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Death Studies
ISSN: 0748-1187 (Print) 1091-7683 (Online) Journal homepage: https://www.tandfonline.com/loi/udst20
Assessing the impact of factors on parental grief
among older Chinese parents
Yongqiang Zheng & Leslie G. Wuest
To cite this article: Yongqiang Zheng & Leslie G. Wuest (2019): Assessing the
impact of factors on parental grief among older Chinese parents, Death Studies, DOI:
10.1080/07481187.2019.1616854
To link to this article: https://doi.org/10.1080/07481187.2019.1616854
Published online: 24 May 2019.
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Assessing the impact of factors on parental grief among older
Chinese parents
Yongqiang Zheng and Leslie G. Wuest
School of Social Work, George Fox University, Newberg, Oregon, USA
ABSTRACT
A sample of 206 older Chinese bereaved parents was recruited and the effects of attach-
ment style, coping strategy, social support, and spirituality on parental grief were investi-
gated utilizing structural equation modeling. The results revealed problem-focused and
dysfunctional coping strategy, insecure attachment style, less social support from family and
friends would likely lead to higher levels of parental grief. The study explored how the
unique context of Chinese culture and policies may shape the severity and duration of par-
ental grief. It provides a baseline to understand the complexity of parental grief in China
and to design and improve future interventions.
Introduction
Parental grief has been recognized as “the most
intense and overwhelming of all grief”(Davies et al.,
2004, p. 506). In addition to the typical grieving
symptoms, bereaved parents also reported higher
prevalence of muscle soreness, lump in the throat,
feeling uneasy in public (Gilllis, Moore, & Martinson,
1997), headaches and fatigue (Foster et al., 2011).
Many grieving parents were found to have higher lev-
els of shame, anger, fear (Arnold, Gemma, &
Cushman, 2005), and blame (Dyregrov, Nordanger, &
Dyregrov, 2003). Furthermore, feelings of rejection,
abandonment, embarrassment, and stigma are fre-
quently voiced by bereaved parents, particularly those
whose children died traumatically by homicide or sui-
cide (Arnold et al., 2005).
Research evidenced parental grief in particular was
often found to be prolonged (Neidig & Dalgas-Pelish,
1991). Clinically, when people continue to grieve for
an extended period of time, they may exhibit symp-
toms of a state known as prolonged grief disorder
(PGD) (Prigerson et al., 2009) or complicated grief
(CG) (Prigerson et al., 1995). Major symptoms differ-
entiating PGD include persistent and disruptive yearn-
ing, pining, longing for the deceased, and trouble
accepting the death. Prolonged grief has been shown
to contribute to worse physical and mental health
(Lannen, Wolfe, Prigerson, Onelov, & Kreicbergs,
2008), more health-risk behaviors (Kivim€
aki, Vahtera,
Elovainio, Lillrank, & Kevin, 2002) and a higher level
of suicidal ideation (Li, Laursen, Precht, Olsen, &
Mortensen, 2005).
Research revealed that grief increasingly impacts
people who are of advanced age. Older adults who are
grieving the death of a child or spouse were found to
have higher prevalence of PGD (Ott, Lueger, Kelber,
& Prigerson, 2007). The death of a child in later life
was found to increase the chances of social isolation
and loneliness (Stroebe, Zech, Stroebe, &
Abakoumkin, 2005). Aging necessitates the older
adults’reliance on others for care and assistance as
the death of a child negates the potential support
from the deceased. It is critical to stress that factors
like aging and needing of care added to the older
parents’complicated and magnified grief responses.
Current research on parental grief has not focused
on the rapidly increasing aging population. The role
various risk or protective factors play in the grieving
process has not been investigated as a whole. In add-
ition, most modern grief theories and clinical working
models are constructed in the context of Western
society. Those theories and models have not been fully
tested in other cultures, especially through a more
comprehensive statistical model. Therefore, there is an
urgent need to embrace the research considering the
older parents’unique characteristics and their cultural
and political context.
CONTACT Yongqiang Zheng yzheng@georgefox.edu School of Social Work, George Fox University, 12753 SW 68th Ave., #P110 Portland, OR 97223
Newberg, USA.
