Parental death in childhood and pathways to increased mortality across the life course in Stockholm, Sweden: A cohort study

Abstract

Background Previous studies have shown that the experience of parental death during childhood is associated with increased mortality risk. However, few studies have examined potential pathways that may explain these findings. The aim of this study is to examine whether familial and behavioural factors during adolescence and socioeconomic disadvantages in early adulthood mediate the association between loss of a parent at age 0 to 12 and all-cause mortality by the age of 63. Methods and findings A cohort study was conducted using data from the Stockholm Birth Cohort Multigenerational Study for 12,615 children born in 1953, with information covering 1953 to 2016. Familial and behavioural factors at age 13 to 19 included psychiatric and alcohol problems in the surviving parent, receipt of social assistance, and delinquent behaviour in the offspring. Socioeconomic disadvantage in early adulthood included educational attainment, occupational social class, and income at age 27 to 37. We used Cox proportional hazard regression models, combined with a multimediator analysis, to separate direct and indirect effects of parental death on all-cause mortality. Among the 12,582 offspring in the study (men 51%; women 49%), about 3% experienced the death of a parent in childhood. During follow-up from the age of 38 to 63, there were 935 deaths among offspring. Parental death was associated with an elevated risk of mortality after adjusting for demographic and household socioeconomic characteristics at birth (hazard ratio [HR]: 1.52 [95% confidence interval: 1.10 to 2.08, p-value = 0.010]). Delinquent behaviour in adolescence and income during early adulthood were the most influential mediators, and the indirect associations through these variables were HR 1.03 (1.00 to 1.06, 0.029) and HR 1.04 (1.01 to 1.07, 0.029), respectively. After accounting for these indirect paths, the direct path was attenuated to HR 1.35 (0.98 to 1.85, 0.066). The limitations of the study include that the associations may be partly due to genetic, social, and behavioural residual confounding, that statistical power was low in some of the subgroup analyses, and that there might be other relevant paths that were not investigated in the present study. Conclusions Our findings from this cohort study suggest that childhood parental death is associated with increased mortality and that the association was mediated through a chain of disadvantages over the life course including delinquency in adolescence and lower income during early adulthood. Professionals working with bereaved children should take the higher mortality risk in bereaved offspring into account and consider its lifelong consequences. When planning and providing support to bereaved children, it may be particularly important to be aware of their increased susceptibility to delinquency and socioeconomic vulnerability that eventually lead to higher mortality.

School Outcomes Among Children Following Death of a Parent

“…1,2 Among many health, behavioral, and social consequences after parental death, 3 high-risk behavior in adolescence and low socioeconomic status in adulthood are important underlying mechanisms. 4 Early education performance of bereaved children 5,6 may deserve further attention because it is associated with subsequent adverse socioeconomic trajectories and health outcomes. 4,[7][8][9] Losing a parent in childhood is highly stressful.…”

“…4 Early education performance of bereaved children 5,6 may deserve further attention because it is associated with subsequent adverse socioeconomic trajectories and health outcomes. 4,[7][8][9] Losing a parent in childhood is highly stressful. Some bereaved children may develop complicated grief and posttraumatic stress, 10 low stress resilience, 11 long-lasting depressive symptoms, 12 a sense of meaninglessness, 10 and high-risk behaviors, 13 leading to lower educational aspiration and achievement, even where university education is free.…”

‘I didn't know what was in front of me’—Bereaved parents' experience of adapting to life when a co‐parent of dependent children has died with cancer

“…Sadly, this is not an uncommon phenomenon for families, with 20% of children in the United Kingdom experiencing the death of a parent before their eighteenth birthday 12 . Parental death in childhood predisposes children to increased levels of anxiety, depression, risk‐taking behaviours and offending, as well as lower academic attainment than the general population 13–15 . While parental support can help mediate such adversities, 16,17 it is not clear how bereaved parents are supporting the children when a parent has died with cancer, who are also at risk of adverse mental health outcomes 18,19 .…”

“…12 Parental death in childhood predisposes children to increased levels of anxiety, depression, risk‐taking behaviours and offending, as well as lower academic attainment than the general population. 13 , 14 , 15 While parental support can help mediate such adversities, 16 , 17 it is not clear how bereaved parents are supporting the children when a parent has died with cancer, who are also at risk of adverse mental health outcomes. 18 , 19 Investigating how bereaved parents navigate bereavement when a co‐parent has died with cancer could aid our understanding if, how and when they can be supported as they care for their children.…”

Very Young Child Survivors’ Perceptions of Their Father’s Suicide: Exploring Bibliotherapy as Postvention Support

“…Of all traumatic childhood events, the death of a parent is one of the most stressful [ 12 , 13 , 14 ]. For surviving children, a parent’s death triggers both short- and long-term physical, emotional, behavioral, and mental health challenges [ 15 , 16 , 17 ].…”