title: Parental death during childhood and subsequent school performance.
abstract: OBJECTIVE
  Parental death during childhood has been linked to increased mortality and mental health problems in adulthood. School failure may be an important mediator in this trajectory. We investigated the association between parental death before age 15 years and school performance at age 15 to 16 years, taking into account potentially contributing factors such as family socioeconomic position (SEP) and parental substance abuse, mental health problems, and criminality.
  
  
  METHODS
  This was a register-based national cohort study of 772,117 subjects born in Sweden between 1973 and 1981. Linear and logistic regression models were used to analyze school performance as mean grades (scale: 1-5; SD: 0.70) and school failure (finished school with incomplete grades). Results are presented as β-coefficients and odds ratios (ORs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  Parental death was associated with lower grades (ORs: -0.21 [95% CI: -0.23 to -0.20] and -0.17 [95% CI: -0.19 to -0.15]) for paternal and maternal deaths, respectively. Adjustment for SEP and parental psychosocial factors weakened the associations, but the results remained statistically significant. Unadjusted ORs of school failure were 2.04 (95% CI: 1.92 to 2.17) and 1.51 (95% CI: 1.35 to 1.69) for paternal and maternal deaths. In fully adjusted models, ORs were 1.40 (95% CI: 1.31 to 1.49) and 1.18 (95% CI: 1.05 to 1.32). The higher crude impact of death due to external causes (ie, accident, violence, suicide) (OR: -0.27 [90% CI: -0.28 to -0.26]), compared with natural deaths (OR: -0.16 [95% CI: -0.17 to -0.15]), was not seen after adjustment for SEP and psychosocial situation of the family.
  
  
  CONCLUSIONS
  Parental death during childhood was associated with lower grades and school failure. Much of the effect, especially for deaths by external causes, was associated with socially adverse childhood exposures.
authors.affiliation: Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden;
authors.forename: Lisa
authors.initials: L
authors.lastname: Berg
authors.forename: Mikael
authors.initials: M
authors.lastname: Rostila
authors.forename: Jan
authors.initials: J
authors.lastname: Saarela
authors.forename: Anders
authors.initials: A
authors.lastname: Hjern
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D063129:Parental Death
keywords: childhood socioeconomic position; parental death; parental mental health; parental substance abuse; school performance