The death of a family member is one of the most distressing life events, often associated with complex emotional, cognitive, behavioral, and physical responses (Shear, 2012). Although grieving individuals commonly experience sadness, trouble concentrating, social withdrawal, fatigue, and/or disrupted daily routines (Benkel et al., 2024; Kaplow et al., 2013), most people accommodate the loss over time. For a minority of people, unremitting and intense persistent yearning, difficulty accepting the death, feelings of meaninglessness, and intense emotional pain continue to affect well-being and daily functioning and can lead to a diagnosis of prolonged grief disorder ([PGD]; Eisma, 2023). PGD symptoms are also associated with functional impairment and suicidality (Maccallum et al., 2025).

Grief is typically viewed as a personal journey, but is commonly experienced within a family context, where family dynamics influence how individuals experience and express loss (Breen et al., 2019). Family dynamics are the patterns of interaction among family members, including communication, roles, relationships, and emotional connections (Jabbari et al., 2023). Most contemporary grief models underplay ways in which family dynamics help or hinder an individual’s grieving process. For instance, the dual process model of grief, developed by Stroebe and Schut (1999), explains that individuals will adapt by oscillating between coping with loss-oriented stressors, involving emotions and facing the death, and coping with restoration-oriented stressors, which involves adjusting to life changes following loss. Stroebe and Schut (2015) later expanded the model to recognize the role of family dynamics, suggesting that some families collectively accepted the loss, shared the pain of grief, and adjusted together to life without the deceased.

Family systems theories emphasize that individuals cannot be understood in isolation from their families, especially during significant changes such as bereavement (Walsh & McGoldrick, 2004). To illustrate, Kissane et al. (1996) conducted a longitudinal cluster analysis of 115 spouses and 152 children whose family member had died in palliative care. The researchers surveyed them at 6 weeks, 6 months, and 13 months post-death and identified distinct family typologies: supportive, conflict-resolving, intermediate, sullen, and hostile. Supportive families encourage open communication and emotional expression, offering members safe spaces to express grief. Conflict-resolving families may experience interpersonal conflict but manage it in a way that provides emotional support and prevents distress. Intermediate families are characterized by moderate cohesion, conflict, emotional expression, and inconsistent communication. Sullen families may avoid conversations and exhibit low emotional expression, increasing the risk for isolation and mental health challenges. Hostile families are depicted by low cohesion, high conflict, and poor expression, often involving blame, anger, and withdrawal.

Walsh (2003) identified three areas that influence how families cope with loss: shared belief systems, communication, and organizational patterns. Such shared belief systems promote collective efforts to face adversity through meaning-making, rituals, spiritual beliefs, and hope; enhance family functioning; and encourage coordinated actions that support adjustment to loss, such as role flexibility and distribution of responsibilities (Morais et al., 2024; Walsh, 2003). Barboza and Seedall (2023) showed that adjustment was strongest when families engaged in shared meaning-making, such as through collective stories and shared perceptions of the loss, which were associated with lower grief, depression, and post-traumatic stress symptoms. When families collectively made sense of the death, their relationships strengthened, supporting adaptation to loss.

There is a series of pioneering case analyses, focused primarily on grieving couples, that expertly bridge the gap between grief theory and family theory. Hooghe et al. (2011) described a bereaved couple, Hilde and Koen, engaging in complex communication, moving between openness and protective silence to balance personal coping with sensitivity to their partner’s grief as they navigated the profound sense of loss following the death of their 13-year-old-son, Jasper, from brain cancer. Hooghe et al. (2012) provided a detailed case study of Els and Gunter grappling with the death of their 6-month-old daughter from leukemia. For this couple, there was an emotional core of sadness to their experience that required dynamic “cycling” of both closeness and distance to regulate emotions, as individuals and as a couple. Barboza et al. (2022) described a couple, Trey and Keisha, dealing with the ripple effects of the sudden death of Trey’s sister followed just one month later by a miscarriage. In the analysis, the authors describe the couple’s search for individual and shared meaning and illustrate meaning co-construction within the grieving dyad. In all three cases, the authors illustrated the ways that each individual grieved as well as the relational, dynamic nature of grief within the dyad of the relationship.