ß2019 Taylor & Francis Group, LLC
DEATH STUDIES
https://doi.org/10.1080/07481187.2019.1616854
The current study focuses specifically on older
Chinese parents. The one-child policy has been imple-
mented in China for over 30 years. Those parents who
complied with the policy decades ago now entered
their late adulthood with the risk of losing their only
child. The estimation is that there are at least 76,000
families who experience the death of a child in China
each year (National Health Department of China,
2010). This particular group of older bereaved parents
whose only child died are referred to as “shiduers”;an
identity that is stigmatized in a Confucian culture that
believes having no posterity amounts to failure. In the
context of the one-child policy, these parents are
growing older without the emotional and financial
support that most Chinese parents depend on (Zheng
& Lawson, 2015). Issues of later life care and mental
health of older bereaved parents have reached crisis
point as this generation ages. These parents are a
growing and understudied group; very limited know-
ledge has been generated to help to understand their
particular grieving experiences. The goal of the cur-
rent study is to gain an understanding of the relation-
ships between factors impacting older bereaved
parents in China who are experiencing prolonged
grief due to the death of their only child.
Researchers suggested in order to understand the
complexity of grief, multiple variables need to be con-
sidered, including personal history, gender, culture,
coping styles, personality traits, and support systems
(Rubin, Malkinson, & Witztum, 2000). Worden
(2009) identifies seven overarching factors for practi-
tioners to consider while working with complicated
bereavement: 1. the relationship to the deceased, 2.
the nature of the attachment, 3. the mode of death, 4.
historical antecedents, 5. personal variables, including
age and gender as well as coping and cognitive style.
6. social variables, including perceived social and emo-
tional supports as well as satisfaction with the level of
this support and religious resources, and 7. concurrent
stresses.
Empirical research examined the above factors. The
number of children in the family and age of the
deceased child were found to be impactful on severity
of grief. Parents who lost their only child appear to
have a more difficult time adjusting than those with
many children (Dyregrov et al., 2003). Keesee,
Currier, and Neimeyer (2008) reported that parents
losing older children were more likely to demonstrate
symptoms of complicated grief. The attachment style
of the parent was suggested to relate to parental loss.
Grief and depression symptoms were more evidenced
among those parents who were more insecurely
attached (Christiansen, Elklit, & Olff, 2013). On the
other hand, secure attachment among bereaved
parents was found to be associated with more active
support seeking behaviors (Kearney & Byrne, 2015).
Research found that emotion-focused and dysfunc-
tional or avoidant coping strategies are likely to be
important predictors of symptomatology in bereaved
parents (Christiansen et al., 2013; Harper, O’Connor,
&O’Carroll, 2014) . Social support from family and
friends was also identified as one of the important
resources for coping with loss, but many bereaved
parents reported that extended family members often
are unable to offer the support they need (Marx &
Davidson, 2003). Lack of social support has been
found to be associated with higher levels of distress,
psychological morbidity, and PTSD following the
death of a child (Scheidt et al., 2012). Research has
also looked into the relationship between spirituality
and parental grief. Berkey (2007) reported bereaved
parents utilized their faith to cope with the death of
their child, and the belief in an afterlife was particu-
larly comforting. However, a relationship between reli-
gion and spirituality with negative bereavement
outcomes has also been found (Wortmann & Park,
2008). This inconsistency of findings indicates the
relationship between religious coping or spirituality
and parental grief is inconclusive and needs to be
studied further.
In summary, the above literature examined many
factors that affect the grieving process, but do not
investigate how these factors work together to impact
the bereaved. The current study is designed to address
this gap in research by utilizing a structural equation
modeling method to test multiple factors simultan-
eously. A statistical model was developed as an initial
attempt to measure the relative contribution of factors
impacting the severity of parental grief among older
parents in China. Variables from Worden’s(2009)
conceptual framework that were identified in the cur-
rent literature and found to be significantly related to
parental grief were used. The resulting model includes
attachment style, coping strategy, social support, and
spirituality, focusing on the direct and indirect link-
ages between the proposed factors and parental grief.
Method
Participants and sampling procedure
A sample of 206 participants were recruited via mul-
tiple online bereaved parents’support groups. People
in these groups used a screen name instead of their
real name. A non-probabilistic convenience sampling
2 Y. ZHENG AND L. G. WUEST
method that relies on available subjects was used for
the recruitment.
Participants who met the following criteria were
included in the study:
1. Must be the age of 55 or over.
2. Self-identified as a parent who experienced the
death of a child.
3. The deceased child has been dead for more than
6 months.
