Losing a child to cancer is one of the most devastating experiences a parent can endure. Bereaved parents are at higher risk for numerous adverse physical and mental health outcomes, including prolonged grief (PG), depression, anxiety, existential distress, adverse health behaviors, neglect of health care, cancer, heart disease, and even death. Parents bereaved by suicide are especially at heightened risk of suicidal ideation and suicidal behaviors, psychiatric hospitalization, and less social support as compared to those bereaved by other causes. They are often left struggling in isolation as they try to make sense of their loss and find meaning in their lives. Despite their suffering, bereaved parents report emotional and logistical barriers to accessing psychosocial support, resulting in underutilization of services. Furthermore, parents describe existing interventions as unhelpful and are less responsive to such interventions. The need for empirically-supported, conceptually sound, acceptable, and accessible interventions for bereaved parents is clear. Grief researchers have long observed that finding meaning after a loss is key to adaptation, suggesting the therapeutic value of facilitating meaning-making to improve bereavement outcomes. Yet meaning-based interventions have not been empirically evaluated for grieving parents. To address this, we pioneered Meaning-Centered Grief Therapy (MCGT) for this critically at-risk and underserved population. MCGT is a novel adaptation of Meaning-Centered Psychotherapy (MCP), originally designed to enhance meaning in advanced cancer patients. Over the past decade, we developed MCGT through formative intervention development studies. In our pilot randomized controlled trial (RCT) comparing MCGT to supportive psychotherapy (SP) in parents bereaved by cancer, MCGT demonstrated superior efficacy over SP for parents with higher baseline PG levels, improving self-reported PG and depression, as well as anxiety, hopelessness, and quality of life domains (moderate to large effect sizes). We are currently conducting a large-scale multisite efficacy trial of MCGT with parents bereaved by cancer. We believe that MCGT has relevance for parents bereaved by suicide, who face unique challenges to making meaning in and after their loss. However, in order to maximize the sensitivity, appropriateness, and impact of MCGT for survivors of suicide loss, empirical research to properly adapt the intervention is critical. The objective of the proposed mixed methods study is to adapt MCGT for parents bereaved by suicide. Following the ORBIT model for developing behavioral interventions (adapting design, proof-of-concept piloting), this study will have two phases. In Phase 1, we will use a modified Delphi approach using stakeholder feedback on the MCGT for survivors of suicide loss (MCGT-SSL) manual from parents bereaved by suicide (n=12) and mental health providers with expertise in suicide loss (n=6). In Phase 2, we will conduct a small open trial of MCGT-SSL with parents bereaved by suicide (n=10), conducting self-report assessments pre-intervention, mid-intervention, post-intervention, and 3 months post-intervention. The specific aims include: 1) adapt the MCGT intervention manual for parents bereaved by suicide, and 2) determine the preliminary feasibility, acceptability, and efficacy of MCGT-SSL and further refine the intervention and study procedures. Findings will support submission of a grant application to support a larger-scale RCT of MCGT-SSL.
