Bereavement Process among Adolescents with Intellectual Disability: An Intervention Program

Abstract

The current dissertation was conducted to study Bereavement Process among Adolescents with Intellectual Disability (ID) with an intervention program. In total 140 adolescents with the age range of 10-19 years according to World Health Organization (WHO, 2018) criteria were selected who lost their loved ones in the time span of last four years and data was gathered from fourteen cities of Pakistan. The Piaget’s concept related to death (universality, cessation, finality, causality, inevitability) is the base of theoretical framework of the study. The research is divided into three phases; Phase-I was the establishment of psychometric properties of Prolonged grief disorder scale named PG-13, evaluation of its factor structure along with assessment of convergent and discriminant validity. It aimed at assessing grief in youngsters through standardized and validated tool in context of Pakistani culture. The World Health Organization (WHO, 2018) guidelines for translation, adaptation and validation were followed. Translation of the scale was done from English to Urdu language i.e., National language of Pakistan. For validation, two methods were followed, where in first method, Confirmatory Factor Analysis (CFA) was done. The model fit indices were χ2/df=3.20, CFI=.95, NNFI=.94 and SRMR=.025. The value of AVE=.81 and CR=.98. All the findings are suggestive of satisfactory model fit indices and confirming the one factor structure of PG-13 Urdu version. For convergent and discriminant validation of PG-13, second method included the assessment of related constructs through different scales. For convergent validation of PG-13, GAD-7 Urdu version (Generalized anxiety disorder scale with 7 items), PSS Urdu Version (Perceived stress scale), NA Urdu version (Negative affect subscale of ICP-Subjective wellbeing scale- SWBS) were utilized. For discriminant validity, PA (Positive affect) and LS (Life satisfaction), sub scales of ICP-SWBS were used. The Cronchbach alpha reliability of PG-13 is .97 with high item total correlation values. PG-13 was positively correlated with GAD-7, PSS and NA with the values of .67, .69 and .68 respectively. PG-13 was negatively correlated with PA and LS with values of -.49 and -.89. Findings were indicative of satisfactory convergent and discriminant validity measures. Participants who scored higher on PG-13 with the loss duration of more than six months were considered having symptoms of Prolonged Grief Disorder (PGD). The Phase-II was based on qualitative exploration of grieving processes in youngsters with ID through semi-structured interviews. It was conducted on seven participants through Interview guide and data was gathered in the form of audio recordings. Through content analysis, six themes are generated namely, Meaning of Death, Death Rituals, Religious Concepts (sub-themes of Will of God, Concept of Angels, Reward and Punishment), Reasons of Death (Biological and Accidental), Grieving Perception (sub-themes of Expression of grief, Memories of the deceased ones), Coping with Grief (Religious rituals involvement, Emotional and social support, Distraction activities). The Piaget’s concept related to death ideas were seen at super-facial level in youngsters and in depth comprehension was lacking. The Phase-III was based on Intervention including group psychotherapeutic intervention of bereaved adolescents with ID and support group intervention of parents and teachers of bereaved youngsters. The participants with high scores on PG-13 were divided in to experimental group (n=12) and waitlist control group (n=16). The group psychotherapeutic intervention based on Play and Behavior therapy was conducted on experimental group having ten sessions for five weeks. The assessment through PG-13 Urdu version was done at three levels, i.e., pre, post and follow up assessment with a gap of 5 weeks and one month respectively. Meanwhile, temporal assessment was also done with waitlist control group (n=16) with the same time duration. For analysis, 2x3 Factorial ANCOVA was done to assess the main and interaction effects of covariates in results. Findings were suggestive of decrease in grieving manifestations in experimental group with F value of 49.586*** at p<.001 and ƞ2 value of .683 shows positive impact of intervention program on lessening grieving symptoms in adolescents with ID. Yet covariates showed no effect on results except groups’ bifurcation which showed significant effect of groups in grief management. Post hoc test also confirms the significant findings. Support group intervention based on four weekly sessions were also conducted with parents and teachers separately of bereaved adolescents. Pre and post assessment was done through Coping styles Scale (CSS- having two subscales named Problem Focused Coping (PFC) and Emotion Focused Coping (EFC)) with the gap of 4 weeks. Results of 2x2 Factorial ANCOVA showed significant results, with F value of 54. 719* at p<.05 and ƞ2 is .763 for PFC in both groups. The value of F is .14* at p>.05 and ƞ2 is .001 for EFC in both groups showing non-significant findings. The covariates again showed no effect on results except for both groups’ differences. The findings were conclusive of availability of standardized grief measurement named PG-13 in Urdu language with single factor structure for assessing prolonged grieving symptoms in youngsters with ID. Exploration of grieving manifestation through qualitative study also showed superficial understanding of different death concepts and lastly the efficacy of ten weeks intervention program for adolescents with ID and four weeks support group intervention for parents and teachers of youngsters was established. The present work is helpful for the professionals in assessment of grief through standardized scale along with availability of planned group psychotherapeutic intervention for bereaved adolescents with ID.