ArticlesMortality in parents after death of a child in Denmark: a nationwide follow-up study
Introduction
Bereavement is a severe life event1, 2, 3 that leads to increased mortality in widowed populations.3, 4, 5, 6, 7 The death of a child is especially stressful, even more so than the death of a spouse,2, 3, 8 but its effect on mortality of other family members is unclear.3, 4, 9, 10, 11 Results of most studies9, 10, 11 indicate that there is no overall association between death of a child and mortality in parents. However, an increased mortality among single mothers9 and a worse cancer survival in fathers have been reported.11
Stressful life events can affect the sympathetic nervous system, the hypothalamic-pituitary-adrenal axis, the neuroendocrine systems, and the immune systems, which could result in various diseases.12, 13 Psychological stress could also raise the risk of unnatural death.6, 14, 15 It might, furthermore, lead to more adverse lifestyle behaviours, which could in turn affect mortality.15, 16, 17, 18, 19
Our aim was to examine whether or not the death of a child increased mortality in parents. We postulated that risk of mortality would change dependent on duration of follow-up,3, 4, 5, 6, 7, 9 and that the effect would be modified by the nature of the death of the child and by sociodemographic factors of possible relevance for coping with stress.3, 20, 21
Section snippets
Participants and protocol
We did a follow-up study based on cohorts identified from national registers in Denmark. For each year, from 1980 to 1996, we identified all children who died at age younger than 18 years and their family members (exposed cohort) by searching the Register of Population Statistics.22 We recorded the number of parents and the number of children in each of these families, and grouped the children in accordance with their age on Jan 1 of the year that their sibling died (<1 year old, 1–2, 3–6, 7–9,
Results
Table 1 shows the characteristics of the 12 512 children who died between 1980 and 1996, minus 440 who could not be matched through the population registers with their parents at the beginning of the year that they died because the children did not live with their parents. Table 2 shows the baseline characteristics of the parents in the exposed (n=21 062) and unexposed (n=293 745) cohorts. These 314 807 individuals yielded 3 316 649 person-years, with a median follow-up time of 11·0 years each.
Discussion
Our data indicate that the death of a child is associated with an overall increased mortality in mothers, and a slightly increased early mortality from unnatural causes in fathers.
Psychological stress after the death of a child could affect health outcomes in several ways. The most intense reactions are often seen shortly after the bereavement, with a short-term peak of mortality from unnatural causes.3, 4, 5, 6, 7 In the long term, various pathophysiological changes related to stress could
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