The scientific backdrop is sobering. Road traffic accidents kill roughly 1.19 million people worldwide each year, and many of the bereaved are children. When a death is sudden and violent, childhood bereavement has been linked to long-lasting psychological consequences, including prolonged grief — a condition now formally recognized in the DSM-5-TR as prolonged grief disorder, marked by persistent separation distress, loneliness, and numbness that cause significant impairment at least six months after the loss in youths. Traumatic loss also elevates the risk of depression and posttraumatic stress symptoms. Yet while clinicians know that grieving happens within families, most research has focused on broad measures of positive parenting, such as warmth and consistent discipline. Far less attention has been paid to the darker corners of the family emotional climate — criticism, irritation, intrusiveness, and emotional coldness — or to the specific things parents say when they and their children sit down and talk about what happened.

The study team recruited twenty parent-child dyads from the Dutch TrafVic Kids project, which investigates the psychological consequences of losing a close person in a traffic accident. The children, aged eight to eighteen with a median age of 13.5, had all lost someone close — often a parent, in 55 percent of cases, or a sibling in a quarter of cases — at least six months before taking part. For the parents, who were overwhelmingly mothers, the loss was frequently that of a partner or even a child, meaning the adults were grieving deeply while trying to support their surviving children. Each child completed an online interview lasting up to ninety minutes, and then parent and child engaged together in a joint narrative task: a roughly twenty-minute, researcher-free conversation in which they discussed the moments before the death and answered prompts such as what they were thinking when they heard that the person had died.

To capture the family’s emotional climate, parents filled out the Level of Expressed Emotion questionnaire, a thirty-eight-item instrument assessing four dimensions: lack of emotional support, intrusiveness, irritation, and criticism. Expressed emotion, a concept long studied in families of people with severe mental illness, describes the overall emotional temperature of parent-child interactions; high expressed emotion means more hostility, criticism, and emotional over-involvement. Decades of work have tied high expressed emotion to mood and anxiety disorders in children, possibly because it acts as a chronic stressor that interacts with a child’s vulnerability and stress reactivity. In the crucible of traumatic bereavement — where children are already stressed and parents are juggling their own grief — the researchers suspected this climate might matter even more.

The loss-specific part of the study was more novel. Borrowing and adapting a coding scheme developed for children’s post-trauma conversations after emergency room visits, the researchers transcribed the twenty-minute conversations, broke parental speech into clause-sized units they called chunks — transcripts ranged from 133 to 1,214 chunks — and classified each chunk into four categories: promotion of avoidance, promotion of approach, negative appraisals, and positive appraisals. An avoidance promotion might sound like “We don’t have to talk about it”; approach promotion might be “Talking about it will help.” Negative appraisals included blaming the child or declaring that the family would never be the same again, while positive appraisals minimized threat, avoided blame, promoted autonomy, or framed change as temporary — for instance, praising how well the child coped. Two trained coders rated a quarter of the transcripts independently, with disagreements resolved through discussion, and reliability was quantified using Krippendorff’s alpha.

The children’s own outcomes were measured with validated instruments: the Traumatic Grief Inventory for Kids assessed prolonged grief according to DSM-5-TR and ICD-11 criteria; the PHQ-9 Modified for Teens measured depression; the Child PTSD Symptom Scale for DSM-5 captured posttraumatic stress; and the KIDSCREEN-27 gauged health-related quality of life across physical, mental, social, and school domains. The clinical picture in this community sample was concerning: fifteen percent of children met probable criteria for prolonged grief disorder, twenty percent for posttraumatic stress disorder, and thirty-five percent for probable major depression. Given the small sample, the team used Bayesian Kendall’s tau correlations, a non-parametric approach suited to small datasets that quantifies evidence for an association through Bayes factors — a value of three, for instance, means the alternative hypothesis is three times as likely as the null.

The headline finding centered on criticism. Parent-reported criticism showed strong positive associations with children’s depression and posttraumatic stress symptoms, each with a tau of 0.37 and Bayes factors around three, meaning the relationships were roughly three times more likely than not. The other expressed emotion dimensions — lack of emotional support, intrusiveness, and irritation — showed weak or negligible evidence of association. The researchers speculate that criticism may inflate the negative self-evaluations and self-blame characteristic of depression, likely through the internalization of negative self-related cognitions and impaired emotion regulation. Because depression and posttraumatic stress share features such as cognitive distortion and negative self-appraisal, criticism may fuel both. Interestingly, prolonged grief and quality of life appeared less sensitive to parental criticism, possibly — and speculatively — because children with profound grief remain so preoccupied with the lost person that other relationships, including with parents, recede in importance.

