The “special grief” of parents bereaved by drug-related death. Mixed methods research - a qualitative driven concurrent design

Abstract

Introduction: This doctoral project was carried out between 2018 and 2021 at the Department of Welfare and Participation, Western Norway University of Applied Sciences. A sociological perspective is incorporated when exploring, analysing and interpreting grief and bereavement, while the psychological perspective forms an important backdrop. The research is situated within the fields of grief, bereavement, welfare and drug research.

Background: Despite extensive preventive actions, reducing drug-related deaths (DRDs) remains an international major health challenge. How bereaved parents experience DRDs has scarcely been studied. Losing a child can be more intense and prolonged than other losses, and bereaved parents who experience unnatural deaths, such as DRDs, are at risk of developing grief complications. Clearly, there is a need to pay attention to the situation of parents, left behind following a DRD.

Aim: The main aim was to explore how bereaved parents experience DRDs, what the consequences are for bereaved parents and how they cope with everyday life. Several research questions have been explored and investigated in four articles:

Article I. A systematic review of the qualitative and quantitative literature regarding how family members experience drug-death bereavement, to understand: (1) the experience of family members before and after losing a next of kin and (2) how they perceive help and support and its influence on their bereavement processes.

Article II. How do parents experience drug-death bereavement and what different kinds of help and support do they receive?

Article III. How do drug-death bereaved parents adjust to life without the deceased and what seems to inhibit or promote adaptation during their grieving process?

Article IV. Do Norwegian parents bereaved from DRDs suffer from prolonged grief symptoms as measured by PG-13, and if so, which predictors are key to explaining their high levels of prolonged grief symptoms?

Method: The design was a qualitative driven, concurrent design, as qualitative results were used to investigate quantitative findings. This article-based thesis consists of a synopsis and four research articles: a systematic review (Article I); qualitative studies using semi-structured in-depth interviews (n=14 parents) and reflexive thematic analysis (Article II, III), and a quantitative study with a crosssectional correlational design, using survey data (n=93 parents) (Article IV). The synopsis gives an overview of the theoretical background, the applied methodology, research design, data collection methods and data analysis. The discussion integrates the findings from Articles II-IV, followed by methodological and ethical discussion. Finally, the implications for practice, policy and research are discussed.

Results: The “special grief” was characterised by the processing of the overload of stress, due to extended parenthood, grief-related emotions and reactions, and perceived societal and self-stigma. How parents cope with the loss was influenced by processes on an intrapersonal (e.g., level of self-efficacy, using proactive coping strategies) and an interpersonal level (e.g., attitudes and norms). How the parents coped was an individual experience, affected by the context. The intensity of processing the overload decreased in the case of most of the bereaved as time went by. The parents who struggled the most, reported low self-efficacy, withdrawal and long-lasting grief. The findings in the “special grief” of parents bereaved by drug-related deaths was discussed with regard to (1) the complexity of the “special grief”; (2) the complications of spill-over stigma; (3) the challenges of providing and receiving support and (4) the oscillation between coping styles.

Conclusion: On an individual level there is a need for immediate, proactive crises help post-loss, broad spectrum and need-related help and help over time. On a group level there is a need for support groups for those bereaved by DRD and support from social networks. Finally, there is a need to take action to reduce stigma related to drug use, enhance public recognition of those bereaved by DRD and to coordinate services on a societal level. The knowledge generated is of national and international relevance for practice, policy and for further research purposes, and may be transferable to other forms of unnatural death.