Despite such growing evidence of relational grieving, much research purporting to be on family experiences of grief relies on data from a single family member, even though doing so overlooks the relational dynamics inherent to the grief experience and masks important differences between members’ experiences, interactions, and coping strategies (Breen et al., 2019). A previous systematic review (Delalibera et al., 2015) examined family dynamics and the grieving process. However, the review lacked rigorous methodology and is limited to older literature (1981–2013), limiting its applicability to practice (Dale & Logsdon, 2022). With increasing recognition that grief is “a family affair” (Lenferink & O’Connor, 2023, p. 7428), we aimed to systematically collate and synthesize the evidence base to understand how family dynamics (e.g., communication, cohesion, roles) influence grief following bereavement and identify potential gaps in the evidence base. Specifically, we focused on studies that include at least two family members per family to address a noted limitation in research where data from one member of a family is considered acceptable to account for the views and experiences of multiple members of the family (see Breen et al., 2019), thereby capturing grief as a relational and systemic process and evaluated the methodological quality and rigor of the included studies.

Method

Design

We preregistered this systematic review with the International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251061451) to strengthen transparency, reduce duplication, and improve credibility (Booth et al., 2012). The review was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement (Page et al., 2021). The research question was informed by the SPIDER framework (Sample, Phenomenon of Interest, Design, Evaluation, and Research type; Methley et al., 2014; see Supplementary Table 1). A narrative synthesis analysis (Popay et al., 2006) was adopted due to the heterogeneity of the evidence base.

Inclusion and exclusion criteria

Studies were eligible if they (a) reported original empirical data on family dynamics and grief; (b) included data from at least two members of multiple families for each death reported (this was to counter research that sources data from one member of a family as a proxy for multiple members of the family); (c) addressed grief following a death; and (d) were published in peer-reviewed journals or as gray literature (e.g., theses, dissertations). No date limits were applied to ensure comprehensive coverage. Studies were excluded if they (a) were not written in English; (b) did not provide full-text access; (c) examined non-death losses; or (d) included data from only one person per family, or from a mixed number of family members (e.g., from one or more family members), or it was not explicitly stated whether data were collected from two or more members within the same family. Family dynamics were defined as patterns of interaction within families (Jabbari et al., 2023) to capture diverse aspects such as communication, cohesion, and conflict.

Information sources and search strategy

Preliminary scoping ensured keywords captured a range of studies relevant to the topic. To minimize potential publication bias, four databases were searched using broad keywords and including diverse study designs. Preliminary readings and Boolean operators informed the final search string: (grief OR bereave* OR mourning OR complicated grief OR prolonged grief disorder OR bereavement process) AND (family functioning OR family dynamic* OR dysfunctional famil* OR family conflict OR family system* OR family coping OR family support). On June 4^th 2025, the final systematic search of the databases CINAHL, Scopus, PsycINFO, and Medline was completed (see example in Supplementary Table 2).

Screening and selection

We uploaded all records into Covidence, which is an online record management tool that assisted our review team via the automatic removal of duplicates and with the collaborative processes of study screening, and data extraction, as well as the reporting requirements of the PRISMA quality standards. Recent iterations of Covidence use some machine learning features but the software requires researchers to determine the inclusion and exclusion of each and all studies. In title and abstract screening, 7,806 records were screened by the first author. To ensure reliability, 20% (n = 1,583) were double-screened by an independent reviewer (M.Q.). This proportion reflected recommended practice (10-20%) to balance feasibility with rigor (Veritas Health Innovation, 2024). In full-text screening, 183 articles were assessed for eligibility. Although guidelines suggest independent screening of approximately 20% of records (Polanin et al., 2019), 90% (n = 166) were independently screened by A.G. to strengthen methodological rigor.

