Depression among Parents Two to Six Years Following the Loss of a Child by Suicide: A Novel Prediction Model

Abstract

BackgroundParents who lose a child by suicide have elevated risks of depression. No clinical prediction tools exist to identify which suicide-bereaved parents will be particularly vulnerable; we aimed to create a prediction model for long-term depression for this purpose.MethodDuring 2009 and 2010 we collected data using a nationwide study-specific questionnaire among parents in Sweden who had lost a child aged 15-30 by suicide in years 2004-2007. Current depression was assessed with the Patient Health Questionnaire (PHQ-9) and a single question on antidepressant use. We considered 26 potential predictors assumed clinically assessable at the time of loss, including socio-economics, relationship status, history of psychological stress and morbidity, and suicide-related circumstances. We developed a novel prediction model using logistic regression with all subsets selection and stratified cross-validation. The model was assessed for classification performance and calibration, overall and stratified by time since loss.ResultsIn total 666/915 (73%) participated. The model showed acceptable classification performance (adjusted area under the curve [AUC] = 0.720, 95% confidence interval [CI] 0.673-0.766), but performed classification best for those at shortest time since loss. Agreement between model-predicted and observed risks was fair, but with a tendency for underestimation and overestimation for individuals with shortest and longest time since loss, respectively. The identified predictors include female sex (odds ratio [OR] = 1.84); sick-leave (OR = 2.81) or unemployment (OR = 1.64); psychological premorbidity debuting during the last 10 years, before loss (OR = 3.64), or more than 10 years ago (OR = 4.96); suicide in biological relatives (OR = 1.54); with non-legal guardianship during the child’s upbringing (OR = 0.48); and non-biological parenthood (OR = 0.22) found as protective.ConclusionsOur prediction model shows promising internal validity, but should be externally validated before application. Psychological premorbidity seems to be a prominent predictor of long-term depression among suicide-bereaved parents, and thus important for healthcare providers to assess.

Mini Review:The Mental and Physical Consequences of Chinese Shidu Parents

“…Based on the 2011 baseline data from the China Health and Retirement Longitudinal Study 17 whose data cover 17,705 individuals aged 45 or older, living in 10,287 households in 450 rural villages or urban communities with 6,739 observations with complete information, the effects were significantly stronger for losing all the children, similar to losing the only child, than those having a living child or not losing, compared the mental health, happiness and loneliness after adjusting for demographic and socioeconomic characteristics. Previous research also has shown that bereaved parents exhibit more symptoms of depression, anxiety, loneliness, grief, and posttraumatic stress disorder than did their non-bereaved counterparts 18,19 . Meanwhile, bereavement was associated with long-term mortality due to illness (e.g., cancer), presumably because of stress, a weakened immune system, or poor health behaviors (e.g., smoking, alcohol consumption).…”

The Impact on Mental Health of Losing an Only Child and the Influence of Social Support and Resilience

“…Previous research has shown that bereaved parents exhibit more symptoms of depression, anxiety, loneliness, grief, and posttraumatic stress disorder than did their nonbereaved counterparts (Harper et al, 2014;Kreicbergs, Valdimarsdo´ttir, Onelo¨v, Henter, & Steineck, 2004;Nyberg et al, 2016). The situation could be even worse in Chinese culture if the child that has died is an only child.…”

“…It is estimated from national census data (collected every 10 years) that the number of PLOCs in China is approximately 821,000, and this number is projected to reach 1.423 million in 2030 (Zhou & Mi, 2013). Although research has revealed strong evidence that losing a child is a tremendous threat to the mental health of parents (Harper, O’Connor, & O’Carroll, 2014; Nyberg, Hed Myrberg, Omerov, Steineck, & Nyberg, 2016), limited empirical studies have investigated the mental health of PLOCs in China, or possible protective factors.…”

Can social support matter? The relationship between social support and mental health among bereaved parents in an only‐child society: Evidence from China

“…Losing a child is considered an enormous risk to the mental health status of parents (Harper, O'Connor, & O'Carroll, 2014; Hogan & Schmidt, 2002; Nyberg, Myrberg, Omerov, Steineck, & Nyberg, 2016; Rubin & Malkinson, 2001), even the loss of a child is perceived as the most difficult of all psychological traumas to overcome (Talbot, 2002). Specifically, bereaved parents are deep in grief over their lost child, experiencing more mental distress, such as anger, guilt, self‐blame, anxiety, depression and sadness than non‐bereaved parents (Cacciatore, Lacasse, Lietz, & Mcpherson, 2014; Harper et al., 2014; Marwit & Klass, 1994; Nyberg et al, 2016; Rogers, Floyd, Seltzer, Greenberg, & Hong, 2008; Talbot, 2002). In addition, bereaved parents are more likely to exhibit symptoms of posttraumatic stress disorder and complicated grief (Kreicbergs, Valdimarsdóttir, Onelöv, Henter, & Steineck, 2004; Nyberg et al., 2016), and it is difficult for them to struggle with (Kersting, Brähler, Glaesmer, & Wagner, 2011; Li, Stroebe, Chan, & Chow, 2014).…”

“…Specifically, bereaved parents are deep in grief over their lost child, experiencing more mental distress, such as anger, guilt, self‐blame, anxiety, depression and sadness than non‐bereaved parents (Cacciatore, Lacasse, Lietz, & Mcpherson, 2014; Harper et al., 2014; Marwit & Klass, 1994; Nyberg et al, 2016; Rogers, Floyd, Seltzer, Greenberg, & Hong, 2008; Talbot, 2002). In addition, bereaved parents are more likely to exhibit symptoms of posttraumatic stress disorder and complicated grief (Kreicbergs, Valdimarsdóttir, Onelöv, Henter, & Steineck, 2004; Nyberg et al., 2016), and it is difficult for them to struggle with (Kersting, Brähler, Glaesmer, & Wagner, 2011; Li, Stroebe, Chan, & Chow, 2014). The adverse suffering is magnified for bereaved parents when their dead child is the only one (Rogers et al., 2008; Wijngaards‐de Meij et al., 2005), as they are embedded in grief of the loss of their active parenthood and emotional attachment, and have to completely re‐define their identity and goals for the future (Floyd, Mailick Seltzer, Greenberg, & Song, 2013).…”