The impact of bereavement and loss on young people

Jane Ribbens McCarthy with Julie Jessop

A wide-ranging review of the literature on the implications of bereavement for young people's lives.

Many young people have experienced the death of someone close to them – but do we understand the implications of bereavement for young people’s lives? In this study, the authors argue that bereavement is in fact a general – if difficult – part of growing up, and should be recognised as such. For some young people, a major loss may be a source of very significant disruption to their lives.

This wide-ranging review of the literature on young people, bereavement and loss examines:

  • Case studies and other evidence of how young people discuss their experiences of bereavement;
  • The theoretical history of research into this issue;
  • The empirical evidence of bereavement as a 'risk factor' in the lives of young people;
  • The social and cultural contexts of bereavement, and approaches to education and intervention;
  • The implications for policy-makers and practitioners developing best procedures and practice for working with bereaved young people.
Summary

Summary

Bereavement is a common – and sometimes life-defining – experience for young people. One study has found that as many as 92 per cent of young people in the UK will experience what they see as a 'significant' bereavement before the age of 16. Between 4 and 7 per cent will lose a parent. Yet there is a dearth of research on the actual extent of bereavement and its impact on young people at what may be a particularly vulnerable time. This review of the available literature, by Jane Ribbens McCarthy from the Open University with Julie Jessop from the University of Cambridge, found that:

  • Mortality rates vary strongly by social class and geography; young people's likelihood of experiencing bereavement will vary accordingly. Those living in disadvantaged circumstances are most likely to experience serious and multiple losses.
  • Researchers, and service providers, have focused on parental and sibling deaths, largely ignoring the death of peers.
  • While many young people find bereavement deeply upsetting, not all the consequences are necessarily negative; opposite effects may occur for different individuals or at different times. Much depends on the context and nature of the bereavement and the meaning it holds for individuals.
  • Those who experience multiple bereavements, or bereavement alongside other difficulties, are statistically 'at risk' of experiencing negative outcomes (in areas such as education, depression, self-esteem and risk-taking behaviour) later in life.
  • Young people's own accounts of bereavement point to the need to take a much longer perspective in understanding its significance in their lives.
  • High numbers of bereaved young people report never having spoken with anybody about their experiences.
  • Current provision is patchy. Counselling is just one possible response: services need to offer a range, from basic information to in-depth individual help, provided by both mainstream and specialist organisations to be potentially available to all.
  • There is also a case for paying particular attention to troubled young people who may have faced significant bereavement earlier in their lives, and to bereaved young people living in disadvantaged circumstances.
  • The researchers conclude that further research is needed into the complexity of young people's experiences, with particular attention on the social context of bereavement and why individuals may respond differently to it.

Introduction

In 2001, a study found that as many as 92 per cent of young people in the UK will experience bereavement of what they defined as a 'close' or 'significant' relationship (including pets) before the age of 16 (L Harrison and R Harrington, 'Adolescents' bereavement experiences. Prevalence, association with depressive symptoms, and use of services.' Journal of Adolescence 24(2): 159-169). Research suggests that between 4 and 7 per cent will lose a parent.

Both bereavement and youth can be times of major transition and significant disruption to the general flow of social life and personal emotions. Young people experiencing bereavement may therefore be doubly vulnerable. This literature review asks whether there are particular issues at stake when we consider bereavement in the context of the lives of young people.

The literature reveals two main perspectives in response to this question:

  • psychological – in which bereavement may be understood as posing particular difficulties in relation to the 'normal' development of adolescence, and
  • sociological – in which bereavement may be understood as creating particular vulnerabilities in the context of the relatively powerless and institutionalised phase of life termed 'youth'.

A further consideration is that not all bereavements will constitute a 'loss' and not all consequences will be negative. At times, it may be more appropriate to consider bereavement in terms of 'change' rather than 'loss'.

