Bereavement Interventions for Children and Adolescents: An Evidence and Gap Map of Primary Studies and Systematic Reviews

Experiencing the death of a loved one can be very distressing for children and adolescents. If the bereavement is not managed, it can lead to lifelong consequences such as poor mental health outcomes. Despite this being a universal experience, there is a lack of agreement in the theoretical definitions of fundamental concepts of grief, loss and bereavement. Research has suggested child grief has specific characteristics determined by their age and developmental stage and needs, as well as the circumstances surrounding the death. A significant challenge in the field is identifying age appropriate and validated interventions that are specific for children and adolescents. Evidence and Gap Maps (EGMs) can contribute to addressing this gap by providing a comprehensive and visual synthesis of the existing evidence.

This EGM aimed to identify, synthesise and map existing published and unpublished (grey literature) evidence of primary studies and systematic reviews of bereavement interventions for children and adolescents, targeted at improving psychosocial outcomes.

The searches for this EGM were carried out using electronic databases (n = 6), web search engines, repositories and grey literature. The search terms were developed based on the participants, bereavement terminology and types of interventions. Searches were conducted over May and June 2024.

All primary studies and systematic reviews of bereavement interventions for children and adolescents between 0 and 24 years of age, in English or Spanish were included in this EGM.

Search results were imported into EndNote, where results were collated and duplicates deleted. Results were then imported into EPPI-reviewer where additional duplicates were removed. Titles and abstracts were screened in duplicate. Potential studies were then divided and full text was screened in duplicate, a third reviewer resolved any conflicts. Data was extracted from sources that fit the inclusion criteria in duplicate. The information extracted was participant age, country, study design, intervention type, intervention name, duration, form of delivery, provider, target death and type of death, evaluation and outcomes.

A total of 99 sources are included in this EGM. Interventions were carried out in different parts of the world but most evidence was identified in the USA, Australia, Canada and The Netherlands. The age that most evidence concentrated on is the age group between 10 to 14 years with underpinning theories, cognitive behavioural therapy and expressive therapies the most reported. The majority of interventions were delivered face to face and included different types (interventions, programmes, support groups and camps). Most reported a duration of 6-10 sessions and targeted parental death. Outcomes reported were various (n = 49), mostly focused on grief, coping, emotional expression, adjustment to death and emotional wellbeing. The majority of systematic reviews were rated as low quality and the majority of domains classified for randomised control trials were unclear.

This EGM provides a systematic, searchable and visual tool for policy makers, practitioners, researchers and members of the public to identify the existing evidence on bereavement interventions for children and adolescents. The EGM identified the areas where most evidence is currently concentrated, as well as areas where further research is warranted for specific age groups and types of death experienced. The EGM also identified the need for higher quality evidence as well as longitudinal evaluations.