The Burden of Bereavement: Early-Onset Depression and Impairment in Youths Bereaved by Sudden Parental Death in a 7-Year Prospective Study

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d4649324e209">Objective</h5> <p id="P1">To determine the long-term impact of sudden parental death on youth and pathways between bereavement and impairment. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d4649324e214">Method</h5> <p id="P2">216 youths who lost a parent to suicide, accident, or sudden natural death and 172 non-bereaved youth were followed periodically for up to 7 years. The incidence and prevalence of disorder and of functional impairment, and pathways to impairment were assessed using Cox and mixed effects logistic regression and Structural Equation Modeling (SEM). </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d4649324e219">Results</h5> <p id="P3">Prior to parental death, bereaved youth had higher rates of psychiatric disorder, parental psychiatric disorder, and maltreatment. Even after adjustment for pre-death risk factors, bereavement was associated with an increased incidence of depression, post-traumatic stress disorder (PTSD), and functional impairment. The peak incidence of depression was in the first two years post-bereavement, with incident depression occurring mainly in those who lost a parent prior to age 12. Youth bereaved by all three causes of death showed higher rate of impairment at all timepoints. SEM found that bereavement had a direct effect on impairment, and was linked to impairment via its impact on early and later depression, and through negative life events. Child psychiatric disorder prior to parental loss also contributed to functional impairment. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d4649324e224">Conclusion</h5> <p id="P4">Parental death increased the incidence of depression in offspring early in the course of bereavement. Early identification and treatment of depression in bereaved youth and augmentation of family resilience may protect against later sequelae of functional impairment. </p> </div>