In addition, participants had to be able to read,
write, and have access to a computer or smartphone
and the Internet since the study utilized an online sur-
vey using a self-completed questionnaire to collect the
data. The survey site opened with an introduction letter
to the study. Prior to the survey, the study adopted a
self-screening procedure to make sure only those who
met the study criteria were included. The survey site
was also set to accept one input from each IP address
to avoid the same participants taking it multiple times.
Measures
Attachment style
The Relationship Scales Questionnaire (RSQ) (Griffen
& Bartholomew, 1994) was used to measure attach-
ment styles. The RSQ contains 30 items on a 5-point
scale, and they were constructed into 4 conceptualized
categories of personal attachment styles: secure, preoc-
cupied, fearful, and dismissing. The RSQ has been
translated and tested in China, with the preoccupied
and the dismissing attachment showing good reliabil-
ity with Cronbach’s alpha values of 0.81 and 0.72 (Ho,
Chan, Ma, & Field, 2013).
Coping strategy
The Brief COPE Inventory (BCI) (Carver, Scheier, &
Weintraub, 1989) was used to measure individual cop-
ing strategy. It has 28 items on a 4-point scale, meas-
uring 14 coping strategies as person’s response to a
stressful situation or event. The BCI includes 3 cate-
gories: emotion-focused coping, problem-focused cop-
ing, and dysfunctional coping. The BCI has been
translated and tested in China, showing a reliability
coefficient of 0.85 (Han et al., 2014).
Social support
Social support was measured by the Multidimensional
Scale of Perceived Social Support (MSPSS) (Zimet,
Dahlem, Zimet, & Farley, 1988). It contains 12 items
that are rated on a 7-point scale, measuring the
participants’perceived support from 3 different cate-
gories: friends, family, and significant others. The
Chinese version of MSPSS has a test-retest reliability
of 0.81, and an internal consistency of 0.85 (Huang,
Jiang, & Ren, 1996).
Spirituality
Individual spirituality was measured by the Daily
Spiritual Experience Scale (DSES) (Underwood &
Teresi, 2002). The scale includes total 16 items with
higher scores indicating more frequent daily spiritual
experience. Six indicators were used for the purpose
of model-building in the study, including presence,
comfort, harmony, love, touch, and reunion. The
Chinese version of DSES demonstrated high internal
consistency with a Cronbach’s alpha of 0.97 (Ng,
Fong, Tsui, Au-Yeung, & Law, 2009).
Parental grief
Parental grief symptoms were measured by the
Prolonged Grief Questionnaire-13 (PG-13) (Prigerson
et al., 2009). The PG-13 has 13 items on a 5-point
Likert scale, with higher scores indicating greater
PGD symptomatology severity. The Chinese version
of PG-13 was found to have satisfactory psychometric
properties, with a Cronbach’s alpha of 0.94 (He,
Wang, Wei, & Tang, 2013).
Analytical strategy
The proposed statistical model was tested using struc-
tural equation modeling (SEM). AMOS 24.0 (IBM)
was used to test the model with robust maximum
likelihood (MLM). Multiple fit indices were used in
model testing, including v
2
, smaller indicates better
model fit, should be non-significant; Root Mean
Square Error of Approximation (RMSEA), 0.05 indi-
cates good fit, 0.08–0.10 indicates adequate; Goodness
of Fit Index (GFI), >0.90 indicates good fit;
Comparative Fit Index (CFI), >0.90 indicates good fit;
Standardized Root Mean Square Residual (SRMR),
<0.10 indicates good fit.
Results
Characteristic of the sample and the
study variables
The mean age of participants was 57.9 years old
(SD ¼6.3). The youngest participant in the study was
55 and the oldest was 77 years old. Female comprised
of 65.53% of the participants (n¼135) and 34.47% of
the participants were male (n¼71). Mean years since
the death of the child was 4.9 (SD ¼4.2), with a range
DEATH STUDIES 3
of 0.5 to 20 years. For 96.60% of the bereaved parents
(n¼199) in this study, the deceased child was their
only one. The reasons for the death included sudden
illness (n¼85, 41.26%), accident (n¼61, 29.61%),
chronic illness (n¼20, 9.71%), homicide (n¼8,
3.88%), suicide (n¼6, 2.91%), and other (n¼26,
12.62%). The current study found a high prevalence
of PGD among the study participants, with 35.5%
(n¼73) of them meeting the clinical diagnostic crite-
ria. Compared to studies in other countries, the
Chinese sample had the highest prevalence rate of
prolonged grief (see Table 1) (Goldsmith, Morrison,
Vanderwerker, & Prigerson, 2008; Kersting, Brahler,
Glaesmer, & Wagner, 2011; Maercker & Znoj, 2010).
