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Parental death increases depression, PTSD risk in offspring

Results from a 7-year follow-up study showed that parentally bereaved offspring had an increased incidence of depression and PTSD, mainly in the first 2 years after parental death and if they were aged 12 years or younger when their parent died.

“The loss of a parent is one of the most stressful events that a child can experience. There is less clarity about the short- and longer-term sequelae of parental bereavement,” Steven Pham, MD, from the department of psychiatry, University of Pittsburgh School of Medicine, and colleagues wrote in The American Journal of Psychiatry. “Longitudinal studies have usually been limited to the first 2 years postbereavement, so that the longer-term effects of parental bereavement and the mechanisms linking bereavement and later outcomes are not well understood.”

Researchers assessed the long-term impact of sudden parental death on children and the pathways by which bereavement can lead to impairment in 216 youths who lost a parent to suicide, accident or sudden natural death and 172 nonbereaved youths followed for up to 7 years. Participants aged 7 years to 18 years were interviewed 9, 21, 33, 62 and 84 months after parental death to measure incidence and prevalence of disorder as well as functional impairment.

The results showed that bereaved children had higher rates of psychiatric disorder, parental psychiatric disorder and maltreatment before parental death.

Compared with nonbereaved children, bereaved children had an increased incidence for depression (IRR = 2.08; 95% CI, 1.45-3.03) during the first 2 years after parent death (IRR = 3.13; 95% CI, 1.89-5.4). After adjusting for predeath risk variables, bereavement still increased the incidence of depression (HR = 2.67; 95% CI, 1.58-4.51). Peak incidence of depression occurred during the first 2 years of bereavement, and depression was mainly present in youth who had lost a parent at age 12 years or younger (HR = 4.92; 95% CI, 2.04-11.87).

The incidence of PTSD was also higher in bereaved children (IRR = 7.27; 95% CI, 2.58-28.29), and was also highest in the first 2 years after parental death (IRR = 10.41; 95% CI, 2.57-91.1). Bereavement increased the incidence of PTSD, even after adjustment (adjusted HR = 5.66; 95% CI, 1.95-16.4)

The investigators also observed increased rates of impairment at all time points in children bereaved by all three causes of parental death compared with nonbereaved children. According to structural equation modeling, bereavement directly affected impairment and was associated with impairment through its effects on depression and negative life events. Furthermore, youth psychiatric disorder before parental death also impacted functional impairment.

“These findings ... highlight the importance of careful monitoring, early identification and treatment of psychiatric disorder in bereaved children and the surviving parent, assessment of family psychiatric and environmental risk factors, and augmentation of family resilience through promotion of positive parenting,” Pham and colleagues wrote. “These steps in early identification and intervention can attenuate the impact of parental loss and help these youths become functional adults despite the burden of bereavement.” – by Savannah Demko

Disclosure: Pham reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.