On the loss-specific side, positive appraisals stole the show. Parents who expressed relatively more positive appraisals during the conversation had children with lower depression scores and, strikingly, higher health-related quality of life — the latter association was strong, with a tau of 0.47 and a Bayes factor of nearly fourteen, meaning that relationship was about fourteen times more likely than no relationship at all. This fits with earlier work showing that caregivers’ positive emotional expression when reminiscing about the deceased is linked to lower depression and anxiety in children. The authors suggest that because depression involves dysregulation of positive affect, parents may help children upregulate positive emotions by focusing on affirmative thoughts about the lost person, consistent with the broaden-and-build theory of positive emotions. Notably, positive appraisals showed no association with prolonged grief or posttraumatic stress — perhaps, the authors speculate, because for deeply grieving children, happy memories can evoke bittersweet pain.

Just as telling were the null results. Negative appraisals, avoidance promotion, and approach promotion showed no reliable links to children’s outcomes, though the authors caution that avoidance and approach responses were rare in the conversations, likely limiting statistical power. They also note that the coding scheme, adapted from a trauma-and-anxiety framework, may not capture grief-specific avoidance — which in prolonged grief can paradoxically masquerade as approach, such as repeatedly talking about the deceased to preserve a connection. Such continuing bonds can even serve an adaptive function by helping families construct meaning, making maladaptive patterns hard to spot from the outside. Deeply ingrained critical cognitions, meanwhile, may simply never surface in a twenty-minute task.

The team is careful about scope. The correlational design cannot establish causality — parental criticism and adolescent distress likely influence each other in both directions — and the small, Dutch, community sample with relatively low symptom levels limits generalizability. Two subscales of the expressed emotion measure had modest internal consistency, and no corrections for multiple testing were applied. Still, the implications are tangible. Bereavement support programs could help parents reflect on harsh communication and practice expressing positive loss-related appraisals, building on existing psychoeducational interventions for trauma-specific parent-child communication. Teachers and other supportive adults, the authors note, are well positioned to notice when families are struggling and to facilitate referral. And methodologically, the study makes a case for observation: self-reports of parenting are prone to bias, and watching how families actually talk about death may reveal what questionnaires cannot. If replicated in larger and more diverse samples, the message to grieving households is simple but powerful — criticism wounds, while a parent’s ability to find something positive in the wreckage of loss may quietly help a child heal.

Subject of Research: The relationship between parental expressed emotion, loss-specific parental responses, and children's psychological outcomes after traumatic bereavement

Article Title: The Role of Parental Expressed Emotion and Loss-Specific Parental Responses in Children’s Loss-Related Outcomes Following Traumatic Loss: A Mixed-Methods Observational Study

Article References: van Dijk, I., Lenferink, L. I., Asberg, L., de Keijser, J., & Boelen, P. A. (2026). The Role of Parental Expressed Emotion and Loss-Specific Parental Responses in Children’s Loss-Related Outcomes Following Traumatic Loss: A Mixed-Methods Observational Study. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-026-03380-4

Image Credits: AI Generated

DOI: 10.1007/s10826-026-03380-4

Keywords: parental criticism, expressed emotion, childhood bereavement, traumatic loss, prolonged grief, posttraumatic stress, depression, parent-child communication, health-related quality of life, traffic accidents, Bayesian analysis, observational methods

The study recruited fourteen Dutch-speaking parents, eight mothers and six fathers with an average age of about fifty-one, all living with an adolescent aged twelve to eighteen who was experiencing depressive symptoms. The adolescents themselves, seven girls and seven boys with an average age of roughly fifteen, were rated by their parents as having moderate to severe depressive symptoms on a standard screening questionnaire. Nine of the fourteen young people were receiving treatment for their symptoms during the study period. Every parent in the sample was a biological parent, and most participated in couples, allowing the researchers to compare how two parents in the same household responded to the same child on the same days.

Methodologically, the study stands out for its use of ecological momentary assessment, a technique in which participants answer brief surveys on their phones in their natural environment rather than recalling events weeks later. Parents received four surveys a day, but the analyses focused on the evening survey, which asked each parent to rate how worried they had been about their child that day, how confident they had felt in their role as a parent, and how warm and how critical they had been toward their child, all on seven-point scales. Crucially, the surveys also asked open-ended follow-up questions: what was the direct cause of the worry, what made the parent feel insecure, and what made them feel confident. Parents could select predefined answers or type their own, and their custom responses were carried forward into later surveys.

On the quantitative side, the team estimated a Gaussian graphical model, a type of network analysis in which variables are represented as nodes and the statistical associations between them as edges, with each edge representing a partial correlation that controls for all other variables in the network. To avoid spurious connections, the researchers applied LASSO regularization with model selection via the Extended Bayesian Information Criterion, and they checked the stability of the estimated edges with a non-parametric bootstrap of one thousand resamples. Across 446 evening observations, the resulting network replicated and extended earlier findings from the RE-PAIR study. Parental worry was positively correlated with parental criticism, with an edge weight of 0.349, the strongest connection in the network. Parental worry and self-efficacy were negatively correlated, meaning that on days when parents worried more, they tended to feel less confident as parents.

