Hostname: page-component-7c8c6479df-5xszh Total loading time: 0 Render date: 2024-03-28T21:19:28.133Z Has data issue: false hasContentIssue false

Offspring death and subsequent psychiatric morbidity in bereaved parents: addressing mechanisms in a total population cohort

Published online by Cambridge University Press:  01 November 2013

T. Ljung*
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
S. Sandin
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
N. Långström
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
B. Runeson
Affiliation:
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
P. Lichtenstein
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
H. Larsson
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
*
*Address for correspondence: Ms. T. Ljung, Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, SE-17177 Stockholm, Sweden. (Email: Therese.Ljung@ki.se)

Abstract

Background

It is unclear if psychiatric morbidity among parents bereaved of a child is related to major loss in general or if the cause of death matters. Whether such a link is consistent with a causal explanation also remains uncertain.

Method

We identified 3 114 564 parents through linkage of Swedish nationwide registers. Risk of psychiatric hospitalization was assessed with log-linear Poisson regression and family-based analyses were used to explore familial confounding.

Results

A total of 3284 suicides and 14 095 any-cause deaths were identified in offspring between 12 and 25 years of age. Parents exposed to offspring suicide had considerably higher risk of subsequent psychiatric hospitalization than unexposed parents [relative risk (RR) 1.90, 95% confidence interval (CI) 1.72–2.09], higher than parents exposed to offspring non-suicide death relative to controls (RR 1.18, 95% CI 1.11–1.26). We found no risk increase among stepfathers differentially exposed to biologically unrelated stepchildren's death or suicide, and the relative risk was notably lower among full siblings differentially exposed to offspring death or suicide.

