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Abstract
Introduction: Experiencing a death of a significant other during adolescence is a potentially disruptive and devastating event. However, it is unclear how many adolescents are bereaved, especially by a suicide death. Also, little is known of their mental health and help-seeking experiences, and a designated grief instrument is lacking.
Aims: First, to investigate the grief, mental health and help-seeking experiences of bereaved adolescents, with a focus on suicide bereavement. Second, to empirically develop a reliable and valid measure of grief in adolescents, aged 12 to 18 years old.
Methods: A mixed-methods study with consecutive steps. Study 1 comprised systematic reviews and meta-analysis establishing the evidence-base of the impact of a suicide death and how many adolescents are affected. These reviews substantiated a large qualitative study with a purposive sample (N=39) involving thematic analysis of data collected through semi-structured interviews (Studies 2 and 3). Study 4 applied an online survey (N=179) with 59 grief items derived from the qualitative study, death- and mental health-related instruments, and a factor analysis of the grief items.
Results: Many adolescents are exposed to a suicide death (4.6% in one year and 18% before adulthood), thus, potentially in need of support (Study 1). Study 2 identified two major themes: Grieving apart together, and Personal growth. High self-reliance and selective sharing were common. Feelings of guilt and ‘why’ questions seemed more pronounced among the suicide bereaved. Experiencing a death could also catalyse personal growth and increased capacity to deal with own mental health. Study 3 uncovered experiences with Formal support, Informal support and School-related support. Adolescents critically appraised positive and negative experiences, and noted crucial help-seeking barriers and facilitators. Study 4 developed the Adolescent Grief Inventory (AGI) comprising 40 items and 6 factors. The AGI discriminated between different groups based on cause of death, kinship, and indicators of mental health and self-harming behaviour.
Conclusions: The step-by-step project provided unique insights into the adolescents’ grief, mental health and help-seeking. The project resulted in the AGI, a novel, comprehensive and valid measure of grief in adolescents. It can be used broadly, including with adolescents at-risk of mental health ramifications.