Current research and theoretical frameworks are heavily rooted in psychological perspectives, focusing strongly on individual and (to a much lesser extent) family processes. There has been little attention paid to the significance of wider social, historical and cultural contexts.

Young people's experiences

While the experience of bereavement is a pervasive part of growing up, for some young people, bereavement is a major event unlike anything else, and carrying potentially significant consequences in both the short and long term.

Very little research has asked young people themselves to voice their own experiences of bereavement. A few autobiographies are available and some clinical and professional case studies exist, centred on young people bereaved of a parent or (sometimes) a sibling. However, we know very little indeed about bereavement more broadly as a general feature of young people's lives.

New case studies written up for the current investigation are unusual in covering a wider range of experiences. These show how bereavement may have significance in young people's lives over long periods of time, even while individuals cope and carry on. This significance may be seen in various terms, including their spiritual development, their perspective on who they are and what is important in their lives, and how to understand their own identities and family histories. The case studies also provide insight into the lives of bereaved young people who are not in touch with services. They may struggle over many years in response to a major bereavement, in ways that appear to be quite unnoticed by those around them.

"A lot has happened [since father's death], … there's been a lot of marriages, but there's been a lot of deaths really, like my dad's best mate, and my gran, she died last week, so it's been quite a rough year really. … still replay it back in my mind, even now, nearly two years ago, wonder what would happen if… [father] wouldn't have got the cancer." (Brian)

These case studies, and other qualitative evidence of young people's own accounts of bereavement, point to the need to take a much longer perspective in understanding the significance of bereavement in their lives. The notion that an individual will 'get over it' may be quite inappropriate: he or she may revisit the bereavement at all sorts of periods of life as the years unfold. Other major themes include: the search for meaning; the struggle to deal with overwhelming feelings; the implications for social relationships and the possibility of isolation; the sense of increased risk and vulnerability; the absence of appropriate help from those around or from organised services; young people's lack of power in terms of decisions made by those around them at a key time in their lives.

Bereavement as a 'risk' factor

Researchers have explored the implications of bereavement for young people's lives in both the short and longer term to see if it may place them at greater statistical risk of experiencing unwelcome 'outcomes'. Different bodies of work focus on social or psychological/mental health outcomes. Some research is based on long-term cohort studies of large numbers of children and young people generally; some is based on smaller scale community-based studies. For the most part, there have been few links made between these approaches. There are also major methodological difficulties in much of the research. The range of outcomes considered includes: educational issues; age of leaving home; sexual activities and health behaviour; aggressive or delinquent behaviour; depression; and self-concept and self-esteem. Other possible outcomes, e.g. the possibility of loneliness and isolation in the longer term, are hinted at in the qualitative literature but have not received sustained attention in the more quantitative studies.

Some studies of bereavement as a source of 'risk' point to the possibility that bereavement in itself may have a significant impact on some individuals' lives. These may or may not show up as negative 'outcomes' in statistical studies. But the evidence is very complex and often contradictory, pointing to the relevance of cross-cutting issues, such as social class, gender, and individual and family differences; all of these may contribute to a level of protection or resilience for some young people. As with the qualitative research, these studies highlight the significance of the meaning of the bereavement to the individual. A variety of findings also raise the possibility of opposite effects occurring for different individuals – some may develop higher expectations for themselves, or find new strengths, while others may be overwhelmed and demotivated, reducing their expectations of life in various ways. Overall, this evidence points to the need for complex models of both causes of stress and of the resources young people can draw on, considered over a very long time span, in order to understand the significance of bereavement for the individual.

The experience of multiple losses or difficulties, however, is shown to be quite clearly related to increased 'risk' of unwelcome outcomes. Such multiple losses are, in turn, likely to be related to social class, geography, and disadvantage generally. In such neighbourhoods, the family and friends of bereaved individuals may be struggling with their own high levels of difficulties.

The social contexts of bereavement for young people

Teenagers are expected to learn to take responsibility for and manage their behaviour and emotions in public and private. This can make the experience of bereavement at this age particularly problematic, especially in educational settings.

