title: Offspring death and subsequent psychiatric morbidity in bereaved parents: addressing mechanisms in a total population cohort.
abstract: BACKGROUND
  It is unclear if psychiatric morbidity among parents bereaved of a child is related to major loss in general or if the cause of death matters. Whether such a link is consistent with a causal explanation also remains uncertain.
  
  
  METHODS
  We identified 3,114,564 parents through linkage of Swedish nationwide registers. Risk of psychiatric hospitalization was assessed with log-linear Poisson regression and family-based analyses were used to explore familial confounding.
  
  
  RESULTS
  A total of 3284 suicides and 14,095 any-cause deaths were identified in offspring between 12 and 25 years of age. Parents exposed to offspring suicide had considerably higher risk of subsequent psychiatric hospitalization than unexposed parents [relative risk (RR) 1.90, 95% confidence interval (CI) 1.72-2.09], higher than parents exposed to offspring non-suicide death relative to controls (RR 1.18, 95% CI 1.11-1.26). We found no risk increase among stepfathers differentially exposed to biologically unrelated stepchildren's death or suicide, and the relative risk was notably lower among full siblings differentially exposed to offspring death or suicide.
  
  
  CONCLUSIONS
  Parental psychiatric hospitalization following offspring death was primarily found in offspring suicide. Familial (e.g. shared genetic) effects seemed important, judging from both lack of psychiatric hospitalization in bereaved stepfathers and attenuated risk when bereaved parents were contrasted to their non-bereaved siblings. We conclude that offspring suicide does not 'cause' psychiatric hospitalization in bereaved parents.
authors.affiliation: Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Ljung
authors.affiliation: Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Sandin
authors.affiliation: Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden.
authors.forename: N
authors.initials: N
authors.lastname: Långström
authors.affiliation: Department of Clinical Neuroscience,Karolinska Institutet,Stockholm,Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Runeson
authors.affiliation: Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Lichtenstein
authors.affiliation: Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Larsson
mesh_terms: D000293:Adolescent; D000328:Adult; D001601:Bereavement; D002648:Child; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D012042:Registries; D013405:Suicide / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult