Abstract
Bereavement by spousal death and child death in adulthood has been shown to lead to an increased risk of mortality. Maternal death in infancy or parental death in early childhood may have an impact on mortality but evidence has been limited to short-term or selected causes of death. Little is known about long-term or cause-specific mortality after parental death in childhood. This cohort study included all persons born in Denmark from 1968 to 2008 (n = 2,789,807) and in Sweden from 1973 to 2006 (n = 3,380,301), and a random sample of 89.3% of all born in Finland from 1987 to 2007 (n = 1,131,905). A total of 189,094 persons were included in the exposed cohort when they lost a parent before 18 years old. Log-linear Poisson regression was used to estimate mortality rate ratio (MRR). Parental death was associated with a 50% increased all-cause mortality (MRR = 1.50, 95% CI 1.43-1.58). The risks were increased for most specific cause groups and the highest MRRs were observed when the cause of child death and the cause of parental death were in the same category. Parental unnatural death was associated with a higher mortality risk (MRR = 1.84, 95% CI 1.71-2.00) than parental natural death (MRR = 1.33, 95% CI 1.24-1.41). The magnitude of the associations varied according to type of death and age at bereavement over different follow-up periods. The main limitation of the study is the lack of data on post-bereavement information on the quality of the parent-child relationship, lifestyles, and common physical environment. Parental death in childhood or adolescence is associated with increased all-cause mortality into early adulthood. Since an increased mortality reflects both genetic susceptibility and long-term impacts of parental death on health and social well-being, our findings have implications in clinical responses and public health strategies. Please see later in the article for the Editors' Summary.
Highlights
Bereavement by the death of a close relative is a major life event [1]
Maternal death in infancy or parental death in early childhood may lead to an increased mortality risk; scientific evidence is limited to short-term observations, historical data, or often studies in low- and mid-income settings [6,7,8,9,10]
We examined the mortality rate ratio (MRR) according to specific cause groups of parental death
Summary
Bereavement by the death of a close relative is a major life event [1]. Spousal bereavement [2,3] or child death in adult populations [4,5] is often followed by an increased mortality risk. Maternal death in infancy or parental death in early childhood may lead to an increased mortality risk; scientific evidence is limited to short-term observations, historical data, or often studies in low- and mid-income settings [6,7,8,9,10]. In high-income countries, 3%–4% of children experience the death of a parent before they reach 18 years of age [11] Such an early life adversity can have substantial impacts on future health in many ways [12,13], but little is known about how it affect immediate or long-term mortality [3]. People may feel angry or guilty, and may be overwhelmed by feelings of sadness and despair They may become depressed or anxious and may even feel suicidal. How long bereavement—the period of grief and mourning after a death—lasts and how badly it affects an individual depends on the relationship between the individual and the deceased person, on whether the death was expected, and on how much support the mourner receives from relatives, friends, and professionals
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