THE ROLE OF SOCIAL NETWORKS IN HELPING YOUNG ADULTS COPE WITH THE DEATH OF A SIBLING
Matthew F. Benoit
A Thesis
Submitted to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of
MASTER OF ARTS
December 2018
Committee:
Catherine Stein, Advisor
Abby Braden
Dara Musher-Eizenman ii ABSTRACT
Catherine H. Stein, Advisor
Sibling relationships are characterized by a strong stability throughout adulthood, but the death of a sibling is often a “forgotten” topic in the bereavement literature. Previous research has primarily focused on ways that parents cope with the death of a child, with few studies describing the experiences of siblings who grieve the loss of a brother or sister. The present study used a personal network approach to examine the perceived social ties of young adults who have experienced the death of a sibling. A mixed-methods research design was used to understand the relationship between perceived structural, functional, and relational content network characteristics and self-reported adjustment (depression, complicated grief, posttraumatic growth, quality of life) among a sample of 19 young adults who had lost a sibling through death.
Results indicated that neither the total network size nor the proportion of family in the young adults’ networks were associated with better adjustment to the loss. Siblings’ reports of higher quality of life were associated with their reports of higher proportions of network members who knew the deceased sibling. Results indicated that the proportion of the network that provided instructional support (advice and guidance) was associated with young adults’ reports of posttraumatic growth. Case study analysis revealed a potential relationship between smaller, closer, more emotionally supportive networks and fewer participant reports of depression. Qualitative findings highlighted the helpfulness of art and media in coping with the loss, and feelings of closer family relationships after the loss. Study results were interpreted largely in the context of the dual processing model of bereavement, with emphasis on how iii different types of social networks might impact the young adults’ balance between focusing on
the loss and focusing on recovery. Implications of present findings for future research in the area were discussed.
Keywords: bereavement, social support, death of a sibling, young adults, depression,
network analysis iv ACKNOWLEDGMENTS
I would like to thank my advisor, Catherine Stein, Ph.D., for all of her guidance and support throughout the process of this study. I would also like to thank my committee members, Abby Braden, Ph.D., Dara Musher-Eizenman, Ph.D., and Dryw
Dworsky, Ph.D. for their recommendations to improve the study. Finally, I would like to thank my hard-working research assistants, Victoria Callahan, Allison
Rodenbucher, and Katelyn Gregg, for the many hours they spent transcribing and entering data for this study. v
TABLE OF CONTENTS
Page
INTRODUCTION ...... 1
Adult Sibling Relationships ...... 2
Sibling Bereavement ...... 3
Young Adult Bereavement ...... 4
Bereavement ...... 5
Social Support ...... 11
Summary ...... 16
Present Study ...... 18
METHODS ...... 20
Sample...... 20
Measures ...... 21
Social Network Interview Protocol ...... 21
Mental health indices ...... 22
Center for Epidemiologic Studies Scale for Depression- Revised
(CESD-R) ...... 22
Inventory of Complicated Grief (ICG) ...... 23
Personal growth and quality of life ...... 23
Posttraumatic Growth Inventory (PTGI) ...... 23
World Health Organization Quality of Life assessment- Abbreviated
Version (WHOQOL-BREF) ...... 24
General bereavement questions ...... 25 vi
Procedure ...... 25
Analysis...... 26
Quantitative analysis ...... 26
Case analysis ...... 27
Qualitative analysis ...... 27
RESULTS ...... 28
Perceived Network Characteristics ...... 28
Structural network variables ...... 28
Functional network variables ...... 29
Relationship content variables ...... 31
Adjustment variables ...... 33
Case Examples ...... 34
High levels of depressed mood: Jamie and Laura ...... 34
Jamie ...... 34
Family context and circumstances of sibling’s death………… 34
Network characteristics……………………………………..... 35
Self-reported adjustment………………….…………...... 35 Laura ...... 36 Family context and circumstances of sibling’s death………… 36
Network characteristics……………………………………..... 36
Self-reported adjustment………………….…………...... 37 Comparison between participants with high levels of depressed mood 37
Low levels of depressed mood: Heather and Cecilia ...... 38
Heather ...... 38 vii
Family context and circumstances of sibling’s death………… 38
Network characteristics……………………………………..... 38
Self-reported adjustment………………….…………...... 39 Cecilia ...... 39
Family context and circumstances of sibling’s death………… 39
Network characteristics……………………………………..... 39
Self-reported adjustment………………….…………...... 40 Comparison between participants with low levels of depressed mood 40 Contrast between high and low levels of depressed mood ...... 40
Qualitative Findings ...... 41
DISCUSSION ...... 45
Network Structure ...... 46
Perceived Social Support ...... 50
Understanding Psychological Adjustment ...... 53
Study Limitations and Implications for Research and Practice ...... 58
REFERENCES ...... 61
APPENDIX A. TABLES ...... 69
APPENDIX B. FIGURES ...... 78
APPENDIX C. PERSONAL NETWORK ANALYSIS PROTOCOL ...... 82
APPENDIX D. CENTER FOR EPIDEMIOLOGIC STUDIES DEPRESSION SCALE-
REVISED ...... 87
APPENDIX E. INVENTORY OF COMPLICATED GRIEF ...... 88
APPENDIX F. POSTTRAUMATIC GROWTH INVENTORY ...... 89
APPENDIX G. WHOQOL-BREF ...... 90
APPENDIX H. INSTITUTIONAL REVIEW BOARD (IRB) APPROVAL ...... 94 Running Head: SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 1
INTRODUCTION
Sibling relationships are characterized by a strong endurance and stability throughout adulthood, even in the face of familial change and adverse life events (White, 2001; Spitze &
Trent, 2016). Research suggests that the death of a sibling can be more disruptive than other familial losses (Hays, Gold, & Pieper, 1997), particularly in young adulthood (Smith, 2015).
Unfortunately, understanding the impact of the death of a sibling is often a “forgotten” topic in the bereavement literature (Dyregrov & Dyregrov, 2005). There are relatively few empirical studies that focus specifically on how young adults adapt and cope with the death of a brother or sister.
Research suggests that supportive relationships with other people play a significant role in limiting distress related to the death of a family member (van der Houwen, Stroebe, Stroebe,
Schut, van den Bout, & Wijngaards-de Meij, 2010; Reed, 1998). There are some studies that also suggest that social support can facilitate mourners’ personal growth as a result of coping with a loved one’s death (Tedeschi & Calhoun, 2004; Engelkemeyer, 2008). However, the majority of the studies investigating the role of social support in coping with loss have assessed individuals’ overall perceptions of support (van der Houwen, Stroebe, Stroebe, Schut, van den Bout, &
Wijngaards-de Meij, 2010; Juth, Smyth, Carey, & Lepore, 2015). A personal network approach to the study of social support allows a more nuanced understanding of young adults’ views of social exchanges with important people in their lives (Walker, Wasserman, & Wellman, 1993).
A network approach involves identifying the significant network ties for an individual, then assessing various aspects of those relationships including type of social support exchanged, perceived closeness, and frequency of contact. A network approach is particularly needed in understanding how individuals cope with the death of a sibling. Vachon and Stylianos (1988) SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 2 described bereavement as a “social network crisis.” This can be particularly true with the loss of a family member, as it disrupts the nature of relationships with other family members. The network approach provides detailed information about the composition of network ties and gives a more targeted assessment of perceived sources of support between family, friends, and other types of network ties. A network analysis can identify perceived sources of conflict among networks ties as well as support.
The present study used a personal network approach to examine the perceived social ties of young adults who have experienced the death of a sibling. The present study investigated the role of “natural” supports perceived to be available in an individual’s life to help him or her cope with the loss of a sibling. The study intended to identify the structural and functional aspects of a grieving sibling’s social network that are associated with greater psychological adjustment.
Adult Sibling Relationships
The average number of children born in the United States per family is between 1.5 and 2
(U.S. Census Bureau, 2015), which means that most people have some experience of a sibling relationship. From their review of the adult sibling literature, Greif and Woolley (2016) conclude that most sibling relationships are affectionate, supportive, and a source of consistent positive impact, which leads to higher well-being, including higher self-esteem, less loneliness, and less depression, for the siblings. In their own study of adult siblings, Greif and Woolley (2016) found that 71% of the 262 participants reported that they trust their sibling and that trust remained consistent into adulthood. In contrast, participant reports of sibling competition and jealousy dropped significantly as the siblings entered adulthood. According to Cicirelli (1995), the interpersonal closeness between siblings typically follows an hourglass shape across the lifespan; it is high in childhood, low in early adulthood, and high again in late adulthood. Despite a SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 3 decrease in contact and social exchange in early adulthood, both proximity and contact remain stable through old age, even after controlling for changes in the family life course (marriage, children, divorce, etc.) (White, 2001).
The sibling relationship is characterized by a tremendous stability. Using the National
Survey of Families and Households, Spitze and Trent (2016) analyzed various forms of support and contact for 1,096 adult siblings in order to understand the impact of life course transitions.
They found that a transition from single to partnered by a sibling leads to less frequent visits, but frequency of other forms of communication and exchange of support remained constant. The data also showed that partner dissolutions do not significantly affect sibling relationships, but becoming a parent leads to an increase in support received from the sibling. Overall, the authors concluded that sibling relationships are relatively stable in the face of life course transitions.
Sibling Bereavement
The loss of a child in the family will inevitably change how family member’s interact, due in part to the lack of presence and role of the deceased sibling, the modified birth order and gender dynamics of the surviving siblings, and the loss of a part of each parent’s sense of self
(Neely, 2013). Breen and O’Connor (2011) interviewed 21 individuals who had lost a family member in a road accident and analyzed the data using grounded theory methodology. They concluded that although the death of a loved one precipitated closer familial and social bonds in some instances, it was more common that those relationships deteriorated and collapsed. Parents may blame and/or be unable to provide typical support for the remaining siblings. Young adult siblings often live independently from the rest of the family and may have to endure their grief in isolation. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 4
Overall, research shows a pattern of sibling’s grief being difficult but the social systems surrounding siblings do not recognize or respond to the loss (Greif & Woolley, 2016). Dyregrov and Dyregrov (2005) even referred to siblings as the “forgotten griever,” in large part due to the parents receiving a bulk of the grief attention and support. Rostila, Saarela, and Kawaci (2012) conducted a national follow-up study that investigated mortality rates based on data from the
Swedish total population register and found that individuals who had lost a sibling had a higher mortality rate than those who had not lost a sibling. Using an Attachment Theory perspective,
Hays, Gold, and Pieper (1997) analyzed data on bereavement experiences from 3,173 older adults. They found that bereaved siblings had worse overall health and were significantly more functionally and cognitively impaired than bereaved friends or bereaved spouses. Another study looked at a sample of 174 bereaved young adults 2-9 years after losing their sibling to cancer.
More than half of the participants reported that they felt that they had not worked through their grief, with perceived lack of social support and shorter time since loss accounting for 21% of the variation (Sveen, Eilegård, Steineck, & Kreicbergs, 2014).
Young Adult Bereavement
The loss of a family member during young adulthood can be especially challenging due to the nature of the developmental changes that occur during this period. Specifically, young adulthood is typically associated with the development of intimate relationships as well as identity formation (Erikson, 1964). The development of identities and values during this time period sets the stage for career directions and/or decisions in intimate relationships. Involvement in the world of romantic relationships begins during adolescence but makes important progressions in young adulthood. These relationships tend to increase in duration and involve SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 5 patterns of greater meaning as well as increases in trust, intimacy, and commitment (Johnson,
Manning, Giordano, & Longmore, 2015).
There are many important factors that can influence identity and romantic relationship development during young adulthood, including mental health and social bonds. In her qualitative study of 7 young women who suffered the loss of a sibling while between the ages of
18 and 30, Sundar (2000) found that the death of a sibling during this important time can have serious implications for the surviving sibling’s family environment, psychological well-being, and social bonds. In particular, Sundar noted that the family can respond in various ways to the loss, including parents overvaluing the surviving children, silence within the family, and attempted replacement of the lost child. Sundar indicated that various emotional reactions, including confusion, guilt, anxiety, anger, loneliness, sadness, stress, and fear, may be common initially after the loss. Sadness and loneliness tend to persist. Feelings of isolation from peers is also a common experience. Sundar, however, notes that personal growth in various aspects of life is also possible in response to the loss, as the young adult may increase in awareness of the value of life or improve in sensitivity to the experiences of others (2000).
Smith (2015) examined the frequency and developmental timing of traumatic loss among
40 young Black men in Baltimore, Maryland using a modified grounded theory approach. He found that participants knew 3 homicide victims, on average, who were overwhelmingly peers.
He noted that the loss of peers through homicide was a “significant developmental turning point” and tended to disrupt the participants’ social networks.
Bereavement
Although bereavement is a common experience, it is one that is often extremely difficult to endure. A few definitions are useful in conceptualizing the loss of someone through death. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 6
Bereavement is the objective experience of having recently lost someone close through death.
Grief refers to the emotional reaction to the loss. Mourning refers to the outward expression of bereavement or grief, which can be largely dependent on time and culture (Stroebe, 2001).
Several theories exist to describe the experience of those individuals who have lost a loved one. Many studies analyze bereavement from an attachment perspective (Hays, Gold, &
Pieper, 1997; Wayment & Vierthaler, 2002). According to Bowlby (1980), attachment theory is defined by its assumption that healthy, supportive, and safe attachments in relationships play a critical role in the development of psychological, social, emotional, and behavioral health and functioning. The theory was originally applied to parent-child relationships, but was expanded to other relationships, including siblinghood (Ainsworth, 1989). Sibling relationships are considered important attachment relationships for several reasons: (1) they begin in infancy or early childhood, (2) they are constant, consistent, and close through the lifespan, (3) they typically last for decades, and (4) they can be sources of safety and security across the lifespan
(Greif & Woolley, 2016). According to Bowlby, the loss of an attachment figure can follow several different trajectories based on the nature of the attachment. A “secure” attachment leads to a grief process that is characterized by deep distress due to detachment from the deceased and a period of intense grief that is relieved by an acceptance of the reality of the loss. An “anxious- ambivalent” attachment, which is characterized by anxiety and distrust in the relationship, leads to a chronic grief reaction that does not abate over time. Alternatively, an “avoidant” attachment, characterized by indifference in the relationship, leads to a delayed or absent grief (Wayment &
Vierthaler, 2002).
One of the most famous theories of bereavement is Kübler-Ross’s five stages of grief
(Kübler-Ross, 1969). The grief stages that she conceptualized include denial, anger, bargaining, SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 7 despair, and acceptance, where an individual will go through at least two of the steps with the goal of eventually accepting that the person has died. These stages have been popularized through media and pop culture references, but Kübler-Ross was not the only theorist who postulated that there are stages to bereavement (Clayton, 1990). To move through the stages, one must conduct “grief work,” which is the process where one acknowledges or confronts the absence of the person who died while attending to the feelings and memories of the deceased without suppressing them (Fraley & Shaver, 1999). The “grief work hypothesis” argues that one must confront the experience of bereavement in order to work through the loss and avoid adverse health consequences (Stroebe, 1992).