Descriptive statistics for the measures in the study
are displayed in Table 2. Regarding attachment styles,
22.82% of the participants (n¼47) showed secure
attachment, 20.87% showed fearful attachment
(n¼43), 51.94% showed preoccupied attachment
(n¼107) and 4.37% were in the dismissing attach-
ment category (n¼9). The mean score for the
emotion-focused coping was 4.27 (SD ¼0.97), prob-
lem-focused coping was 5.31 (SD ¼1.05), and
dysfunctional coping was 5.12 (SD ¼1.08). In the
study, self-blaming (M¼6.27), planning (M¼5.90),
and self-distraction (M¼5.65) were most commonly
utilized by the study sample. Coping strategies like
humor, religion, and substance use were least fre-
quently used by the participants. The study found
47.57% of the participants (n¼98) perceived more
help came from their families, 20.39% of them per-
ceived more help came from their friends (n¼42),
and 23.79% of them perceived more help came from
significant others (n¼49). Among those who met the
diagnostic criteria for prolonged grief, 63.59% experi-
enced emotional pain on a daily basis (n¼131),
84.47% reported the symptoms of separation distress
continued to be elevated at least 6 months after the
death (n¼174), 75.24% had significant impairment in
social, occupational, or other important areas of func-
tioning (n¼155).
Correlations were examined to determine the
relatedness of the observed variables in the proposed
model. The data showed all correlations were
less than 0.70, indicating little likelihood of
multicollinearity in the sample. In addition, the
Mahalanobis D
2
was utilized to test for the presence
of multivariate outliers. No outliers were identified in
the study sample. The VIF (variance inflation factor)
value used was to determine the problem of multicol-
linearity, variables with high VIF were not included in
the model building process.
Model development
The initial measurement model included 5 latent factors
measured by 29 indicators. A confirmatory factor ana-
lysis was run and indicators with low factor loading
were removed. The values of Modification Indices
(M.I.) were evaluated to see if any additional paths
would improve the model fit by reducing the chi-square
value. A model was then specified with 5 factors and 15
indicators: 1) preoccupied, fearful, and dismissing
attachment in the attachment style measurement; 2)
problem-focused and dysfunctional coping; 3) social
support from family and friends; 4) daily spiritual expe-
riences of presence, comfort, love, touch, and reunion;
and 5) three items in the parental grief measurement.
The structural model was constructed specifying
direct effects from the four factors to parental grief.
The model fit indices were v
2
¼155.34(df ¼81,
p¼.00), RMSEA ¼0.07, GFI ¼0.91, CFI ¼0.89,
SRMR ¼0.07. The Normed v
2
(ratio between the chi-
square and the degrees of freedom) was calculated
and the model attained a Normed v
2
value of 1.92,
meeting the good fit criteria of less than 2.0 (Kline,
2015). The model fit indices indicated the structural
model showed an adequate model fit to the data.
The current study confirmed four statistically sig-
nificant direct effects in the structural model: a
Table 1. Prevalence of prolonged grief disorder comparison between studies.
Author/year PGD prevalence Participants/Nationality Age
Zheng & Wuest (current study) 35.5% 206/China M¼57.0
Maercker & Znoj, 2010 4.2% 712/Swiss 60–94
Kersting, Brahler, Glaesmer, & Wagner, 2011 4.0% 122/Germany M¼44.0
Goldsmith, Morrison, Vanderwerker, & Prigerson, 2008 11.6% for Whites
21.2% for African-Americans
222/the U.S. M¼59
Table 2. Descriptive statistics and Cronbach’s alpha values for
the measures (N¼206).
M SD Range Cronbach’sa
RSQ 92.37 16.31 43.0–129.0 0.66
BCI 68.02 11.92 31.0–110.0 0.84
MSPSS 48.30 1.17 12.00–84.00 0.90
DSES 31.98 14.95 16.00–94.00 0.90
PGD 32.31 8.98 9.00–45.00 0.90
Note. BCI: brief COPE inventory; DSES: daily spiritual experience scale;
MSPSS: multidimensional scale of perceived social support; PGD: pro-
longed grief questionnaire; RSQ: relationship scales questionnaire.
