The objective of this study was to examine mental disorders and treatment use among bereaved siblings in the general population. Siblings (N57243) of all deceased children in the population of Manitoba, Canada who died between 1984 and 2009 were matched 1:3 to control siblings (N521,729) who did not have a sibling die in the study period. Generalized estimating equations were used to compare the two sibling groups in the two years before and after the index child's death on physician-diagnosed mental disorders and treatment utilization, with adjustment for confounding factors including pre-existing mental illness. Analyses were stratified by age of the bereaved (<13 vs. 131). Results revealed that, in the two years after the death of the child, bereaved siblings had significantly higher rates of mental disorders than control siblings, even after adjusting for pre-existing mental illness. When comparing the effect of a child's death on younger versus older siblings, the rise in depression rates from pre-death to post-death was significantly higher for siblings aged under 13 (p<0.0001), increasing more than 7-fold (adjusted relative rate, ARR57.25, 95% CI: 3.65-14.43). Bereaved siblings aged 131 had substantial morbidity in the two years after the death: 25% were diagnosed with a mental disorder (vs. 17% of controls), and they had higher rates of almost all mental disorder outcomes compared to controls, including twice the rate of suicide attempts (ARR52.01, 95% CI: 1.29-3.12). Siblings in the bereaved cohort had higher rates of alcohol and drug use disorders already before the death of their sibling. In conclusion, the death of a child is associated with considerable mental disorder burden among surviving siblings. Pre-existing health problems and social disadvantage do not fully account for the increase in mental disorder rates.Key words: Sibling, bereavement, epidemiology, depression, suicide, mental disorder (World Psychiatry 2016;15:59-66) Most children have a sibling 1 . While fertility rates are lower in Western nations and family sizes have diminished in recent decades, the majority of households with children in the U.S. in 2010 had two or more children 2 . Each year more than 40,000 children and adolescents die in the U.S., leaving a substantial number of bereaved siblings 3 .Sibling bereavement is an experience with a very sparse literature and thus the consequences of losing a sibling are unclear. A series of Swedish national cohort studies revealed increased mortality of bereaved siblings when compared to non-bereaved controls 4-8 . These analyses, however, were restricted to adult sibling populations and did not examine outcomes other than death.Other smaller studies have examined bereavement experiences related to specific causes of sibling death, namely cancer and suicide, with mixed findings 9-12 . One study of cancerrelated bereavement showed no differences in anxiety and depression between bereaved and non-bereaved siblings 13 , while other descriptive case series found anxiety, substance mis...
Limited research exists examining long-term mental and physical health outcomes in adult survivors of pediatric burns. The authors examine the postinjury lifetime prevalence of common mental and physical disorders in a large pediatric burn cohort and compare the results with matched controls. Seven hundred and forty five survivors of childhood burns identified in the Burn Registry (<18 years old and total BSA >1% between April 1, 1988 and March 31, 2010) were matched 1:5 to the general population based on age at time of injury (index date), sex, and geographic residence. Postinjury rate ratio (RR) was used to compare burn cases and control cohorts for common mental and physical illnesses through physician billings, and hospital claims. RR was adjusted for sex, rural residence, and income. Compared with matched controls, postburn cases had significantly higher RR of all mental disorders, which remained significant (P < .05) after adjustment (major depression RR = 1.5 [confidence limit {CL}: 1.2-1.8], anxiety disorder RR = 1.5 [CL: 1.3-1.8), substance abuse RR = 2.3 [CL: 1.7-3.2], suicide attempt RR = 4.3 [CL: 1.6-12.1], or any mental disorder RR = 1.5 [CL: 1.3-1.8]). The relative rate of some physical illnesses was also significantly increased in burn survivors: arthritis RR = 1.2 (CL: 1.1-1.4), fractures RR = 1.4 (CL: 1.2-1.6), total respiratory morbidity RR = 1.1 (CL: 1.02-1.3), and any physical illness RR = 1.2 (CL: 1.1-1.3). Adult survivors of childhood burn injury have significantly increased rates of postburn mental and physical illnesses. Screening and appropriate management of these illnesses is essential when caring for this population.
this is the optimal or correct dose to be used for the treatment of mood disorders.As correctly noted, all treatment with ketamine remains off-label and supported by limited published data. When more data become available on alternative dosing strategies, such as the soon-to-be-released results of the National Institutes of Health-funded RAPID study (NCT01920555), we will be able to provide a more informed statement on dosing. However, until such information is available, we believe that potential patients should be made aware of the fact that most published reports citing ketamine's antidepressant effects to date have used the 0.5-mg/kg dose provided over 40 minutes as part of an informed consent process, and that clinicians weigh this fact in their consideration of using alternative doses. We are not calling for a special informed consent process when using alternative ketamine dosing strategies, but a comprehensive informed consent process for all patients considering the treatment.As highlighted in the recent publications by Kraus et al 4 and Singh et al, 5 we agree with the importance of acknowledging established ethical and legal frameworks, in addition to the available scientific information, when considering the use of ketamine therapy. We especially agree with the call to use the virtue of humility in acknowledging the uncertainties that accompany the use of this novel treatment strategy.We also agree with Golzari and Mahmoodpoor regarding the need for special considerations to be made for specific medical conditions. We sought to provide the most accurate and complete information available in the consensus statement and acknowledge the limitations of this information. We encourage clinicians to do the same when providing informed consent and treating patients. We support the formation of a national or international registry to advance our knowledge of the treatment, and thus allow for the development of more specific and meaningful guidelines in the near future.
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