Os Impactos da Pandemia para a Elaboração do Luto Infantil: Uma Revisão de Literatura / The Impacts of Pandemic for the Elaboration of Child Bereavement: A Literature Review / Los Impactos de la Pandemia para la Elaboración del Duelo Infantil: Una Revisión de la Literatura

A pandemia pela COVID-19 tem causado perdas significativas para as crianças, sendo o luto um processo de elaboração de perdas vividas que é experienciado de forma singular e pode ser difícil e doloroso. Consequentemente, o presente trabalho teve como objetivo identificar na literatura os impactos da pandemia covid-19 para a elaboração do luto infantil. A pergunta norteadora foi: "Quais são os impactos da pandemia para a elaboração do luto infantil?" e ela foi elaborada utilizando-se a estratégia PICO (Paciente/Problema, Intervenção, Controle/Comparação e Resultados). O levantamento bibliográfico transcorreu nas bases de dados Pepsic, Scielo e Google Acadêmico utilizando o cruzamento de palavras-chaves: "Luto infantil" AND "Pandemia" e "Luto infantil" AND "Covid-19". Dos 14 artigos selecionados, apenas 3 foram analisados. Os trabalhos analisados mostram que o luto se manifesta de diferentes maneiras em crianças durante a pandemia e evidencia a importância dos responsáveis para auxiliá-los nesse processo. Diante disso, nota-se uma necessidade de maiores estudos na área para ter um maior conhecimento e avaliar os impactos da pandemia na elaboração do luto infantil, visando medidas de preservação da saúde mental das crianças.

The COVID-19 pandemic has caused significant losses for children, and grief is a process of formulating the losses experienced in a unique way and can be very difficult and painful for those who experience it. Thus, this study aims to identify in the literature the impacts of COVID-19 pandemic on the child bereavement process. The guiding question was: "What are the impacts of the pandemic on the preparation of child bereavement?" and it was elaborated using the PICO strategy (Patient/Problem, Intervention, Control/Comparison and Results). The bibliographic survey was carried out in the Pepsic, Scielo and Google Academic databases using the crossing of keywords: "Children's grief" and "Pandemic" and "Infant grief" AND "COVID-19". From the 14 articles selected, only 3 met the review criteria and were analyzed. The selected works show that grief can manifest in different ways in children during the pandemic of COVID-19 and also the importance of those responsible to assist them in this process. In view of the results, there is a need for further studies in order to have a better understanding to evaluate the impacts of the pandemic on the child bereavement process, focusing on measures to preserve the mental health of children.

La pandemia por COVID-19 ha causado pérdidas significativas para los niños, y el duelo es un proceso de elaboración de pérdidas vividas que se experimenta de una manera única y puede ser difícil y dolorosa. En consecuencia, el presente estudio tuvo como objetivo identificar en la literatura los impactos de la pandemia de covid-19 para la elaboración del duelo infantil. La pregunta principal fue: "¿Cuáles son los impactos de la pandemia para la elaboración del duelo infantil?" y se elaboró utilizando la estrategia PICO (Paciente/Problema, Intervención, Control/Comparación y Resultados). La encuesta bibliográfica se realizó en las bases de datos Pepsic, Scielo y Google Scholar utilizando el cruce de palabras clave: "Duelo infantil" AND "Pandemia" y "Duelo infantil" AND "Covid-19". De los 14 artículos seleccionados, solo 3 fueron analizados. Los estudios analizados muestran que el duelo se manifiesta de diferentes maneras en los niños durante la pandemia y la importancia de que los responsables los asistan en este proceso. En vista de los resultados, es necesario realizar más estudios en el área para tener un mayor conocimiento y evaluar los impactos de la pandemia en la elaboración del duelo infantil, con el objetivo de adoptar medidas para preservar la salud mental de los niños.

Suicidal Thoughts and Behaviors Among Swedish Suicide-Bereaved Women: Increased Risk Associated With the Loss of a Child, Feelings of Guilt and Shame, and Perceived Avoidance From Family Members.

Previous studies have shown that suicide-bereaved individuals may suffer increased risk of suicidal thoughts and behaviors (STBs) due to traumatic grief. In this paper, we present the self-reported rate of STB among Swedish suicide-bereaved women (N = 293). Data was collected in a cross-sectional anonymous survey on the homepages of Sweden's leading suicide survivor organization, SPES. We used logistic regression to evaluate risks (of any STB event) related to losing a child compared to other relatives and the experience of social avoidance from family members, as well as feelings of shame and guilt. The self-reported rate of suicidal thoughts, plans, and attempts was 60, 24, and 5 percent, respectively, considerably higher than in the general population. Results showed that all of the investigated variables were independent risk factors for STB (ORs ranged between 1.29 and 2.69). Women who had both lost a child and experienced family avoidance reported the highest STB rate (87.5%), and we found an interaction effect between these two risk factors (OR = 3.45; 95% CI = 1.05-11.32) that was related to self-reported shame. It is concluded that perceived responsibility for someone else's suicide, and the social avoidance associated with it, may play an important role for suicide survivors and should be targeted by postvention activities.