4 Y. ZHENG AND L. G. WUEST
positive effect of attachment style on parental grief
(b¼0.93, p<.05), a positive effect of coping strategy
on parental grief (b¼1.69, p<.05), a negative effect
of perceived social support on parental grief
(b¼–0.77, p<.05), and a positive effect of spirituality
on parental grief (b¼0.80, p<.05). According to
Kline (2015), evaluation of the effect is based on
Cohen’s effect size criteria. Thus, the effects in the
current study were considered large.
Covariances between coping strategy and attach-
ment style, social support, and spirituality were found
significant (p<.05). This pattern of covariances sug-
gested that attachment style, social support, and spir-
ituality change together with coping strategy, and
coping strategy might mediate between the other three
factors and parental grief. The model was therefore
modified and displayed in Figure 1. The model fit
indices indicated the final structural model showed an
adequate model fit to the data.
The modified final model found none of the total
effects in the model were significant but confirmed
that the above four statistically significant direct
effects remain. Meanwhile, the following statistically
significant indirect effects mediated by coping strategy
were found: a positive effect of perceived social sup-
port on parental grief (0.78, p<.05) and a negative
effect of attachment style on parental grief (–0.80,
p<.05). The result confirmed that coping strategy
mediated the effect from perceived social support and
attachment style to parental grief. The study found
coping strategy had no mediating effect between spir-
ituality and parental grief.
Discussion
The present study investigated the relationship
between attachment style, coping strategy, social sup-
port, spirituality and the severity of parental grief
among a group of older parents in China. Expanding
upon previous research, the study assessed these fac-
tors simultaneously through a statistical model.
Further, the mediating effects of coping strategy
were examined.
The study found coping strategy, specifically prob-
lem-focused and dysfunctional coping, was more
likely to be related to higher levels of prolonged grief.
The emotion-focused coping strategies were not used
frequently by study participants and were thus not
included in the model. Most literature in Western cul-
ture identified problem-focused coping as adaptive
and leading to a better mental health outcome
(Lazarus & Folkman,1984), however, the current
study’s finding is inconsistent with this. It is generally
recognized that specific coping strategies are not uni-
formly effective (or ineffective) across all contexts and
situations. Bonanno and Burton (2013) indicated that
Figure 1. The final structure model with standardized coefficients.
DEATH STUDIES 5
individual’s coping efficacy is dependent on awareness
of contextual demands and responsivity to internal
and external feedback. To better understand the rela-
tionship between prolonged grief and problem-focused
coping in the current study, the cultural and policy
context of the older bereaved parents in China must
be taken into consideration.
Research found that in a culture which emphasizes
harmony and social cohesion, Chinese people are
eager to change themselves to fit the environment,
mobilize the resources to handle stressful situations,
and use social means to gain control of the external
environment (Spector, Sanchez, Siu, Salgado, & Ma,
2004). Older bereaved parents in China were found to
organize, advocate, and protest for better services
(Zheng, Lawson, & Head, 2017), which could be
related to problem-focused coping. Cultural context
can also explain why emotion-focused coping was not
significant to study participants. Chinese culture
devalues expressing intense emotions of grief since it
is considered hazardous to people’s health and harmo-
nious interpersonal relationships (Chow, Chan, & Ho,
2007). Research suggests without the use of emotional
coping, problem-focused coping may not lead to a
positive psychological outcome (Holahan &
Moos, 1987).
The death of an adult child is viewed as a particu-
larly tragic situation in Chinese culture since it
deprives parents of the continuation of their heredity.
The failure of passing on the family names, as a cul-
tural stigma, creates profound stress on the bereaved
older parents; sometimes leading to remarriage and
adoption in attempts to reconstruct their parental
identity (Zheng & Lawson, 2015). In China, it is diffi-
cult for bereaved older parents to access resources
they need as they age because of the one-child family
mode and legislation designating an adult child’s
responsibility to be the main caregiver to their
parents. They therefore face a reality in which neither
the deceased child nor the government is available to
provide legitimate care in their old age (Zheng
et al., 2017).
Coping strategy is considered to likely mediate the
relationship between interpersonal and intrapersonal
variables (Stroebe, Folkman, Hansson, & Schut, 2006).
The current study confirmed competitive meditating
effects of coping strategy, where the mediated effect
and direct effect are in opposite directions (Zhao,
Lynch & Chen, 2010); in this case, specifically the dir-
ect effect from attachment style to parental grief was
positive, while the mediated effect was negative; the
direct effect from social support to parental grief was
negative, while the mediated effect was positive.
