Children who had a parent who died suddenly have three times the risk of depression than those with two living parents, along with an increased risk for post-traumatic stress disorder (PTSD) according to a report in the May issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
About 4 percent of children in Western countries experience the death of a parent, according to background information in the article. Parents who have psychiatric disorders, including mood disorders and substance abuse, are more likely to die from suicide, accidents and heart disease. The same psychiatric factors that increase parents’ risk of sudden death also predispose their children to similar mental health problems.
Nadine M. Melhem, Ph.D., of the University of Pittsburgh School of Medicine, and colleagues identified 140 families in which one parent died of suicide, accident or sudden natural death. They were compared with 99 control families in which two parents were living and no first-degree relatives had died within the past two years. The offspring, ages 7 to 25, underwent interviews and assessments for psychiatric disorders, as well as a review of their parents’ psychiatric history.
Children whose parents had died, along with their surviving caregivers, were at higher risk for depression and post-traumatic stress disorder (PTSD) than those in control families. This association remained after controlling for psychiatric disorders in the deceased parent. Children and caregivers in families where a parent had died of suicide were no more likely than those in families where a parent died of other causes to develop PTSD or other psychiatric disorders. Children’s symptoms of depression, anxiety, PTSD, suicidal behavior and complicated grief (severe, lasting unhappiness) were associated with similar symptoms in surviving caregivers.
“Our findings have important clinical and public health implications,” the authors conclude. “The best way to attenuate the effect of parental bereavement among offspring is to prevent early death in their parents by improving the detection and treatment of bipolar illness, substance and alcohol abuse and personality disorders, and by addressing the lifestyle correlates of these illnesses that lead to premature death.”
When parents die, surviving caregivers should be monitored for depression and PTSD, since their psychiatric health affects that of children. “Given the increased risk of depression and PTSD, bereaved offspring should be monitored and, if needed, referred and treated for their psychiatric disorder,” the authors write. “Further studies are needed to examine the course and long-term effect of bereavement on offspring and their surviving caregivers, to test the mechanisms by which parental bereavement exerts these effects and to identify the subset of bereaved families who may require treatment, which can then frame targets for intervention and prevention efforts.”
The study authors’ “findings that sudden parental death is associated with an increased risk for child mental health problems as well as increased mental health problems for the surviving parent have significant implications for pediatric practice,” write Irwin Sandler, Ph.D, and Thomas F. Boat, M.D., of Arizona State University, Tempe, in an accompanying editorial.
“First, a pediatrician should be aware that parental death, as well as other family adversities, is a risk factor for childhood mental disorders,” they write. “The second implication for pediatric practice is that once the pediatrician becomes aware of increased risk of children due to parental death or other family adversities, the pediatrician may have a responsibility to help link children and/or their parents with appropriate services. To do this effectively, pediatricians should become familiar with the kinds of services offered in their community and the evidence for their effectiveness.”
1. Arch Pediatr Adolesc Med. 2008;162:403-410.
2. Arch Pediatr Adolesc Med. 2008;162:487-488.