Inter-rater reliability was assessed using Cohen’s kappa (McHugh, 2012). Title and abstract screening produced κ = .27 (fair agreement) and full-text screening produced κ = .53 (moderate agreement). Despite these values, raw agreement was high (.92 and .89, respectively), illustrating the kappa paradox, where high overall agreement can be masked by a high proportion of “exclude” decisions (Derksen et al., 2024).

Following the independent assessment of articles at each stage, the research team met to discuss the application of the inclusion and exclusion criteria. Because some team members were junior researchers, there were some instances of reviewers being overly conservative (e.g., including for full-text review articles that should have been excluded at the title and abstract stage) and this lowered the kappa, but the process did not exclude studies that should have been included. Further, the number of reasons to exclude a study also affected the kappa at the full-text review stage. For instance, if one member of the research team excluded a study because it did not include at least two members of the same family and another member of the review team excluded it because it the study was not about grief, the decision to exclude the study was correct but Covidence coded the decision as an incongruent agreement. These disagreements between reviewers at both stages were resolved through discussion until consensus was reached. Interim review of the selected articles (n = 26) by an external expert led to the team reviewing and refining their selection of articles, with three articles initially excluded at the full-text review stage later included in the final analysis (i.e., 29 studies). These process discussions were fruitful for skill development and likely improved our application of the inclusion and exclusion criteria for the remainder of the studies.

Data extraction

We extracted data using a pre-determined matrix including authorship, design, sample characteristics, recruitment context, data collection strategies and analyses, and findings.

Quality assessment and risk of bias

Methodological quality was evaluated using the Quality Appraisal for Diverse Studies (QuADS; Harrison et al., 2021), which was selected for its suitability in appraising heterogeneous study designs. The QuADS has 13 criteria (e.g., clarity of research aims), with each rated from 0 (not addressed) to 3 (explicit and detailed), producing a total score ranging from 0 to 39 that is converted to a percentage (Harrison et al., 2021). All 29 included studies were assessed by the first author (see Supplementary Table 3), and a random 20% (n = 6) were rated by a second reviewer (A.G.). Inter-rater agreement was fair (κ = .27). Differences were discussed until consensus. No studies were excluded based on quality; however, we considered quality when interpreting the findings.

Data analysis and synthesis

Narrative synthesis (Popay et al., 2006) was conducted due to heterogeneity of selected studies. The data extraction matrix described above was used as the basis for synthesis, following the approach outlined by Ryan and the Cochrane Consumers and Communication Review Group (Ryan & Cochrane 2013). The first author conducted a preliminary synthesis of study findings. These findings across populations, contexts, and family roles, including cultural and relational influences, were coded according to common ideas within and across studies, which enabled the grouping of related data and the identification of higher-order themes. Throughout this process, themes were refined to capture the scope of the data. For instance, the theme initially labeled Communication became Communication and Cohesion to reflect better the interconnected nature of dialogue and relational closeness within families. To optimize study interpretation, themes were discussed and reviewed within the research team, consistent with recommendations for collaborative analysis, to ensure thematic coherence and mitigate bias (Thomas & Harden, 2008).

Results

Study selection

After duplicates were removed, 7,806 articles were identified. During title and abstract screening, 7,623 articles were excluded as irrelevant (e.g., focused on the pre-death period or non-death losses such as divorce or receiving a diagnosis), leaving 183 articles for full-text review. Of these, 154 studies were excluded for: not examining family dynamics, not providing original empirical data from at least two members of multiple families (e.g., reviews, commentaries, or theoretical papers), collecting data from only one family member or a mixed number (e.g., one or more family members) per deceased person, not explicitly stating whether data were collected from two or more members within the same family, and focusing on other types of loss (e.g., divorce, chronic illness). Five studies were inaccessible in full text despite database and institutional searches, preventing adequate appraisal and extraction of relevant data. One study was excluded for not being accessible in English. This left 26 studies to be included for data extraction and analysis (Figure 1).

