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Meen G, Reime MA, Lindeman S, Selseng LB. Beyond troubled and untroubled positions - an intersectional analysis of siblings who are bereaved by drug-related deaths' meaning-making stories about their deceased brothers and sisters. Int J Qual Stud Health Well-being 2024; 19:2372864. [PMID: 38920102 PMCID: PMC11210408 DOI: 10.1080/17482631.2024.2372864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/22/2024] [Indexed: 06/27/2024] Open
Abstract
PURPOSE This study investigates how social categories work and intersect in siblings bereaved by drug-related deaths' (DRDs) stories about their relationships to their deceased brother or sister. The sociocultural embedded process of making meaning of the relationship with the deceased individual is essential in adapting to the loss. However, insight into such experiences of siblings bereaved by a DRD is scarce. Previous research has suggested that DRDs may be stigmatized life experiences for bereaved family members, and this paper furthers understanding of the experiences and issues involved in losing a sibling in a stigmatized death. METHODS An intersectional analysis is applied to interviews with 14 bereaved siblings. By investigating and displaying how different categories intertwine, various positionings are identified. FINDINGS Categorization of the deceased siblings as "addicts" constructs a troubled position. However, when "addict" intersects with the categories "unique," "sibling," and "uncle," the troubled subject's position as an "addict" can be concealed. CONCLUSIONS Normative conceptions of addiction and DRDs produce troubled subject positions. By intermingling the category of "addict" with other categories, less problematic positions are created. Still, intersections of categories can also construct further complexities of remorse and self-blame for the bereaved siblings.
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Affiliation(s)
- Gunhild Meen
- Institute of Welfare and Participation, Western Norway University College of Applied Science, Bergen, Norway
| | - Monika Alvestad Reime
- Institute of Welfare and Participation, Western Norway University College of Applied Science, Bergen, Norway
| | - Sari Lindeman
- Institute of Welfare and Participation, Western Norway University College of Applied Science, Bergen, Norway
| | - Lillian Bruland Selseng
- Institute of Welfare and Participation, Western Norway University College of Applied Science, Bergen, Norway
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Zipple MN. Reducing childhood mortality extends mothers' lives. Sci Rep 2024; 14:10649. [PMID: 38724642 PMCID: PMC11082133 DOI: 10.1038/s41598-024-61217-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
During the twentieth century, childhood mortality was dramatically reduced globally, falling by more than 90% in the United States and much of Europe. Total fertility also fell, with the combined result that many parents who otherwise would have experienced the loss of a child were spared the trauma and negative health consequences that accompany such a loss. Here I use mathematical modeling to argue that the reduction in the frequency of child death that occurred in the twentieth century indirectly led to a substantial reduction in female mortality, resulting in an extension of female lifespan. I estimate that the reduction in maternal bereavement in the US during the twentieth century indirectly increased mean female lifespan after age 15 by approximately 1 year. I discuss implications for our understanding of the persistence of the sex gap in longevity and approaches to improving maternal health outcomes in countries that still face high levels of childhood mortality.
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Affiliation(s)
- Matthew N Zipple
- Laboratory for Social Animal Evolution and Recognition, Department of Neurobiology and Behavior, Cornell University, Ithaca, NY, USA.
