Childhood Bereavement and Lower Stress Resilience in Late Adolescence

Kennedy, Beatrice; Chen, Ruoqing; Valdimarsdóttir, Unnur; Montgomery, Scott; Fang, Fang; Fall, Katja

doi:10.1016/j.jadohealth.2018.02.002

Cited by 31 publications

(18 citation statements)

References 32 publications

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“…Our finding suggesting that a diagnosis of stress related disorders in early life is associated with the largest relative risk increase in life threatening infections is in line with findings showing that childhood exposure to trauma might have a lifelong impact on susceptibility to disease, through promoting inflammatory reactions,50 51 interrupting neuropsychological and cognitive development,52 53 or an interplay between genes and the environment 54. Indeed, the extent of epigenetic modifications, measured as frequency of DNA methylation changes, were up to 12 times higher in participants with PTSD who were exposed to trauma in childhood compared with participants with PTSD who were trauma-free in childhood 54.…”

Section: Discussionsupporting

confidence: 89%

Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study

Song

Fall

Fang

et al. 2019

BMJ

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Objective To assess whether severe psychiatric reactions to trauma and other adversities are associated with subsequent risk of life threatening infections. Design Population and sibling matched cohort study. Setting Swedish population. Participants 144 919 individuals with stress related disorders (post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions) identified from 1987 to 2013 compared with 184 612 full siblings of individuals with a diagnosed stress related disorder and 1 449 190 matched individuals without such a diagnosis from the general population. Main outcome measures A first inpatient or outpatient visit with a primary diagnosis of severe infections with high mortality rates (ie, sepsis, endocarditis, and meningitis or other central nervous system infections) from the Swedish National Patient Register, and deaths from these infections or infections of any origin from the Cause of Death Register. After controlling for multiple confounders, Cox models were used to estimate hazard ratios of these life threatening infections. Results The average age at diagnosis of a stress related disorder was 37 years (55 541, 38.3% men). During a mean follow-up of eight years, the incidence of life threatening infections per 1000 person years was 2.9 in individuals with a stress related disorder, 1.7 in siblings without a diagnosis, and 1.3 in matched individuals without a diagnosis. Compared with full siblings without a diagnosis of a stress related disorder, individuals with such a diagnosis were at increased risk of life threatening infections (hazard ratio for any stress related disorder was 1.47 (95% confidence intervals1.37 to 1.58) and for PTSD was 1.92 (1.46 to 2.52)). Corresponding estimates in the population based analysis were similar (1.58 (1.51 to 1.65) for any stress related disorder, P=0.09 for difference between sibling and population based comparison, and 1.95 (1.66 to 2.28) for PTSD, P=0.92 for difference). Stress related disorders were associated with all studied life threatening infections, with the highest relative risk observed for meningitis (sibling based analysis 1.63 (1.23 to 2.16)) and endocarditis (1.57 (1.08 to 2.30)). Younger age at diagnosis of a stress related disorder and the presence of psychiatric comorbidity, especially substance use disorders, were associated with higher hazard ratios, whereas use of selective serotonin reuptake inhibitors in the first year after diagnosis of a stress related disorder was associated with attenuated hazard ratios. Conclusion In the Swedish population, stress related disorders were associated with a subsequent risk of life threatening infections, after controlling for familial background and physical or psychiatric comorbidities.

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Section: Discussionsupporting

confidence: 89%

Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study

Song

Fall

Fang

et al. 2019

BMJ

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“…In the analysis in which follow-up started in 1973, the association between parental death and mortality became weaker when delinquency was adjusted for; this may indicate that delinquency may be particularly relevant to early death. Fourth, although the direct path (path 3) was statistically nonsignificant, given the small effect size of the mediating paths and the relatively high magnitude of the direct path, other paths that were not included in the present study may still be relevant, such as increased susceptibility to stress in offspring who have experienced parental loss [62]. Furthermore, the mediation analysis assumes that there is no confounder between the mediator and outcome relationship that is affected by the exposure.…”