The study found that participants who showed
more insecure attachment style had more symptoms
of prolonged grief. The result is consistent with previ-
ous research, however, existing literature primarily
focused on younger bereaved parents’attachment style
(Wijngaards-de Meij et al., 2007), lacking evidence
from older parents. Research found that insecure
attachment may increase with age based on the ser-
ious adverse life experiences (Schachner, Shaver, &
Gillath, 2008). In addition, aging highlights the shift
from children depending on their parents, to parents
needing to rely more heavily on their children, par-
ticularly in times of illness or disability. Unlike
younger bereaved parents, older parents are beyond
childbearing age and increasingly aware of depend-
ency and mortality. Death of an attachment figure,
such an adult child, particularly if that is their only
child, means the attachment needs of the older
parents are more difficult to be secured, resulting in
higher levels of prolonged grief as the current study
found. Research revealed that coping strategies are an
important meditator of the relationship between inse-
cure attachment and grief reactions (Delespaux,
Ryckebosch-Dayez, Heeren, & Zech, 2013). The cur-
rent study confirmed the existence of this media-
ting effect.
The current study revealed that perceiving less
social support from family and friends leads to more
severe parental grief, which is consistent with existing
research (Scheidt et al., 2012). Although social support
is generally considered beneficial for the bereaved,
research also found increased social isolation after the
death of a child (Collins et al., 2016). More research is
needed to explore specific kinds of support needed to
improve health outcomes for bereaved parents in their
cultural context. Research found bereaved parents
turned to fellow bereaved peers for support, believing
that their losses were arguably more difficult for fam-
ily and friends to understand or empathize with
(Zheng & Lawson, 2015). Research supports the role
of coping strategy mediating between social support
and mental health outcomes (Wang & Gan, 2011).
The current study confirmed the existence of a media-
ting effect of coping strategy in relation to social sup-
port and parental grief.
The study found that parents who had more daily
spiritual experiences tended to have higher levels of
PG. This result revealed the spiritual struggles of
bereaved older Chinese parents and adds another
piece to the inconsistency about spirituality’s role in
6 Y. ZHENG AND L. G. WUEST
post-traumatic psychological outcomes as presented in
existing research (Wortmann & Park, 2008). Since the
current study did not support the role of coping
strategy as a mediator between spirituality and paren-
tal grief, more research is needed to explore
this dynamic.
The primary limitations of this study include the
selection bias inherent in the sampling and data col-
lection procedures used. The deliberate use of a sam-
ple of individuals who have been reaching out to
online mutual support groups has excluded those who
have not reached out for this kind of assistance. The
online survey method may have altered the responses
obtained, threatening the study’s internal validity.
Future research is needed to test the model with dif-
ferent populations in order to explore the differences
between them. In addition, future research could util-
ize a prospective longitudinal design and a larger
sample to test the relationship of the factors and par-
ental grief over time and to gain a more comprehen-
sive understanding of older bereaved Chinese
parents’grief.
Some of the foundational in the field of grief
research assumptions have been questioned due to
lack of empirical validation (Wortman & Silver, 2001).
The current study uses a sophisticated quantitative
method to examine the factors related to parental
grief. This study contributes to the knowledge base
regarding the particular population of older bereaved
Chinese parents. Investigating and understanding
multiple factors is critical for mental health professio-
nals to design and improve the effectiveness of their
interventions with this population. With life expect-
ancy significantly increasing in China, more older
adults are likely to experience the death of their adult
child. This situation creates an urgent need for more
attention to the issue on micro, mezzo, and macro
levels. Findings of this study raise timely and relevant
questions about how to support older parents in the
Chinese cultural and societal context. For this hidden
population, changes need to happen on multiple
fronts; services targeting their personal coping strat-
egies that alleviate grief, optimized social support
involving peers, and policies created to provide med-
ical, long term care, and financial support.
Recognition of this forgotten population and reducing
the cultural stigma of childlessness would enable these
older adults to be re-integrated as valued members of
Chinese society. Overall, this study may serve as a
baseline to critically evaluate policy implications and
develop further measures to address the bereaved
older parents’psychosocial needs.
Funding
This study was not funded.
Disclosure statement
The author declares that he has no conflict of interest.
Research involving Human Participants and/or
Animals: The study was approved by the Institutional
Review Boards at University of Louisville (IRB
NUMBER: 15.0606).
ORCID
Yongqiang Zheng http://orcid.org/0000-0002-5503-4262
Leslie G. Wuest http://orcid.org/0000-0002-8099-2278
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