Testing the anniversary reaction: causal effects of bereavement in a nationwide follow-up study from Sweden

Abstract

Lingering grief associated with the death of a loved one has been hypothesized to precipitate acute health events among survivors on anniversary dates. We sought to study excess mortality risk in parents around the death date and birth date of a deceased child as an indication of a "bereavement effect". We conducted a population based follow-up study using Swedish registries including links between children and parents. All biological and Swedish-born parents who experienced the death of a minor child born were observed during the period 1973-2008 (n = 48,666). An increased mortality risk was found during the week of a child's death among mothers who lost a child aged 0-17 years (SMRR = 1.46, 95% CI 0.98-2.17). The association was stronger among mothers who lost a child aged 1-17 years (SMRR = 1.89, 95% CI 0.97-3.67) as compared to those who lost an infant (SMRR = 1.29, 95% CI 0.78-2.12). Cardiovascular diseases and suicides were overrepresented as causes of death in mothers who died around the anniversary. We found no significant increase in the mortality risk around the date of child's birth, nor any suggestion of excess mortality risk among fathers, but rather a depression of paternal death (SMRR = 0.60, 95% CI 0.34-1.03). Our study indicates an anniversary reaction among mothers who lost a young child. These results suggest that bereavement per se could have an effect on health and mortality which should be acknowledged by public health professionals working with bereaved people.

Prolonged Grief, Posttraumatic Stress, and Depression Among Bereaved Parents: Prevalence and Response to an Intervention Program

“…Research shows that vulnerability seems to be affected by markers in time like death or birth anniversaries. For example, a higher mortality risk was found in Swedish bereaved mothers around the day of their child’s death (standardized mortality ratio = 1.46; Rostila et al., 2015). Another promising research area related to this study might be to examine how treatments such as the FOR program can affect the ability of people suffering from a loss to cope with markers in time.…”

The mother’s risk of premature death after child loss across two centuries

“…Thus, child loss has been associated with elevated risks of psychiatric symptoms (Kreicbergs et al, 2004), psychiatric hospitalizations (Li et al, 2005) and sickness absence (Wilcox et al, 2015), cardiovascular disease (Li et al, 2002a; Li et al, 2003a), and some cancers (Fang et al, 2011; Huang et al, 2013; Li et al, 2002b). Studies also suggest that parents, particularly mothers, who lose a child face increased risk of death (Li et al, 2002a; Li et al, 2003a; Levav et al, 1988; Li et al, 2003b; Qin and Mortensen, 2003; Agerbo, 2005; Rostila et al, 2012; Rostila et al, 2015; Espinosa and Evans, 2013; Harper et al, 2011; Chen et al, 2012; Schorr et al, 2016), both from suicide and natural causes. The aforementioned studies were all conducted in affluent developed populations, where infant mortality rates are low and life expectancy is high.…”

Sex Differences in the Relationship Between Child Maltreatment, Recent Bereavement, and Average Heart Rate

“…The experience of markers in time (anticipated, repeated, and unavoidable time periods/dates that are highly emotional and distressing) may impact an individual's ability to cope with their loss, resulting in potential psychological distress and related physiological symptomology. While some preliminary research supports the association of anniversary reactions and cardiovascular events (Rostila et al, 2015), additional research accounting for the subjective experience of time and markers in time is needed to better determine the effect of time and timing on the cardiovascular functioning in bereaved individuals.…”

“…In addition to the lack of nuance in differentiating the impact of child maltreatment from bereavement, it is also difficult to discern if this association reflects an actual trend in the population or a sampling bias in literature. A large number of studies exploring the link between bereavement and cardiovascular disease relied on samples of women who had lost spouses (mostly women, as women tend to survive their mail partners; Buckley et al, 2010;Rostila, Saarela, Kawachi, & Hjern, 2015;Theorell & H€ arenstam, 2000;Utz et al, 2011) and caregivers who had lost a child (i.e., early infant death; e.g., Christiansen, Elklit, & Olff, 2013). As a result, it is difficult to detect accurate sex differences in the health outcomes associated with bereavement.…”