"I just can't get over [my mother's death] at times … when it's really hard, it's like losing part of yourself … it's like learning to walk again … Maybe the rest of them are just coping with it or looking as if they're coping with it but I'm not. There's times when I really don't cope at all." (Neville)

Some studies suggest that large numbers of bereaved young people never talk to anyone about their experiences; some evidence points to a risk of social isolation over time. Bereaved young people may have very different relationships with both peers and family members: they can be either key sources of support or of additional problems. Young people themselves most often cite close friends as the group they find most helpful, but peers can also stigmatise and bully, or may lack confidence in their ability to help. Families are also key players in young people's experiences of bereavement: young people often report that families too are major sources of support. However, for teenagers family support can be ambiguous even at the best of times (e.g. talk may constitute a form of control as well as support). Clearly, at a time of major crisis due to bereavement, there may be further issues between family members. These might include mutual protection or particular expectations of appropriate behaviour or responses being imposed by more powerful family members. Bereaved young people may also find their families alienating or abusive.

When [my great-grandfather] died I think it made me realise that I can't waste the time and seeing that the years are going by so quickly … I feel like they're just slipping from underneath me sometimes, like a day will come and then the next day is gone ... 'cause of that it made me realise that I don't have much time to waste." (Shirleen)

The evidence thus points to the importance of policies seeking to enable young people, families and communities, as well as general professionals in contact with young people, to respond helpfully to bereaved young people. As a society, we need to understand that bereavement is a general feature of most young people's lives, without necessarily seeing bereavement as an issue for 'experts' to deal with. This may be a strong argument for the inclusion of 'death education' in schools. Peer support groups – whether based in schools or bereavement organisations – may have a particular relevance in dealing with bereavement difficulties, as well as other issues in young people's lives.

But research also points to the need for more support and training for general professionals in dealing with bereavement issues.

Specialist palliative care organisations have paid increasing attention in recent years to the needs of bereaved individuals, and of children and young people among them. There have been many valuable new initiatives, such as interactive websites for bereaved children and young people. But current voluntary funded services are very patchy, often centred on hospices and thus only focused on anticipated deaths.

There is minimal research into the question of how young people may access help or services for themselves, whether or not they are already in touch with bereavement organisations. This relates to much wider issues concerning health education and personal help for young people generally. Such broad areas of policy development need to ensure that bereavement is included and receives proper consideration in its own right as a potentially significant and difficult issue for young people. At the same time, it is also crucial for policies to pay particular attention to how to make bereavement support available to those living in areas of deprivation and disadvantage; these are the areas where young people are likely to be most at risk as a result of bereavements.

So, while the evidence suggests the need for a range of services to be potentially available to all, there is also a case for paying particular attention to troubled young people who may have faced significant bereavement earlier in their lives, and to bereaved young people living in disadvantaged circumstances.

Areas for further research

There is a serious gap in research which can improve our knowledge and understanding of the needs and experiences of bereaved young people, particularly putting such experiences more clearly into social context. Such research needs to be both qualitatively and quantitatively based, using rigorous methods and community-based samples, including people not already in touch with bereavement services, covering a wide range of bereavement experiences, and drawing on a range of theoretical perspectives. Such requirements pose a real challenge to the research community.

About the project

This literature review centred primarily on young people rather than children more broadly, although in practice much literature covers a broad age range. The project used a combination of systematic electronic searches using targeted key words, and more serendipitous explorations of a wide variety of literatures. The case studies were drawn from a series of longitudinal research projects using in-depth interviews in a variety of UK locations; these studies are based at South Bank University (http://www.lsbu.ac.uk/fhss/ff/) and were written up by Sue Sharpe. The literature review was based at the Open University, and was primarily undertaken by Dr Jane Ribbens McCarthy (Open University) with help from Dr Julie Jessop (Cambridge University), both of whom are family sociologists.

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