LOS ANGELES-When a child dies - especially when the death is unexpected - surviving parents have a 67% higher risk of hospitalization for mental illness than do parents who never experience the death of a child.
What's more, mothers are especially vulnerable, Jørn Olsen, MD, PhD, and colleagues reported in Thursday's New England Journal of Medicine.
The likelihood that grieving mothers will be hospitalized for affective disorders such as clinical depression, bipolar disorder or anxiety is almost twice that of mothers who don't experience the death of child, says Dr. Olsen, who is chairman of epidemiology at the UCLA School of Public Health.
Action Points
- Bereaved parents, especially parents of children who die unexpectedly, are at increased risk of developing a number of mental disorders, especially affective disorders.
- Research suggests that mothers have a greater risk than fathers. Encourage both parents to seek professional help following the death of a child, but closely monitor mothers.
He says that for mothers this increased risk was almost double (91% greater) than of mothers who did not lose a child. The risk is greatest during the first year after the child dies but remained significantly elevated five years or more after the death. "We also found a dose effect - mothers who lose more than one child, have a greater risk," he says.
For fathers, the risk of a mental health hospitalization is 61% higher than for fathers who don't lose a child, says Dr. Olsen.
Coincidentally, the study comes at a time when the nation is riveted by two news stories of struggling parents: Bob and Mary Schindler who continue a legal crusade to keep their brain damaged daughter alive. At the same time, there are the grieving parents of six high school students who were killed Monday in a shooting incident at Red Lake High School in Red Lake, Minn.
Dr. Olsen says the study results suggest the need for close monitoring of parents of the slain high school students because parental bereavement risks are greatest when death occurs suddenly.
Elizabeth Berger MD, speaking for the American Psychiatric Association, says the study findings confirm her own observations from years of practice. "The loss of a child is uniquely devastating," she said. "It is the worst thing."
Dr. Berger, who is the author of "Raising Children With Character," says the "take home message for physicians is that the bereaved parents remain an at risk group on all measures - psychiatric hospitalization is just one crude measure of this continuing risk."
The mental illness study is the last in a series of studies by Dr. Olsen and a team researchers from Denmark, all of which investigated the "the general hypothesis of whether stress could trigger mental or physical disorders." He says they decided to investigate bereaved parents because it was considered "the highest stress exposure."
In earlier papers they reported increased risk of mortality - especially accidental death and suicide - and increased risk of cardiovascular disease among bereaved parents. In both cases, Dr. Olsen says, the increased risk was greatest for mothers.
In this study, Dr. Olsen's team identified 1,082,503 persons who were born in Denmark from 1952 to 1999 and who had a child 18 years old or younger during the study period from 1970 to 1999. Birth and death registries as well as medical records were analyzed to confirm childhood mortality and health status of parents.
Among the findings:
- Compared with parents who didn't lose a child, parents who lost a child had an overall risk of first psychiatric hospitalization for any disorder of 1.67 (95% CI 1.53-1.83).
- Bereaved mothers had a higher risk for any psychiatric hospitalization: 1.78 compared with bereaved fathers 1.38.
- For bereaved mothers risk of hospitalization for affective disorders is 1.91 (95% CI 1.59 to 2.30) versus 1.61 (95% CI 1.15 to 2.27) for grieving fathers.
Dr. Olsen says the study has a number of limitations that may over-estimate or underestimate the effect of a child's death: The authors could not adjust for family history of psychiatric illness or socioeconomic status - both factors that could bias the results. "Confounding might also be possible it a shared genetic predisposition led to both the death of the child and psychiatric hospitalization in the parent…" the authors write.
As the study included only patients who were hospitalized, it is possible that it underestimated incidence rates for overall psychiatric illness.
The study was supported by grants form the Danish National Research Foundation and the Danish Medical Research Council to the Danish Epidemiology Science Center and the National Center for Register-Based Research.
Primary Source
New England Journal of Medicine
Source Reference: Jiong L, Laursen TM, Precht DH et al. Hospitalization for Mental Illness among Parents after the Death of a Child. N Engl J Med 2005; 352: 1190-6.