Science & Technology: Sudden Death of Parent Boosts Risk of Depression in Surviving Children

The children of parents who die suddenly—whether by suicide, accident, or natural causes—are three times more likely to develop depression and are at higher risk for post-traumatic stress disorder (PTSD) than children who don’t face such a difficult life event, according to a University of Pittsburgh School of Medicine study published in the current issue of the Archives of Pediatric Adolescent Medicine, one of the JAMA/Archives journals.

In the first controlled, population-based study of its kind, the team of Pitt and University of Pittsburgh Medical Center (UPMC) researchers also found that parents who died of suicide had higher rates of bipolar disorder, alcohol and substance abuse, and personality disorders. Higher rates of these disorders are expected in suicide victims; however, those who died accidentally or from sudden natural death also had higher rates of psychiatric disorders—specifically, alcohol and substance abuse—and personality disorders, and showed a trend toward higher rates of bipolar disorder.

While the death of a parent is consistently rated as one of the most stressful events that a child can experience, little has been known about the psychiatric outcomes in bereaved children until now. “Our study shows that when premature parental death occurs, physicians should be alert to the increased risk for depression and post-traumatic stress disorder in bereaved offspring and in their surviving caregivers,” said David A. Brent, academic chief of child and adolescent psychiatry at Western Psychiatric Institute and Clinic and professor of psychiatry, pediatrics, and epidemiology in Pitt’s School of Medicine.

“Not surprisingly, we found that bereaved offspring are at increased risk for adverse outcomes in part because of factors that may have contributed to the parent’s death,” Brent added.

The study involved 140 families in which one parent had died of either suicide, accidental death—such as drug overdoses and car accidents—or sudden natural death. A control group consisted of 99 families with two living biological parents who were matched to the deceased parents in the study group based on sex, age, and neighborhood. Ages of the children at their parents’ deaths ranged from 7 to 25 years.

Other factors that affected outcomes included the nature of the last conversation with the deceased. Researchers found that a caregiver’s recollection of a supportive conversation led to a higher risk of depression. “Understanding the effects of bereavement is essential to identifying those at highest risk who should be targeted for future prevention and intervention efforts,” noted Nadine Melhem, first author and a professor of psychiatry in Pitt’s School of Medicine.

These findings point out the importance of improving the detection and treatment of bipolar illness, substance and alcohol abuse, and personality disorders, as well as the significance of addressing the lifestyle associations of these illnesses that lead to premature deaths, according to Brent.

“The caregivers should be monitored for depression and PTSD, because restoring their normal mental functioning could lead to more positive outcomes for the children,” Brent said. “However, given the increased risk of depression and PTSD, the bereaved children also should be monitored and, if necessary, referred and treated for their psychiatric disorders.”

Coauthors of the study include researchers Monica Walker of Western Psychiatric Institute and Clinic and the Department of Psychiatry in Pitt’s School of Medicine and Grace Moritz from UPMC’s Division of Collaborative Care Medicine.