Study characteristics

The 29 included studies (Table 1) were cross-sectional (n = 18) and longitudinal (n = 8) designs and intervention trials (n = 3). In terms of primary data type, 18 were qualitative and 11 were quantitative. Participants were recruited from various settings, including death registers, community hospice programs, online support networks, social media platforms, and hospital-based interventions, broadening the generalizability of findings. Across studies, several validated measures were used to assess family dynamics and grieving, supported by study-specific interviews and questionnaires. Ages ranged from early childhood to older adulthood; however, precise age ranges could not be determined as some studies only reported mean ages of participants. Participants across studies included parents, children, siblings, couples, and grandparents bereaved through causes such as illness, suicide, or accident. Designs and samples ranged from qualitative studies with three siblings in one family to large randomized controlled trials with 620 members from 170 families. Most studies were conducted in Western contexts primarily in the United States, Sweden, and United Kingdom, with only one study originating from a non-Western context (i.e., India) and two studies focused on minority group within a Western-dominant country (i.e., Mexican American and Hispanic families in the United States).

Quality appraisal and risk of bias

QuADS scores ranged from 64.10% to 94.87% (M = 82.40%, SD = 8.52; Table 1), indicating generally strong methodological rigor across the samples. Studies with lower quality ratings often lacked clearly defined aims, recruitment details, stakeholder involvement, and transparent reporting of strengths and limitations. Risk of bias was considered narratively, and overall conclusions remained consistent when lower-quality studies were included, suggesting that methodological quality did not materially affect the synthesis outcomes.

Synthesis of findings

We identified four themes that capture the influence of family dynamics on grieving processes: communication and cohesion, caregiver influence on child adjustment, roles and reorganization, and cultural and societal influences.

Communication and cohesion

Across 18 studies, open communication was described as one of the most effective ways to cope with grief as a family (Angelhoff et al., 2021; Ayers et al., 2014; Barboza et al., 2025; Barboza & Seedall, 2025; Bartel, 2020; Cerel et al., 2000; Cutrer-Párraga et al., 2022; Fletcher, 2002; Foster et al., 2012; Garcia et al., 2023; Howard Sharp et al., 2020; Kaplow et al., 2013; Kenney et al., 2022; Kissane et al., 2016; Lindqvist et al., 2008; Randall et al., 2022; Weber Falk et al., 2022; Weber et al., 2019). Sharing feelings with one another facilitated mutual understanding while reducing conflict, underscoring stronger relationships and easier adaptation to loss (Barboza et al., 2025; Barboza & Seedall, 2025; Bartel, 2020, Fletcher, 2002; Weber et al., 2019). For instance, open communication and the creation of new family rituals and remembrance practices aided in reminiscence, continuing bonds, and meaning making (Bartel, 2020). In contrast, families where members limited emotional expression and withdrew from conversation were more likely to report difficulties processing grief (Angelhoff et al., 2021; Fletcher, 2002). When grief remained unspoken, family members tended to internalize their emotions rather than express and process them together, which increased vulnerability to psychological distress and PGD (Angelhoff et al., 2021; Kaplow et al., 2013). Parentally bereaved children described coping better when emotions, memories, and information were shared openly and honestly within the family (Kenney et al., 2022).

Family members experienced variability in communication after bereavement. In one study, 19% of mothers, 17% of fathers, and 23% of siblings reported greater openness and closeness after bereavement, reporting things like “we talk more” and “we pay attention to each other” (Foster et al., 2012, p. 348). In contrast, a smaller number of family members (3% of mothers, 4% of fathers, and 8% of children) described increasing distance or conflict, with one child noting, “my parents split up” (Foster et al., 2012, p. 351) following bereavement. Angelhoff et al. (2021) found that family cohesion weakened as communication declined. Adolescents’ ratings of parent-adolescent communication reflected this pattern, with open communication scores decreasing as time passed following bereavement (Angelhoff et al., 2021). Parents additionally reported that communication was often more open with daughters than sons, suggesting that gendered dialogue patterns may also shape cohesion (Angelhoff et al., 2021). For suicide bereavement, where shame and secrecy are common, communication within the family was challenging and support networks were limited (Cerel et al., 2000; Cutrer-Párraga et al., 2022; Lindqvist et al., 2008).

