title: Childlessness, parental mortality and psychiatric illness: a natural experiment based on in vitro fertility treatment and adoption.
abstract: BACKGROUND
  Childlessness increases the risk of premature mortality and psychiatric illness. These results might, however, be confounded by factors that affect both the chance of parenthood as well as the risk of premature death and psychiatric illness.
  
  
  METHODS
  Using population-based health and social registers, we conducted a follow-up study of 21 276 childless couples in in vitro fertility treatment.
  
  
  RESULTS
  The crude death rate ratio in women who become mothers to a biological child is 0.25 (95% CI 0.16 to 0.39). In other words, childless women experience a fourfold higher rate of death, that is, 4.02 (2.56 to 6.31). The analogous death rate in fathers is approximately halved: 0.51 (0.39 to 0.68) and 0.55 (0.32 to 0.96) associated with having a biological child and an adopted child, respectively. With substance use disorders being the exception, none of the crude rates of psychiatric illness in parents of a biological child were statistically distinguishable from the rates in the childless. These findings were slightly confounded by age, calendar year, income, education, somatic comorbidity and marital breakup.
  
  
  CONCLUSIONS
  Mindful that association is not causation, our results suggest that the mortality rates are higher in the childless. Rates of psychiatric illness do not appear to vary with childlessness, but the rate of psychiatric illness in parents who adopt is decreased.
authors.affiliation: CIRRAU-Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark. ea@ncrr.dk
authors.forename: Esben
authors.initials: E
authors.lastname: Agerbo
authors.forename: Preben Bo
authors.initials: PB
authors.lastname: Mortensen
authors.forename: Trine
authors.initials: T
authors.lastname: Munk-Olsen
mesh_terms: D000223:Adaptation, Psychological; D000300:Adoption; D000328:Adult; D002423:Cause of Death; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005307:Fertilization in Vitro; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D009026:Mortality / Q000639:trends*; D009679:Nuclear Family; D016487:Parenting / Q000523:psychology*; D010298:Parity; D011159:Population Surveillance; D011247:Pregnancy; D012042:Registries; D012307:Risk Factors