Psychological disturbance and service provision in parentally bereaved children: prospective case-control study

The paper by Dowdney et al[1] highlights the needs of bereaved
children for appropriate support. Their paper suggests that the primary
care team have an important role to play both in direct support of the
bereaved parents and children and in referral of children with more
complex difficulties to appropriate services.

A study in North Wales found that bereaved children consulted the
General Practitioner almost three times more frequently than their age sex
matched controls in the year following the death of a parent[2] and with
symptoms for which no organic cause can be found. There was, however a
lack of acknowledgement by General Practitioners of the bereavement when
the child presented at the surgery and few links made between the frequent
presentations and the bereavement. This may reflect the lack of teaching
on bereavement during vocational training.

For the majority of children, the opportunity to talk about their
concerns or feelings will be sufficient and few children require formal
psychological or psychiatric interventions.[3] In the U.K. 2% of all
children are bereaved of a parent before the age of 18 - as Dowdney's
paper suggests, the primary care team have a critical role in supporting
these families, but may need access to training in order to provide
appropriate support.

Dr Mari Lloyd-Williams

(Specialist Registrar Palliative Medicine)

The Leicestershire Hospice,
Groby Road,
Leicester LE3 9QE

References

1 Dowdney L, Wilson R, Maughan B, et al, Psychological disturbance and
service provision in parentally bereaved children: prospective case -
controlled study BMJ 1999;319:354-357

2 Lloyd-Williams M, Wilkinson C, Lloyd-Williams F, Do bereaved children
consult the primary care team more frequently?, European Journal of Cancer
Care, 1998;7:120-124

3 Harrington R, Harrison L, Unproven assumptions about the impact of
bereavement on children; J R Soc. Med 1999;92:230-233