The roles of exposure, family relationships, and symptoms in children bereaved on September 11th: Comparisons of explanatory models

This study examined individual- versus family-level mediational models that included the roles of gender, age, exposure, family relationships, and symptoms in children who were parentally bereaved during the September 11 th World Trade Center (WTC) attacks in New York City (NYC). The first model tested (Model A) hypothesized that family relationships mediated the relationship between exposure and children's symptoms. The second model tested (Model B) hypothesized that children's symptoms mediated the relationship between exposure and family relationships. Both models were tested by first controlling for gender and age (residualized mediational models), and then by stratifying by gender and age (moderated mediational models). The sample consisted of 86 children, ages 8 to 18, of emergency service personnel who died on September 11th, 2001 and was part of a larger, randomized clinical trial that examined the effects of Traumatic Grief Cognitive-Behavioral Therapy and Client Centered Therapy (Brown & Goodman, 2001). Participants completed measures of exposure (physical proximity, emotional proximity, and secondary adversities), family environment characteristics (cohesion and conflict), symptoms (childhood traumatic grief (CTG), anxiety, and depression), and demographic characteristics. Results supported four cases of moderated mediational models (two for younger boys and two for younger girls). In two models, family relationships mediated the relationship between secondary adversities and symptoms of CTG (Model A) and in two models, symptoms of CTG mediated the relationship between secondary adversities and family relationships (Model B). There were differential roles for family relationship variables however, with cohesion playing an important protective role for younger boys, and conflict playing an important risk role for younger girls. There was some speculative support for Model A versus Model B. The results highlight the ways in which secondary adversities may impact both the individual and family system, the importance of examining both individual- and family-level variables, and taking into account gender and age differences in studies of children. Study strengths and limitations, clinical implications, and directions for future research are also discussed.