title: Functional impairment due to bereavement after the death of adolescent or young adult offspring in a national population study of 1,051,515 parents.
abstract: OBJECTIVE
  This study addresses the burden of grief after the death of an adolescent or young adult offspring. Parental bereavement following the death of an adolescent or young adult offspring is associated with considerable psychiatric and somatic impairment. Our aim is to fill a research gap by examining offspring death due to suicide, accidents, or natural causes in relation to risk of parental sickness absence with psychiatric or somatic disorders.
  
  
  METHODS
  This whole population-based prospective study included mothers and fathers of all offspring aged 16-24 years in Sweden on December 31, 2004 (n = 1,051,515). This study had no loss to follow-up and exposure, confounders, and the outcome were recorded independently of each other. Cox survival analysis was used to model time to sickness absence exceeding 30 days, adjusting for parental demographic characteristics, previous parental sickness absence and disability pension, and inpatient and outpatient psychiatric and somatic healthcare prior to offspring death in 2001-2004. This large study population provided satisfactory statistical power for stratification by parents' sex and adolescent and young adults' cause of death.
  
  
  RESULTS
  Mothers and fathers of offspring suicide and accident decedents both had over tenfold higher risk for psychiatric sickness absence exceeding 30 days as compared to parents of live offspring. Fathers of suicide decedents were at 40 % higher risk for somatic sickness absence.
  
  
  CONCLUSIONS
  This is the largest study to date of parents who survived their offspring's death and the first study of work-related outcomes in bereaved parents. This study uses a broad metric of work-related functional impairment, sickness absence, for capturing the burden of sudden offspring death.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 550 North Broadway Room 921, Baltimore, MD, 21205, USA, hwilcox1@jhmi.edu.
authors.forename: Holly C
authors.initials: HC
authors.lastname: Wilcox
authors.forename: Ellenor
authors.initials: E
authors.lastname: Mittendorfer-Rutz
authors.forename: Linnea
authors.initials: L
authors.lastname: Kjeldgård
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
authors.forename: Bo
authors.initials: B
authors.lastname: Runeson
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D032721:Adult Children / Q000706:statistics & numerical data*; D002423:Cause of Death; D017281:Cost of Illness; D003645:Death, Sudden / Q000453:epidemiology*; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D011446:Prospective Studies; D012306:Risk; D018582:Sick Leave / Q000706:statistics & numerical data*; D013405:Suicide / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult