title: Unresolved grief in a national sample of bereaved parents: impaired mental and physical health 4 to 9 years later.
abstract: OBJECTIVE
  To assess unresolved parental grief, the associated long-term impact on mental and physical health, and health service use.
  
  
  METHODS
  This anonymous, mail-in questionnaire study was performed as a population-based investigation in Sweden between August 2001 and October 2001. Four hundred forty-nine parents who lost a child as a result of cancer 4 to 9 years earlier completed the survey (response rate, 80%). One hundred ninety-one (43%) of the bereaved parents were fathers, and 251 (56%) were mothers. Bereaved parents were asked whether or not, and to what extent, they had worked through their grief. They were also asked about their physical and psychological well-being. For outcomes of interest, we report relative risk (RR) with 95% CIs as well as unadjusted odds ratios and adjusted odds ratios.
  
  
  RESULTS
  Parents with unresolved grief reported significantly worsening psychological health (fathers: RR, 3.6; 95% CI, 2.0 to 6.4; mothers: RR, 2.9; 95% CI, 1.9 to 4.4) and physical health (fathers: RR, 2.8; 95% CI, 1.8 to 4.4; mothers: RR, 2.3; 95% CI, 1.6 to 3.3) compared with those who had worked through their grief. Fathers with unresolved grief also displayed a significantly higher risk of sleep difficulties (RR, 6.7; 95% CI, 2.5 to 17.8). Mothers, however, reported increased visits with physicians during the previous 5 years (RR, 1.7; 95% CI, 1.1 to 2.6) as well as a greater likelihood of taking sick leave when they had not worked through their grief (RR, 2.1; 95% CI, 1.2 to 3.5).
  
  
  CONCLUSIONS
  Parents who have not worked through their grief are at increased risk of long-term mental and physical morbidity, increased health service use, and increased sick leave.
authors.affiliation: Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA. plannen@ispm.unibe.ch
authors.forename: Patrizia K
authors.initials: PK
authors.lastname: Lannen
authors.forename: Joanne
authors.initials: J
authors.lastname: Wolfe
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
authors.forename: Erik
authors.initials: E
authors.lastname: Onelov
authors.forename: Ulrika C
authors.initials: UC
authors.lastname: Kreicbergs
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001601:Bereavement; D005220:Fathers / Q000523:psychology; D005260:Female; D006117:Grief; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D009035:Mothers / Q000523:psychology; D009369:Neoplasms; D010290:Parents / Q000523:psychology*; D011795:Surveys and Questionnaires; D013548:Sweden; D013997:Time Factors