Possibilidades da Clínica Gestáltica no Atendimento de Crianças Enlutadas / Possibilities of the Gestalt Clinic in the Care of Bereaved Children / Posibilidades de la Clínica Gestaltáltica en el Cuidado de Duelo en la Infancia

O luto é compreendido como o processo psíquico de elaboração de uma perda que rompe com toda a constituição de mundo interno e segurança da criança, exigindo que novas formas de ajustamento sejam criadas. A presença de um outro-suporte é fundamental para que a criança possa percorrer seus ciclos de contato e alcançar a satisfação de suas necessidades no enfrentamento do luto. A Gestalt-terapia é uma abordagem fenomenológico-existencial, focada na construção dialógica, na qual a relação terapeuta-cliente ganha um eixo central. Em termos de prática clínica, o terapeuta se coloca em abertura à espera do outro-humano que o busca, na expectativa de que se revele, acolhendo os conteúdos, reconhecendo sua manifestação, em um processo de aceitação, confirmação e inclusão. Neste sentido, a intervenção terapêutica acompanha a expressão do brincar como linguagem para a criança comunicar, compreender e assimilar o vivido. O caminho escolhido para realização deste estudo foi a revisão bibliográfica de teóricos da Gestalt-terapia e estudos em luto na contemporaneidade, com enfoque nas bases relacionais destas teorias associadas a vinhetas de casos clínicos para ampliar a compreensão e possibilidades de intervenção com crianças enlutadas na clínica gestáltica. (AU)

Grief is understood as the psychic process of elaboration of a loss that breaks with the entire constitution of the inner world and the child's safety, requiring that new forms of adjustment be created. The presence of another support is fundamental for the child to be able to go through their cycles of contact and achieve the satisfaction of their needs in facing grief. Gestalt therapy is a phenomenological-existential approach, focused on dialogic construction, where the therapist-client relationship takes on a central axis. In terms of clinical practice, the therapist stands open waiting for the other human who seeks him, expecting to reveal himself, welcoming the contents, recognizing their manifestation, in a process of acceptance, confirmation and inclusion. In this sense, therapeutic intervention accompanies the expression of play as a language for the child to communicate, understand and assimilate the lived experience. The path chosen for this study was the bibliographic review of Gestalt therapy theorists and studies in mourning in contemporaneity, focusing on the relational bases of these theories associated with clinical case vignettes to broaden the understanding and possibilities of intervention with bereaved children in the clinic gestalt. (AU)

El duelo se entiende como el proceso psíquico de elaboración de una pérdida que rompe con toda la constitución del mundo interior y la seguridad del niño, requiriendo la creación de nuevas formas de ajuste. La presencia de otro apoyo es fundamental para que el niño pueda pasar por sus ciclos de contacto y alcanzar la satisfacción de sus necesidades al enfrentar el dolor. La terapia gestáltica es un enfoque fenomenológico-existencial, centrado en la construcción dialógica, donde la relación terapeuta-cliente adquiere un eje central. En términos de práctica clínica, el terapeuta permanece abierto esperando al otro ser humano que lo busca, esperando revelarse, acogiendo los contenidos, reconociendo su manifestación, en un proceso de aceptación, confirmación e inclusión. En este sentido, la intervención terapéutica acompaña la expresión del juego como lenguaje para que el niño se comunique, comprenda y asimile la experiencia vivida. El camino elegido para este estudio fue la revisión bibliográfica de los teóricos de la Terapia Gestalt y los estudios contemporáneos de duelo, centrándose en las bases relacionales de estas teorías asociadas con viñetas de casos clínicos para ampliar la comprensión y las posibilidades de intervención con niños en duelo en la clínica gestáltica. (AU)

Black, White, and Hispanic Children's Health and Function 2-13 Months After Sibling Intensive Care Unit Death.

OBJECTIVE: To describe children's anxiety, depression, behaviors, and school performance at 2-13 months after sibling neonatal/pediatric intensive care unit (NICU/PICU) or emergency department (ED) death and compare these outcomes by child age, sex, race/ethnicity, whether the child saw their sibling in the NICU/PICU/ED, and attended the sibling's funeral. STUDY DESIGN: Children in 71 families were recruited for this longitudinal study from 4 children's hospitals and 14 other Florida hospitals. Children rated anxiety (Spence Children's Anxiety Scale) and depression (Children's Depression Inventory); parents rated child behaviors (Child Behavior Checklist) and reported school performance (detentions, suspensions, requested parent-teacher meetings) at 2, 4, 6, and 13 months post-sibling death. Analyses included repeated measures-ANOVA, t-tests, and 1-way ANOVA. RESULTS: In total, 132 children and 96 parents participated. More children were female (58%), black (50%), and school-age (72%). Of the children, 43% had elevated anxiety and 6% had elevated depression over 13 months post-sibling death. Child-rated anxiety was higher for girls and black vs white children. Child-rated anxiety and depression were lower if they saw their sibling in the NICU/PICU/ED before and/or after the death, and/or attended the funeral. Teens were more withdrawn than school-age children at all time points. Children who did not see their deceased sibling in the NICU/PICU/ED after death had more requests for parent-teacher conferences. CONCLUSIONS: Children's anxiety was more common than depression, especially in girls and black children. Children who saw their siblings in the NICU/PICU/ED before/after death and/or attended funeral services had lower anxiety and depression over the first 13 months after sibling death.