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Huang C, Peng J, Lee PMY, Wang C, Wei K, Liang M, Qin G, Yu Y, Li J. Sibling Death in Childhood and Early Adulthood and Risk of Early-Onset Cardiovascular Disease. JAMA Netw Open 2024; 7:e2350814. [PMID: 38190182 PMCID: PMC10774991 DOI: 10.1001/jamanetworkopen.2023.50814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/17/2023] [Indexed: 01/09/2024] Open
Abstract
Importance Sibling death is a highly traumatic event, but empirical evidence on the association of sibling death in childhood and early adulthood with subsequent risk of incident cardiovascular disease (CVD) remains limited. Objective To evaluate the association between sibling death in the early decades of life and subsequent risk of incident early-onset CVD. Design, Setting, and Participants This population-based cohort study included 2 098 659 individuals born in Denmark from 1978 to 2018. Follow-up started at age 1 year or the date of the first sibling's birth, whichever occurred later, and it ended at the first diagnosis of CVD, the date of death, emigration, or December 31, 2018, whichever came first. Data analyses were conducted from November 1, 2021, through January 10, 2022. Exposures The death of a sibling. Main Outcomes and Measures The outcome was early-onset CVD. Cox models were used to estimate hazard ratios (HRs) with 95% CIs. Results This study included 2 098 659 individuals (1 076 669 [51.30%] male; median [IQR] age at death of sibling, 11.48 [4.68-21.32] years). During the median (IQR) follow-up of 17.52 (8.85-26.05) years, 1286 and 76 862 individuals in the bereaved and nonbereaved groups, respectively, were diagnosed with CVD. Sibling death in childhood and early adulthood was associated with a 17% increased risk of overall CVD (HR, 1.17; 95% CI, 1.10-1.23; cumulative incidence in bereaved individuals, 1.96% [1.61%-2.34%]; cumulative incidence in nonbereaved individuals at age 41 years, 1.35% [1.34%-1.37%]; cumulative incidence difference: 0.61% [95% CI, 0.24%-0.98%]). Increased risks were also observed for most type-specific CVDs, in particular for myocardial infarction (HR, 1.66; 95% CI, 1.12-2.46), ischemic heart disease (HR, 1.52; 95% CI, 1.22-1.90), and heart failure (HR, 1.50; 95% CI, 1.00-2.26). The association was observed whether the sibling died due to CVD (HR, 2.54; 95% CI, 2.04-3.17) or non-CVD (HR, 1.13; 95% CI, 1.06-1.19) causes. The increased risk of CVD was more pronounced for individuals who lost a twin or younger sibling (HR, 1.25; 95% CI, 1.15-1.36) than an elder sibling (HR, 1.11; 95% CI, 1.03-1.20). Conclusions and Relevance In this cohort study of the Danish population, sibling death in childhood and early adulthood was associated with increased risks of overall and most type-specific early-onset CVDs, with the strength of associations varying by cause of death and age difference between sibling pairs. The findings highlight the need for extra attention and support to the bereaved siblings to reduce CVD risk later in life.
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Affiliation(s)
- Chen Huang
- Department of Biostatistics, Key Laboratory for Health Technology Assessment, National Commission of Health, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Jiahuan Peng
- Department of Biostatistics, Key Laboratory for Health Technology Assessment, National Commission of Health, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Priscilla Ming Yi Lee
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ce Wang
- Department of Biostatistics, Key Laboratory for Health Technology Assessment, National Commission of Health, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Kecheng Wei
- Department of Biostatistics, Key Laboratory for Health Technology Assessment, National Commission of Health, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Minhong Liang
- Shanghai Hongkou Center for Disease Control and Prevention, Shanghai, China
| | - Guoyou Qin
- Department of Biostatistics, Key Laboratory for Health Technology Assessment, National Commission of Health, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China
| | - Yongfu Yu
- Department of Biostatistics, Key Laboratory for Health Technology Assessment, National Commission of Health, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China
| | - Jiong Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
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Andriessen K. Improved grief and symptoms of depression in bereaved siblings: promising findings from an online intervention. Evid Based Nurs 2023; 26:156. [PMID: 37369564 DOI: 10.1136/ebnurs-2022-103665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Karl Andriessen
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Song H, Shang Y, Fang F, Almqvist C, Pedersen NL, Magnusson PKE, Larsson H, Valdimarsdóttir UA. Mortality among twin individuals exposed to loss of a co-twin. Int J Epidemiol 2023; 52:600-610. [PMID: 35849345 PMCID: PMC10114119 DOI: 10.1093/ije/dyac145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although the death of a child, sibling or spouse has been associated with elevated risk of mortality, less is known about the survival of twin siblings exposed to a co-twin loss. METHODS In a Swedish population-based sibling-matched cohort, we compared the mortality of 5548 twin individuals who lost their co-twin between 1932 and 2011 with that of 27 740 age-matched and sex-matched twin individuals without such a loss and 6772 full siblings of these exposed twin individuals. Cox regression models were used to estimate the hazard ratios (HRs) of all-cause and cause-specific mortality. RESULTS We found increased risk of all-cause mortality among twin individuals exposed to a co-twin loss compared with matched unexposed twin individuals (HR = 1.30, 95% CI: 1.18-1.43) and their full siblings (HR = 1.10, 95% CI: 0.96-1.27) after adjusting for multiple covariates. The all-cause mortality risk was greater for loss of a co-twin due to unnatural deaths (HR = 1.54, 95% CI: 1.17-2.03) than natural deaths (HR = 1.26, 95% CI: 1.14-1.40). For cause-specific mortality, co-twin loss was associated with a higher risk of unnatural deaths both among twin individuals who lost their co-twin due to unnatural deaths (HR = 1.98, 95% CI: 1.27-3.10) and those whose loss was due to natural deaths (HR = 1.48, 95% CI: 1.07-2.06). The risk elevations were generally stronger for loss of a monozygotic co-twin than loss of a dizygotic co-twin. CONCLUSION Loss of a co-twin, especially a monozygotic co-twin, was associated with increased mortality, particularly of unnatural causes, among the surviving twin individuals. The excess mortality is likely attributable to both shared disease susceptibility within the twin pair and the adverse health sequelae of bereavement.