There was evidence that some family members inhibited open discussions to shield one another from further distress, creating what Kenney et al. (2022) called a “conspiracy of silence” (p. 236). Adolescents, too, could constrain their feelings to protect their parents. As one explained, “I don’t think I can tell my mother how I really feel about some things” (Howard Sharp et al., 2020, p. 1086). Alternately, families who listened, answered clearly, and acknowledged each other’s feelings maintained stronger bonds (Howard Sharp et al., 2020). Couples who shared stories and humor gained understanding (Randall et al., 2022). Programs that encourage open communication, emotional expression, and collaborative problem-solving were shown to reduce conflict, support emotional well-being, and improve family functioning, helping families navigate grief together rather than in isolation (Ayers et al., 2014; Kissane et al., 2016; Weber Falk et al., 2022).

Caregiver influence on child adjustment

Across 10 studies, children’s adjustment to bereavement was consistently related to caregiver warmth, emotional expression, involvement, and closeness (Angelhoff et al., 2021; Ayers et al., 2014; Boelen & Spuij, 2024; Foster et al., 2012; Garcia et al., 2023; Gilmer et al., 2012; Holmgren, 2021; Howard Sharp et al., 2020; Kissane et al., 2016; Weber Falk et al., 2022). Distress was linked to negative family dynamics characterized by low warmth, heightened parental control, and elevated internalizing and externalizing symptoms (Ayers et al., 2014; Howard Sharp et al., 2020).

Widowed fathers often adopted a practical, task-focused parenting style after their partner’s death, prioritizing routines and responsibilities over emotional expression (Holmgren, 2021). Becoming sole caregivers and decision-makers brought a heavy sense of responsibility. One father explained:

I really enjoyed my work, but it was also very busy and did not fit with being a lone parent at all. So, it has been a really big change just to let go of that job and then … well, now I am primarily there for the children, and that has been a big change. (Holmgren, 2021, p. 135)

Although a change in employment allowed fathers to provide stability for their children, it also meant that they sometimes neglected their own needs, as one father explained, “I have become a kind of ‘practical device’ and then I am lonely” (Holmgren, 2021, p. 132).

Children often noticed emotional changes that parents themselves did not acknowledge. In Gilmer et al. (2012) study of families bereaved by a child’s death from cancer, about one-third of siblings (31%) described their parents as sad and having seen them cry. However, few parents reported sadness, indicating a discrepancy between parents’ self-reports and their children’s perceptions. Gilmer et al. (2012) also noted that “bereaved parents have reported more parenting stress than controls, and bereaved siblings have reported less communication, availability, and support from parents after the death” (p. 573). Similarly, Foster et al. (2012) found that when parents were consumed by their own grief, siblings often “received limited support and communication” (p. 348), leaving them feeling sad, withdrawn, or insecure.

Programs were seen to be beneficial in improving caregiver influences on child adjustment to bereavement. The Family Bereavement Program was found to reduce parental depression, improve coping, strengthen discipline and improve caregiver-child relationships, leading to long-term improvements in children’s adjustment (Ayers et al., 2014). Additionally, Family-Focused Grief Therapy directly targeted caregiver psychological health in high-risk families, lowering the prevalence of PGD to 3.3% compared with 15.5% in standard care (Kissane et al., 2016). Similarly, the Grief and Communication Family Support Intervention used psychoeducation and problem-solving to improve parental communication and self-esteem and reduce anxiety, and these changes were associated with decreases in children’s behavioral difficulties (Weber Falk et al., 2022). However, not all evidence showed a clear association between caregivers and children’s adjustment to bereavement. In a study of 159 bereaved children and their caregivers, children reporting more warmth/involvement from mothers also reported more prolonged grief symptoms, whereas children reporting more warmth/involvement from fathers also reported less prolonged grief symptoms (Boelen & Spuij, 2024).

