title: Parental mortality rates in a western country after the death of a child: assessment of the role of the child's sex.
abstract: BACKGROUND
  Loss of a child has been associated with elevated mortality rates in parents. Studies that focus on the influence of the child's sex on parental mortality are sparse.
  
  
  OBJECTIVE
  The main objective of the present study was to reevaluate the combined impact of the parents' and child's sex within a larger sample and focus on adverse health effects as an objective measure of possible long-term effects of maladaptive grief reactions.
  
  
  METHODS
  For the time period between 1980 and 1996, all children in Denmark who died before 18 years of age were identified. Parents who had lost a child were identified as the bereaved (exposed) group. Mortality rates of parents within the same-sex parent-child dyad were compared with mortality rates of parents within the opposite-sex parent-child dyad. Separate analyses were performed for bereaved fathers and for bereaved mothers, and additional analyses were conducted to examine the sole effect of the child's sex, irrespective of parental gender. A Cox proportional hazards regression model was used to estimate the hazard ratios (HRs) with 95% CIs.
  
  
  RESULTS
  The study population consisted of 21,062 parents (mean age at entry, 32 years; 11,221 mothers, 9841 fathers). Bereaved parents who had lost a child of the same sex had similar overall mortality as bereaved parents who had lost a child of the opposite sex (HR = 1.02; 95% CI, 0.85-1.22). Similar findings were observed for mortality due to natural death (HR = 0.96; 95% CI, 0.78-1.18) or mortality due to unnatural death (HR = 1.22; 95% CI, 0.84-1.77). Bereaved fathers who had lost a son had similar mortality as those bereaved by the death of a daughter (HR = 1.10; 95% CI, 0.86-1.40). Bereaved mothers who had lost a daughter had similar mortality as those bereaved by the death of a son (HR = 0.93; 95% CI, 0.70-1.22). Bereaved parents who had lost a son had mortality rates similar to those who had lost a daughter (HR = 1.09; 95% CI, 0.91-1.31). The interactions between grouping variable and sex of parents were not significant, indicating that the differential effect of losing a child based on sex of the child was not greater for fathers than for mothers.
  
  
  CONCLUSIONS
  The results of this study revealed no significant effect of sex of the deceased child on mortality in these bereaved parents. The results might differ if this study was replicated in a population with a different grief culture and, more importantly, different gender schemas.
authors.affiliation: Department of Clinical Psychological Sciences, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands. Jessica.Werthmann@maastrichtuniversity.nl
authors.forename: Jessica
authors.initials: J
authors.lastname: Werthmann
authors.forename: Luc J M
authors.initials: LJ
authors.lastname: Smits
authors.forename: Jiong
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D002648:Child; D003643:Death; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D009026:Mortality; D009769:Object Attachment; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors