title: Anxiety and depression in parents 4-9 years after the loss of a child owing to a malignancy: a population-based follow-up.
abstract: BACKGROUND
  Some consider the loss of a child as the most stressful life event. When the death is caused by a malignancy, the parents are commonly exposed not only to their own loss, but also to the protracted physical and emotional suffering of the child. We investigated parental risk of anxiety and depression 4-9 years after the loss of a child owing to a malignancy.
  
  
  METHODS
  In 2001, we attempted to contact all parents in Sweden who had lost a child due to a malignancy during 1992--1997. We used an anonymous postal questionnaire and utilized a control group of non-bereaved parents with a living child.
  
  
  RESULTS
  Participation among bereaved parents was 449/561 (80 %); among non-bereaved 457/659 (69%). We found an increased risk of anxiety (relative risk 1.5, 95 % confidence interval 1.1-1.9) and depression (relative risk 1.4, 95 % confidence interval 1.1-1.7) among bereaved parents compared with non-bereaved. The risk of anxiety and depression was higher in the period 4-6 years after bereavement than in the 7-9 years period, during which the average excess risks approached zero. Psychological distress was overall higher among bereaved mothers and loss of a child aged 9 years or older implied an increased risk, particularly for fathers.
  
  
  CONCLUSIONS
  Psychological morbidity in bereaved parents decreases to levels similar to those among non-bereaved parents 7-9 years after the loss. Bereaved mothers and parents who lose a child 9 years or older have on average an excess risk for long-term psychological distress.
authors.affiliation: Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet Z6:01, Karolinska Hospital, SE-171 76 Stockholm, Sweden. Ulrika.Kreicbergs@onkpat.ki.se
authors.forename: Ulrika
authors.initials: U
authors.lastname: Kreicbergs
authors.forename: Unnur
authors.initials: U
authors.lastname: Valdimarsdóttir
authors.forename: Erik
authors.initials: E
authors.lastname: Onelöv
authors.forename: Jan-Inge
authors.initials: JI
authors.lastname: Henter
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001008:Anxiety Disorders / Q000209:etiology*; D001601:Bereavement; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003643:Death; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009369:Neoplasms; D010287:Parent-Child Relations; D012307:Risk Factors; D013315:Stress, Psychological