Skip to main content Accessibility help

Long-term effects of the Family Bereavement Program on spousally bereaved parents: Grief, mental health problems, alcohol problems, and coping efficacy

  • Irwin Sandler (a1), Jenn-Yun Tein (a1), Heining Cham (a2), Sharlene Wolchik (a1) and Tim Ayers (a1)...


This study reports on the findings from a 6-year follow-up of a randomized trial of the Family Bereavement Program (FBP) on the outcomes for spousally bereaved parents. Spousally bereaved parents (N = 131) participated in the trial in which they were randomly assigned to receive the FBP (N = 72) or literature control (N = 59). Parents were assessed at four time points: pretest, posttest, and 11-month and 6-year follow-up. They reported on mental health problems, grief, and parenting at all four time periods. At the 6-year follow-up, parents reported on additional measures of persistent complex bereavement disorder, alcohol abuse problems, and coping efficacy. Bereaved parents in the FBP as compared to those in the literature control had lower levels of symptoms of depression, general psychiatric distress, prolonged grief, and alcohol problems, and higher coping efficacy (for mothers) at the 6-year follow-up. Multiple characteristics of the parent (e.g., gender, age, and baseline mental health problems) and of the spousal death (e.g., cause of death) were tested as moderators of program effects on each outcome, but only 3 of 45 tests of moderation were significant. Latent growth modeling found that the effects of the FBP on depression, psychiatric distress, and grief occurred immediately following program participation and were maintained over 6 years. Mediation analysis found that improvement in positive parenting partially mediated program effects to reduce depression and psychiatric distress, but had an indirect effect to higher levels of grief at the 6-year follow-up. Mediation analysis also found that improved parenting at the 6-year follow-up was partially mediated by program effects to reduce depression and that program effects to increase coping efficacy at the 6-year follow-up was partially mediated through reduced depression and grief and improved parenting. FBP reduced mental health problems, prolonged grief, and alcohol abuse, and increased coping efficacy of spousally bereaved parents 6 years later. Mediation pathways for program effects differed across outcomes at the 6-year follow-up.


Corresponding author

Address correspondence and reprint requests to: Irwin Sandler, Department of Psychology, Arizona State University, Tempe, AZ 85281; E-mail:


Hide All
Achenbach, T. M. (1997). Manual for the Young Adult Self-Report and Young Adult Behavior Checklist. Burlington, VT: University of Vermont, Department of Psychiatry.
Achenbach, T. M. (2001). Manual for the ASEBA School-Age Forms and Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.
Achenbach, T. M. (2003). [Data from the CBCL and YABCL]. Unpublished raw data.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Archer, J. (1999). The nature of grief: The evolution and psychology of reactions to loss. New York: Brunner–Routledge.
Ayers, T. S., Sandler, I. N., & Twohey, J. (1998). Conceptualization and measurement of coping in children and adolescents. In Ollendick, T. H. & Prinz, R. J. (Eds.), Advances in clinical child psychology (Vol. 20, pp. 243301). New York: Plenum Press.
Ayers, T. S., Wolchik, S. A., Sandler, I. N., Towhey, J. L., Lutzke Weyer, J. R., Jones, S., et al. (2013–2014). The Family Bereavement Program: Description of a theory-based prevention program for parentally-bereaved children and adolescent. Omega: Journal of Death and Dying, 68, 293314.
Ayers, T. S., Wolchik, S. A., Weiss, L., Sandler, I. N., Jones, S., Cole, E., et al. (2008). Family Bereavement Program: Group leader intervention manual for parent program. Tempe, AZ: Arizona State University Press.
Barlow, J., Smailagic, N., Huband, N., Roloff, V., & Bennett, C. (2012). Group-based parent training programmes for improving parental psychosocial health. Campbell Systematic Reviews, 8.
Beck, A. T., & Steer, R. A. (1993). Manual for the Beck Depression Inventory. San Antonio, TX: Psychological Corporation.
Benjamini, Y., & Yekutieli, D. (2001). The control of the false discovery rate in multiple testing under dependency. Annals of Statistics, 29, 11651188.
Boelen, P. A., de Keijser, J., van den Hout, M. A., & van den Bout, J. (2007). Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 75, 277284.
Boelen, P. A., & Prigerson, H. G. (2007). The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults: A prospective study. European Archives of Psychiatry and Clinical Neuroscience, 257, 444452.
Bonanno, G. A., Neria, Y., Mancini, A., Litz, B., Coifman, K. G., & Insel, B. (2007). Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity. Journal of Abnormal Psychology, 116, 342351.