Roles and reorganization

Across 14 studies, bereavement was shown to influence family roles (Albuquerque et al., 2017; Barboza et al., 2025; Barboza & Seedall, 2025; Black & Santanello, 2012; Campbell-Jackson et al., 2014; Cutrer-Párraga et al., 2022; Das et al., 2021; Denham, 1999; Fletcher, 2002; Foster et al., 2012; Garcia et al., 2023; Walker & Sque, 2019; Weber et al., 2019; White et al., 2008). For instance, family members often took on extra responsibilities and couples sometimes felt unbalanced by different levels of emotional engagement and avoidance (Albuquerque et al., 2017; Campbell-Jackson et al., 2014; Denham, 1999). Learning to identify and harmonize with each other’s grief required an active and evolving process between grieving couples (Barboza et al., 2025) and can include choosing between emotional coregulation strategies such as being present with the partner, giving the partner space, expressing appreciation, resonating with the partner, or protecting them from a “dark place,” among other responses (Barboza & Seedall, 2025). Parents who balanced loss-oriented stressors (e.g., focusing on grief and absence) with restoration-oriented stressors (e.g., taking on new roles and tasks) accommodated family responsibilities more effectively than those who remained focused on grief (Albuquerque et al., 2017). Fletcher (2002) found that after a child’s death, families experienced role disruption and reorganization as they aimed to redistribute responsibilities once held by the deceased and “renegotiate how conflict is resolved” (pp. 61–62). Weber et al. (2019) similarly noted shifts in parental roles when surviving parents tried to balance their grief with children’s needs, sometimes becoming withdrawn or overprotective.

Children and siblings often described changes in family roles after a death. Following parental suicide, some were compelled to care for siblings and support the surviving parent. One child explained:

A lot of times I would sleep in her bed if I was scared or thought she was lonely. If she was lonely, I’d go and sit by her and ask her if she needed anything and stuff. If she was sad and crying, I would just sit there and give her a hug. (Cutrer-Párraga et al., 2022, p. 1848)

Some siblings described becoming more compassionate to others’ needs, such as one child who explained, “I’ve been more aware of people’s feelings and more caring towards them, and … more forgiving” (Foster et al., 2012, p. 349). In particular, children commonly felt “protective of and responsible for” their parents (Foster et al., 2012), highlighting how perceptions of parental vulnerability prompted them to adopt caregiving roles. Some parents also reported that children often undertook tasks once managed by the deceased sibling, helping to maintain family routines (Foster et al., 2012).

The death of a child also reshaped sibling positions, with some siblings becoming the oldest, youngest, or only child. Foster et al. (2012) noted that 25% of mothers, 8% of fathers, and 18% of children described these shifts. Weber et al. (2019) found that siblings sometimes competed for the attention of the surviving parent, creating feelings of unfairness in how attention and emotional support were shared within the family. Changes in family roles also extended to decision-making. For instance, when organ donation was decided collectively, families drew on the deceased’s values to guide them and found comfort in making what they believed to be “the right decision” (Walker & Sque, 2019, p. 232).

Broader family networks further shaped role reorganization. For some families, grandparents or in-laws stepped into caregiving roles, “giving parents space to grieve while the children were cared for” (White et al., 2008, p. 113). However, extended family members could also cause strain for the family. Black and Santanello (2012) explain that families sometimes fragment due to arguments about inheritance or the “right” way to grieve. Das et al. (2021) showed that in-laws could initially be supportive but later shift to blame, disrupting the family’s grieving process.

Gender expectations were also seen to influence the roles parents undertook during grief. Bereavement appeared to strengthen traditional gender roles, with mothers becoming the main caregivers when children were ill or needed help managing their health (Denham, 1999) whereas fathers took on the role of primary provider (Denham, 1999; Garcia et al., 2023). One father explained needing to “stay strong” and continue “providing the household income” (Campbell-Jackson et al., 2014, pp. 2 and 6). Following stillbirth, a mother described an “added pressure to be a fantastic mummy … to prove that I would have been a good mum to (first child)” (p. 8), whereas a father reported he did not “really get an outlet [to grieve]” (Campbell-Jackson et al., 2014, p. 7).

