Bereavement guilt in Chinese adult children : the conceptualization, measurement, risk factors and association with grief outcomes

Abstract

Bereavement is one of the most painful experiences in one’s life, and guilt is one of the various emotions associated with it. Guilt is widely reported by bereaved people, but it is not yet sufficiently understood by researchers. There is a lack of convergence in conceptualizing guilt, and no valid measurement exists to assess this important construct in grief. Meanwhile, this emotion is particularly significant in Chinese adult given the cultural value of filial piety. Therefore, this thesis aims to fill this gap and enhance understanding of the nature and consequences of bereavement guilt in Chinese adult children. This sequential mixed method research comprises three parts. To better define and conceptualize bereavement guilt, 16 bereaved adult children were interviewed in the first study about their subjective experience of guilt. Their narratives illustrated the content and feelings of bereavement guilt. It suggested that guilt was based on various evaluations of their behaviors, which failed to meet their inner standards or expectations. It also revealed that they felt guilt for contributing to the death, for hurting the deceased, and for not paying enough back to the parent. Those thoughts were evidently accompanied by distressful feelings. In study two, the Bereavement Guilt Scale (BGS) was developed based on findings in study one. It was then validated with survey data collected from 873 bereaved adult children. The scale comprises five factors: (1) responsibility towards the death, (2) hurting the deceased, (3) survivor guilt, (4) indebtedness guilt and (5) guilt feelings. It was proved to have good dimensionality and construct validity, satisfactory internal consistency and test-retest reliability. Study three aimed to build the model for bereavement guilt, exploring its prevalence, predictors and relationship with complicated grief. The same data set in study two was analyzed and the results revealed various occurrence rates for different subtypes of bereavement guilt. The most common type is indebtedness guilt (81%), followed by guilt feelings (70%), responsibility for the death (37%), survivor guilt (27%) and guilt about hurting the deceased (23%). It was also revealed that guilt is more commonly experienced by people bereaved from unnatural death than natural death. Investigating a group of demographic and death-related variables simultaneously, this study found that different types of guilt have distinct predictors, but that three risk factors predicted most of them. These are the adult children being of a younger age, losing a mother, and low psychological preparation for the death. Finally, a strong association between guilt and complicated grief was established by the data. The relationship between complicated grief and guilt was stronger than with demographic variables, death-related variables, depression and anxiety. Such association remains significant even when controlling for these variables. This thesis proposes a multidimensional conceptualization of bereavement guilt and has developed a valid measurement tool. It builds a preliminary model of risk factors, bereavement guilt and health outcomes in bereavement. The implications and limitations are also discussed.