The dual process model of bereavement proposed by Schut and Stroebe (1999) is an adaptation of the “grief work hypothesis.” The dual process model expands on this notion of grief work, defining two different forms of coping. The first one is referred to as loss-oriented coping, which is similar to grief work. It involves a focus on aspects of the lost relationship, yearning for the deceased, and reminiscing in both the painful and joyful memories. The second form of coping is recovery-oriented, whereby the bereaved individual focuses on adjusting to new roles in life, dealing with needs created by the loss, and developing a new identity in the context of the loss (Schut & Stroebe, 1999). The development of a new identity may be of particular importance to young adults who are likely already amidst a crucial period in identity formation. The theory emphasizes an oscillation between these two types of coping. At times, the individual focuses on the loss, and at others, he or she focuses on the adjustment and new life.
The authors theorized that this balance between actively confronting the loss and taking a break from the loss would facilitate greater adjustment than a constant focus on loss. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 8
Overall, research has found a relationship between experiences of bereavement and a variety of positive and negative outcomes. Stroebe, Stroebe, and Schut (2007) reviewed the literature regarding the various health outcomes of bereavement and found that most of the studies investigated either bereaved spouses or parents who had lost a child. They concluded that bereaved individuals have an excess risk of depression, PTSD, complicated grief, poor physical health, and even death, after controlling for socioeconomic and lifestyle factors.
In particular, experiences of depression are common in bereaved populations; depression is often regarded as one of the stages of grief (Kübler-Ross, 1969; Clayton, 1990). Research points to an increase in depressive symptoms and clinically relevant levels of depression in bereaved populations. Hensley’s (2006) review of the literature on bereavement-related depression found that 40% of the bereaved meet criteria for depression one month following the death of a loved one. Even at one year after the death, bereavement-related depression had a prevalence of 15%. At two years after the death, 7% still show symptoms of major depression.
Zisook and Kendler (2007) reviewed studies of bereavement-related depression (BRD) to investigate whether it is different than standard (non-bereavement-related) major depression
(SMD). Overall, the studies they found indicated that BRD, similar to SMD, is more common in younger than older adults, predicated by poor health and limited social support, followed by recurrent major depressive episodes (MDEs), and associated with a responsivity to antidepressant medication. The research points to BRD being similar to SMD, which is characterized by a depressed mood or a loss of interest or pleasure, as well as impaired social, occupational, and/or educational function (American Psychiatric Association, 2013). These findings also point to the likelihood that young adults may be more susceptible to experiences of depression following a loss than older adults. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 9
Complicated, or prolonged, grief is another related, but distinct, experience for those coping with the loss of a loved one. Complicated grief involves significant functional impairment related to prolonged grief symptoms, including a sense of disbelief about the death, anger and bitterness, yearning and longing for the deceased, and preoccupation with the deceased (Shear,
Frank, Houck, & Reynolds, 2005). In her review of the prevalence and treatments for complicated grief, Hensley (2006) found that studies indicated between 10% and 20% of their samples experienced complicated grief, which could persist for years after the loss. A 2013 study used self-report measures to learn about the experiences of depression and complicated grief among young adults who had lost a sibling or close friend in the past three years. The authors found that 19% of the young adults met criteria for complicated grief while 37% had mild to severe depression. Those who lost a sibling were significantly more likely to meet criteria for complicated grief and reported significantly more symptoms of complicated grief than those who lost a close friend. The researchers concluded that complicated grief and depression are common in bereaved young adults and that sibling loss is particularly distressing because of the higher levels of depth in the relationship (Herberman Mash, Fullerton, & Ursano, 2013). Comorbidity of complicated grief with psychiatric disorders is prevalent and can be quite severe (Hensley,
2006). Mitchell, Kim, Prigerson, and Mortimer (2005) conducted a study where 66 adults self- reported on measures of depression and complicated grief within one month of losing a loved one by suicide. Complicated grief was associated with a nearly ten times greater likelihood of suicidal ideation after controlling for depression, indicating that symptomatic experiences of complicated grief provide a unique contribution to more severe outcomes of losing a loved one.
Research on bereavement has recently experienced a paradigm shift whereby more studies are investigating the positive outcomes such as opportunities for personal growth of SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 10 individuals who are coping with the loss of a loved one, rather than focusing exclusively on psychopathology and impaired functioning (Rothaupt & Becker, 2007). Many individuals are resilient through their grief and experience posttraumatic growth (PTG). Posttraumatic growth is one of the most common terms used for understanding growth that individuals can experience as a result of losing a loved one through death. Tedeschi and Calhoun (2004) defined posttraumatic growth as a positive change that occurs as a result of struggling with a challenging life crisis.
They also defined five areas that reflect possible personal enhancements. An enhancement in self-concept, the first of the five, reflects experiencing a newfound sense of strength and aptitude for overcoming adversity. Survivors also can experience positive changes in relationships, which reflect, but are not limited to, showing more empathy and optimism in interpersonal relationships. The third area, recognition of new possibilities, suggests that survivors reflect positivity when assigned new roles or responsibilities that they may not have had an opportunity to pursue in the past. The fourth area of growth is obtaining a stronger appreciation of life. The final area of growth is a redefined existential understanding, which highlights the newfound idea that life is finite and, therefore, life should be lived to the fullest (Calhoun, Tedeschi, Cann, &
Hanks, 2010). John Palladino (2012) conducted qualitative interviews and focus groups with 80 bereaved spouses and found evidence of posttraumatic growth in some, but not all members of the bereaved in his sample. Based on his review of the themes from the transcripts, he concluded that the transformational model developed by Tedeschi and Calhoun for bereavement and PTG was the most consistent with the findings from his study.
Sean Engelkemeyer (2008) used self-report measures on 114 participants coping with the loss of an immediate family member. He also found evidence in support of Tedeschi and
Calhoun’s model of PTG, in that emotional and advice-giving social support had positive SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 11 associations with participant reports of PTG. He speculated that other types of social support (i.e. tangible support, companionship support) may also facilitate the growth process.
Social Support
Many of the studies discussed previously have touched on the importance of social support for individuals coping with the loss of a loved one. Social support refers to “a social network’s provision of psychological and material resources intended to benefit an individual’s ability to cope with stress” (Cohen, 2004, p. 676). Social support can be valuable to individuals in a variety of ways. Most studies define four main types of social support: emotional, tangible, instructional, and appraisal (Walker, Wasserman, & Wellman, 1993). Others imply companionship support as well (Bottomley, Burke, & Neimeyer, 2015). Emotional support encompasses support that is self-esteem enhancing, such as showing empathy or listening carefully. Tangible support is the provision of material goods or services. Instructional support involves giving advice or ideas. Appraisal support is providing feedback on one’s views or behavior, and companionship support involves spending time with the individual or participating in a shared activity.
The stress buffering theory is often used to explain the role of social support in studies of individuals who have experienced a significant stressor. In this model, social support allows for the provision of psychological and material resources for the individual enduring the stressor, i.e. losing a loved one. The belief that supportive network members will provide necessary support during times of need leads to a reappraisal of the situation, an increase in one’s perceived ability to cope with demands, and a decrease in effective stress (Cohen, 2004). Depending on the type of social support received, support can alleviate stress by providing a solution, by reducing the perceived importance of the problem, or by providing a distraction from the problem. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 12
The Deficit Model (Stroebe, Stroebe, Abakoumkin, & Schut, 1996) was developed as an adaptation of the stress buffering theory for individuals who have lost a loved one. The model was originally developed to describe the experience of losing a partner and the deficits in areas for which the grieving individual used to count on the partner. The Deficit Model postulates that social support will alleviate the stress of bereavement, but only to the extent that it helps replace the deficits created by the loss of the partner. Similarly, for other relationships, the model suggests that bereaved individuals will need social support that matches the type of social support that was typically provided by the lost loved one.
Vachon and Stylianos (1988) described bereavement as a social network crisis and argued, “An inadequate social network is associated with high distress over the course of bereavement. Interventions aimed at increasing social support can decrease the distress of bereavement” (p. 175). Bereavement support groups are the most common intervention used by individuals coping with the death of a loved one, and are fundamentally a social support provision. In a review of the grief support group literature, Steiner (2006) found that support groups can help bereaved individuals find a place to: talk about death, receive emotional support, identify with others, legitimate feelings, find transitional support when other supports wane, and find reciprocal relationships. She conducted interviews and focus groups on 20 individuals who had experienced the loss of a loved one and 12 professionals who counseled bereaved individuals. Participants repeatedly cited that the most helpful support was someone who could listen and relate, and that person could be either an informal or formal support. Participants also found companionship support, like spending time with children, friends, or other family members, to be beneficial (Steiner, 2006). One question that precipitates from these findings is whether the bereaved are finding adequate social support from sources other than support groups. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 13
Jordan and McNemany (2004) did a review of the literature on interventions for individuals who lost a loved one to suicide and concluded “... very little is known about … what types of formal and informal assistance survivors receive from professional caregivers, family, friends, and others in their social network” (p. 345).
Furthermore, Reed (1998) explains that, “Social support from family and close friends plays a major and consistent role in alleviating separation anxiety, feelings of rejection, and depression among the suddenly bereaved” (p. 295). More research is needed to understand how these different types of support relate to helping individuals cope with the loss of a loved one.
Bottomley, Burke, & Neimeyer (2015) used self-report measures to investigate the role of social support in determining outcomes of bereavement in 47 African-Americans who lost a loved one through homicide. They found that a griever’s level of satisfaction with tangible support was predictive of lower levels of depression, anxiety, and PTSD six months later, while lower need for physical assistance predicted lower complicated grief. Juth, Smyth, Carey, and Lepore (2015) investigated whether social constraint (i.e., having limited opportunities to disclose thoughts and feelings in a supportive context) is associated with poor adjustment in bereavement. In their study of 238 bereaved adults in a community sample, the authors found that higher social constraint was associated with higher depressive symptoms and greater difficulty in adjustment.
Some studies, in contrast, found evidence against certain types of social support. Stroebe,
Stroebe, Schut, Zech, and van den Bout (2002) conducted a study of 128 bereaved people younger than the age of 66 whose spouse had died suddenly. In a two-year study, no evidence was found that supported the belief that emotional disclosure facilitated psychological adjustment after a loss. Few studies, however, even differentiate between different types of social support. Most studies assessed social support using a quantitative scale or inventory, which SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 14 usually involves dichotomous questions or questions on a Likert scale (Reif, Patton, & Gold,
1995; Wagner & Calhoun, 1992; Reed, 1998; van der Houwen, Stroebe, Stroebe, Schut, van den
Bout, & Wijngaards-de Meij, 2010; Juth, Smyth, Carey, & Lepore, 2015; Stroebe, Stroebe,
Abakoumkin, & Schut, 1996). While these methods are efficient, they do not uncover the details about the social support network as a whole.
Using a network approach, researchers can analyze the various types of social support an individual receives from the different members of his or her social network (Walker,
Wasserman, & Wellman, 1993). Social support, as a construct, is interactional and interdependent and, therefore, lends itself to being studied through network analysis. Personal network analyses involve the ego (the participant) listing the network ties (people with whom they interact) and defining several aspects about that relationship. The average North American has about 20 significant ties, which tend to be the focus of network analyses (Walker,
Wasserman, & Wellman, 1993). The total number of significant ties, as well as the total number or proportion of ties for an ascribed role (family, friend, etc.) is referred to as the structure of the network. The part of the analysis that focuses on social exchange and the functional role of the network ties is called the function of the network. Researchers also investigate the characteristics of the dyadic relationship, such as proximity, emotional closeness, and frequency of contact, which are referred to as the content of the network. By analyzing these three aspects of social networks (structure, function, and content), a great deal can be learned about the how the social support network assists individuals in coping with the loss of a loved one.
Several studies have used personal network analysis to assess social support networks.
Theo van Tilburg (1998) used a network analysis during a four-year longitudinal study that examined the change in social support networks for 2,903 older adults. Although his population SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 15 did not strictly include those who had lost a loved one, the methods provide a strong example of how a network analysis can be used to understand more details about social support in adult populations. His analysis focused mostly on the structure of the network in addition to the instrumental and emotional support received and given in participant relationships. The network approach allowed him to conclude that older adults experience a stable total network size, although close relative network size typically increased and friend network size typically decreased.
A few studies to date have looked at social support networks in bereavement. For example, Burke, Neimeyer, and McDevitt-Murphy (2010) used the Arizona Social Support
Interview Schedule to assess social support networks of 54 African-American adults who lost a loved one through homicide. The network analysis allowed them to analyze functional variables of the network such as support network size and proportion of negative supports, as well as structural variables like proportion of family supporters. This network approach led them to find that network size was not correlated with experience of grief-related support, meaning that having a large support network does not imply that an individual will get all the support he or she needs in bereavement. The authors found that the percentage of negative relationships in an individual’s network was positively correlated with self-report scores of depression, complicated grief, and PTSD, while the total quantity of network members was not correlated with any of the psychological indices. The authors did not find a relationship between the proportion of family supports in the network and any of the outcome variables.
Farberow, Gallagher-Thompson, Gilewski, and Thompson (1992) employed a network approach to assess social support for 110 spouses bereaved through suicide, 199 spouses bereaved through natural deaths, and 163 non-bereaved controls. They assessed the participants SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 16 four times over a three-year period after the loss. The method allowed them to contrast the structure and function of the social support network, in that those bereaved by natural deaths did not have bigger support networks than those bereaved by suicides, but they did receive more emotional support. In addition, individuals who experienced a greater amount of emotional support showed greater improvement in grief and depression compared to individuals who experienced less emotional support. Using network analyses, researchers are able to gain a clearer picture of the aspects of social support networks that lead to more positive outcomes in bereavement.
Summary
Siblinghood is defined by a strong bond between brothers and sisters that typically persists through the lifespan (Spitze & Trent, 2016). In a majority of circumstances, siblings consistently provide support and affection, and limit loneliness and depression for one another
(Greif & Woolley, 2016). Individuals who are bereaved of a sibling often have a difficult time adapting to the loss and are at risk for psychological difficulties (Hays, Gold, & Pieper, 1997), in particular for young adults who are already undergoing various life transitions (Smith, 2015).
Much of the research in the bereavement field focuses on parents who have lost a child because it is expected that they would exhibit the most intense grief reactions. Consequently, siblings may experience a loss of both the support of the deceased sibling and their parents. Overall, the bereavement literature suggests that bereaved individuals have an elevated risk of depression, complicated grief, and even death (Stroebe, Stroebe, & Schut, 2007). Paradoxically, research also suggests the possibility of resiliency for individuals coping with the loss of a loved one, leading to personal growth. (Palladino, 2012; Tedeschi & Calhoun, 2004). SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 17
Scholars highlight the role of supportive relationships with others in helping adults cope
with the loss of a loved one (Reed, 1998). Studies specifically endorsed tangible support (e.g.,
providing money or physical assistance) and emotional support (e.g., listening attentively) as
most beneficial in adjusting to the loss (Farberow, Gallagher-Thompson, Gilewski, &
Thompson, 1992; Bottomley, Burke, & Neimeyer, 2015; Juth, Smyth, Carey, & Lepore, 2015).
