Self-injury in youths who lost a parent to cancer: nationwide study of the impact of family-related and health-care-related factors.
BACKGROUND
Self-injury, a manifestation of severe psychological distress, is increased in cancer-bereaved youths. Little is known about the potential influence on the risk for self-injury of factors that could be clinically relevant to and modifiable by the health-care professionals involved in the care of the dying parent.


METHODS
In a nationwide population-based anonymous study, 622 (73.1%) youths (aged 18-26) who, 6 to 9 years earlier at ages 13 to 16, had lost a parent to cancer answered study-specific questions about self-injury and factors related to the family and parental health care.


RESULTS
Univariable analyses showed that the risk for self-injury was increased among cancer-bereaved youths who reported poor family cohesion the years before (relative risk [RR], 3.4, 95% confidence interval [CI], 2.5-4.6) and after the loss (RR, 3.3, 95% CI, 2.4-4.4), distrust in the health care provided to the dying parent (RR, 1.7, 95% CI, 1.2-2.4), perceiving poor health-care efforts to cure the parent (RR 1.5, 95% CI, 1.1-2.1) and poor efforts to prevent suffering (RR, 1.6, 95% CI, 1.1-2.4), that at least one of their parents had been depressed or had troubles in life (RR, 1.5, CI, 1.1-2.1) and believing 3 days before the loss that the treatment would probably cure the parent (RR, 1.6, CI, 1.1-2.3). In the total multivariable models, only poor family cohesion before and after the loss remained statistically significantly associated with self-injury.


CONCLUSIONS
Poor family cohesion before and after the loss of a parent to cancer is associated with an increased risk of self-injury in teenage children.
Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Research and Development, Stockholm Sjukhem Foundation, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Tove
T
Bylund Grenklo
Ulrika
U
Kreicbergs
Unnur A
UA
Valdimarsdóttir
Tommy
T
Nyberg
Gunnar
G
Steineck
Carl Johan
CJ
Fürst
D000293:Adolescent; D000328:Adult; D001601:Bereavement; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D010287:Parent-Child Relations; D063129:Parental Death / Q000523:psychology*; D011159:Population Surveillance; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000523:psychology*; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013548:Sweden; D013727:Terminal Care; D035502:Trust; D055815:Young Adult
cancer; oncology; risk factors; self-injury; teenage bereavement