Section: Plos Medicinementioning

confidence: 86%

Parental death in childhood and pathways to increased mortality across the life course in Stockholm, Sweden: A cohort study

et al. 2021

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Background Previous studies have shown that the experience of parental death during childhood is associated with increased mortality risk. However, few studies have examined potential pathways that may explain these findings. The aim of this study is to examine whether familial and behavioural factors during adolescence and socioeconomic disadvantages in early adulthood mediate the association between loss of a parent at age 0 to 12 and all-cause mortality by the age of 63. Methods and findings A cohort study was conducted using data from the Stockholm Birth Cohort Multigenerational Study for 12,615 children born in 1953, with information covering 1953 to 2016. Familial and behavioural factors at age 13 to 19 included psychiatric and alcohol problems in the surviving parent, receipt of social assistance, and delinquent behaviour in the offspring. Socioeconomic disadvantage in early adulthood included educational attainment, occupational social class, and income at age 27 to 37. We used Cox proportional hazard regression models, combined with a multimediator analysis, to separate direct and indirect effects of parental death on all-cause mortality. Among the 12,582 offspring in the study (men 51%; women 49%), about 3% experienced the death of a parent in childhood. During follow-up from the age of 38 to 63, there were 935 deaths among offspring. Parental death was associated with an elevated risk of mortality after adjusting for demographic and household socioeconomic characteristics at birth (hazard ratio [HR]: 1.52 [95% confidence interval: 1.10 to 2.08, p-value = 0.010]). Delinquent behaviour in adolescence and income during early adulthood were the most influential mediators, and the indirect associations through these variables were HR 1.03 (1.00 to 1.06, 0.029) and HR 1.04 (1.01 to 1.07, 0.029), respectively. After accounting for these indirect paths, the direct path was attenuated to HR 1.35 (0.98 to 1.85, 0.066). The limitations of the study include that the associations may be partly due to genetic, social, and behavioural residual confounding, that statistical power was low in some of the subgroup analyses, and that there might be other relevant paths that were not investigated in the present study. Conclusions Our findings from this cohort study suggest that childhood parental death is associated with increased mortality and that the association was mediated through a chain of disadvantages over the life course including delinquency in adolescence and lower income during early adulthood. Professionals working with bereaved children should take the higher mortality risk in bereaved offspring into account and consider its lifelong consequences. When planning and providing support to bereaved children, it may be particularly important to be aware of their increased susceptibility to delinquency and socioeconomic vulnerability that eventually lead to higher mortality.

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“…We have previously reported higher excess risk of life-threatening infections and cardiovascular disease among individuals with stress-related disorders after trauma at an earlier age ( Song et al, 2019 ; Song et al, 2018 ). Long-lasting biological interruptions, for example promoted inflammatory reactions ( Danese et al, 2011 ) and neuropsychological/cognitive impairment ( De Bellis and Zisk, 2014 ; Kennedy et al, 2018 ), have been associated with childhood exposure to trauma.…”

Section: Discussionmentioning

confidence: 99%

Risk of psychiatric disorders among the surviving twins after a co-twin loss

Song

Larsson

Fang

et al. 2020

eLife

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Losing a co-twin by death is a severely stressful event yet with unknown impact on the surviving twin’s risk of psychiatric disorders. We identified all Swedish-born twins who lost a co-twin by death between 1973 and 2013 (n = 4,528), their 4939 non-twin full siblings, together with 22,640 age- and sex-matched non-bereaved twins. Compared to the non-bereaved twins, exposed twins were at increased risk of receiving a first diagnosis of psychiatric disorders (hazard ratio = 1.65, 95% confidence interval1.48–1.83), particularly during the first month after loss. Similarly, compared to non-twin full siblings, the relative risks were significantly increased after loss of monozygotic co-twin (2.45-fold), and loss of a dizygotic co-twin (1.29-fold), with higher HR observed with greater age gaps between twins and non-twin siblings. As dizygotic twins share equal genetic relatedness to the deceased twin as their full siblings, this pattern suggests that beyond the contribution of genetic factors, shared early life experiences and attachment contribute to the risk of psychiatric disorders among surviving twins after co-twin loss.

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Childhood Bereavement and Lower Stress Resilience in Late Adolescence

Cited by 31 publications

References 32 publications

Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study

Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study

Parental death in childhood and pathways to increased mortality across the life course in Stockholm, Sweden: A cohort study

Risk of psychiatric disorders among the surviving twins after a co-twin loss

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