The Deficit Model (Stroebe, Stroebe, Abakoumkin, & Schut, 1996) is used to explain the
importance of social support for grieving individuals. In this model, supportive relationships will
help buffer the stresses of bereavement if the support provided helps fill the deficits left by the
lost loved one. In the case of bereaved siblings, this gap in perceived support would most likely
include emotional support and companionship support (e.g., doing a shared activity).
Network analysis offers an opportunity to understand young adults’ perceptions of the
structure and supportiveness of their social network ties (Walker, Wasserman, & Wellman,
1993). Previous studies that have used a network approach in understanding the supportive ties
of adults coping with the loss of a loved one have found various relationships between perceived
structural and functional network variables and psychological adjustment. In particular, the
perceived number of network members who provided emotional support was found to have a
negative relationship with reports of depression (Farberow, Gallagher-Thompson, Gilewski, &
Thompson, 1992). In addition, the perceived number of negative relationships in one’s network
was positively correlated with depression, complicated grief, and PTSD, while the total quantity
of network members was not associated with any of the mental health indices (Burke, Neimeyer,
& McDevitt-Murphy, 2010). A network approach has the potential to provide a nuanced examination of the role of social relationships for adults coping with the death of a sibling. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 18
Present Study
The present research assessed the structure, content, and function of the personal networks reported by young adults who have experienced the death of a brother or sister.
Specifically, the present study investigated relationships between aspects of their perceived
social networks and their reports of psychological adjustment related to the loss of a sibling.
Functional network variables (i.e., variables highlighting the social exchange between
network ties) are most frequently implicated as significant to bereavement in previous research.
As a result, the present research described the role of perceived functional network composition
(proportion of participants’ networks providing various types of social support, proportion of participants’ networks that made grieving more difficult) in understanding siblings’ reports of adjustment (depression, complicated grief, posttraumatic growth, quality of life). Based on previous studies, it was expected that more experiences of tangible support, emotional support, and companionship support, respectively, would be associated with more positive adjustment to the loss of a sibling. Further, it was expected that more experiences with individuals who make grief more difficult in any way, or are a negative support, would be associated with more difficulty in adjustment.
Network studies have also shown that structural aspects of social support networks play a role in adjustment for those who have lost a loved one. In terms of network structure, the study described the role of perceived network composition (total network size, proportion of family and friends in the participants’ network, proportion of network members with a personal relationship with the sibling) in dealing with the loss of a brother or sister. Due to the possibility of other family members experiencing similarly strong grief reactions as the sibling, it was expected that they would be less effective at providing support. Therefore, it was expected that SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 19 experiencing more support from those who had a personal relationship with the deceased sibling would be associated with more difficulty in coping with the loss. Further, based on previous research, it was expected that the total number of network ties would not be associated with adjustment to the loss. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 20
METHODS
Sample
A total of 19 young adults who had lost a sibling participated in the present study.
Demographic information about the participants is summarized in Table 1. The 19 young adults
(16 women, 3 men) were primarily Caucasian (58%) and African American (26%). The young
adult sample was an average age of 23.5 years old (SD = 3.59) and ranged in age from 18 to 30 years. Overall, these participants were never married (68%), students (74%), and employed
(68%), of which most worked part-time (77%). The sample of young adults reported an average of 3.4 siblings (SD = 2.5), with a range from 1 to 8 siblings. Average annual family income was fairly evenly distributed for the young adults (37% less than $30,000; 42% between $30,000 and
$90,000; 21% more than $90,000). According to self-report, nine participants (47%) had seen a
mental health professional for various issues, with depression (55%) and anxiety (44%) being the
most common. Only 22% of participants who reported a history of mental health services
indicated that they were currently in treatment.
Demographic information about the siblings is found in Table 2. The deceased siblings
(15 brothers, 4 sisters) were an average of 21.2 years old (SD = 5.1; a range of 9 to 30). Siblings
were either full biological siblings (74%) or half-siblings. Participants largely indicated that the
loss of their sibling was unexpected (84%), although several noted during the interview that the
loss was a mix between expected and unexpected. Ten young adults (53%) reported that they lost
their sibling through suicide or murder, four (21%) through an accident, and five (26%) through
an illness. Participants reported an average of 32.3 months (SD = 18.3; range of 12 to 68) since
the loss. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 21
Measures
Social Network Interview Protocol
This semi-structured interview protocol (Appendix C) was adapted from Stein, Aguirre,
and Hunt (2013) to assess adults’ perceptions of their personal network ties. The interview involves a personal network analysis, which is a type of social network analysis that only requires the perspective of one member of a network rather than every member (Walker,
Wasserman, & Wellman, 1993). Participants were asked to delineate their social network ties
based on an importance criteria (“I would like for us to come up with a list of people who have played a big part in helping you deal with the passing of your brother/sister.”).
Participants were then asked questions to understand more about the structure, content, and function of their network. Structure is the total size of the network and the proportion of the various roles. Content refers to the dimensions of a single, dyadic relationship, and function describes the role of each member to the participant. For each network member listed by the
participant, the interviewer asked a number of questions about the participant’s views of his or
her relationships that includes: 1) identifying social role (family, friend, significant other,
coworker, professional, other) of each network member (structure), 2) identifying network
members who provide the participant with social support (structure), 3) assessing the types of social support provided: emotional, tangible, instructional, or companionship (function), 4) assessing whether the network member had a personal relationship with the deceased sibling
(structure), 5) assessing whether the participant reciprocated support to the network tie
(function), 6) assessing whether the network member did anything that made grieving more
difficult in any way (function), and 7) assessing the nature of the dyadic relationship between SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 22
the network member and the participant that includes perceived interpersonal closeness of the relationship and perceived frequency of contact (content).
In addition, the interview included basic demographic questions designed to gain an
understanding of participants’ backgrounds, including age, gender, ethnicity, religion,
employment, educational background, income, relationship status, mental health history,
circumstances of the sibling’s death, time since loss, relationship with the deceased sibling
(frequency of contact and closeness), sibling age at death, and sibling gender.
Mental health indices
Center for Epidemiologic Studies Scale for Depression- Revised (CESD-R)
The CESD-R is an updated version of the CES-D (Eaton, Smith, Ybarra, Muntaner, &
Tien, 2004). The CESD-R more accurately reflects criteria for depression than the CES-D. It is a 20–item self-report scale designed to measure depressive symptomatology in the general
population. See Appendix D for the measure. Response options include “Not at all or less than
one day” (0 points), “1-2 days last week” (1 point), “3-4 days last week” (2 points), “5-7 days last week” (3 points), and “Nearly every day for 2 weeks.” (3 points). Scores are calculated by summing the points from each of the 20 questions and therefore, the scores range from 0 to 60.
A score equal to or above 16 indicates a person at risk for clinical depression (Eaton, Smith,
Ybarra, Muntaner, & Tien, 2004). The CESD-R was found to have very high internal consistency (Cronbach’s α = 0.92) and theoretically consistent convergent and divergent validity with anxiety (r = 0.73, p < 0.01), schizotypy (r = 0.43, p < 0.01), and positive (r = -0.26, p <
0.01) and negative affect (r = 0.58, p < 0.01) (Van Dam & Earleywine, 2011). In the present
study, the internal consistency for the measure was excellent (α = 0.91). SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 23
Inventory of Complicated Grief (ICG)
The ICG (Appendix E) is a 19-item self-report scale designed to assess the participants’
symptom severity of prolonged grief. The ICG asks the participants to report the frequency with
which they experience several emotional, cognitive, and behavioral states (Prigerson et al.,
1995). Response options include: 0 = never; 1 = rarely; 2 = sometimes; 3 = often; 4 = always.
The values for each response are summed to produce a total score.
The ICG is a well-validated measure, with high internal consistency (alpha =. 92-.94;
test-retest reliability = .80). The ICG had relatively high concurrent validity with the Beck
Depression Inventory (BDI ) total score (r = 0.67, p < 0.001 ) as well as the total score of another grief inventory, the Texas Revised Inventory of Grief (TRIG ) (r = 0.87, p < 0.001). When using the ICG to distinguish complicated grievers from uncomplicated grievers, significant differences were found between the groups on important quality of life variables, including bodily pain (p =
0.02), mental health (p < 0.01), physical health (p < 0.01), and social functioning (p = 0.04).
(Prigerson et al., 1995). In the present study, the internal consistency for the measure was very
good (α = 0.88 ).
Personal growth and quality of life
Posttraumatic Growth Inventory (PTGI)
The PTGI (Appendix F) is a 21-item inventory designed to assess the positive change
that may occur in an individual after experiencing a traumatic event. The PTGI is one of the
most common measures of posttraumatic growth for individuals experiencing bereavement.
This measure was designed to examine the positive change that may occur in an individual after
experiencing a traumatic event (Tedeschi & Calhoun, 1996). The inventory highlights five different dimensions of personal growth: relating to others, new possibilities, personal strength, spiritual change, and appreciation of life. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 24
Responses range from “I did not experience this change as a result of my crisis” (scored
0), to “I experienced this change to a very great degree as a result of my crisis” (scored 5). There
are intermediate scores if participants experience change to a very small degree (1), a small
degree (2), a moderate degree (3), and a great degree (4). The scores for each response are summed to obtain a total score. The internal consistency is very high, yielding a Cronbach's α of
0.90. In addition, the test-retest reliability over a two-week period was 0.71, further
demonstrating the strong psychometric properties of this scale (Tedeschi & Calhoun, 1996). In
the present study, the internal consistency for the measure was excellent (α = 0.92 ).
World Health Organization Quality of Life assessment- Abbreviated Version
(WHOQOL-BREF)
The WHOQOL-BREF (Appendix G) is a 26-item measure to analyze an individual’s
current quality of life (WHOQOL Group, 1998). The WHOQOL-BREF was designed as a shorter version of the 100-item WHO Quality of Life assessment after factor analysis revealed
that 4 domains fit the data better than the original 6 domains in the WHOQOL. The WHOQOL-
BREF includes measures of mortality and morbidity, the impact of disease and impairment on
daily activities and behavior, perceived health measures, and disability/functional status
measures. It consists of 4 domains: physical health, psychological, social relationships, and
environment.
Internal validity using Cronbach's α was acceptable for 3 domains (physical health 0.82,
psychological 0.81, and environment 0.80) and marginal for social relationships (0.68). The
WHOQOL-BREF was found to have significant discriminant validity, with all domains able to
distinguish sick from well samples with p < 0.01 (WHOQOL Group, 1998). In the present study,
the internal consistencies for the subscales were varied (Physical health, α = 0.85; Psychological,
α = 0.76; Social Relationships, α = 0.40; Environment, α = 0.77). SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 25
General bereavement questions
The participants were asked several qualitative questions about their overall experience
of the bereavement process. Questions included: “How do you think you are handling the loss of your sibling?”; “What did you think of the circumstances of how you lost your sibling? Tell me more about it. Was it expected/unexpected? Avoidable/unavoidable?”; “How do you see your family coping with the loss of your sibling?”; “What was it like getting support for you? What
was your overall experience?”; “What are some things besides support from people that you
used to help you deal with losing your sibling? People in the past have used books and online
resources.”; “What were some of the most common difficulties you encountered as a result of
your sibling’s passing?”; and “What were some positive things, if any, that came about as a
result of your sibling’s passing?”
Procedure
Eligible individuals were invited to participate in the study following approval from the
Institutional Review Board of a Midwestern University where the study was conducted. To be eligible to participate, individuals had to be between 18 and 30 years of age and have experienced the death of a sibling between 1 and 5 years previously. Participants were recruited
from a Midwestern University through calls for participation placed in a variety of venues,
including emails, the daily campus update, and flyers in public areas. Individuals who expressed
interest were contacted via phone to discuss the research in further detail and complete a
telephone screening survey to determine eligibility. A total of 61 adults completed the telephone
screening and 25 individuals (41%) met eligibility requirements. A total of 76% (19/25) of young adults who met the inclusion criteria participated in the research. Interviews were
conducted by a doctoral student in clinical psychology at locations convenient to the participant
or over Webex. Webex is a secure Cisco Systems communications and collaborations software SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 26
technology. Webex provides a secure, password-protected communication channel used for
collaborations, interviews, and video conferencing. Interviews generally lasted for about an hour
and each participant received a $10 gift card as a token of appreciation for their participation.
The Social Network Interview Protocol and general bereavement questions were audio
recorded, and network analysis notes were taken for each interview. Upon completion, network
analysis notes were coded, double checked for accuracy, and inputted into a software package
(SPSS) for data analysis. Survey measures were scored, double checked for accuracy, and
entered in SPSS for data analysis, along with demographic information. Answers to the
qualitative questions were transcribed verbatim.
Analysis
Quantitative analysis
Demographic characteristics for the sample included participants’ age, gender, ethnic
background, student status, employment, religious affiliation, family annual income, mental
health history, participants’ relationship status, and number of siblings. Information collected
about the deceased sibling included circumstances of the sibling’s death, expectedness of the
death, time since loss, contact and closeness with the sibling, and the age and gender of the
deceased sibling.
Major structural network variables were calculated for each participant: total number of
network ties, proportion of network ties with relationship to the deceased, and proportion of network ties who were family. Functional variables included proportion of network ties providing each type of social support, proportion of reciprocal network ties, and proportion of negative network ties. Content variables included average contact with each type of social
support, average contact with a role category (family or friend), average closeness with negative
supports, average closeness and contact with reciprocal network ties, average closeness of SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 27
network ties with a personal relationship to the deceased, and average closeness of network ties without a personal relationship to the deceased.
Case analysis
The present study employed a case analysis technique in order to focus on several
participants in more detail. A case study involves a descriptive and exploratory analysis of a
single individual, group or event to explore the causes of underlying principles. The current
investigation focused on the two participants with the highest and the two with the lowest scores
on the CESD-R to gain a more thorough understanding of self-reported experiences of
depression. The analysis was intended with the hope of developing hypotheses with regard to
which network characteristics might play a role in young adults’ experiences of depression.
Qualitative analysis
The present study also utilized a qualitative content analysis, as described by Miles,
Huberman, and Saldaña (2014). Content analysis was used to analyze responses for each of the seven open-ended general bereavement questions. Participant utterances were grouped into
themes for each question. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 28
RESULTS
Perceived Network Characteristics
Structural network variables
Descriptive characteristics for the structural network variables are summarized in Table
3. With regards to structural network variables, participants reported 12.21 network ties on
average (SD = 7.08; range of 3 to 27), consisting mostly of family (M = 6.74; SD = 3.68; range of 2 to 16) and friends (M = 3.79; SD = 3.29; range of 0 to 13). Networks reported by
participants consisted of a sizable percentage of network members who had their own
relationship with the lost sibling (M = 58% of total network size; SD = 14%; range of 33% to
90% of total network size).
Results of Pearson two-tailed correlations indicated no significant associations between
structural network variables and age, income, number of siblings, sibling age, sibling contact, or time since loss. One-way ANOVAs did not reveal any significant differences in structural network variables as a function of gender, religion, ethnicity, current relationship status, student
status, history of mental health treatment, listing a professional, sibling gender, circumstances of
death, or expectedness of death. There was a significant positive correlation between sibling
closeness and proportion of network ties with a relationship with the sibling (r = 0.61, p < 0.01),
such that participants with a closer relationship with their lost sibling generally reported higher
proportions of network members who knew the sibling. Proportion of network ties with a
relationship with the sibling also differed significantly by employment (F = 4.68, p = 0.04), such
that participants who were employed generally reported a higher proportion of their network
knows the deceased sibling. Proportion of the support network that is family differed
significantly by listing a significant other network tie at the time of loss (F = 7.53, p = 0.01), SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 29
such that those who listed a significant other in their network generally reported higher
proportions of family members in their network.
Results of Pearson’s correlations between adjustment variables and structural network
variables are found in Table 4. Results suggest no significant correlations between total network
size and participants’ scores on any of the adjustment variables. In addition, there were no
significant correlations between family proportion of network and scores on any of the
adjustment variables. Proportion of the network ties with a relationship with the sibling was positively correlated with participants’ scores on all four subscales of the WHOQOL-BREF
(Physical Health, r = 0.62, p < 0.01; Psychological, r = 0.54, p = 0.02; Social Relationships, r =
0.50, p = 0.03; Environment, r = 0.54, p = 0.02), such that participants who had a larger
proportion of network members who knew the sibling generally reported better quality of life.
Functional network variables
With regards to functional network variables (see Table 5), participants reported an
average of 9.79 emotional support network ties (SD = 5.81; range of 3 to 22), an average of 5.16
tangible support network ties (SD = 4.26; range of 0 to 18), an average of 5.37 instructional
network ties (SD = 3.32; a range of 0 to 12), and an average of 6.84 companionship network ties
(SD = 4.09; range of 2 to 15). In addition, participants reported an average of 2.68 negative
network ties (SD = 3.46; a range of 0 to 16) and an average of 4.68 reciprocal network ties (SD =
3.32; a range of 1 to 14).
Pearson two-tailed correlation analysis indicated no significant correlations between
functional variables and income, sibling age, sibling closeness, sibling contact, or time since
loss. One-way ANOVAs did not reveal any significant differences in functional network
variables as a function of employment, ethnicity, current relationship status, student status,
history of mental health treatment, sibling gender, listing a professional as a network tie, listing a SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 30
significant other as a network tie at the time of loss, circumstances of death, or expectedness of death. There was a significant negative correlation between age and proportion of the network
providing emotional support (r = -0.55, p = 0.02), such that younger participants generally
reported having a larger proportion of their network that provided emotional support. There was
a significant negative correlation between number of siblings and proportion of the network
providing companionship support (r = -0.66, p < 0.01), such that participants with more siblings
generally reported having a smaller proportion of their network that provided companionship
support. Proportion of the network providing tangible support differed significantly by religion
(F = 0.51, p = 0.03), such that individuals identifying as “No religious affiliation” generally
reported as having a larger proportion of their network that provided tangible support.
Results of Pearson’s correlations between adjustment variables and functional network
variables are found in Table 6. Interestingly, there was a significant positive correlation between
proportion of network providing instructional support and participants’ scores on the PTGI (r =
0.47, p = 0.04), such that young adults who reported larger proportions of their network
providing advice or guidance generally reported more experiences of posttraumatic growth.
Contrary to hypotheses, there were no significant correlations between emotional network
proportion, tangible network proportion, nor companionship network proportion with
participants’ scores on any of the adjustment variables. Proportion of the network that
participants’ reported provided conflictual or negative support was significantly negatively
correlated with three of the subscales of the WHOQOL-BREF (Physical health, r = -0.48, p =
0.04; Psychological, r = -0.62, p < 0.01; Social relationships, r = -0.46, p = 0.05). These
correlations suggest that participants whose networks were more saturated with negative
supports generally reported lower physical health, psychological, and social quality of life. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 31
Relationship content variables
Descriptive characteristics for the relationship content variables are found in Table 7. On
average, participants indicated that their network ties were “closer than most relationships” they
have had with others (M = 3.76; SD = 0.44; range of 2.54 to 4.33). The young adults reported
their closeness with negative network ties was “about as close as most relationships” on average
(M = 2.83; SD = 1.09; range of 1.33 to 5). Participants indicated that network ties with whom support was reciprocal were “closer than most relationships” (M = 3.98; SD = 0.61; range of 2.5 to 5) and participants were in contact with these members “weekly” on average (M = 4.19; SD =
0.56; range of 3 to 5). Closeness with both network ties that had a relationship with the sibling
(M = 3.62; SD = 0.62; range of 2.29 to 5) and network ties that did not have a relationship with
the sibling (M = 3.80; SD = 0.78; range of 2.36 to 5) were “closer than MOST relationships” on
average. Participants reported contact with their family (M = 3.91; SD = 0.55; range of 3 to 5) and friends (M = 4.07; SD = 0.76; range of 3 to 5) as “weekly.” Contact with all types of social support network ties was about “weekly” on average (Emotional: M = 4.09, SD = 0.43, range of
3.43 to 5; Tangible: M = 4.23, SD = 0.51, range of 3.25 to 5; Instructional: M = 4.24, SD = 0.41,
range of 3.5 to 5; Companionship: M = 4.43, SD = 0.53, range of 3.7 to 5).
Content network variables were assessed using Pearson two-tailed correlation and there
were no significant correlations with age, sibling closeness, or sibling contact. One-way
ANOVAs did not reveal any significant differences in content network variables as a function of
gender, religion, employment, current relationship status, student status, history of mental health treatment, sibling gender, circumstances of death, or expectedness of death.
There was a significant negative correlation between income and average closeness with
network members (r = -0.54, p = 0.02), such that participants with higher incomes generally SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 32
reported lower average closeness with their network members. There was a significant positive correlation between time since loss and average contact with reciprocal network members (r =
0.57, p = 0.01), such that participants with a longer time since they lost their sibling generally reported higher average contact with network members with whom support was reciprocal.
There was a significant positive correlation between sibling age and average contact with family network members (r = 0.53, p = 0.02), such that participants who lost older siblings generally reported higher average contact with family members in their network. There was a significant positive correlation between number of siblings and average contact with network members providing companionship support (r = 0.57, p = 0.01), such that participants with more siblings generally reported higher average contact with their network members who provided companionship support.
Average closeness with negative network members (F = 6.72, p = 0.02) differed significantly by ethnicity, such that people of color generally reported lower average closeness with network members who made grieving more difficult. Average closeness with outgroup network members (F = 7.49, p = 0.01) differed significantly by ethnicity, such that people of color generally reported lower average closeness with network members who did not know their sibling. Average closeness with the entire network (F = 5.48, p = 0.03) differed significantly by listing a professional as a network tie, such that participants who listed a professional contact generally reported lower average closeness with network members.
Results of Pearson’s correlations between adjustment variables and content network variables are found in Table 8. There was a significant positive correlation between average contact with family network members and participants’ scores on the Psychological subscale of the WHOQOL-BREF (r = 0.50, p = 0.03), such that participants who reported higher average SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 33
contact with family members generally reported higher psychological quality of life. There was a
significant positive correlation between average closeness with negative network members and participants’ scores on the Physical Health subscale of the WHOQOL-BREF (r = 0.50, p = 0.04),
such that participants who reported higher average closeness with negative network members
generally reported greater physical health quality of life. There was a significant positive
correlation between average closeness with network members who knew the lost sibling and
participants’ scores on the Psychological subscale of the WHOQOL-BREF (r = 0.52, p = 0.02), such that participants who reported higher average closeness with network members who knew
the sibling generally reported higher psychological quality of life.
Adjustment variables
Descriptive characteristics for the adjustment variables are found in Table 9. Six young adults (32%) reported clinically significant levels of depression (16 or higher), while four young
adults (21%) reported significant levels of complicated grief (26 or higher). Pearson two-tailed
correlation analysis indicated that there were no significant correlations between adjustment
variables and age, income, number of siblings, sibling age, sibling contact, sibling closeness, or
time since loss. One-way ANOVAs did not reveal any significant differences in adjustment variables as a function of gender, religion, student status, ethnicity, current relationship status,
employment, history of mental health treatment, circumstances of the death, expectedness of the death, or having a significant other at the time of the loss.
Participants’ scores on the CESD-R (F = 5.16, p = 0.04) differed significantly by sibling
gender, such that participants who lost a sister generally reported more experiences with
depression. Participant scores on the PTGI (F = 5.31, p = 0.03) differed significantly by sibling
gender, such that participants who lost a sister generally reported fewer experiences of SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 34
posttraumatic growth. Participant scores on the Physical Health subscale of the WHOQOL-
BREF (F = 6.80, p = 0.02) differed significantly by sibling gender, such that participants who
lost a sister generally reported lower quality of life with regard to physical health. Participant
scores on the Psychological subscale of the WHOQOL-BREF (F = 4.72, p = 0.04) differed
significantly by sibling gender, such that participants who lost a sister generally reported lower
psychological quality of life. Participant scores on the Environment subscale of the WHOQOL-
BREF (F = 4.49, p < 0.05) differed significantly by sibling gender, such that participants who lost a sister generally reported lower quality of life with regard to their environment. Results of
Pearson two-tailed correlations among the adjustment variables can be found in Table 10.
Case Examples
In addition to aggregating perceived network characteristics over participants, network
analysis allows researchers to provide rich descriptions of social ties reported by individual
participants. Four case examples have been selected for further analysis to compare and contrast
the self-reported networks of participants who differed in their reports of depressed mood.
Given the lack of quantitative findings between network characteristics and self-reported
depressed mood, the network characteristics of the two participants with the highest scores on the CESD-R and the two participants with the lowest CESD-R scores are considered. A review of these case examples is employed for hypothesis generation for future research in the area.
High levels of depressed mood: Jamie and Laura
Jamie
Family context and circumstances of sibling’s death. Jamie is a 28-year-old married
African female who identified as Christian. She was in her first year of a graduate program and
reported no current employment outside of the home. Jamie and her sister came from a middle- SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 35 class family of ten children, of which Jamie and her sister were fourth and fifth oldest, respectively. Her sister was 21 years old when she died due to an illness. Jamie indicated that her sister became sick very suddenly five years ago before passing away several months later. She noted that, at the time her sister became sick, her family did not anticipate that she would die from the illness. As a result, the loss was very unexpected for them.
Network characteristics. A visual representation of Jamie’s network is shown in Figure 1.
Jamie reported one of the larger networks (24 members), consisting mostly of family (67%). Her network was a mix between people who had their own relationship with the participant (54%) and those who did not. Of note, her network consisted of many extended family members (aunts, uncles, cousins), a couple of classmates, a professional (her pastor), and a significant other (her husband). She exchanged reciprocal support with only 17% of her network. Most of her network
(75%) provided tangible support. She reported a lower average closeness (3.21), including in her relationship with her one negative support, which she described as “not as close” as most of her relationships. She reported nearly daily average contact with her network members (4.80), with her emotional supports (4.80), with her instructional supports (4.50) and with her companionship supports (4.80).
Self-reported adjustment. Jamie’s score on the CESD-R was significant (16 and above), including the highest scores on the Loss of Interest (Anhedonia), Sleep, Appetite,
Thinking/Concentration, and Guilt (Worthlessness) subscales. Her score on the ICG (20) was in the middle of the pack and did not indicate significant distress in that domain. Her scores on the
PTGI and the physical health, psychological, and environmental subscales of the WHOQOL-
BREF were on the lower end for participants, indicating that she is not identifying many experiences of positive change from the loss and her current perceived quality of life is low SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 36
compared to her peers in the sample. Overall, she seemed to be one of the participants having the
most difficulty with adjusting to the loss of her sibling, although her experiences with
complicated grief are relatively consistent with those of the other young adults.
Laura
Family context and circumstances of sibling’s death. Laura is a 19-year-old single
African-American female who identified as Catholic. Laura was a freshman undergraduate
student and denied any current employment outside of the home. Laura and her sister came from
an upper-middle class family of four children, of which Laura was the second oldest and her
sister was the youngest. Her sister died due to a brain rupture one year ago at the age of 9 years
old. Laura noted that her sister went from “perfectly fine little girl” to “unconscious and
throwing up” in the course of five minutes. She added that her sister died within a week and the
whole process was difficult and very unexpected.
Network characteristics. A visual representation of Laura’s network is shown in Figure 2.
Laura reported one of the larger networks (24 members), consisting mostly of a mix between
friends (42%) and family (38%). She was one of only three participants who listed more friends
than family members. The network was also a mix of people who had their own relationship with
the participant (42%) and those who did not. Of note, her network consisted of a couple of her lost sister’s friends, several teammates, her boss, a few professionals (her therapist and a couple of teachers), and a significant other (her ex-boyfriend). Most of her network provided emotional support (92%) and companionship support (63%). She also reported a high proportion of network members (67%) who made grieving more difficult in some way. She reported a lower average overall closeness with her network members (3.29), including the second lowest average closeness with network members who knew the sibling. Of the 12 participants who listed a SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 37
significant other as a network member, Laura reported the least contact with her romantic
partner (monthly).
Self-reported adjustment. Laura’s scores on the CESD-R and ICG were significant (16
and above for the CESD-R; 26 and above for the ICG). She had the highest scores on the
Sadness (Dysphoria), Tired (Fatigue), and Suicidal Ideation subscales of the CESD-R. She had
the second highest score on the ICG, indicating she struggled significantly with complicated
grief. Her scores on the PTGI and all four subscales of the WHOQOL-BREF were on the lower
end for participants, indicating that she had difficulty identifying any experiences of positive
change from the loss and her current perceived quality of life is low compared to her peers in the
sample. Overall, she seemed to be the participant having the most difficulty with adjusting to the
loss of her sibling across all the domains of adjustment measured.
Comparison between participants with high levels of depressed mood
These two participants had the highest scores on the CESD-R. Both participants were women of color who were unemployed students in their first years at their schools. The two
young adults lost younger sisters very suddenly from an illness. The two participants indicated that they were in daily contact with their sibling and reported that the relationship was closer
than most relationships in their lives. Both women listed larger networks (24 members)
including professionals and significant others, and they both reported relatively low average
closeness with their network members. This could possibly indicate broad but limited closeness
of relationships in the support network. They were two of only three participants who did not
indicate daily contact with their significant others. They both scored on the lower end of the
PTGI and the physical health, psychological, and environmental subscales of the WHOQOL-
BREF, indicating they had difficulty across several measures of adjustment. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 38
Low levels of depressed mood: Heather and Cecilia
Heather
Family context and circumstances of sibling’s death. Heather is a 19-year-old single white female who identified as Catholic. Heather was a freshman undergraduate student who also worked part-time as a cashier at a pizza restaurant. Heather and her brother came from an upper class family of five children, of which she is the youngest and her brother is the second youngest. The oldest three half-siblings were eight years older than her brother. Heather indicated that her relationship with her brother was closer than any relationship she had ever had.