Bonanno, G. A., Wortman, C. B., Lehman, D. R., Tweed, R. G., Haring, M., Sonnega, J., et al. (2002). Resilience to loss and chronic grief: A prospective study from preloss to 18-months postloss. Journal of Personality and Social Psychology, 83, 11501162.
Braver, S. L., Shapiro, J. R., & Goodman, M. R. (2005). The consequences of divorce for parents. In Fine, M. A. & Harvey, H. (Eds.), Handbook of divorce and relationship dissolution (pp. 313337). Mahwah, NJ: Erlbaum.
Bruce, M. L., Kim, K., Leaf, P. J., & Jacobs, S. (1990). Depressive episodes and dysphoria resulting from conjugal bereavement in a prospective community sample. American Journal of Psychiatry, 147, 608611.
Bryant, R. A., Kenny, L., Joscelyne, A., Rawson, N., Maccullum, F., Cahill, C., et al. (2014). Treating prolonged grief disorder: A randomized clinical trial. JAMA Psychiatry, 71, 13321339.
Carnelley, K. B., Wortman, C. B., Bolger, N., & Burke, C. T. (2006). The time course of grief reactions to spousal loss: Evidence from a national probability sample. Journal of Personality and Social Psychology, 91, 476492.
Cole, D. A., & Maxwell, S. E. (2003). Testing mediational models with longitudinal data: Questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology, 112, 558577.
Conger, K. J., Rueter, M. A., & Conger, R. D. 2000. The role of economic pressure in the lives of parents and their adolescents: The Family Stress Model. In Crockett, L. J. & Silbereisen, R. K. (Eds.), Negotiating adolescence in times of social change (pp. 201223). New York: Cambridge University Press.
Cook, R. D. (1977). Detection of influential observations in linear regression. Technometrics, 19, 1518.
Currier, J. M., Neimeyer, R. A., & Berman, J. S. (2008). The effectiveness of psychotherapeutic interventions for bereaved persons: A comprehensive quantitative review. Psychology Bulletin, 134, 648661.
DeGarmo, D. S., Patterson, G. R., & Forgatch, M. S. (2004). How do outcomes in a specified parent training intervention maintain or wane over time? Prevention Science, 5, 7389.
Dohrenwend, B. P., Shrout, P. E., Ergi, G., & Mendelsohn, F. S. (1980). Non-specific psychological distress and other dimensions of psychopathology. Archive of General Psychiatry, 39, 12291236.
Evenson, R. J., & Simon, R. W. (2005). Clarifying the relationship between parenthood and depression. Journal of Health and Social Behavior, 46, 341358.
Faschingbauer, T. R. (1981). Texas Inventory of Grief—Revised manual. Houston, TX: Honeycomb.
Gardner, F., Burton, J., & Klimes, I. (2006). Randomized controlled trial of a parenting intervention in the voluntary sector for reducing child conduct problems: Outcomes and mechanisms of change. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 47, 11231132.
Gottfredson, D. C., Cook, T. D., Gardner, F. E. M., Gorman-Smith, D., Howe, G. W., Sandler, I. N., et al. (in press). Standards of evidence for efficacy, effectiveness, and scale-up research in prevention science: New generation. Prevention Science.
Hagan, M. J., Tein, J.-Y., Sandler, I. N., Wolchik, S. A., Ayers, T. S., & Luecken, L. J. (2012). Strengthening effective parenting practices over the long term: Effects of a preventive intervention for parentally bereaved families. Journal of Clinical Child and Adolescent Psychology, 41, 177188.
Haine, R. A., Sandler, I. N., Wolchik, S. A., Tein, J.-Y., & Dawson-McClure, S. R. (2003). Changing the legacy of divorce: Evidence from prevention programs and future directions. Family Relations, 52, 397405.
Hussong, A. M., Jones, D. J., Stein, G. L., Baucom, D. H., & Boeding, S. (2011). An internalizing pathway to alcohol use and disorder. Psychology of Addictive Behavior, 25, 390404.
Jones, S., & Twohey, J. L. (1998). Parents' Expression of Emotions Questionnaire: Psychometric properties. Paper presented at the 106th Annual Convention of the American Psychological Association, San Francisco, CA.
Keyes, K. M., Pratt, C., Galea, S., McLaughlin, K. A., Koenen, K. C., & Shear, M. K. (2014). The burden of loss: Unexpected death of a loved one and psychiatric disorders across the life course in a national study. American Journal of Psychiatry, 171, 864871.
