{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T19:57:08Z","timestamp":1783108628928,"version":"3.54.6"},"reference-count":41,"publisher":"Mathematical Modelling and Numerical Simulation with Applications","issue":"01","funder":[{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["UG1HD083170"],"award-info":[{"award-number":["UG1HD083170"]}]},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["UG1HD049981"],"award-info":[{"award-number":["UG1HD049981"]}]},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["UG1HD63108"],"award-info":[{"award-number":["UG1HD63108"]}]},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["UG1HD083166"],"award-info":[{"award-number":["UG1HD083166"]}]},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["UG1HD083171"],"award-info":[{"award-number":["UG1HD083171"]}]},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["UG1HD049983"],"award-info":[{"award-number":["UG1HD049983"]}]},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["U01HD049934"],"award-info":[{"award-number":["U01HD049934"]}]},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["UG1HD050096"],"award-info":[{"award-number":["UG1HD050096"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Pediatr Intensive Care"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Therapeutic alliance reflects the strength and quality of the physician\u2013patient\/family relationship. We investigated the association between therapeutic alliance and bereaved parents' mental health and perceived overall health following their child's death in a pediatric intensive care unit (PICU). Bereaved parents were surveyed 6 months after their child's death in a PICU affiliated with the Collaborative Pediatric Critical Care Research Network. Parents were evaluated for complicated grief, depression, and post-traumatic stress using the Inventory of Complicated Grief (ICG), the Patient Health Questionnaire (PHQ-8), and the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), respectively. Overall health was evaluated using a single item. Therapeutic alliance between parents and their deceased child's PICU physicians was assessed using the Human Connection scale (HCS). Two hundred and thirty-five parents of 158 deceased children completed surveys. Mean ICG score was 34.4\u2009\u00b1\u200914.9 with 142 (60.4%) parents screening positive for complicated grief. Mean PHQ-8 score was 9.1\u2009\u00b1\u20096.2 with 102 (43.4%) screening positive for at least moderate depression. Mean SPRINT score was 14.6\u2009\u00b1\u20098.2 with 122 (51.9%) screening positive for post-traumatic stress disorder. Overall health was perceived as fair for 47 (20.0%) parents and poor for 10 (4.3%). Using multivariable modeling, higher HCS score (greater therapeutic alliance) was significantly associated with lower (better) ICG score (\u22120.23, 95% CI \u22120.42, \u22120.04, p\u2009=\u20090.018). HCS score was not significantly associated with PHQ-8, SPRINT, or overall health scores. We conclude that bereaved parents experience a high level of adverse mental health symptoms including complicated grief, depression, and post-traumatic stress symptoms. Greater therapeutic alliance with PICU physicians may lessen symptoms of complicated grief during bereavement.<\/jats:p>","DOI":"10.1055\/s-0041-1727179","type":"journal-article","created":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T19:33:13Z","timestamp":1621279993000},"page":"003-011","source":"Crossref","is-referenced-by-count":3,"title":["The Association between Therapeutic Alliance and Parental Health Outcomes following a Child's Death in the Pediatric Intensive Care Unit"],"prefix":"10.53391","volume":"12","author":[{"given":"Markita","family":"Suttle","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W.","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murray M.","family":"Pollack","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's National Hospital, Washington, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Berg","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick S.","family":"McQuillen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter M.","family":"Mourani","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Hospital of Colorado, University of Colorado School of Medicine, Colorado, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Sapru","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph A.","family":"Carcillo","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Startup","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Holubkov","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan Michael","family":"Dean","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A.","family":"Notterman","sequence":"additional","affiliation":[{"name":"Department of Molecular Biology, Princeton University, New Jersey, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen L.","family":"Meert","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, Central Michigan University, Mt. Pleasant, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"31409","published-online":{"date-parts":[[2021,5,17]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s10880-018-9590-7","article-title":"The grief of parents after the death of a young child","volume":"26","author":"S Morris","year":"2019","journal-title":"J Clin Psychol Med Settings"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.aucc.2015.01.005","article-title":"What is \u201cnormal\u201d in grief?","volume":"28","author":"B J Arizmendi","year":"2015","journal-title":"Aust Crit Care"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1056\/NEJMcp1315618","article-title":"Clinical practice. 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