Cultural and societal influences

Three studies explored how cultural and societal factors influence grief processes in families (Black & Santanello, 2012; Das et al., 2021; Doran & Downing Hansen, 2006). Across different contexts, rituals provided families with ways to maintain continuing bonds with the deceased; however, they also imposed expectations that may exacerbate distress. Doran and Downing (2006) examined Mexican American Catholic families, where loyalty, closeness, and obligations to extended kin are emphasized through storytelling and helped families sustain the memory of the deceased. One sibling explained, “nobody [in the extended family] wants to talk about Esteban’s death. We prefer to talk about how he lived” (Doran & Downing Hansen, 2006, p. 206). In North India, cultural expectations of gender strongly shaped grieving. Mothers could express their grief openly, but fathers were expected to stay composed and return to work within 5–20 days (Das et al., 2021). Women were not permitted at burial grounds, and in some cases, mothers were faulted for the death of the child (Das et al., 2021). One religious leader explained, “yes, many families usually blame the woman for the death” (p. 10). A mother shared, “my husband…says due to your negligence all this happened… Now we fight more, and also, we are not able to take care of our other child” (Das et al., 2021, p. 8).

In the United States, rituals reflect values of individuality and self-expression (Black & Santanello, 2012). Funerals and memorials were frequently personalized with photos, eulogies, and stories about the deceased. These stories helped families make sense of the loss and stay connected. However, disagreements surfaced when family members told conflicting stories or focused on different relationships with the deceased, weakening the family’s sense of unity, often leaving family members feeling isolated in their grief (Black & Santanello, 2012).

Discussion

A systematic review and narrative synthesis of 29 studies revealed that constructs of family dynamics influence how individuals adapt to bereavement. However, within these studies of family dynamics that drew from data from at least two members of the same family, some constructs appear to be more researched than others, and the evidence base for some is more established than for others. For instance, communication appears to play an important role in how families adjust to bereavement, and this is consistent with Walsh’s (2003) Family Resilience Framework. Families whose members were open and honest with each other are more likely to adapt better (Angelhoff et al., 2021; Kaplow et al., 2013) but when communication is avoided, families might find it harder to make sense of the death, internalize emotions, and experience greater distress, which are patterns similar to Kissane et al. (1996) description of sullen or hostile families. Findings about caregivers influence children’s adjustment to bereavement (e.g., Ayers et al., 2014; Garcia et al., 2023) align with systems theory, which views the family as an interconnected system where changes in one member can impact the entire family (Walsh & McGoldrick, 2004). Interventions such as the Family-Focused Grief Therapy and the Family Bereavement Program were shown to help families improve communication and relationships while reducing conflict. These programs benefited families, helping them feel more supported in their grieving process and promoting healthier coping through improved communication (Ayers et al., 2014; Kissane et al., 2016).

In line with Stroebe and Schut (2015) Dual Process Model, flexibility in family roles and responsibilities was shown to be associated with more effective adaptation to bereavement than families where members become overwhelmed by or withdrawn (Albuquerque et al., 2017; Denham, 1999; Weber et al., 2019). However, few studies explored family dynamics in cultural contexts, showing the limited evidence base available to clinicians supporting bereaved families that are not Western, Educated, Industrialized, Rich, and Democratic (WEIRD; Henrich et al., 2010). As such, culturally informed frameworks are needed to ensure grief support reflects diverse family values and practices. We anticipate that these findings might spur more research to address the current state of fragmented evidence that demonstrates substantial heterogeneity and gaps across populations, contexts, and methodologies.