Kwok, O.-M., Haine, R., Sandler, I. N., Ayers, T. S., & Wolchik, S. A. (2005). Positive parenting as a mediator of the relations between parental psychological distress and mental health problems of parentally-bereaved children. Journal of Clinical Child and Adolescent Psychology, 34, 261272.
Levinson, D., Darrow, C. N., Klein, E. B., Levinson, M. H., & McKee, B. (1978). The seasons of a man's life. New York: Ballantine Books.
Luthar, S. S. (2003). Resilience and vulnerability: Adaptation in the context of childhood adversities. New York: Cambridge University Press.
MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test the significance of the mediated effect. Psychological Methods, 7, 83104.
Masten, A., & Cicchetti, D. (2010). Developmental cascades. Development and Psychopathology, 22, 491495.
Melhem, N. M., Walker, M., Moritz, G., & Brent, D. A. (2008). Antecedents and sequalae of sudden parental death in offspring and surviving caregivers. Archives of Pediatric and Adolescent Medicine, 162, 403410.
Múthen, L. K., & Múthen, B. O. (1998–2012). Mplus user's guide (7th ed.). Los Angeles: Author.
Neimeyer, R. A., Hogan, N. S., & Laurie, A. (2008). The measurement of grief: Psychometric considerations in the assessment of reactions to bereavement. In Stroebe, M. S., Hansson, R. O., Schut, H., Stroebe, W., & Van den Blink, E. (Eds.), Handbook of bereavement research and practice: Advances in theory and intervention (pp. 133161). Washington, DC: American Psychological Association.
Neter, J., Wasserman, W., & Kutner, M. (1989). Applied linear regression analysis. Homewood, IL: Irwin.
Nolen-Hoeksema, S., & Ahrens, C. (2002). Age differences and similarities in the correlates of depressive symptoms. Psychology and Aging, 17, 116124.
Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Asian, M., Goodkin, K., et al. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLOS Medicine, 6, e1000121.
Prigerson, H. G., Vanderwerker, L. C., & Maciejewski, P. K. (2008). A case for inclusion of prolonged grief disorder in DSM-V. In Stroebe, M. S., Hansson, R. O., Schut, H., Stroebe, W., & Van den Blink, E. (Eds.), Handbook of bereavement research and practice: Advances in theory and intervention (pp. 165186). Washington, DC: American Psychological Association.
Prigerson, H. O., & Jacobs, S. C. (2001). Traumatic grief as a distinct disorder: A rationale, consensus criteria, and a preliminary empirical test. In Stroebe, M. S. H., Hansson, Robert O., Stroebe, W., & Schut, H. (Eds.), Handbook of bereavement research: Consequences, coping, and care (pp. 613645). Washington, DC: American Psychological Association.
Rubin, S., & Malkinson, R. (2001). Parental response to child loss across the life cycle: Clinical and research perspectives. In Stroebe, M. S., Hansson, R. O., Stroebe, W., & Schut, H. (Eds.), Handbook of bereavement research: Consequences, coping and care (pp. 219240). Washington, DC: American Psychological Association.
Sandler, I. N., Ayers, T. S., Tein, J. Y., Wolchik, S., Millsap, R., Khoo, S. T., et al. (2010). 6-year follow-up of a preventive intervention for parentally-bereaved youth: A randomized controlled trial. Archives of Pediatrics and Adolescent Medicine, 164, 907914.
Sandler, I. N., Ayers, T. S., Wolchik, S. A., Tein, J.-Y., Kwok, O. M., Haine, R. A., et al. (2003). Family Bereavement Program: Efficacy of a theory-based preventive intervention for parentally-bereaved children and adolescents. Journal of Consulting and Clinical Psychology, 71, 587600.
Sandler, I. N., Ingram, A., Wolchik, S., Tein, J. Y., & Winslow, E. (2015). Long-term effects of parenting-focused preventive interventions to promote resilience of children and adolescents. Child Development Perspectives, 9, 164171.
Sandler, I. N., Ma, Y., Tein, J. Y., Ayers, T. S., Wolchik, S., Kennedy, C., et al. (2010). Long-term effects of the Family Bereavement Program on multiple indicators of grief in parentally bereaved children and adolescents. Journal of Consulting and Clinical Psychology, 78, 131144.
Sandler, I. N., Schoenfelder, E. N., Wolchik, S. A., & MacKinnon, D. P. (2011). Long-term impact of prevention programs to promote effective parenting: Lasting effects but uncertain processes. Annual Review of Psychology, 62, 299329.