She indicated that she was in weekly contact with her brother when he died by suicide almost three years ago. Her brother was 20 years old at the time of his passing and did not have a family of his own. She indicated that his death was somewhat expected as he had attempted suicide several times, adding that he was “really unhappy.” She noted that he struggled with bipolar disorder and did not like to take his medication. She felt that the loss was expected but unavoidable because he engaged in a lot of risky behaviors.
Network characteristics. A visual representation of Heather’s network is shown in
Figure 3. Heather reported a network of ten members, consisting of mostly family members
(70%) and people who had their own relationship with the participant (70%). Of note, her network included two of her half-siblings, her step-grandma, her ex-boyfriend, and her best friend. Her only negative support was her father. Everyone in her network provided emotional support. She had one of the higher averages of closeness with her network (4.10) and was in daily contact with her two friends (5.00) and her three network members (5.00) who did not have a relationship with her brother (the highest average of any participant for those two variables). SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 39
She reported daily average contact with her instructional supports (5.00) and with her
companionship supports (5.00).
Self-reported adjustment. Heather denied any symptoms of depression on the CESD-R and had the lowest score on the ICG, indicating that she has minimal distress from depression and complicated grief. She also had the highest scores on the physical health, psychological, and
environmental subscales of the WHOQOL-BREF, indicating that she reported experiencing high
physical health, psychological, and environmental quality of life. Overall, Heather seemed to be
adjusting well to the loss of her brother according to the variables measured.
Cecilia
Family context and circumstances of sibling’s death. Cecilia is a 27-year-old married
white female who identified as Mormon. Cecilia was not employed outside the home but does
have a Master’s in Business Education. Cecilia and her brother grew up in a lower-class family of three children, of which she was the oldest and her brother was the second oldest. Cecilia
indicated that her relationship with her brother was about as close as most of her relationships
with others. She indicated that she was in monthly contact with her brother when he passed away one year ago from an enlarged heart. He was 24 years old at the time. He did not have a family
of his own. She noted that he had suffered from heart problems as a baby but had no recent
concerns that indicated he could die. As a result, she felt the loss was totally unexpected and
unavoidable.
Network characteristics. A visual representation of Cecilia’s network is shown in Figure
4. Cecilia reported a network of mostly family members (89%) who were a mix between those
who had their own relationship with the participant (56%) and those who did not. Of note, her
network included her two children, several grandparents, and her mother-in-law. Most of her SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 40
network provided emotional support (89%) and instructional support (67%). She reported
daily contact with her two companionship supports (her two children) and weekly contact on
average with the three other types of support (4.00).
Self-reported adjustment. Cecilia denied any symptoms of depression on the CESD-R
and had one of the lower scores on the ICG, indicating she reported minimal distress from
depression and complicated grief. She had fairly typical scores compared to her peers for all four
domains of the WHOQOL-BREF, indicating good, but not great, perceived quality of life.
Similarly for the PTGI, Cecilia scored in the middle of the pack on posttraumatic growth,
indicating she was able to identify some, but not substantial, positive changes from the loss.
Comparison between participants with low levels of depressed mood
These two participants had the lowest two scores on the CESD-R and were among the lowest scores on the ICG. Both participants were white females who lost a brother. The two
participants reported no history of mental health treatment. The two women listed a similar
number of network members (9-10), including a significant other with whom they had daily contact. Neither participant listed a professional in her network. These young women reported
high proportions of family in the network (70% and 89%) and high proportions of emotional support (100% and 89%).
Contrast between high and low levels of depressed mood
Generally speaking, the two young adults who scored the highest on the depression
measure struggled across various domains of adjustment whereas the two who scored the lowest
did well or average across the domains of adjustment. The individuals with lower depression
scores reported a smaller number of network members, which tended to be saturated with family
and perceived emotional supports. The young adults with higher scores on the depression
measure had larger networks with lower average closeness among network members. These
two participants were both women of color compared to the two participants with the lowest SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 41
scores on the depression measure being white women. This pattern of people of color reporting
more experiences of depression was also seen as an effect in the quantitative analysis and is
consistent with findings in the literature (Dunlop, Song, Lyons, Manheim, & Chang, 2003). The
two young adults with the lowest scores on the depression measure lost brothers while the two
young adults with the highest scores lost sisters, potentially highlighting particular difficulty in
losing a sister. All four participants reported a significant other in their network, but the two
participants with the lowest scores on the depression measure indicated daily contact with their
romantic partner while the two who scored the highest indicated either weekly or monthly contact. The two participants with the highest depression scores listed at least one professional in
their networks whereas the two women with low depressions scores did not list a professional.
Qualitative Findings
A total of 18 of the 19 participants completed the qualitative questions about their grief
surrounding the loss of their sibling. When asked about the circumstances of their sibling’s
death, 11 (61%) young adults noted that it was completely unexpected. As Paula explained, “Oh
it was unexpected. I mean…We [family] like didn’t even know it was a possibility.” With
regards to the circumstances of their sibling’s death, other issues described by participants
included their loved one having mental health problems (3 participants), dying by firearm (3
participants), drug involvement in their loved one’s death (5 participants), legal trouble related
to their sibling’s death (2 participants), and the nature of their sibling’s suffering prior to death
(6 participants).
When prompted, seven of the young adults (39%) indicated their family was coping
relatively well overall with the loss. Ten participants (55%) indicated that a parent was SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 42
struggling while four (22%) of them mentioned another sibling was struggling. As Jennifer
described, “…my dad was pretty ripped up about it because he, you know, I mean, I don’t have
kids, but I would assume, and I can see it through his eyes. If you have one of your babies die, it
would probably really bother you.” With regards to the family’s adjustment to the loss, other
issues described by participants included a family member experiencing depression, a family
member blaming his or her self for the death, and family members employing a variety of coping
tools and methods to deal with the loss (alcohol, religion, Facebook, emotion suppression,
starting a nonprofit, and counseling services).
Eight of the 18 young adults (44%) reported that they were handling the loss relatively
well overall. Five (28%) of the participants noted that it was initially difficult to handle their
sibling’s death, but felt that they were currently doing better. Four (22%) mentioned that their ability to handle the loss currently fluctuates. As Erin stated “It definitely is something that changes day to day.”
Participants were also invited to discuss their overall experience of getting support from others. Eight (44%) of the young adults indicated that they had an overall positive experience getting support. Kyle stated, “For getting support, it just all really came to me. I never really like had to reach out for support, because it was like always there. For like the first year or so, like people made it a point to support me and my family.” Three (17%) participants reported having some difficulty getting support from family. With regards to the overall experience of getting support, other issues described by participants included needing to speak with people who could understand the loss, the importance of a significant other as an important source of support (2 participants), and the importance of a professional counselor in helping the participant get the support he or she needed. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 43
When asked about other helpful tools in dealing with the loss, eleven (61%) of the young
adults noted some form of art or media as helpful, including music (5 participants), reading (5
participants), writing (3 participants), physical movement (2 participants), and video games.
Olivia noted, “Music. I like listening to music a lot. I also like to read stuff online ‘cause my family sent me all these pages that are supportive, so I read some of their articles. I love different quotes, so I would just read a lot of quotes online.” Four (22%) of the participants mentioned faith or religion as beneficial in dealing with their sibling’s death. Participants also noted alcohol, partying, indulging, work, and routine as sometimes being helpful.
When questioned about unexpected negative consequences of the loss, participants endorsed reminders (28%) and hurtful words and actions from others (28%) as particularly challenging. Erin said, “Definitely all the constant reminders that he was actually gone. ‘Cause he was really the only one that I could talk to about my family, like the only one who would understand.” Jodie noted, “My mother saying the weird things, saying, ‘well now I have more money to spend on you and now we will have more time together.’ That was very odd and difficult to deal with, what do you say to that?” With regards to unexpected negative consequences, other issues described by participants included struggling with having to watch their family hurting (2 participants), frustrations associated with financial issues (2 participants), dealing with their own mental health issues (2 participants), experiencing guilt related to the loss of their sibling (2 participants), a loss of support they previously had, the increased feelings of loneliness, a newfound distaste for moments when other people make light of suicide, and difficulty in handling expectations about how he or she is supposed to grieve.
Participants were also invited to share any positive circumstances that might have resulted from the loss of their sibling. Half of the participants endorsed closer family SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 44 relationships. Erin said, “Definitely new and stronger relationships…that’s definitely the best thing that’s come out of it. I feel close to my siblings when other people, who were a big part of his [deceased sibling] life, were around me.” With regards to positive changes, other themes described by participants included that they could not identify any positive changes (2 participants), that he or she began to help others more, that he or she developed new relationships with others, that he or she experienced comfort in the belief that the sibling is no longer suffering, and that he or she developed a new outlook on life. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 45
DISCUSSION
The present study used a mixed-methods research design to understand the relationship between perceived network characteristics and self-reported psychological adjustment among 19 young adults who had lost a sibling through death. The findings highlighted several aspects of perceived social support networks that were associated with various levels of adjustment after the loss of a sibling. With regard to structural network characteristics, no significant associations were found between network size or family network proportion and scores on any of the four measures of adjustment (depression, complicated grief, posttraumatic growth, quality of life).
Having a higher proportion of the network ties who knew the deceased sibling was associated with higher self-reported quality of life. With regard to functional network characteristics, having a higher proportion of network ties who provided instructional support (advice and guidance) was associated with more self-reported experiences of posttraumatic growth. In addition, having a larger proportion of network ties who made grief more difficult was associated with participants’ reports of a lower quality of life. With regard to content network characteristics, reports of higher average contact with one’s family and greater closeness with network members who knew the sibling were associated with participants’ reports of a better psychological quality of life.
In terms of participants’ reports of psychological adjustment, 32% of participants indicated significant levels of depression while 21% reported significant levels of complicated grief. People of Color reported significantly more experiences of depression than Caucasians.
The loss of a sister was associated with significantly more difficulty across several domains of adjustment than the loss of a brother. Case analysis results were consistent with prior research
(Burke, Neimeyer, & McDevitt-Murphy, 2010) emphasizing the lack of relationship between SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 46
large networks and participants’ reports of depression. These results also point to smaller, closer
networks full of emotional support potentially having a relationship to participants’ reports of
depression. They also highlighted the importance of contact with a significant other. Interesting
findings from the qualitative data included adjusting well overall and being able to get the
support they needed, the helpfulness of art and media, and the positive change of closer family
relationships after the loss. Overall, the present findings were consistent with results from previous literature on bereavement and social support, while also suggesting new ways to conceptualize social support networks during bereavement in young adulthood.
Network Structure
The young adults in this study reported about 12 network ties on average, notably less than the average for North Americans of about 20 significant ties reported in previous research
(Walker, Wasserman, & Wellman, 1993). Several explanations may account for this difference.
First, experiences of depression are more common in samples of young adults experiencing bereavement than the general population (Herberman Mash, Fullerton, & Ursano, 2013; Hensley,
2006). Even if the young adults do not meet criteria for depression, feelings of loneliness and isolation from peers is a common experience following the loss of a sibling (Sundar, 2000).
Loneliness and depressive emotions can often lead to social isolation. The distress associated with the loss, therefore, may restrict the grievers’ request for, presumption of, and/or perception of support, resulting in a smaller perceived network. In other words, young adults experiencing the death of a sibling may generally perceive fewer supportive others than their non-distressed
counterparts.
Alternatively, a methodological aspect of the study may account for the difference
between the average number of network ties in the present study and the average number for SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 47
North Americans. The present study used an importance criterion to delineate participants’ social network ties (“I would like for us to come up with a list of people who have played a big part in helping you deal with the passing of your brother/sister.”). The criterion may then preclude the young adults from including some significant ties in their networks. Network ties were only counted if they provided the participant with some form of social support, which would exclude non-supportive, but significant, potential network members. This could explain why the participants had a smaller number of network members than the general population, as the importance delineation may have narrowed participants’ responses to network members who specifically helped the participant deal with the loss. Finally, selection bias may have played a role in limiting the number of network ties. Young adults with fewer network ties may have anticipated greater benefits from participating in the present study than young adults with more network ties. Consequently, the average number of network ties in the present study would be lower than in the general population.
Overall, there were very limited findings from the present study with regard to associations between self-reported network structure and individual adjustment. Consistent with prior research (Burke, Neimeyer, & McDevitt-Murphy, 2010), no relationship was found between total network size and adjustment in the present study. It is not the quantity of network ties, but the quality and function of those network ties that appears to be most valuable in adjusting to a loss. One example is the value of having network members who understand the nature of the individual’s loss. It was expected that having a larger proportion of the network who did not know the sibling would be associated with better adjustment because it was expected that the other individuals who knew the sibling would also be grieving, and, therefore, limited in their ability to provide adequate support. In contrast, participants with larger SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 48
proportions of the network who knew the sibling generally reported higher quality of life.
Average closeness with network ties who knew the sibling was positively correlated with self-
reported psychological quality of life. These findings, in conjunction with the qualitative reports
that participants feel a need to speak with someone who understands the loss, suggest an
association between perceived quality of life and supportive others who can relate to the loss.
There is existing research that emphasizes the importance of having supportive network
ties who can understand and relate to the loss (Steiner, 2006). The present findings provide
possible specifications for which aspects of adjustment are impacted by having supportive others
who understand the experience of loss. Average closeness with network members who knew the
sibling was correlated with psychological quality of life, but not self-reported depression nor
complicated grief. The psychological subscale of the quality of life measure is thought to measure mental health functioning more generally, whereas the CESD-R and ICG measure more specific mental health consequences like depression and complicated grief, respectively.
Therefore, mental health as a whole, rather than depression or complicated grief specifically, might potentially be more amenable to the effect of supportive others who understand the loss.
These findings may be understood through the lens of the dual process model of
bereavement (Schut & Stroebe, 1999). The dual process model of bereavement is an adaption of the “grief work hypothesis” that emphasizes the importance of the griever balancing between two different types of coping: loss-oriented and recovery-oriented. Loss-oriented coping involves working through the loss in the griever’s life as a consequence of the death while recovery- oriented coping involves adjusting to new roles, dealing with needs created by the loss, and potentially developing a new identity in the context of the loss. Network members who knew the sibling would likely be more effective at assisting the grieving young adult with loss-oriented SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 49
coping, as these individuals are more likely to have shared experiences with the lost sibling to
provide understanding and opportunities to reminisce. Young adults tend to indicate they have
not “worked through” their grief (Sveen, Eilegård, Steineck, & Kreicbergs, 2014), which is
typically more in line with loss-oriented coping. As a result, the young adults may be drawn
toward individuals who would provide this opportunity to reminisce and “work through” the
loss. More opportunities for loss-oriented coping may have a preventive effect against excessive
rumination, a common correlate with depression. More research is needed to understand the
importance of these network members and what aspects of the support provided by these
network members are so important for grieving siblings.
