Loneliness in Bereaved Children and Adolescents
Introduction: Bereavement in children and adolescents was a common life event, but often unrecognized. It is potentially followed by a reaction of grief. Bereavement may cause feelings of loneliness, which is associated with poor mental well-being. This study aims to understand the impact of loneliness on bereaved children and adolescents. Methods: Literature Review. Results: Childhood loss is a significant social and public health problem associated with developmental disorders — including relational, academic, and occupational functioning — as well as an increased risk of mental health problems. Loneliness occurs in childhood and adolescence is a risk factor for poorer well-being. Loneliness in children and adolescents is a risk factor for depression, social anxiety, behavioral disorders, hyperactivity, substance abuse, suicide, and premature death. Studies showed more than 50% of mental health problems develop during childhood and adolescence, with the average age being 14.5, and poorer well-being resulting from loneliness has a long-term impact on health and well-being during adulthood. Conclusions: Bereavement during childhood and adolescence period is a risk of loneliness, which is associated with a variety of mental and behavioral health problems, decreased academic performance, and impairments in developmental tasks. Early prevention and intervention are needed to reduce the risk of disorders later in life and to increase resilience among bereaved children and adolescents.
Keywords: Bereavement, Loneliness, Well-Being, Children And Adolescent
Introduction
The death of a loved one is one of the various life events that can cause suffering. Coping with bereavement is considered a notably challenging experience. Bereaved individuals may experience a range of negative emotions such as sadness, disbelief, longing, anxiety, anger, and feelings of guilt[1],[2].
The prevalence of bereavement in childhood and adolescence is estimated to be around 1.5% in cases of loss of siblings and overall at 3.5% in the loss of a family member. Children can be spared the suffering associated with bereavement due to the immature development of cognitive and psychological functions. As a result, they are insensitive to loss. Studies suggest that a child who deals with bereavement is at risk for many health problems[2]–[6].
Bereavement can cause somatic symptoms in children (sleep disturbances, enuresis, decreased appetite, and anorexia). The psychosomatic and socioeconomic impacts of children experiencing bereavement include anxiety disorders, internalizing and behavioral externalization disorders, sleep disorders, low self-esteem, suicide attempts, substance use, mental disorders such as schizophrenia, and social withdrawal. Mental health problems that developed due to bereavement might be associated with loneliness[4],[7].
Loneliness is a subjective negative emotion that arises when a person feels that their social relationships are not as desired, quality or quantity. Loneliness can occur in children and adolescents as a consequence of bereavement and can affect the mental health of children and adolescents up to 9 years later. Studies have shown that loneliness in children and adolescents was considered a risk factor for poorer well-being[8]–[10].
This literature review aimed to understand the impact of loneliness on bereaved children and adolescents.
Reviews
Bereavement in Children and Adolescents
A. Definition
Grief is a natural human response to bereavement or loss, especially the loss of a loved one. The terms grief, mourning, and bereavement are often used interchangeably but have different meanings. “Deuil” is a French word that means the loss of a loved one as well as the reaction of grief caused by the experience of loss. English vocabulary presents definitions of the three aspects: bereavement, which is defined as a major life event in the form of loss of a loved one; grief, which deals with cognitive, affective, and behavioral responses to loss; and mourning, which is the process of adaptation to loss, a dynamic process strongly influenced by sociocultural norms. Bereaved individuals may experience a period of intense emotional pain and thoughts which include yearning and longing, intense sadness and crying, anger, anxiety, loneliness, guilt, blame, depersonalization, preoccupation with thoughts and memories of the deceased person, insistent memories, disturbed neuro vegetative functions, difficulty concentrating, and relative disinterest in other people and disruption of daily life activities, that is both expected as well as socially sanctioned. The normal process of bereavement takes 3 to 6 months in the acute phase, and up to 1 year for complete resolution[2],[11],[12].
The clinical approach to grief among children is the developmental approach. This required a phase of mental and cognitive development that must be taken into account in order to understand and accurately describe the grief reaction of children. Children gain five concepts in understanding and dealing with death, namely (1) irreversibility (permanent death), (2) personal mortality (death applies to oneself), (3) universality (death is inevitable), (4) non-functionality (termination of all functions of life), and (5) causality (a realistic understanding of the concept of death). A proper understanding of the concept of death is generally achieved between the ages of 9 and 11, although brain maturation and higher cognitive function continue to develop during adolescence and early adulthood[4],[13].
B. Prevalence
The prevalence of children and adolescents experiencing bereavement is estimated to be approximately 1.5% in cases of loss of a sibling, and overall 3.5% experiencing the loss of a family member. Epidemiological studies of bereavement in childhood and adolescence in the United Kingdom showed that 3.5% experienced the death of a parent or sibling, and 6.3% experienced the death of a close friend. Another study conducted in the United States showed that 4% of children and adolescents experienced the death of a parent before the age of 18. A study conducted by Berg, et al (2016) showed that of 862,554 people included in the study population, there were 1.1% of children experienced maternal loss, 2.6% lost fathers, and 519 people experienced the loss of both parents before the age of 18 years[2],[5],[6],[14].
C. Psychological Impacts
Bereavement in children and adolescents is a risk factor for various psychiatric and somatic disorders. Childhood bereavement is also a significant social and public health problem associated with developmental disorders — including relational, academic, and occupational functioning — as well as an increased risk of mental health problems, substance abuse, suicide, and premature death. The death of the figure of attachment to any cause, and the symptoms resulting from the difficulties experienced after death can significantly disrupt the lives of children, impact health, and disrupt the developmental phase. Unlike adults, bereaved children might show withdrawal, seek attention, misbehave, complain of aches and pains, pick fights easily, argue, have nightmares, fear the dark, lose their appetites, or overeat. Secondary stressors also add to family difficulties in grieving households so bereaved teens also often experience decreased financial security and changes at school and home
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