Six-Year Follow-up of a Preventive Intervention for Parentally-Bereaved Youth: A Randomized Controlled Trial

Approximately 3.4% of youth in the U.S. experience parental death.1 Research has found that parental death increases children’s short-term and long-term risk for mental health problems and their parents’ risk for depression3. Given these negative outcomes, the development of effective preventive interventions has high public health significance. However, there is no empirical support from randomized trials for the efficacy of programs for parentally-bereaved children. A recent meta-analysis of 13 controlled trials found a non-significant overall effect size.4 Further, no studies assessed program effects longer than one year after program completion and few studies have addressed sub-group differences in benefits, issues of critical importance for prevention research5. Although several reviews have proposed that only survivors of traumatic deaths and those with elevated levels of symptoms would benefit,4,6 there is limited evidence on this issue for bereaved youth. This study presents findings from a six-year follow-up of a randomized experimental trial of the Family Bereavement Program (FBP), a brief dual-component intervention designed to improve outcomes for bereaved youth and their parents. The FBP was designed to prevent negative outcomes by changing multiple, empirically-supported risk and protective factors.7 The FBP demonstrated significant benefits at 11-month follow-up to reduce mental health problems for girls and youth with greater mental health problems at program entry8, and significantly reduced caregiver mental health problems at post-test. It was hypothesized that at the six-year follow-up, the FBP as compared to a literature control (LC) would lead to lower prevalence of mental disorder, lower levels of mental health problems and higher levels of positive developmental outcomes of youth as well as reduce mental health problems of their spousally-bereaved parents. Although there is no evidence that bereaved children are at elevated risk for high risk sexual behavior and substance use, we examined these as secondary outcomes because of their developmental significance. Based on the findings from at the FBP8 and a meta-analysis of interventions for the bereaved9 we hypothesized that the benefits would be greater for those with higher initial levels of mental health problems, females, and those whose parent experienced a violent death. We also explored whether the FBP had differential effects across youth age.