Source:Li J, Laursen TM, Precht DH, et al. Hospitalization for mental illness among parents after the death of a child.
N Engl J Med.

The authors from the Danish Epidemiology Science Center, University of Aarhus, and Bispebjerg Hospital, Denmark used national registries to identify 1.2 million citizens in Denmark born between 1952 and 1999 who had at least 1 child <18 years of age before 1999 to determine whether death of a child was associated with risk of hospital treatment of a mental disorder for the bereaved parent. Patients with a prior diagnosis of mental illness before the death of a child were excluded.

The primary outcome was hospital admission for first-time treatment of a mental illness. Diagnoses of particular interest included affective disorders, substance abuse, and schizophrenia and related disorders. The authors collected information on the year of hospitalization, parent age at the time of the child’s death, parental age when their first child was born, and the number of children in the family. Data on 19,124 parents who died, left the country, or were lost during the study period were censored.

The bereaved cohort consisted of 17,033 parents with 11,551,710 person-years of follow-up, during which there were 20,567 first psychiatric admissions. The authors reported that the relative risk for hospitalization for any psychiatric condition among those who lost a child was 1.67 (95% CI, 1.53 to 1.83) compared to parents who had not lost a child. Bereaved mothers had greater risk than fathers (RR 1.78 compared to RR 1.38). Mothers who had lost 2 or more children were more than 3 times as likely to have hospitalized care compared to non-bereaved mothers (RR 3.35; 95% CI 2.26 to 4.97), while fathers were over 2 times as likely to have hospitalized care (RR 2.49; 95% CI, 1.14 to 5.03) compared to non-bereaved fathers.

The authors evaluated time after the child’s death and found that the risk of hospital care for affective disorders and schizophrenia was greatest in the year following the child’s death and decreased over time; risk for treatment of substance abuse did not decline for women during the first 4 years after a child’s death. Mothers over 30 years of age at the time of their child’s death tended to have a greater risk for hospitalized psychiatric care than younger mothers; however, a similar pattern was not seen in fathers. The number of surviving children was inversely related to the risk of hospitalized care for a bereaved parent. If an only child died, the relative risk of the mother requiring hospitalized care for an affective disorder was almost 4; however, if the mother had 2 or more surviving children the relative risk was 1.3 compared to women who had not lost a child.

Dr. Bratton has disclosed no financial relationships relevant to this commentary.

The authors report an important study following a large population for 30 years. As might logically be expected,1 they showed that bereaved parents are at...

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