Does the death of a child influence parental use of psychotropic medication? A follow-up register study from Finland.

Mikael Rostila,Netta Mäki,Pekka Martikainen,Christine Leong

doi:10.1371/journal.pone.0195500

Abstract

BackgroundSeveral studies have found that the loss of a child is associated with psychiatric health problems, yet few studies examined whether child loss influences psychotropic medication use. This study examined short- and long-term use of psychotropic medication, both before and after the death of a child, and its potential effect modifiers.Methodology/Principal findingsA random sample of 205,456 parents, including 902 bereaved parents, were selected from a Finnish total population registry. The analyses were based on linear regressions using generalised estimation equations (GEE) and adjusted for sociodemographic factors. Annual psychotropic use was defined as having purchased prescribed psychotropic medication between 1996 and2012. Bereaved parents were followed for four years prior to and up to four years after the death of their child. An increase in the use of antidepressants and anxiolytics was found in parents following their loss. The highest percentage of use was found around one year after bereavement, followed by a steady decrease although this remained higher than the level of use among non-bereaved four years after the death. Between 20–25% of bereaved mothers and 10–15% of bereaved fathers used antidepressants or anxiolytics one year after bereavement while the corresponding number in non-bereaved was 5–10%. An increase in psychotropic medication was also found several years before the disease-related loss of a child.Conclusions/SignificanceThe use of psychotropic medication is markedly higher among parents after losing a child. Patterns of use leading up to and following the death of a child should be further examined in relation to clinical risk factors so as to identify at risk populations.Medical subject headingsBereavement, child death, psychotropic medication, death, child, register, Finland

Highlights

In high income countries, the loss of a child is often rare and unexpected
Several studies have found that the loss of a child is associated with psychiatric health problems, yet few studies examined whether child loss influences psychotropic medication use
The analyses of psychotropic medication use were based on linear regressions using generalised estimation equations (GEE), with the results shown as the prevalence of use of psychotropic medication

Summary

Introduction

The loss of a child is often rare and unexpected. it is considered to be one of the most stressful and traumatic life events a person may encounter, especially when the event occurs early in the child’s and parent’s lives [1,2]. Individual reactions to bereavement include suicidal ideation [5,6,7]; insomnia [8]; depression, anxiety and depression [9,10,11]; somatic symptoms; social dysfunction [12]; psychiatric hospitalization [13] and suicide [14]. These reactions are most likely to arise in the early stages of bereavement [3,15,16,17]. This study examined short- and long-term use of psychotropic medication, both before and after the death of a child, and its potential effect modifiers.

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