Conclusions

Parental psychiatric hospitalization following offspring death was primarily found in offspring suicide. Familial (e.g. shared genetic) effects seemed important, judging from both lack of psychiatric hospitalization in bereaved stepfathers and attenuated risk when bereaved parents were contrasted to their non-bereaved siblings. We conclude that offspring suicide does not ‘cause’ psychiatric hospitalization in bereaved parents.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bailley, SE, Kral, MJ, Dunham, K (1999). Survivors of suicide do grieve differently: empirical support for a common sense proposition. Suicide and Life-Threatening Behavior 29, 256271.Google Scholar
Bolton, JM, Au, W, Leslie, WD, Martens, PJ, Enns, MW, Roos, LL, Katz, LY, Wilcox, HC, Erlangsen, A, Chateau, D, Walld, R, Spiwak, R, Seguin, M, Shear, K, Sareen, J (2013). Parents bereaved by offspring suicide: a population-based longitudinal case-control study. JAMA Psychiatry 70, 158167.Google Scholar
Brent, DA, Mann, JJ (2006). Familial pathways to suicidal behavior – understanding and preventing suicide among adolescents. New England Journal of Medicine 355, 27192721.Google Scholar
Brent, DA, Melhem, N (2008). Familial transmission of suicidal behavior. Psychiatric Clinics of North America 31, 157177.Google Scholar
Brent, DA, Moritz, G, Bridge, J, Perper, J, Canobbio, R (1996). Long-term impact of exposure to suicide: a three-year controlled follow-up. Journal of the American Academy of Child and Adolescent Psychiatry 35, 646653.Google Scholar
de Faire, U, Friberg, L, Lorich, U, Lundman, T (1976). A validation of cause-of-death certification in 1,156 deaths. Acta Medica Scandinavica 200, 223228.Google Scholar
D'Onofrio, BM, Van Hulle, CA, Goodnight, JA, Rathouz, PJ, Lahey, BB (2012). Is maternal smoking during pregnancy a causal environmental risk factor for adolescent antisocial behavior? Testing etiological theories and assumptions. Psychological Medicine 42, 15351545.CrossRefGoogle ScholarPubMed
Ellenbogen, S, Gratton, F (2001). Do they suffer more? Reflections on research comparing suicide survivors to other survivors. Suicide and Life-Threatening Behavior 31, 8390.Google Scholar
Ellingson, JM, Rickert, ME, Lichtenstein, P, Langstrom, N, D'Onofrio, BM (2012). Disentangling the relationships between maternal smoking during pregnancy and co-occurring risk factors. Psychological Medicine 42, 15471557.Google Scholar
Goldacre, M, Seagroatt, V, Hawton, K (1993). Suicide after discharge from psychiatric inpatient care. Lancet 342, 283286.CrossRefGoogle ScholarPubMed
Groot, MH, Keijser, J, Neeleman, J (2006). Grief shortly after suicide and natural death: a comparative study among spouses and first-degree relatives. Suicide and Life-Threatening Behavior 36, 418431.Google Scholar
Harris, EC, Barraclough, B (1997). Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 170, 205228.CrossRefGoogle ScholarPubMed
Harwood, D, Hawton, K, Hope, T, Jacoby, R (2002). The grief experiences and needs of bereaved relatives and friends of older people dying through suicide: a descriptive and case-control study. Journal of Affective Disorders 72, 185194.Google Scholar
Ilgen, MA, Bohnert, AS, Ignacio, RV, McCarthy, JF, Valenstein, MM, Kim, HM, Blow, FC (2010). Psychiatric diagnoses and risk of suicide in veterans. Archives of General Psychiatry 67, 11521158.Google Scholar
Jordan, JR (2001). Is suicide bereavement different? A reassessment of the literature. Suicide and Life-Threatening Behavior 31, 91102.Google Scholar
Kreicbergs, U, Valdimarsdottir, U, Onelov, E, Henter, JI, Steineck, G (2004). Anxiety and depression in parents 4–9 years after the loss of a child owing to a malignancy: a population-based follow-up. Psychological Medicine 34, 14311441.CrossRefGoogle ScholarPubMed
Li, J, Laursen, TM, Precht, DH, Olsen, J, Mortensen, PB (2005). Hospitalization for mental illness among parents after the death of a child. New England Journal of Medicine 352, 11901196.CrossRefGoogle ScholarPubMed
Li, J, Precht, DH, Mortensen, PB, Olsen, J (2003). Mortality in parents after death of a child in Denmark: a nationwide follow-up study. Lancet 361, 363367.Google Scholar
Nock, MK, Hwang, I, Sampson, NA, Kessler, RC (2010). Mental disorders, comorbidity and suicidal behavior: results from the National Comorbidity Survey Replication. Molecular Psychiatry 15, 868876.Google Scholar
Parkes, CM, Weiss, RS (1983). Recovery from Bereavement. Basic Books: New York.Google Scholar
Qin, P, Mortensen, PB (2003). The impact of parental status on the risk of completed suicide. Archives of General Psychiatry 60, 797802.CrossRefGoogle ScholarPubMed
Qin, P, Nordentoft, M (2005). Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Archives of General Psychiatry 62, 427432.Google Scholar
Rubinstein, G (2004). Locus of control and helplessness: gender differences among bereaved parents. Death Studies 28, 211223.Google Scholar
Runeson, B, Asberg, M (2003). Family history of suicide among suicide victims. American Journal of Psychiatry 160, 15251526.Google Scholar
Rutter, M (2007). Proceeding from observed correlation to causal inference: the use of natural experiments. Perspectives on Psychological Science 2, 377395.Google Scholar
Savitz, JB, Cupido, CL, Ramesar, RS (2006). Trends in suicidology: personality as an endophenotype for molecular genetic investigations. PLoS Medicine 3, e107.Google Scholar
Schneider, B, Grebner, K, Schnabel, A, Georgi, K (2011). Is the emotional response of survivors dependent on the consequences of the suicide and the support received? Crisis 32, 186193.Google Scholar
Statistics Sweden (1994). Facts about the Swedish Family [in Swedish]. Demographic reports 1994:2. Statistics Sweden: Stockholm.Google Scholar
Sveen, CA, Walby, FA (2008). Suicide survivors’ mental health and grief reactions: a systematic review of controlled studies. Suicide and Life-Threatening Behavior 38, 1329.Google Scholar
Tidemalm, D, Langstrom, N, Lichtenstein, P, Runeson, B (2008). Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. British Medical Journal 337, a2205.Google Scholar
Tidemalm, D, Runeson, B, Waern, M, Frisell, T, Carlstrom, E, Lichtenstein, P, Langstrom, N (2011). Familial clustering of suicide risk: a total population study of 11.4 million individuals. Psychological Medicine 41, 25272534.Google Scholar
Vance, JC, Foster, WJ, Najman, JM, Embelton, G, Thearle, MJ, Hodgen, FM (1991). Early parental responses to sudden infant death, stillbirth or neonatal death. Medical Journal of Australia 155, 292297.Google Scholar
von Borczyskowski, A, Lindblad, F, Vinnerljung, B, Reintjes, R, Hjern, A (2011). Familial factors and suicide: an adoption study in a Swedish National Cohort. Psychological Medicine 41, 749758.Google Scholar
Whitehead, J (1980). Fitting Cox's regression model to survival data using GLIM. Journal of the Royal Statistical Society, Series C (Applied Statistics) 29, 268275.Google Scholar
Supplementary material: File

Ljung Supplementary Material

Table

Download Ljung Supplementary Material(File)
File 74.2 KB