Social Determinants Associated With Exposure to Childhood Parental Bereavement and Subsequent Risk for Psychiatric Disorders

Abstract

ImportancePrevalence of childhood parental death varies by race and ethnicity and socioeconomic status, yet whether similar variation persists in the association with lifetime psychiatric disorder is unknown.ObjectiveTo assess whether race and ethnicity and parental educational attainment are associated with the risk of death of a parent; to determine whether the risk for lifetime psychiatric disorder associated with death of a parent was moderated by race and ethnicity and highest parental educational attainment; and to examine a potential intersection of race and ethnicity with parental educational attainment in the risk of lifetime psychiatric disorder associated with death of a parent.Design, Setting, and ParticipantsThis retrospective cohort study used data from the National Comorbidity Study: Adolescent Supplement (NCS-A), 2001 to 2004. Participants included youth aged 13 to 18 years, restricted to Black, Hispanic, and White youth due to power limitations. Data were analyzed from February 26, 2021, to April 21, 2022.ExposureDeath of a parent during childhood.Main Outcomes and MeasuresThe primary study outcome was any lifetime Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) psychiatric disorder, assess via assessed via structured clinical interviews.ResultsAmong 9501 youth (mean [SD] age, 15.2 [1.5] years; 50.9% female), including 511 youth who had experienced parental death and 8990 youth who had not, the cumulative hazard of parental death by age 18 years was approximately doubled for Hispanic (10.1%; 95% CI, 6.9%-14.7%) and Black (14.0%; 95% CI, 10.6%-18.4%) youth compared with White youth (6.0%; 95% CI, 4.7%-7.8%). Similar patterns were noted by parental educational attainment: the cumulative hazard of parental death for youth of parents with less educational attainment was nearly double (10.1%; 95% CI, 8.1%-12.6%) compared with youth of parents with more education (6.6%; 95% CI, 5.2%-8.4%). Death of a parent was positively and significantly associated with risk of any lifetime psychiatric disorder (aOR, 1.34; 95% CI, 1.03-1.75) compared with youth who had not experienced death of a parent. However, this association was not moderated by race and ethnicity (aOR, 1.05; 95% CI, 0.58-1.92) or parental educational attainment (aOR, 1.19; 95%, 0.70-2.04), although power analyses suggest that larger sample sizes are needed.Conclusions and RelevanceIn this cross-sectional study, Black and Hispanic youth experienced elevated parental death compared with White youth, yet the risk for any lifetime psychiatric disorder after parental death was not significantly moderated by race and ethnicity or parental education. Both individual- and population-level interventions may be needed to address the increased risk of psychiatric disorders, although additional studies with larger sample sizes are needed.