Sandler, I. N., Tein, J.-Y., Mehta, P., Wolchik, S. A., & Ayers, T. S. (2000). Coping efficacy and psychological problems of children of divorce. Child Development, 71, 10971118.
Sandler, I. N., Wolchik, S. A., & Ayers, T. S. (2008). Resilience rather than recovery: A contextual framework on adaptation following bereavement. Death Studies, 32, 5973.
Sandler, I. N., Wolchik, S. A., Ayers, T. S., Tein, J. Y., & Luecken, L. (2013). Family Bereavement Program (FBP) approach to promoting resilience following the death of a parent. Family Science, 4, 8795.
Sandler, I., Wolchik, S. A., Cruden, G., Mahrer, N. E., Ahn, S., Brincks, A., et al. (2014). Overview of meta-analyses of the prevention of mental health, substance use, and conduct problems. Annual Review of Clinical Psychology, 10, 243273.
Schaefer, E. S. (1965). Children's report of parental behavior: An inventory. Child Development, 36, 413424.
Schoenfelder, E. N., Sandler, I. N., Millsap, R. E., Wolchik, S. A., Berkel, C., & Ayers, T. S. (2013). Caregiver responsiveness to the Family Bereavement Program: What predicts responsiveness? What does responsiveness predict? Prevention Science, 14, 545557.
Selzer, M. L., Vinokur, A., & van Rooijen, L. (1975). A self-administered Short Michigan Alcoholism Screening Test (SMAST). Journal of Studies on Alcohol, 36, 117126.
Shapiro, E. R. (1994). Grief as a family process: A developmental approach to clinical practice. New York: Guilford Press.
Shear, K., & Shair, H. (2005). Attachment, loss and complicated grief. Developmental Psychobiology, 47, 253267.
Shear, M. K. (2015). Complicated grief. New England Journal of Medicine, 372, 153160.
Shear, M. K., Wang, Y., Skritskaya, N., Duan, N., Mauro, C., & Ghesquiere, A. (2014). Treatment of complicated grief in elderly persons: A randomized clinical trial. JAMA Psychiatry, 71, 12871295.
Simon, N. M., Shear, K. M., Thompson, E. H., Zalta, A. K., Perlman, C., Reynolds, C. F., et al. (2007). The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief. Comprehensive Psychiatry, 48, 395399.
Simon, R. W. (1992). Parental role strains, salience of parental identity and gender differences in psychological distress. Journal of Health and Social Behavior, 33, 2535.
Stroebe, M. S., & Schut, H. A. W. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23, 128.
Taylor, A. B., MacKinnon, D., & Tein, J.-Y. (2008) Test of the three path mediated effect. Organization Research Methods, 11, 241269.
Tein, J. Y., Sandler, I. N., Ayers, T. S., & Wolchik, S. A. (2006). Mediation of the effects of the Family Bereavement Program on mental health problems of bereaved children and adolescents. Prevention Science, 7, 179197.
Walters, E., Kessler, R., Nelson, C., & Mroczek, D. (2002). Scoring the World Health Organization's Composite International Diagnostic Interview—Short Form (CIDI-SF). Retrieved from
West, S., Finch, J., & Curran, P. (1995). Structural equation models with nonnormal variables: Problems and remedies. In Hoyle, R. H. (Ed.), Structural equation modeling: Concepts, issues and applications (pp. 5675). Thousand Oaks, CA: Sage.
Wittouck, C., Van Autreve, S., De Jaegere, E., Portzky, G., & van Heeringen, K. (2011). The prevention and treatment of complicated grief: A meta-analysis. Clinical Psychology Review, 31, 6978.
Wyman, P., Sandler, I. N., Wolchik, S. A., & Nelson, K. (2000). Resilience theory and interventions: Cumulative developmental promotion and protection. In Cichetti, D., Rappaport, J., Sandler, I. N., & Weissberg, R. (Eds.), The promotion of wellness in children and adolescents (pp. 133189). Washington, DC: CWLA Press
Yuan, K. H., & Bentler, P. M. (2000). Three likelihood-based methods for mean and covariance structure analysis with nonnormal missing data. Sociological Methodology, 30, 165200.
Zisook, S., & Schucter, S. R. (1991). Depression through the first year after the death of a spouse. American Journal of Psychiatry, 148, 13461352.
Zisook, S., Shucter, S. R., Sledge, P., & Mulvihill, M. (1993). Aging and bereavement. Journal of Geriatric Psychiatry and Neurology, 6, 137143.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed