View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by University of New Mexico University of New Mexico UNM Digital Repository Nursing ETDs Electronic Theses and Dissertations 1-30-2013 THE EFFECTS OF CONTINUING BOND ON POSTTRAUMATIC STRESS DISORDER AND COMPLICATED GRIEF AMONG PARENTS BEREAVED BY THE SUICIDE OF THEIR CHILD Carol Capitano Follow this and additional works at: https://digitalrepository.unm.edu/nurs_etds Recommended Citation Capitano, Carol. "THE EFFECTS OF CONTINUING BOND ON POSTTRAUMATIC STRESS DISORDER AND COMPLICATED GRIEF AMONG PARENTS BEREAVED BY THE SUICIDE OF THEIR CHILD." (2013). https://digitalrepository.unm.edu/nurs_etds/10 This Dissertation is brought to you for free and open access by the Electronic Theses and Dissertations at UNM Digital Repository. It has been accepted for inclusion in Nursing ETDs by an authorized administrator of UNM Digital Repository. For more information, please contact [email protected]. i ii THE EFFECTS OF CONTINUING BOND ON POSTTRAUMATIC STRESS DISORDER AND COMPLICATED GRIEF AMONG PARENTS BEREAVED BY THE SUICIDE OF THEIR CHILD by CAROL CAPITANO Diploma, Nursing, Jackson Memorial School of Nursing, 1979 B.S., Nursing, Virginia Commonwealth University, 1987 M.S., Nursing, Virginia Commonwealth University, 1992 DISSERTATION Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Nursing The University of New Mexico Albuquerque, New Mexico December 2012 iii © 2012, Carol Capitano iv DEDICATION This dissertation is dedicated to my parents, Rosina (1908 to 2006) and John Capitano (1910 to 1996), who taught me the value of education and to follow my dreams, wherever they may take me. To my sister Catherine Alvarez, for her optimism, my sister Marie DeLuca, for her gentle prodding, and my brother-in-law John DeLuca, for his no- nonsense emails of encouragement. Their love and encouragement were invaluable. To my sister Madeleine (1939 to 1961), who taught me that love has no boundaries and is never- ending. To my cousin Joe DiPietra (1936 to 1976), who is loved and remembered for his kindness and gentleness. Lastly, this is dedicated to all my family, friends, spiritual guides, and teachers who have helped me along this path; without their help, this would not have been possible. This is also dedicated to the hundreds of parents who responded to my research and shared their most sacred moments with me. Without their participation, this research would not have been possible. It is my hope they were helped in some small way and that the knowledge gained will help other parents through the grieving process. v ACKNOWLEDGMENTS I would like to acknowledge the dedication, support, and mentorship of my committee chair: Geoff Shuster, DNSc, and committee members: Cindy Mendelson, PhD, Beth Tigges, PhD, and Paula Hensley, MD. They taught me the value of constructive feedback and the privilege and responsibility associated with research. Their feedback helped me to grow both intellectually and professionally. Their attention to detail taught me the rigors needed for ethical research and enhanced my study. I would also like to thank Dr. Shuster for his patience and persistence; both were of great value to me. Finally, I would like to express my sincere gratitude to Dr. Mark Parshall for his expertise and assistance in the initial data retrieval process from REDCap. Dr. Hensley has been my mentor and supporter since 2001. She has encouraged me in all aspects of my professional life and has been there to support and inspire me. Without her example of scholarship and excellence, I would not have pursued this degree, nor would I be the clinician I am today. It is also with pleasure I thank and acknowledge the numerous people in the suicide research community who have offered their support for this study. Although the names are too numerous to mention, I would like to acknowledge the various organizations and websites: American Association of Suicidology American Foundation for Suicide Prevention Parents of Suicides vi Survivors of Suicide Support Groups: Albuquerque, New Mexico, and United States Suicide Awareness Voices of Education Suicide: Finding Hope Survivors of Bereavement by Suicide: United Kingdom vii THE EFFECTS OF CONTINUING BOND ON POSTTRAUMATIC STRESS DISORDER AND COMPLICATED GRIEF AMONG PARENTS BEREAVED BY THE SUICIDE OF THEIR CHILD by CAROL CAPITANO Diploma, Jackson Memorial School of Nursing, 1979 B.S., Nursing, Virginia Commonwealth University, 1987 M.S., Nursing, Virginia Commonwealth University, 1992 Ph.D., Nursing, University of New Mexico, 2012 ABSTRACT There is a paucity of research on the effect of parents maintaining a continuing bond with their child who died by suicide. Furthermore, there is a gap in the research literature regarding differences among the parental continuing bond, posttraumatic stress, and complicated grief between parents who directly witnessed the suicide or found the body of their child and parents who were notified of the suicide by indirect methods (police, clergy, family, media, etc). This quantitative study included a convenience sample of 219 participants (response rate = 63.29%) who self-identified as parents whose child died by suicide 6 or more months prior to the initiation of the study. Participants were predominately White (85.8%), married (67.1%), female (91.3%), and mostly between the ages of 51 and 60 (44.7%). Data were collected on the Internet using the REDCap software program. The survey, which was completed anonymously, contained viii demographic information and three questionnaires: The Impact of Event Scale–Revised (IES-R), 22 items (0-88); Inventory of Complicated Grief (ICG), 19 items (0-76); and Continuing Bond Scale (CBS), three items (0-15). The mean score for the IES- R was 34.75, mean score for ICG was 33.03, and mean score for CBS was 6.28. The results suggest that the higher the parent’s continuing bond was, the higher were the levels of posttraumatic stress disorder and complicated grief. There were no differences between the group who observed the suicide or found the body and the group who was notified by other methods. ix TABLE OF CONTENTS LIST OF FIGURES ........................................................................................................ xv LIST OF TABLES ......................................................................................................... xvi CHAPTER 1: INTRODUCTION .................................................................................... 1 Background ............................................................................................................. 2 Bereavement ........................................................................................................... 4 Posttraumatic Stress Disorder ................................................................................. 6 Complicated Grief ................................................................................................... 7 Continuing Bond ..................................................................................................... 7 Survivors of Suicide ................................................................................................ 9 Theoretical Framework.........................................................................................10 Statement of the Problem………………………………………………….…......11 Significance of the Study…………………………………………………….......13 Purpose of the Research…………………………………………………….…....14 Hypotheses and Research Question………………………………………..….....14 Nature of the Study……………………………………………………………....15 Definition of Terms..............................................................................................16 Assumptions......................................................................................................... 18 Conclusion………………………………………………………………….........19 CHAPTER 2: REVIEW OF THE LITERATURE…………..……………………....20 Brief Overview of Suicide………………………………………………..….…..21 Parental Bereavement...…………………………………………….…………....23 x Emotional Response ……………………………………………….………….....25 Physical Effects…………………………………………...……………...………27 Social Support……………………………………………………………………29 Family Dynamics…………………………………………………………….…..31 Spiritual Issues…………………………………………………………….….….33 Posttraumatic Stress Disorder.…………………………………………….…......35 Historical overview of PTSD………………………………………….…......35 PTSD and Parents Bereaved by Sudden Death…………………………..…..38 Evolution of Grief Theories From Detachment to Attachment……………….....46 Complicated Grief Versus Traumatic Grief……………………………………...51 Continuing Bond Theory: A Paradigm Shift ......................................................57 Benefits of Parental Bereavement Research ......................................................60 CHAPTER 3: METHODOLOGY ................................................................................. 63 Research Design.................................................................................................... 64 Description of Sample ................................................................................... 64 Power Analysis .............................................................................................. 65 Inclusion/Exclusion Criteria for Study Participants ...................................... 66 Inclusion Criteria.......………………………………………………........ 66 Exclusion Criteria………………………………………………….......... 66 Questionnaires for Data Collection……………………………….……… ... 66 The Demographic Questionnaire………………………………….….