Limitations and future directions

Many of the included studies relied on self-report measures and cross-sectional designs, introducing potential biases such as social desirability and a reliance on retrospective memory. These factors may have led participants to underreport symptoms or recall experiences inaccurately, offering only a partial view of how family dynamics influence grief. Cross-sectional studies capture data at only one point, making it difficult to understand how family dynamics and grief influence each other over time. Future research could draw on longitudinal tracking of family dynamics to better understand how families experience grief together. For example, Lenferink and O’Connor (2023) analyzed longitudinal self-report data on PGD symptoms assessed at four time points in 257 adult parent-child bereaved dyads in Denmark. Cross-lagged panel modeling analyses showed that changes in PGD levels in parents significantly predicted PGD levels in their adult children, but not vice versa. Such designs and analyses could be applied to understanding the role of family dynamics in grief to reduce reliance on retrospective memory and get “real-time” data on how family dynamics influence grief following bereavement, and how grief influence family dynamics.

The limited number of included studies and their heterogeneity constrained the ability to examine the potential influence of important moderating factors, including religiosity, cultural and ethnic background, and pre-loss family relationships. These variables are relevant within bereavement research, and their limited and disjointed consideration within the corpus of included studies prevented pooled analyses. The heterogeneity of the included studies meant that narrative synthesis was most suitable method of analysis. Although this approach facilitated a detailed synthesis of the literature on family dynamics and the grieving process, it has been criticized for its interpretive nature (Popay et al., 2006) and potentially weakens the overall strength of the findings. To address such concerns, the team discussed and refined interim themes, ensuring they were coherent, grounded in the data, and credible (Thomas & Harden, 2008).

Our adherence to the PRISMA guidelines and use of Covidence and a pre-piloted standardized extraction matrix enhanced the methodological transparency, reproducibility, and interpretive integrity of the review; however, it is possible that relevant studies were omitted. We did not manually search reference lists due to time constraints, which may have limited the identification of additional relevant studies. As Bartels (2013) noted, reviewing reference lists is an important final step in systematic searching, as it can reveal older or significant works not included in electronic databases. Additionally, hand searching is valuable in systematic reviews, as it can identify missed studies, ensuring a more complete and transparent review process (Zhang et al., 2024). Future research could include manual citation searching to ensure more comprehensive coverage of the literature and could use meta-analysis once the literature affords such analyses to be conducted.

Implications

Viewing grief solely as an individual experience fails to account for the relational and systemic contexts in which grieving occurs (Breen et al., 2019). This individualized perspective is concerning in general and specifically when supporting families with children, because bereavement in childhood and adolescence is associated with heightened risks of depression, anxiety, post-traumatic stress symptoms, suicide, incarceration, and poor academic performance (Morris et al., 2016; Oosterhoff et al., 2018; Pham et al., 2018; Weinstock et al., 2021; Wilson, 2025). Growing evidence for family-based interventions enables clinicians and policymakers to address the broader systems that influence adjustment, rather than viewing grief as isolated to the individual. However, much more evidence is needed to understand how interventions can be culturally responsive and integrate culturally relevant grieving practices.

Additionally, policies should promote family-centered bereavement programs across the community and healthcare systems. This would ensure that care focuses not only on the individual but also on their families and the relationships that shape grief. Encouraging collaboration between these services could help identify “at-risk” families earlier and provide coordinated support that acknowledges each family’s unique needs, allowing them to adjust after bereavement. Therefore, government bodies and healthcare organizations could consider implementing policies that provide family-centered bereavement programs that recognize both individual and family needs.

Conclusion

Grief is not only an individual experience but also a relational process shaped by family dynamics, including communication, caregiver well-being, role flexibility, and cultural and societal contexts. The findings from this review highlight the need for research to develop and apply family-based frameworks that show how family members grieve and adjust together. Despite growing recognition of this interdependence, much research focuses on individuals in isolation. If we are to understand and support grieving families, there is a need for (a) more research that develops this understanding by including diverse cultural groups, using longitudinal designs, and enabling pooled analyses, and (b) expanding the reach of family-based interventions so that individuals and families cope adaptively. Without this shift, we will continue to neglect the context in which most grief occurs—the family.

Supplementary Material.docx