The present study found no significant relationship between the proportion of family
members in the participants’ networks and various aspects of self-reported adjustment. This is consistent with previous research using network analysis (Burke, Neimeyer, & McDevitt-
Murphy, 2010). It may be that adjustment is dependent on the nature of the family relationships rather than merely the presence of a supportive network saturated with family. Indeed, in the present study, more frequent contact with family network members was associated with better psychological quality of life. Participant reports from the qualitative questions indicate that some of the young adults found variation in how their family members were handling the loss.
Although some of the participants witnessed several family members who were struggling, many young adults noted that closer family relationships were one of the few positive outcomes they could identify after the loss. This is consistent with previous findings in the research contrasting the possibilities resulting from the loss of loved one, including closer familial and social bonds in
some instances versus deterioration and collapse of family systems in others (Breen &
O’Connor, 2011). The case study analysis also pointed to the importance of family support as the SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 50 two participants who scored the lowest on the depressed mood measure had higher proportions of family in their networks. Present findings potentially lend credence to the value of frequent contact with family after the loss, particularly in young adulthood when the individual is less likely to be currently living with family.
As family members tend to experience lifelong relationships with one another, the dual- processing model (Schut & Stroebe, 1999) might suggest that these network members are crucial to both types of coping. Family members who share a relationship with the lost sibling may be particularly effective at loss-oriented coping, providing the grieving sibling an opportunity to reminisce in both joyful and painful memories as well as someone to share in yearning for the deceased. The death of a loved one can be considered a social network crisis (Vachon &
Stylianos, 1988), particularly among the family system. Consequently, the family environment may be an area ripe with possibilities for the grieving sibling to engage in important recovery- oriented coping experiences, such as adjusting to new roles and created needs in the family in addition to developing a new identity in the family system. It is possible that family saturation in the network was not associated with adjustment because the mere presence of a larger number of supportive family members in the network does not indicate whether these family members are assisting the grieving young adult in this important balance between focusing on loss and focusing on recovery. More research is needed to understand family members’ unique roles in assisting grieving young adults with these two types of coping.
Perceived Social Support
Overall, there were fewer relationships between participants’ perceived social support and self-reported adjustment than expected. None of the emotional support, companionship support, nor tangible support variables were found to be associated with higher scores on the SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 51
CESD-R, ICG, PTGI, nor the four domains of the WHOQOL-BREF. One significant result found was that the proportion of young adults’ networks perceived as offering instrumental support was significantly positively associated with their reports of posttraumatic growth.
Emotional and tangible support were the types of support most consistently found to assist in dealing with a loss in prior research (Farberow, Gallagher-Thompson, Gilewski, & Thompson,
1992; Bottomley, Burke, & Neimeyer, 2015; Juth, Smyth, Carey, & Lepore, 2015), although research has shown some inconsistencies in importance of emotional support (Stroebe, Stroebe,
Schut, Zech, & van den Bout, 2002). Tangible support may be less relevant for young adults who are more likely to be living independently from the family. In accordance with the Deficit Model
(Stroebe, Stroebe, Abakoumkin, & Schut, 1996), companionship support was expected to be important in adjustment based on companionship being a common type of support between siblings. The Deficit Model postulates that social support will alleviate the stress of bereavement, but only to the extent that it helps replace the deficits created by the loss of the loved one. Based on the Deficit Model, it was expected that having more companionship support would lead to greater adjustment because it would fill the gap left by the loss of the sibling’s role in the participant’s life. Since the proportion of young adults’ networks perceived as offering companionship support was not significantly associated with their reports on any of the adjustment variables, present findings are inconsistent with Deficit Model hypotheses. It may be that companionship is not a role that siblings fill in early adulthood, as young adults tend to leave home and be physically distant from their family members.
The surprising relationship between instructional network proportion and posttraumatic growth may be understood in the context of the dual process model of bereavement (Schut &
Stroebe, 1999). Specifically for posttraumatic growth, a network more saturated with informative SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 52
and advice-giving supports may be most beneficial for young adults. These supportive network
members may be especially valuable to recovery-oriented coping in the dual process model of
bereavement by providing the young adults tools to adapt to new roles, instruction for handling
needs created by the loss, and instruction in developing a new identity in the context of the loss.
Young adults may benefit more from this type of instruction and guidance to navigate the
complexities of grief and change in positive ways. These findings are consistent with the work of
Engelkemeyer (2008) who found that advice-giving support was positively associated with posttraumatic growth for those who had lost an immediate family member. The present network analysis may provide hints at the network support variables most likely to impact various domains of adjustment. As an individual establishes the process of identity formation in his or her late teens or early twenties, the loss of a significant life pillar has the potential to deeply impact the young adult’s self-definition. If that individual perceives a larger proportion of his or her network to provide advice/guidance that was helpful in dealing with the loss, that individual may find a steadier path to navigate the already changing complexities of young adulthood.
In contrast, a network populated with members perceived to be making an already difficult process even more difficult is likely to destabilize the adjustment process. Indeed, the proportion of the network that was a negative support was significantly negatively correlated with quality of life in the present study, indicating that a network saturated with members who made grief more difficult is associated with lower physical health, psychological, and social quality of life. Counterintuitively, the average closeness with these negative network ties was positively correlated with physical health quality of life such that participants with closer relationships with network members who made grief more difficult generally reported better quality of life with regard to physical health. These results may suggest that greater salience of SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 53
the negative members in the network may negatively impact some domains of one’s quality of
life, while keeping close relationships with these members may positively impact other domains.
In light of the dual-processing model of bereavement (Schut & Stroebe, 1999), a network more
saturated with negative network members may unbalance the coping style too much toward loss-
oriented coping. The lack of recovery-oriented coping, then, might limit the young adults’ ability
to make necessary changes to move forward, negatively impacting their adjustment and quality
of life. More research is needed to understand the role of negative network members.
Understanding Psychological Adjustment
It is notable that the rate of depression found in the present sample was double the typical rate associated with bereavement at one year after a loss, while the rate of complicated grief is at the higher end of the reported typical range (Hensley, 2006). However, the present rates are
consistent with a 2013 study of young adults who lost a sibling or close friend in the past three
years (Herberman Mash, Fullerton, & Ursano, 2013). Zisook and Kendler (2007) noted that
bereavement-related depression is more common in younger than older adults and is predicated
by limited social support. Surprisingly, there were no correlations between any of the measured
perceived social support network variables and scores on the CESD-R. The bereavement and
psychological literatures suggest that depression is a common element in the grieving process
(American Psychiatric Association, 2013; Kübler-Ross, 1969) and social support is often implicated as a source of relief during a time of loss (Cohen, 2004). The current study did not find any correlations between network variables and self-reported depression nor between network variables and self-reported complicated grief. The quantitative and case analyses, however, revealed some interesting findings that may be worth investigating further in future studies. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 54
Ethnicity was one factor that distinguished the two young adults who scored the highest on the depression measure from the two who scored the lowest. The two participants who scored the highest on the depression measure were both women of Color compared to the two participants who scored the lowest being White women. People of Color generally reported higher rates of depression in this study, which is consistent with findings in the literature
(Dunlop, Song, Lyons, Manheim, & Chang, 2003). In addition, the analyses highlighted a difference in the gender of the lost sibling. The two participants with the highest scores on the depression measure both lost a sister whereas the two participants with the lowest scores on the depression measure lost a brother. This pattern was also reflected in the quantitative findings; the loss of a sister was associated with greater self-reported depression, fewer reports of posttraumatic growth, and lower self-reported quality of life than the loss of a brother. Generally, losing a sister seemed to be associated with particular difficulty in adjustment. This finding may reflect a gender difference in the importance of siblings in terms of support and identity in young adulthood. If a sister is a more critical network member, losing her may be associated with particular difficulty across various aspects of adjustment. Indeed, sisters tend to provide more emotional support and caregiving to family members than brothers (Cross, Taylor, & Chatters,
2018). Having a sister can protect the other siblings from negative emotions such as loneliness, self-consciousness, and fear (Padilla-Walker, Harper, & Jensen, 2010). The current literature on bereaved siblings is limited. Although there is some research distinguishing between male and female bereavement (Lawrence, Jeglic, Matthews, & Pepper, 2006), there is a dearth of current studies investigating differences in grief experiences between losing a sister and losing a brother.
More research is needed to clarify if the associations between bereavement and psychological adjustment differ significantly by the gender of the lost sibling. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 55
The case analysis examined the circumstances of four participants at either end of the
depression spectrum as indicated by their scores on the CESD-R. Both the case analysis and
qualitative findings were used to develop hypotheses with regard to experiences of young adults
who have lost a sibling. An interesting distinction between the networks of the young adults who
scored highest versus lowest on the depression measure is the presence of a large, less close
network for the participants who scored the highest versus a medium-sized, closer network for
the participants who scored the lowest. As discussed above, larger networks are rarely associated with better adjustment but feeling close with one’s network may be. Parent-child closeness, romantic partner closeness, and friendship closeness have been shown to buffer the mental health consequences of stressful life events (Ge, Natsuaki, Neiderhiser, & Reiss, 2009; Chow, Ruhl, &
Buhrmester, 2015). Present study findings may reflect the importance of young adults perceiving closer relationships with network members as a whole. This overall level of closeness could serve as a buffer against a sense of isolation the young adult may already be experiencing following the loss of the sibling. Research involving more participants and more diverse simples is needed to investigate the role of network closeness in facilitating the grieving process in young adulthood.
In addition, the two participants who scored the highest on the depression measure had non-daily rates of contact with their significant other at the time of the loss, which was very unusual for this sample. Most of the participants who noted a significant other in their networks indicated daily or almost daily contact with their partners, including the two young adults who scored the lowest on the depression measure. In contrast, the two participants with the highest scores on the depression measure indicated weekly and monthly contact, respectively. It is possible that the less frequent contact with an intimate partner may have exacerbated feelings of SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 56 isolation that can already be common in grief. So while these young adults may have already felt isolated from the loss of their sibling, the infrequent contact with a romantic partner, who is often a network member with high levels of closeness and who often can play a critical role in a young adult’s daily routine, may have an additive effect with the isolation felt from the loss of the sibling. Research has shown that negative life experiences can increase one’s sensitivity to stressors, making individuals more vulnerable to Major Depressive Episodes (Patten, 2013).
Bereavement, then, could act as a triggering event, leading to an increase in sensitivity to stressors for the young adults. Consequently, even a potentially minor stressor (feeling isolated due to infrequent contact with a significant other) may be an additive factor toward experiences of depression in bereaved young adults. Recently, Stroebe and Schut (2016) incorporated the concept of overload into the dual process model of bereavement. Overload occurs when the griever perceives more loss- and/or restoration-oriented stressors than he or she is able to handle.
The researchers identify some symptoms of the burnout that can result from overload, including low energy, hopelessness, helplessness, and negative attitudes toward life. These experiences have notable overlap with the symptoms of depression. It is possible then, that the two participants with the highest scores on the depression measure are experiencing some degree of overload consistent with the dual process model of bereavement. Future studies are needed to investigate the potential interaction of stressors that can lead to overload in young adults grieving the loss of a sibling.
The qualitative findings also indicated some possible hypotheses for future studies.
During the qualitative questioning, a majority of the young adults indicated the importance of some form of art or media in dealing with the loss. The forms mentioned were quite varied: music, reading, writing, dance, tumbling, pictures, and video games. Observing or participating SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 57
in beauty in some way could facilitate the grief process or serve as a distraction, potentially
fulfilling the role of either of the two oscillating types of grief work (loss-oriented or recovery-
oriented, respectively) (Schut & Stroebe, 1999). Various forms of media have the possibility of
facilitating both types of coping, depending on the circumstances and intention. Future studies
could investigate how young adults use art and media to deal with a loss, and in what ways their
uses of the art and media fit into the dual process model of bereavement.
In response to a question about positive changes that occurred after loss of their sibling,
many participants indicated that they noticed closer family relationships. This further highlights the complexities of the role of family members after the loss of a sibling. Although the family network correlations were mixed, this may be due to the mixed responses from families and may not necessarily be a negative reflection on the importance of the families themselves. In other words, family members may be more likely to be the most important at assisting the young adult in fulfilling both types of coping required by the dual process model of bereavement. Schut and
Stroebe (2015) recently modified their model to incorporate family-level bereavement. The authors emphasized a “common sense position- namely that families not only contribute to but also help provide solutions for difficulties in bereavement.” There is tremendous variability in how these family members react to the loss (Breen & O’Connor, 2011), likely influencing how well they end up being able to assist the young adults. This variability would likely nullify any effects between family network proportion and the measures of adjustment, but the importance
and complexity of the family after a loss are seen in other quantitative findings as well as in the
qualitative findings. More research is need to identify if families are indeed the most critical in
assisting the bereaved in going through both types of coping and what can be done to assist SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 58 young adults who are not engaging in the necessary grief work at both the individual- and family-level.
Study Limitations and Implications for Research and Practice
Although findings are intriguing, results from the present study are limited in a number of respects. The study’s small sample size may limit the statistical power needed to detect meaningful relationships between variables, and findings must be interpreted with caution.
Sample size also precluded a detailed examination of the role of various factors related to the deceased sibling such as circumstances of the loss, time since loss, and expectedness of the death on participants’ reports of adjustment and social network ties. Moreover, the study sample consisted of primarily Caucasian young adult students living in the Midwestern United States, which further limits the generalizability of findings.
Network analysis relies heavily on correlational analysis to describe significant associations between network variables and scores on self-reported well-being. Given the number of variables considered in the present study, the likelihood of finding significant correlations among variables by chance (Type I error) may be increased. Given the small sample size, and the exploratory nature of the present study, Bonferroni correction methods were not used to control for Type I error. Research is needed to replicate present findings using larger and more diverse samples of young adults who have lost a sibling through death. Longitudinal research is needed to investigate potential causal associations between network variables and adjustment after a loss. The cross-sectional nature of the research makes it impossible to determine the direction of relationships between variables of interest in the present study. The present study is based exclusively on self-report data from participants. Conducting research using data collected from participants and multiple network members can provide a more SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 59
detailed analysis of the types of network structures that may be most conducive to coping and
growth after the death of a sibling.
Although exploratory, the present study is among the first to examine supportive
networks ties and adjustment to a loss at a specific phase of the adult life course. The present
research highlights the importance of identifying the various aspects of social networks that may be differentially valuable to young adults encountering challenges associated with adjusting to the loss of a sibling. Future studies should seek to identify more specific aspects of the structure and function of social networks in longitudinal and cross-sectional studies to systematically
examine the ability of young adults to handle significant loss. Directions for future research
include studying the role of romantic partners, the importance of advice and guidance, and
network closeness on individual adjustment and social network composition.
