Death of a Child Linked to Emotional Breakdown

Study finds parents' loss increases chances of hospitalization

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WEDNESDAY, March 23, 2005 (HealthDay News) -- The devastating grief parents suffer when they lose a child increases their chances of being hospitalized for a psychiatric disorder, Danish researchers report.

Bereaved mothers are particularly vulnerable, the study found. Their risk of hospitalization is twice as great as that of fathers. And while the mothers' risk is highest in the first year after a child's death risk, it remains significantly elevated even five years or more after the loss.

"It was a surprise that increased hospitalization for mental disorders lasted for so many years afterbereavement," said co-author Dr. Jorn Olsen, a professor of epidemiology at the University of Aarhus in Denmark and chairman of epidemiology at the University of California, Los Angeles, School of Public Health.

The findings appear in March 24 issue of the New England Journal of Medicine.

Family therapist Gloria Horsley, who serves as a professional adviser to The Compassionate Friends (TCF), a national self-help group, fears the study may create an inaccurate impression about the fate of bereaved parents.

"We would not want professionals to think that the death of a child causes mental illness," said Horsley, whose 17-year-old son Scott died in a fiery automobile accident in 1983.

J. Shep Jeffreys, an assistant professor of psychiatry and behavioral science at Johns Hopkins University School of Medicine in Baltimore, echoed that concern.

"There are so many factors that affect the nature of the grief reaction when anybody dies, but especially when a child dies," said Jeffreys, author of Helping Grieving People When Tears Are Not Enough: A Handbook for Care Providers.

For example, the study fails to compare the sudden, unexpected or violent death of a child to a child's death after a long illness. It's also unclear how the Danish findings may apply to parents in America, where the expression of feelings, acceptance of psychiatric referrals and other cultural differences may have an impact, he said.

Yet despite these and other gaps, the study is interesting, Jeffreys said, because there is so little research focused on the hospitalization of bereaved parents.

"I think its value is that it does raise the alert that grief of people who have lost children does have a serious impact," added Jeffreys, who lost his 8-year-old son Steven in 1975 after a three-year battle with cancer.

The new study is based on a group of more than 1 million people who were born between 1952 and 1999 and had at least one child under the age of 18 during a nearly 30-year follow-up period, from 1970 to 1999. Parents were categorized as "bereaved" from the date of their child's death.

Overall, parents who lost a child had a 67 percent greater risk for a first psychiatric hospitalization than parents who did not lose a child, the study found.

Mothers' and fathers' risk of hospitalization was increased for each psychiatric diagnosis included in the study, compared with parents who did not lose a child.

But it was the bereaved mothers who were most at risk. Their likelihood of being hospitalized was twice as great as that of bereaved fathers, 78 percent vs. 38 percent, the study found.

That's not surprising, considering mothers tend to be the primary caregivers, Horsley said. "They're the ones who had that constant connection with the child," she said. But with the child's passing, "they're kind of out of a job."

The study authors admit a potential weakness: They were unable to adjust the findings to allow for a family history of psychiatric illness. That lack of prior history makes it impossible to know whether parents were vulnerable even before the death of a child.

Losing a child can make people behave in ways that seem unusual, but it doesn't have to lead to a breakdown, mental health experts said.

"It's a time when you feel like you're losing control, or have lost control," said Horsley, who is coordinating a seminar designed to teach professionals in all fields how to recognize grief and help bereaved families. The June 30 event will be held in conjunction with The Compassionate Friends' annual conference in Boston.

While the grief parents experience is lifelong, having people around to validate those feelings is a comfort, she said. "You learn to come to a new normal."

More information

The Compassionate Friends can tell you more about what happens to grieving families when a child dies.

SOURCES: Jorn Olsen, M.D., Ph.D., professor, epidemiology, University of Aarhus, Denmark, and chairman, epidemiology, University of California, Los Angeles, School of Public Health; Gloria Horsley, Ph.D., R.N., MFC, family therapist and author, San Francisco, and professional adviser, The Compassionate Friends, Oak Brook, Ill.; J. Shep Jeffreys, Ed.D., assistant professor, psychiatry and behavioral science, Johns Hopkins University School of Medicine, and affiliate faculty, pastoral counseling, Loyola College in Maryland, Baltimore; March 24, 2005, New England Journal of Medicine

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