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May 2008

Antecedents and Sequelae of Sudden Parental Death in Offspring and Surviving Caregivers

Author Affiliations

Author Affiliations: Western Psychiatric Institute and Clinic and the Department of Psychiatry, University of Pittsburgh School of Medicine (Drs Melhem and Brent and Ms Walker), and the Division of Collaborative Care Medicine, University of Pittsburgh Medical Center, Montefiore Hospital (Ms Moritz), Pittsburgh, Pennsylvania.

Arch Pediatr Adolesc Med. 2008;162(5):403-410. doi:10.1001/archpedi.162.5.403

Objectives  To examine the psychiatric antecedents that put parents at risk for early death, and the psychological sequelae of bereavement in offspring and caregivers.

Design  A population-based study.

Setting  Bereaved families were recruited through the coroner's records and by advertisement. Control families were recruited by random-digit dialing and advertisement.

Participants  Families with biological offspring from 7 to 25 years of age in which 1 parent died of suicide, accident, or sudden natural death were included (n = 140). Controls (n = 99) had 2 living parents and their biological offspring and had no death of a first-degree relative within the past 2 years.

Main Outcome Measures  Lifetime psychiatric history for deceased parents (probands) and new-onset psychiatric disorders, self-reported symptoms, and functional status in offspring and surviving caregivers.

Results  Bipolar disorder, substance abuse, and personality disorders are more common in probands who died of suicide or accident than in control parents. Bereaved offspring and their caregivers were at increased risk for depression and posttraumatic stress disorder. Bereaved offspring had a 3-fold (95% confidence interval, 1.3-7.0) increased risk of depression, even after controlling for antecedent and concomitant risk factors. Offspring bereaved by suicide showed similar outcomes compared with those bereaved by other types of death.

Conclusions  Bereavement conveys an increased risk of depression and posttraumatic stress disorder above and beyond other vulnerability factors. Better integration of medical and psychiatric care may prevent premature parental death, but once it occurs, physicians should be alert to the increased risk for depression and posttraumatic stress disorder in bereaved offspring and their caregivers.