Present study results also remind clinicians that young adulthood loss and sibling loss
may provide unique issues to address in the experience of bereavement. The loss of a sibling
may be a “double” loss of both the parents’ support as well as the lost sibling’s support (Dyregov
& Dyregov, 2005), which may exacerbate a young adult’s sense of isolation from the typical
physical distance from the family associated with this developmental period. Young adults may
also differ in the types and structures of supportive networks that are beneficial compared to
other developmental periods, as seen in the value of instructional support in this study.
Moreover, clinicians are reminded that the death of a sibling during this important time can have
serious implications for the young adult’s family environment, psychological well-being, and
social bonds (Sundar, 2000).
Present findings underscore structural and functional features of perceived social
networks that may shape both positive and negative dimensions of adjustment after the loss of a SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 60 sibling. Practitioners may wish to examine basic features of the social networks of the clients and families during grief counseling, keeping in mind that smaller, closer networks may protect the griever from a sense of isolation during a tumultuous period. Studies that place the interpersonal experiences of adults who have lost a loved one into a larger social context are essential to sensitive and informed research and clinical practice. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 61
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APPENDIX A. TABLES
Table 1. Demographics of participants Number (%) Number (%) Gender Employment Female 16 (84) Full-time 3 (16) Male 3 (16) Part-time 10 (53) Unemployed 6 (32) Age 18-20 years old 5 (26) Student Status 21-25 years old 9 (47) Freshman 3 (16) 26-30 years old 5 (26) Sophomore 3 (16) Junior 1 (5) Number of Siblings Senior 4 (21) 1 5 (26) Graduate Student 3 (16) 2-3 8 (42) Non-student 5 (26) 4+ 6 (32) Education Ethnicity High School Graduate 1 (5) White 11 (58) Some College 11 (58) African-American 5 (26) 4-year Degree 3 (16) Other 3 (16) Some Graduate School 2 (11) Advanced Degree 2 (11) Relationship Status Single, Never Married 13 (68) Religion Married/Partnered 6 (32) Catholic/Protestant 6 (32) Other Christian 6 (32) Income No Religious Affiliation 2 (11) Less than $30,000 7 (37) Atheist/Agnostic 2 (11) $30,000 to $90,000 8 (42) Other 3 (16) More than $90,000 4 (21) SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 70
Table 2. Demographics of siblings Number (%) Number (%) Gender Female 4 (21) Time Since Loss Male 15 (79) 12-24 months 8 (42) 25-36 months 4 (21) Age 37-48 months 4 (21) Under 18 years old 5 (26) 49+ months 3 (16) 18-25 years old 12 (63) 26-30 years old 3 (16) Circumstances of the Death Suicide/Murder 10 (53) Sibling Own Family Accident 4 (21) Spouse 1 (5) Illness 5 (26) Children 3 (16) Spouse and Children 1 (5) Expectedness of Death None 14 (74) Expected 3 (16) Unexpected 16 (84) Sibling Relationship Biological Sibling 14 (74) Half-Sibling 5 (26) SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 71
Table 3. Structural network descriptive statistics Variable Mean Std. Deviation Minimum Maximum
Total Network Size 12.21 7.08 3 27
Family Network Size 6.74 3.68 2 16
Friend Network Size 3.79 3.29 0 13
In-Group Network Size 7.05 4.26 2 17
Out-Group Network Size 5.16 3.47 1 14
Family Network Proportion 0.65 0.19 0.33 1
In-Group Network Proportion 0.58 0.14 0.33 0.9
Note. In-group refers to individuals in the network who had their own relationships with the lost sibling. Out-group members did not have such a relationship.
Table 4. Pearson Correlations between adjustment variabls and structural network variables ICG WHO WHO WHO WHO PTGI CESD-R QOL QOL QOL QOL Domain 1 Domain 2 Domain 3 Domain 4
Total Network Size 0.14 -0.15 -0.18 0.08 -0.10 0.09 0.24
In-Group Network -0.07 0.62** 0.54* 0.50* 0.54* 0.26 -0.27 Proportion
Family Network -0.01 0.08 -0.01 0.11 0.10 -0.32 0.00 Proportion
Note. In-group refers to individuals in the network who had their own relationships with the lost sibling. Domain 1: Physical Health; Domain 2: Psychological; Domain 3: Social Relationships; Domain 4: Environment *p < 0.05; **p < 0.01 SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 72
Table 5. Functional network descriptive statistics Variable Mean Std. Deviation Minimum Maximum
Emotional Network Size 9.79 5.81 3 22
Tangible Network Size 5.16 4.26 0 18
Instructional Network Size 5.37 3.32 0 12
Companionship Network Size 6.84 4.09 2 15
Negative Network Size 2.68 3.46 0 16
Reciprocal Network Size 4.68 3.32 1 14
Emotional Network Proportion 0.83 0.19 0.42 1
Tangible Network Proportion 0.43 0.25 0 1
Instructional Network Proportion 0.48 0.27 0 1
Companionship Network Proportion 0.59 0.21 0.21 0.91 SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 73
Table 6. Pearson Correlations between adjustment variables and functional network variables ICG WHO WHO WHO WHO PTGI CESD-R QOL QOL QOL QOL Domain Domain Domain Domain 1 2 3 4
Emotional Network 0.07 0.30 0.19 0.08 0.26 0.42 -0.45 Proportion
Tangible Network Proportion -0.02 0.21 -0.01 0.03 -0.08 0.33 -0.11
Instructional Network 0.15 0.34 0.25 0.26 0.14 0.47* -0.28 Proportion
Companionship Network 0.13 -0.08 -0.04 -0.07 -0.02 -0.00 0.02 Proportion
Negative Network * ** * Proportion 0.15 -0.48 -0.62 -0.46 -0.43 -0.24 0.20
Reciprocal Network 0.14 0.21 0.01 -0.18 0.07 -0.09 -0.03 Proportion
Note. Domain 1: Physical Health; Domain 2: Psychological; Domain 3: Social Relationships; Domain 4: Environment *p < 0.05; **p < 0.01 SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 74
Table 7. Content network descriptive statistics Variable Mean Std. Deviation Minimum Maximum
Average Closeness 3.76 0.44 2.54 4.33
Average Reciprocal Network Closeness 3.98 0.61 2.50 5.00
Average Reciprocal Network Contact 4.19 0.56 3.00 5.00
Average Negative Network Closeness 2.83 1.09 1.33 5.00
Average In-Group Network Closeness 3.62 0.62 2.29 5.00
Average Out-Group Network Closeness 3.80 0.78 2.36 5.00
Average Family Network Contact 3.91 0.55 3.00 5.00
Average Friend Network Contact 4.07 0.76 3.00 5.00
Average Tangible Network Contact 4.23 0.51 3.25 5.00
Average Emotional Network Contact 4.09 0.43 3.43 5.00
Average Instructional Network Contact 4.24 0.41 3.50 5.00
Average Companionship Network 4.43 0.53 3.70 5.00 Contact
Note. In-group refers to individuals in the network who had their own relationships with the lost sibling. Out-group members did not have such a relationship. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 75
Table 8. Pearson Correlations between adjustment variables and content network variables ICG WHO WHO WHO WHO PTGI CESD-R QOL QOL QOL QOL Averages Domain Domain Domain Domain 1 2 3 4 Overall Closeness 0.07 0.26 0.40 0.32 0.17 0.04 -0.12
Reciprocal Network 0.20 0.32 0.37 0.44 0.21 0.08 0.06 Closeness
Reciprocal Network 0.01 -0.02 0.24 0.34 0.04 -0.10 0.22 Contact
Negative Network 0.21 0.50* 0.25 0.35 0.41 0.17 -0.33 Closeness
In-Group Network 0.32 0.44 0.52* 0.43 0.22 0.17 -0.03 Closeness
Out-Group Network -0.36 0.03 0.11 -0.06 0.13 0.04 -0.37 Closeness
Family Network 0.28 0.31 0.50* 0.27 0.20 0.20 0.03 Contact
Friend Network -0.03 0.06 -0.06 -0.21 -0.08 -0.19 0.27 Contact
Tangible Network -0.29 -0.16 0.21 -0.02 0.11 -0.01 -0.13 Contact
Emotional Network -0.03 -0.03 -0.06 0.05 -0.07 -0.31 0.29 Contact
Instructional Network 0.08 0.11 0.09 0.23 0.10 -0.23 0.21 Contact
Companionship -0.03 0.22 0.22 -0.11 0.06 0.14 -0.10 Network Contact Note. In-group refers to individuals in the network who had their own relationships with the lost sibling. Out-group members did not have such a relationship. *p < 0.05; **p < 0.01 SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 76 Table 9. Adjustment variable descriptive statistics Variable Mean Std. Deviation Minimum Maximum
ICG 19.79 11.02 4 46
WHOQOL-BREF: Physical Health 16.8 2.90 9.71 20
WHOQOL-BREF: Psychological 14.81 2.82 8.67 18.67
WHOQOL-BREF: Social Relationships 15.30 2.68 9.33 18.67
WHOQOL-BREF: Environment 5.16 3.47 1 14
PTGI 53.05 22.90 16 91
CESD-R 13.70 12.20 0 42
Note. ICG: Inventory of Complicated Grief; WHOQOL-BREF: World Health Organization Quality of Life assessment- Abbreviated Version; PTGI: Posttraumatic Growth Inventory; CESD-R: Center for Epidemiologic Studies Scale for Depression- Revised SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 77
Table 10. Correlations among adjustment variables 1 2 3 4 5 6 7
1. ICG 1 ------
2. PTGI -0.15 1 - - - - -
3. CESD-R 0.38 -0.66** 1 - - - -
4. WHOQOL-BREF: -0.01 0.61** -0.63** 1 - - - Physical Health
5. WHOQOL-BREF: -0.30 0.56* -0.63** 0.71** 1 - - Psychological
6. WHOQOL-BREF: 0.03 0.15 -0.36 0.48* 0.68** 1 - Social Relationships
7. WHOQOL-BREF: -0.40 0.51* -0.71** 0.80** 0.80** 0.54* 1 Environment
Note. ICG: Inventory of Complicated Grief; WHOQOL-BREF: World Health Organization Quality of Life assessment- Abbreviated Version; PTGI: Posttraumatic Growth Inventory; CESD-R: Center for Epidemiologic Studies Scale for Depression- Revised *p < 0.05; **p < 0.01 SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 78
APPENDIX B. FIGURES
Figure 1: Support Network for Jamie
In-Group Brother Sister Father Mother T E I E I E I T E I Friend #3 T C Half- Half-Brother Sister T T Husband E I Uncle #2 T I Mom's Brother Friend #2 T T C
Jamie Stepmom Aunt #3 T T
Classmate #1 Dad's Brother E C T
Friend #4 Classmate #2 Uncle #3 T C E I Aunt #1 T Friend T E Pastor #1 Aunt #2 Cousin Uncle #1 T I C T T I E I C T E
Legend: T = Tangible support A dotted line signifies a non-reciprocal support I = Instructional support A two-sided arrow signifies Reciprocal support C = Companionship support A black circle signifies Negative support E = Emotional support In-Group = personally knew the lost sibling
SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 79
Figure 2: Support Network for Laura
Mother In-Group
E I C Brother Cousin #1 Grandma #1 #1 E I C T E C C Father Cousin Grandma #2 E I C #2 Grandpa C E C T E C Sister's Sister's Friend #1 Friend #2 E E
Schoolmate Friend #1 #1 T E I C
Brother Friend #2 #2 Laura E
Schoolmate Aunt #2 E C
Teammate #2 Teammate #4 T E C Friend #3 E Therapist E Teammate E I C #1 Teammate #3 E C Teacher E #1 E Friend/ Teacher Coworker Ex- Boyfriend #2 E C Boss E T E C E
Legend: T = Tangible support A dotted line signifies a non-reciprocal support I = Instructional support A two-sided arrow signifies Reciprocal support C = Companionship support A black circle signifies Negative support E = Emotional support In-Group = personally knew the lost sibling
SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 80
Figure 3: Support Network for Heather
In-Group Half-brother Aunt E Half-sister T E E
Mother Step-grandma T E C E
Heather Grandpa Cousin E T E I C
Ex-boyfriend Best friend Friend E C Father E I C T E I
Legend: T = Tangible support A dotted line signifies a non-reciprocal support I = Instructional support A two-sided arrow signifies Reciprocal support C = Companionship support A black circle signifies Negative support E = Emotional support In-Group = personally knew the lost sibling
SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 81
Figure 4: Support Network for Cecilia
In-Group
Brother
E Father Grandma #1 E I E I
Grandpa Grandma #2 T E I T E I
Cecilia
Son # 2 Step-mom C
Son #1 Mother-in- law E C T E I Husband T E I C
Legend: T = Tangible support A dotted line signifies a non-reciprocal support I = Instructional support A two-sided arrow signifies Reciprocal support C = Companionship support A black circle signifies Negative support E = Emotional support In-Group = personally knew the lost sibling
SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 82
APPENDIX C. PERSONAL NETWORK ANALYSIS PROTOCOL
I really appreciate you taking the time to talk with me today. I am hoping this study will help us understand more about how people experience social support after they have lost a sibling. I understand that some of these things may be difficult to talk about so please feel free to take a break at any time. We really value your input and I will do my best to assist you in this process. It may be hard for you to remember some of the things I ask about but please do your best. If you are unsure of anything, just give your best guess. 1. Demographics I would like to start by learning a little bit about you. 1. ID: ______2. Age: ______3. Identified Gender: ______4. Ethnic Background: ____ Caucasian _____Asian-American _____Hispanic _____Biracial/multi-racial ____ African-American _____Pacific Islander _____Other:______
5. Relationship Status: ____ Single, Never Married ______Long Term Dating Relationship ____ Separated/Divorced (how long _____ ) ____ Married/Partnered ____ Widowed ____ Re-married (how long _____ ) ____ Co-habiting (living together)
6. Religious Affiliation: _____Catholic ______Protestant/Other Christian (circle) _____Jewish ______Buddhist/Muslim/Hindu (circle) ____Agnostic/Atheistic (circle) ______No Religious Affiliation SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 83
____Other: ______7. Employment/Student Status: Are you employed outside of the home? If so, what type of work do you do? What is your job title? ______Do you work: Full time or Part time? If Student: Current Year of School: ____ Freshman ____ Sophomore ____ Junior ____ Senior ____ Graduate Student (year____) ____ Other:
8. Educational Background: What is the highest year in school that you completed? ____ Some High School ____ 2 year degree (college/technical school) ____ High School Graduate ____ 4 year college degree ____ Some College ____ Some graduate school ____ Advanced Degree: ______(type)
9. Your approximate (family) annual income: ____ less than $30,000 ____ $90,000 to $119,999 ____ $180,000 to $209,999 ____ $30,000 to $59,999 ____ $120,000 to $149,999 ____ $210,000 to $239,999 ____ $60,000 to $89,999 ____ $150,000 to $179,999 ____ more than $240,000
10. Have you ever seen someone for a mental health problem? ____ Yes ____ No Nature of problem: ______Seeking treatment? Yes No ____ Before loss of sibling _____ After loss of sibling ______Both Currently in treatment? ____ Yes _____ No
11. Participation in support group ____ Online ______In-person ______None Name of Group: ______Leadership Role: ______Yes ______No SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 84
12. Family of origin How many siblings do you have (including lost sibling)? ______What are their ages? ______
13. Does your sibling have a family of his/her own? ____ Yes ____ No ______Spouse ______Children (how many ______)
2. Network Delineation Now I’d like to learn more about the people in your life. In order to do that, I would like for us to come up with a list of people who have played a big part in helping you deal with the passing of your brother/sister. Let’s start with your FAMILY OF ORIGIN. Tell me the first names of the people in your family. Now tell me who you LIVE WITH. What are the first names of the people who live in the same residence as you? Ok, now tell me the first names of people you consider to be CLOSE RELATIVES who played a big part in helping you deal with the passing of your brother/sister. These can be grandparents, cousins, aunts/uncles or someone else. It does not matter where they live, or how recently you saw them. You must decide who, for you, is a close relative; someone who is close to you as a person who was important to you in dealing with your loss. Could you please tell me their names? Now tell me the first names of people you consider to be GOOD FRIENDS who helped you. It does not necessarily matter where they live, or how often you see them. What are their first names? Could you now tell me the first names of anyone who PROVIDED YOU WITH SUPPORT in helping you deal with the loss of your brother/sister that you did not list above? It could be a coworker, roommate, professional, etc. Sometimes people tell us that others have said bad things to them or done things that made it harder than it already was to deal with the passing of their sibling. Is there anyone who you have not already listed who treated you this way or did anything else that made it MORE DIFFICULT for you to deal with the passing of your brother/sister? Can you now tell me the first names of ANYONE ELSE who was important to you in helping you deal with the loss of your sibling? SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 85
