondent's parents to die; and whether the death was expected or unexpected.
Correlations, t-tests and ANOVAs were utilized to examine the bivariate associations between the grief scores and a number of possible predictors. Factors found to be significantly associated (p<.05) to either initial or residual grief were included in multiple regression analyses.
Responses to items regarding initial and residual grief are displayed in TABLE 2. The most frequent initial reactions to a parent's death included difficulties sleeping, working, keeping up with normal activities and getting along with certain people. Analysis revealed no significant differences between initial reactions to the deaths of mothers and fathers.
With regard to residual reactions to their parents' deaths, 25% or more of the respondents indicated that they still become upset when thinking about the parent who died, find it painful to recall the parent's memory, still cry when thinking about the parent, can't avoid thinking about the parent, and feel that it was unfair that she or he had died. Not surprisingly, the majority of respondents reported that they very much miss the parent, they still feel the need to cry, they cannot replace the parent, and things and people continue to remind them of the parent. Analysis revealed no significant differences between current residual grief reactions regarding the deaths of mothers and fathers.
Bivariate analyses revealed that initial reactions to a mother's death were stronger when the mother was younger at the time of death (r= --.39, p<.0001), the respondent was younger (r= - .43, p<.0001), there was more telephone contact (r=.21, p<.05), the level of filial autonomy was lower (r= - .30, p<.001), and the death was unexpected (t = 2.20, p =.05). Initial reactions to a father's death were stronger when the level of filial autonomy was lower (r = - 31, p<.0001), the respondent was a daughter (t=3.35, p= .001), and the death was unexpected (t = 2.60, p = .02).
Current residual grief reactions to a mother's death were greater when the mother was younger at her death (r = .19, p< .05), the death was unexpected (t= .2.13, p = .03), and the respondent had fewer years of education (r= .20, p<.05), had more telephone contact (r=.36, p<.0001), had a more positive attachment (r = .25, p< .01), and was less autonomous (r= 37, p<.0001). Residual reactions to a father's death were greater when the death was unexpected (t=4.17, p=.0001) and the respondent was less autonomous (r= .31, p<.001). Factors not found to be associated with initial or residual grief reactions included the respondent's race and religion, the order in which the mother and father died, the recency of the death, the amount of in person contact prior to the parent's death, the balance of assistance given and received, and the extent of disruption in the childhood relationship with the parent. Factors found to be associated significantly with initial or residual grief reactions in the bivariate analyses were utilized in the development of regression models. The final regression models, shown in TABLE 3, include those items found to be significant predictors of either initial or residual grief, with as well as the measures of attachment autonomy, and assistance. Significant predictors of initial reactions to a mother's death included the respondent's age, whether the death was expected, and the level of filial autonomy. For initial reactions to a father's death, significant predictors included the respondent's gender and whether the death was expected. Factors found to contribute significantly to residual reactions to a mother's death included whether the death was expected, and the levels of filial autonomy and attachment. For a father's death, significant predictors were whether the death was expected and filial autonomy.
Two factors were found to be primary contributors to the extent of both initial and residual grief reactions: 1) the expectedness of a parent's death, and 2) the extent of filial autonomy. The first finding is consistent with research on widowhood, which has found less somatic and psychiatric distress when a spouse's death is anticipated than when the death occurs suddenly (Lundin, 1984; Sanders, 1979 80). Deaths that are expected apparently allow for anticipatory coping, including preparatory grief work designed to reduce the impact of the loss and preserve a sense of personal control (Rando, 1983).
The other consistent contributor to the impact of parental death was the extent of filial autonomy. Consonant with studies of reactions to widowhood (Parkes & Weiss, 1983; Raphael, 1983; Sable, 1986), respondents who were the most dependent on the deceased for emotional support and approval had the greatest difficulty when that person died. However, in contrast to predictions by some attachment theorists (Bowlby, 1979; Parkes & Weiss, 1983), respondents whose adult parent child relationships were marked by other classic signs of anxious attachment, such as tension, interpersonal conflict, and discomfort giving and receiving assistance, did not consistently experience greater distress following a parent's death. Nor did the reported extent of disruption in the early parent child relationship contribute significantly to distress following the parent's death, although interpretation of these findings must be made with caution because of the lack of a developmental history and the fact that the sample did not include individuals who had actually lost a parent in childhood. Apparently, dependency and the need for parental approval were more salient predictors of distress following a parent's death than were other characteristics usually considered to be signs of anxious attachment.
The salutary implications of achieving healthy self reliance and individuation from a parent have been discussed by object relations theorists (Fairbairn, 1952; Mahler, Pine & Bergman, 1975; Wolf, 1980) and transgenerational family theorists (Boszormenyi Nagy & Spark, 1973; Bowen, 1978; Williamson, 1982). Healthy adult parent child relationships are presumed to reflect "filial maturity" (Blenkner, 1965), the ability to attain an adult adult relationship with one's parent where neither parent nor child assumes the dominant role and where the adult child no longer regards the parent as her or his primary source of emotional validation and support (Williamson, 1982). Such relationships have been associated with decreased care giving strain (Scharlach, 1987; Walter, 1989) and decreased vulnerability when a parent dies (Weiss, 1982).
Other factors found to contribute significantly to filial grief were the respondent's age (for initial reaction to a mother's death) and the respondent's gender (for initial reaction to a father's death). Among factors not found to contribute significantly to filial grief scores were the respondent's education, ethnicity, length of time since the death, order of parental death, amount of contact with the parent prior to death, or balance of assistance given. Contrary to some predictions (e.g., Bowlby, 1980; Troll & Smith, 1976), the closeness associated with greater levels of contact and assistance did not produce greater distress following the parent's death. It appears that the intensity of filial grief reactions is not so much related to the amount of contact per se, but to the dynamics of the interaction.
This study is an initial step toward a deeper understanding of parental death and the factors associated with the resolution of filial grief, although the generalizability of its findings may be limited by the retrospective nature of the responses, the absence of validity data on the Filial Relationship Scale, and reliance on a self selected sample. It is hoped that this report will stimulate further research regarding the ways in which filial relationships and their termination affect the process of adult psychological and social development.
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In the article, "Relationship of Perceived Maternal Acceptance Rejection in Childhood and Social Support Networks of Pregnant Adolescents," by Barry R. Sherman and Barry R. Donovan (Journal, January 1991, 61, 103 113), a revision in the text was not matched by a commensurate change in Table 3 (p. 111). As a result, the values of the numbers in three columns in that table are reversed. Numbers in the columns headed "REJECTION" and "PARQ TOTAL" are negative values and should have been preceded by minus signs; entries in the column headed "ACCEPTANCE" are positive numbers and should not have been preceded by minus signs.