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Section 5
Complicated Grief and Depression Following Loss

Question 5 | Test | Table of Contents

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In the last section, we discussed involving children in change when a loss occurs.

In this section, we will discuss depression and melancholic features.  As you know depression is normal following a loss.  However, intense feelings of depression may represent clinical depression. 

In this section, we will discuss ways to differentiate between natural depression and clinical depression. Two signs to look for when evaluating a client for depression are normal behavior and clinical signs. As you listen to this section, consider a grieving client you are treating and how this information might apply related to depression.

♦ #1 Normal behavior
Tom became concerned regarding his daughter Samantha, age 7. Samantha’s mother had died during child birth when she was born, so Samantha was partially raised by Tom’s grandmother, Phyllis. Tom had anticipated Phyllis’s death due to her age and condition, but Samantha had not been informed. 

Tom stated, "I expected Samantha to be sad about Grandma Phyllis’s death, but I’m starting to worry. Like I said I know she’s supposed to be sad, but Samantha has started to act strangely.  About a week ago, she asked me how she could die so she could join Grandma in heaven. She also started talking about death a lot. Because I was worried, I asked the teachers at her school to keep an eye on her. On Tuesday, I got a call about a family picture Samantha drew which showed her Grandma in heaven and me standing next to Samantha’s dead body. Then Samantha’s counselor called and told me Samantha was telling the other kids that she was going to die soon." 

Think of your Samantha. Does your grieving client have an preoccupation with death resulting from depression? As you know the DSM indicates that Melancholic-feature specifics include early morning wakening; psychomotor retardation or agitation; anorexia or weight loss; and excessive or inappropriate guilt, as discussed in the previous section. Atypical features include increased appetite or weight gain; hyper-somnia; sensitivity to perceived rejection.

♦ #2 Clinical Signs
The faculty at Samantha’s school attempted to verify that her preoccupation with death was related to clinical depression.  They asked Tom some basic questions.  Since signs of clinical depression in children are similar to those of an adult, two questions Samantha’s teacher asked Tom were,
1. "Does Samantha complain of not feeling well?" and
2. "Does Samantha feel tired often?" 

I then evaluated Samantha for further signs of clinical depression.  I looked for poor concentration, withdrawal, change in eating and sleeping habits, constant sadness, and crying.  Samantha did not show these signs of clinical depression.  However, it was apparent that Samantha’s pain of grief was so intense that she wished for death herself

♦ Technique: Coping with Depression
Because Samantha was experiencing normal depression and not clinical depression, I used two simple techniques for coping with depression that you may find beneficial with grieving clients you are treating. 

1. The first technique I used was drawing happy and unhappy memories .  Samantha had already used drawing as a technique to share her feelings when she drew her family picture.  Therefore, drawing seemed like a technique from which she could benefit.  First, I suggested Samantha draw a favorite memory.  Samantha’s drawing was of her Grandmother baking cookies with her. 

Because maintaining a balanced  perspective on death can be especially important when dealing with children, I asked Samantha to also draw an unhappy memory.  Samantha drew her Grandmother spanking her for drawing on the walls.  Could drawing help your client cope with depression as well as maintain a realistic perspective on death? 

2. The second technique I used was focusing on keepsakes. For this technique, I spoke with Tom, Samantha’s father.  I encouraged him to spend time with Samantha focusing on treasured items related to Grandma Phyllis and photographs.  Tom later stated, "I thought it would be a good idea to make a scrapbook.  It was good to see Samantha smile as we talked about Grandma Phyllis." 

Tom found that scrap booking and focusing on keepsakes provided an opportunity for open communication while doing an activity that benefited Samantha grief work.  Think of your Samantha.  Could she benefit from these techniques regarding coping with depression?  Would it be helpful to use drawing and keepsake discussion explained in this section to act as a catalyst for grief work’s unresolved feelings.

In this section, we have discussed depression.  We very briefly discussed ways to differentiate between natural depression and clinical depression. 

- Asarnow, J. R., Jaycox, L. H., & Tompson, M. C. (2001). Depression in Youth: Psychosocial Interventions. Journal of Clinical Child & Adolescent Psychology, 30(1), 33-47. doi:10.1207/s15374424jccp3001_5

In the next section, we will discuss fear.  Three concepts regarding fear are why children become afraid, manifestations of fear, and identifying specific fears.
Reviewed 2023

Peer-Reviewed Journal Article References:
Cummings, C. M., Caporino, N. E., & Kendall, P. C. (2014). Comorbidity of anxiety and depression in children and adolescents: 20 years after. Psychological Bulletin, 140(3), 816–845.

Eisma, M. C., Stroebe, M. S., Schut, H. A. W., Stroebe, W., Boelen, P. A., & van den Bout, J. (2013). Avoidance processes mediate the relationship between rumination and symptoms of complicated grief and depression following loss. Journal of Abnormal Psychology, 122(4), 961–970. 

Marshall, A. D., Roettger, M. E., Mattern, A. C., Feinberg, M. E., & Jones, D. E. (2018). Trauma exposure and aggression toward partners and children: Contextual influences of fear and anger. Journal of Family Psychology, 32(6), 710–721. 

Murray, K. J., Sullivan, K. M., Lent, M. C., Chaplo, S. D., & Tunno, A. M. (2019). Promoting trauma-informed parenting of children in out-of-home care: An effectiveness study of the resource parent curriculum. Psychological Services, 16(1), 162–169.

Review of Life & loss: A guide to help grieving children (2000). [Review of the book Life & loss: A guide to help grieving children (2nd ed.), by L. Goldman]. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 21(3), 141. 

Salinas, C. L. (2021). Playing to heal: The impact of bereavement camp for children with grief. International Journal of Play Therapy, 30(1), 40–49.

 QUESTION 5
What are some of the DSM specifics for Melancholic-features? To select and enter your answer go to Test.

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