At any point in the interview, if you think of someone who played a role in helping you deal with the loss of your sibling that we have not listed, please let me know and I can add them. *If participant lists more than 25 people, ask: “Did everyone on this list play a BIG part in helping you through the loss of your sibling?” 3. Assess Network a. Assess frequency and closeness I am going to ask how close you are with the people on this list. I am going to ask how often you are in contact with the people on this list. b. Assess Positive support network Now I’d like you to look down this list and tell me who has provided you with some kind of social support in regards to the death of your sibling. Now I’d like to find out more about what kinds of support these people have provided. We can think about several kinds of social support. People can provide emotional support by doing things like listening and talking to you about the loss of your sibling, expressing care and concern about your grieving, and showing empathy to you. People can provide tangible support by doing things like getting you groceries, preparing meals, or by providing goods or services to assist you with dealing with the loss of your sibling People can provide instructional support by giving advice, guidance, suggestions, or other useful information in dealing with the loss of your sibling. People can provide companionship support by spending time with you or participating in different activities with you. For each individual listed, please choose all types of support that person has provided. Let’s start with the first person. What kinds of support have they provided you? c. Assess In-group/Out-group There are probably some people on this list who knew your brother and some who did not. I assume everyone in your family knew your brother, but I am interested to know if anyone else on this list had a relationship or friendship with your brother, independent of you. Another way of thinking about it is would they have ever spent time together without you? d. Assess Reciprocity Who, if anybody, on this list did you provide support to in relation to the loss of your sibling? e. Assess Network Negativity Who, if anybody, on this list provided was a burden or made it more difficult for you to deal with the loss of your sibling? This can include people who say insensitive things related to the death, blame others for the death, or isolate from others. Sometimes grieving individuals can also feel judged by others, even if the other people do not explicitly say anything. Who, if anyone, did you experience any of these or other unhelpful supports from? SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 86
f. Assess Support Group attendance (If participant attends a support group) Do any of the people you listed attend your support group? Review: “Does this seem right? Anyone or anything I missed?” 4. Qualitative Questions a. How do you think you are handling the loss of your sibling? b. What did you think of the circumstances of how you lost your sibling? Tell me more about it. Was it expected/unexpected? Avoidable/unavoidable? c. How do you see your family coping with the loss of your sibling? d. What was it like getting support for you? What was your overall experience? e. What were some things besides support from people that you used to help you deal with losing your sibling? People in the past have used books, online resources. f. What were some of the most common difficulties you encountered as a result of your brother/sister’s passing? g. What were some positive things, if any, that came about as a result of your brother/sister’s passing?
5. Outcome Variables Now I am going to have you answer some questions on paper.
Have participants fill out self-report surveys. SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 87
APPENDIX D. CENTER FOR EPIDEMIOLOGIC STUDIES DEPRESSION SCALE- REVISED
Last Week Nearly Not at every Below is a list of the ways you might have felt or all or day for behaved. Please check the boxes to tell me how 1 -2 3 – 4 5 – 7 Less 2 often you have felt this way in the past week or so. days days days than 1 weeks day My appetite was poor. 0 1 2 3 4 I could not shake off the blues. 0 1 2 3 4 I had trouble keeping my mind on what I was 0 1 2 3 4 doing. I felt depressed 0 1 2 3 4 My sleep was restless. 0 1 2 3 4 I felt sad. 0 1 2 3 4 I could not get going. 0 1 2 3 4 Nothing made me happy. 0 1 2 3 4 I felt like a bad person. 0 1 2 3 4 I lost interest in my usual activities. 0 1 2 3 4 I slept much more than usual. 0 1 2 3 4 I felt like I was moving too slowly. 0 1 2 3 4 I felt fidgety. 0 1 2 3 4 I wished I were dead. 0 1 2 3 4 I wanted to hurt myself. 0 1 2 3 4 I was tired all the time. 0 1 2 3 4 I did not like myself. 0 1 2 3 4 I lost a lot of weight without trying to. 0 1 2 3 4 I had a lot of trouble getting to sleep. 0 1 2 3 4 I could not focus on the important things. 0 1 2 3 4 Sadness (Dysphoria): (Q. 2, 4, 6), Loss of Interest (Anhedonia): (Q. 8, 10), Appetite: (Q. 1, 18), Sleep: (Q. 5, 11, 19), Thinking / concentration: (Q. 3, 20), Guilt (Worthlessness): (Q. 9, 17), Tired (Fatigue): (Q. 7, 16), Movement (Agitation): (Q. 12, 13), Suicidal Ideation: (Q. 14, 15) SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 88
APPENDIX E. INVENTORY OF COMPLICATED GRIEF
1. I think about this person so much that it’s hard for me to do the things I normally do 2. Memories of the person who died upset me 3. I feel I cannot accept the death of the person who died 4. I feel myself longing for the person who died 5. 1 feel drawn to places and things associated with the person who died 6. I can’t help feeling angry about his/her death 7. I feel disbelief over what happened 8. I feel stunned or dazed over what happened 9. Ever since he/she died, it is hard for me to trust people 10. Ever since he/she died, I feel as if I have lost the ability to care about other people or I feel distant from people I care about 11. I feel lonely a great deal of the time ever since he/she died 12. I have pain in the same area of my body or have some of the same symptoms as the person who died 13. I go out of my way to avoid reminders of the person who died 14. I feel that life is empty without the person who died 15. I hear the voice of the person who died speak to me 16. I see the person who died stand before me 17. I feel that it is unfair that I should live when this person died 18. I feel bitter over this person’s death 19. I feel envious of others who have not lost someone close
Response Options
1 2 3 4 5 Never Rarely Sometime Often Always SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 89
APPENDIX F. POSTTRAUMATIC GROWTH INVENTORY
Indicate for each of the statements below the degree to which this change occurred in your life as a result of your crisis.
1. My priorities about what is important in life. 2. An appreciation for the value of my own life. 3. I developed new interests. 4. A feeling of self-reliance. 5. A better understanding of spiritual matters. 6. Knowing that I can count on people in times of trouble. 7. I established a new path in my life. 8. A sense of closeness with others. 9. A willingness to express my emotions. 10. Knowing I can handle difficulties. 11. I’m able to do better things with my life. 12. Being able to accept the way things work out. 13. Appreciating every day. 14. New opportunities are available which wouldn’t have been otherwise. 15. Having compassion for others. 16. Putting effort into my relationships. 17. I’m more likely to try to change things which need changing. 18. I have stronger religious faith. 19. I discovered that I’m stronger than I thought I was. 20. I learned a great deal about how wonderful people are. 21. I accept needing others.
Response Options
0- “I did not experience this change as a result of my crisis” 1- “I experienced this change to a very small degree as a result of my crisis” 2- “I experienced this change to a small degree as a result of my crisis” 3- “I experienced this change to a moderate degree as a result of my crisis” 4- “I experienced this change to a great degree as a result of my crisis” 5- “I experienced this change to a very great degree as a result of my crisis”
Factor Loading
Factor I: Relating to Others = Items 6, 8, 9, 15, 16, 20 Factor II: New Possibilities = Items 3, 7, 11, 14, 17 Factor III: Personal Strength = Items 4, 10, 12, 19 Factor IV: Spiritual Change = Items 5, 18 Factor V: Appreciation of Life = Items 1, 2, 13 SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 90
APPENDIX G. WHOQOL-BREF
The following questions ask how you feel about your quality of life, health, or other areas of your life. I will read out each question to you, along with the response options. Please choose the answer that appears most appropriate. If you are unsure about which response to give to a question, the first response you think of is often the best one.
Please keep in mind your standards, hopes, pleasures and concerns. We ask that you think about your life in the last four weeks.
Neither Very Poor poor nor Good Very good poor good 1. How would you rate 1 2 3 4 5 your quality of life?
Neither Very satisfied Very Dissatisfied Satisfied dissatisfied nor satisfied dissatisfied 2. How satisfied are you 1 2 3 4 5 with your health?
The following questions ask about how much you have experienced certain things in the last four weeks.
A Very An extreme Not at all A little moderate much amount amount 3. To what extent do you feel that physical pain 1 2 3 4 5 prevents you from doing what you need to do?
4. How much do you need 1 2 3 4 5 any medical treatment to SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 91
function in your daily life? 5. How much do you enjoy 1 2 3 4 5 life? 6. To what extent do you feel your life to be 1 2 3 4 5 meaningful?
A Not at all A little moderate Very much Extremely amount 7. How well are you able 1 2 3 4 5 to concentrate 8. How safe do you feel in 1 2 3 4 5 your daily life? 9. How healthy is your 1 2 3 4 5 physical environment?
The following questions ask about how completely you experience or were able to do certain things in the last four weeks.
Not at all A little Moderately Mostly Completely
10. Do you have enough energy in your day-to 1 2 3 4 5 day life? 11. Are you able to accept 1 2 3 4 5 your bodily experience? 12. Have you enough money to meet your 1 2 3 4 5 needs? 13. How available to you is the information that you 1 2 3 4 5 need in your day-to-day life? SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 92
14. To what extent do you have the opportunity for 1 2 3 4 5 leisure activities?
Neither Very Poor poor nor Good Very good poor good 15. How well are you able 1 2 3 4 5 to get around?
Neither Very satisfied Very Dissatisfied Satisfied dissatisfied nor satisfied dissatisfied 16. How satisfied are you 1 2 3 4 5 with your sleep? 17. How satisfied are you with your ability to 1 2 3 4 5 perform your daily living activities? 18. How satisfied are you with your capacity to 1 2 3 4 5 work? 19. How satisfied are you 1 2 3 4 5 with yourself? 20. How satisfied are you with your personal 1 2 3 4 5 relationships? 21. How satisfied are you 1 2 3 4 5 with your sex life? 22. How satisfied are you with the support you 1 2 3 4 5 get from your friends? 23. How satisfied are you with the conditions of 1 2 3 4 5 your living place? SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 93
24. How satisfied are you with your access to 1 2 3 4 5 health services? 25. How satisfied are you 1 2 3 4 5 with your transport?
The following question refers to how often you have felt or experienced certain things in the last four weeks.
Very Never Seldom Quite often Always often 26. How often do you have negative feelings such as 1 2 3 4 5 blue mood, despair, anxiety, depression?
Do you have any comments about the assessment?
[The following table should be completed after the interview is finished]
Transformed Raw scores Equations for computing domain scores Score 4-20 0-100
27. Domain 1 (6-Q3) + (6-Q4) + Q10 + Q15 + Q16 + Q17 + Q18 a. = b: c: + + + + + +
28. Domain 2 Q5 + Q6 + Q7 + Q11 + Q19 + (6-Q26) a. = b: c: + + + + +
29. Domain 3 Q20 + Q21 + Q22 a. = b: c: + +
30. Domain 4 Q8 + Q9 + Q12 + Q13 + Q14 + Q23 + Q24 + Q25 a. = b: c: + + + + + + + SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 94
APPENDIX H. INSTITUTIONAL REVIEW BOARD (IRB) APPROVAL
DATE: December 15, 2016
TO: Matthew Benoit FROM: Bowling Green State University Human Subjects Review Board
PROJECT TITLE: [957600-3] The role of social networks in helping adults cope with the loss of a sibling SUBMISSION TYPE: Revision
ACTION: APPROVED APPROVAL DATE: December 15, 2016 EXPIRATION DATE: November 5, 2017 REVIEW TYPE: Expedited Review
REVIEW CATEGORY: Expedited review category # 7
Thank you for your submission of Revision materials for this project. The Bowling Green State University Human Subjects Review Board has APPROVED your submission. This approval is based on an appropriate risk/benefit ratio and a project design wherein the risks have been minimized. All research must be conducted in accordance with this approved submission.
The final approved version of the consent document(s is available as a published Board Document in the Review Details page. You must use the approved version of the consent document when obtaining consent from participants. Informed consent must continue throughout the project via a dialogue between the researcher and research participant. Federal regulations require that each participant receives a copy of the consent document.
Please note that you are responsible to conduct the study as approved by the HSRB. If you seek to make any changes in your project activities or procedures, those modifications must be approved by this committee prior to initiation. Please use the modification request form for this procedure.
All UNANTICIPATED PROBLEMS involving risks to subjects or others and SERIOUS and UNEXPECTED adverse events must be reported promptly to this office. All NON-COMPLIANCE issues or COMPLAINTS regarding this project must also be reported promptly to this office.
This approval expires on November 5, 2017. You will receive a continuing review notice before your project expires. If you wish to continue your work after the expiration date, your documentation for continuing review must be received with sufficient time for review and continued approval before the expiration date.
Good luck with your work. If you have any questions, please contact the Office of Research Compliance at 419-372-7716 or [email protected]. Please include your project title and reference number in all correspondence regarding this project.
- 1 - Generated on IRBNet SOCIAL NETWORKS OF BEREAVED YOUNG ADULT SIBLINGS 95
This letter has been electronically signed in accordance with all applicable regulations, and a copy is retained within Bowling Green State University Human Subjects Review Board's records.
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