Self-efficacy, in turn, showed a positive correlation with parental warmth, at 0.289, and a small negative correlation with criticism. Warmth and criticism themselves were negatively related. Because parental criticism has repeatedly been linked in prior research to elevated depressive symptoms in adolescents, these connections matter: they sketch a plausible pathway in which a parent’s anxiety about a child’s condition could feed into harsher or more critical interactions, while a parent’s confidence could support warmer ones. What the network cannot yet establish is direction. Whether worry drives criticism, or criticism amplifies worry, or whether confidence fosters warmth or warmth fosters confidence, remains an open question that the authors flag for future research.

The qualitative half of the study tackled that blind spot from a different angle. Using thematic analysis, the researchers coded the reasons parents gave for their worry and self-efficacy into six overarching themes: adolescent behavior, adolescent well-being, family interaction, the parent, the future, and parenting behavior. For worry, the most frequently reported themes were adolescent behavior, adolescent well-being, and family interaction. Within adolescent behavior, the dominant subthemes were a lack of activities, school absence, and eating habits. Parents described children staying in bed, canceling appointments, and refusing to discuss school, and several linked eating problems to physical complaints such as fainting. Within well-being, the runaway leader was the adolescent’s negative mood, selected by all fourteen parents a combined 137 times. One parent even reported worry tied to a child who kept thinking of death, a stark reminder of the suicidality that shadows adolescent depression.

Family interaction emerged as the third major worry theme, driven overwhelmingly by a lack of contact with the child. Parents wrote that it was difficult to really discuss anything, that their child avoided contact, or that their child would not leave their room. Notably, when the researchers mapped which reasons co-occurred on the same evening, a child’s lack of activities frequently appeared alongside negative mood, and school absence frequently appeared alongside withdrawal, suggesting that parents experience these symptoms not as isolated problems but as a clustered, mutually reinforcing picture of their child’s decline.

The drivers of self-efficacy told a complementary story. The most selected reason for feeling less confident as a parent was, again, lack of contact with the child, followed by the adolescent’s negative mood and doubts about parenting behavior itself. Parents reported not knowing how to help or support their child, wondering whether to raise difficult topics such as school attendance or substance use, and feeling constantly insecure in their role. One parent captured the ambivalence poignantly, writing that they knew they were a good parent even though it did not always feel that way. On the positive side, the strongest booster of self-efficacy was contact with the child, including fun conversations and shared activities, followed by a good family atmosphere and feeling supported by a partner. The contrast is striking: the same domain, parent-child connection, sits at the heart of both the parents’ distress and their resilience.

Zooming in on one couple, the researchers estimated individual time-series networks for each parent, revealing that the group-level patterns did not hold uniformly within families. One parent showed the expected positive link between self-efficacy and warmth, while the other did not, and the two parents cited overlapping but distinct reasons for their worry, with one pairing negative mood with lack of contact and the other pairing school absence with mood. The couple’s weekly patterns also showed that worry and its reasons fluctuated together across the intervention, generally easing from the first week to the last, though the same core concerns persisted. This within-family variation, the authors argue, underscores the case for personalized, family-level approaches rather than one-size-fits-all advice.

The practical implications are direct. The authors conclude that parents of adolescents with depression need specialized care focused on the adolescent-parent interaction, including concrete guidance on managing a child’s negative affect and behaviors such as social withdrawal, eating problems, and screen use. They also highlight the power of simply asking parents, in the moment, what is driving their worry and insecurity, a low-burden diary method that parents in the study said helped them reflect on their own daily behavior. Strengthening support between partners and within the wider family, the study suggests, could be a fruitful clinical target, since perceived partner support reliably lifted parental confidence. As adolescent depression rates continue to climb worldwide, this research makes a compelling case that treating the teenager alone is not enough: the worried parent behind the withdrawn child is part of the system, and helping that parent may be one of the most effective ways to help the child.

Subject of Research: Daily diary study of parental worry, self-efficacy, and parenting behaviors in families raising adolescents with depression

Article Title: Parental Worry, Self-Efficacy, and Parenting Behaviors when Raising Adolescents with Depression: A Mixed-Method Daily Diary Study

Article References: Veenman, M., Kullberg, M. L. J., Kielstra- van der Schalk, C., van den Nouweland- van Baars, R., Ruys- Zonnenberg, M., Fried, E. I., & Elzinga, B. M. (2026). Parental Worry, Self-Efficacy, and Parenting Behaviors when Raising Adolescents with Depression: A Mixed-Method Daily Diary Study. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-026-03369-z

Image Credits: AI Generated

DOI: 10.1007/s10826-026-03369-z

Keywords: adolescent depression, parental worry, parental self-efficacy, parenting behavior, ecological momentary assessment, network analysis, family systems, parental criticism, parental warmth, mixed methods, daily diary study, parenting intervention