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Affiliation(s)
- Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yanan Shang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, University of Southern California, Los Angeles, USA
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Unnur A Valdimarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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Chen H, Janszky I, Rostila M, Wei D, Yang F, Li J, László KD. Bereavement in childhood and young adulthood and the risk of atrial fibrillation: a population-based cohort study from Denmark and Sweden. BMC Med 2023; 21:8. [PMID: 36600284 PMCID: PMC9814172 DOI: 10.1186/s12916-022-02707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Adverse childhood life events are associated with increased risks of hypertension, ischemic heart disease, and stroke later in life. Limited evidence also suggests that stress in adulthood may increase the risk of atrial fibrillation (AF). Whether childhood adversity may lead to the development of AF is unknown. We investigated whether the loss of a parent or sibling in childhood is associated with an increased risk of AF and compared this effect to that of similar losses in young adulthood. METHODS We studied 6,394,975 live-born individuals included in the Danish (1973-2018) and Swedish Medical Birth Registers (1973-2014). We linked data from several national registers to obtain information on the death of parents and siblings and on personal and familial sociodemographic and health-related factors. We analyzed the association between bereavement and AF using Poisson regression. RESULTS Loss of a parent or sibling was associated with an increased AF risk both when the loss occurred in childhood and in adulthood; the adjusted incident rate ratios and 95% confidence intervals were 1.24 (1.14-1.35) and 1.24 (1.16-1.33), respectively. Bereavement in childhood was associated with AF only if losses were due to cardiovascular diseases or other natural causes, while loss in adulthood was associated with AF not only in case of natural deaths, but also unnatural deaths. The associations did not differ substantially according to age at loss and whether the deceased was a parent or a sibling. CONCLUSIONS Bereavement both in childhood and in adulthood was associated with an increased AF risk.
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Affiliation(s)
- Hua Chen
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Imre Janszky
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.,Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Dang Wei
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Fen Yang
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden. .,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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Chen H, Wei D, Janszky I, Dahlström U, Rostila M, László KD. Bereavement and Prognosis in Heart Failure: A Swedish Cohort Study. JACC. HEART FAILURE 2022; 10:753-764. [PMID: 36175061 DOI: 10.1016/j.jchf.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The role of stress in the prognosis of heart failure (HF) is unclear. This study investigated whether the death of a close family member, a severe source of stress, is associated with mortality in HF. OBJECTIVES This study assessed whether the death of a close family member is associated with mortality in HF. METHODS Patients from the Swedish Heart Failure Registry during 2000-2018 and/or in the Swedish Patient Register with a primary diagnosis of HF during 1987-2018 (N = 490,527) were included in this study. Information was obtained on death of family members (children, partner, grandchildren, siblings, and parents), mortality, sociodemographic variables, and health-related factors from several population-based registers. The association between bereavement and mortality was analyzed by using Poisson regression. RESULTS Loss of a family member was associated with an increased risk of dying (adjusted relative risk: 1.29; 95% CI: 1.27-1.30). The association was present not only in case of the family member's cardiovascular deaths and other natural deaths but also in case of unnatural deaths. The risk was higher for 2 losses than for 1 loss and highest in the first week after the loss. The association between bereavement and an increased mortality risk was observed for the death of a child, spouse/partner, grandchild, and sibling but not of a parent. CONCLUSIONS Death of a family member was associated with an increased risk of mortality among patients with HF. Further studies are needed to investigate whether less severe sources of stress can also contribute to poor prognosis in HF and to explore the mechanisms underlying this association.
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Affiliation(s)
- Hua Chen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Dang Wei
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Imre Janszky
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Dyregrov K, Titlestad KB, Selseng LB. Why Informal Support Fails for Siblings Bereaved by a Drug-Related Death: A Qualitative and Interactional Perspective. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221129372. [PMID: 36154325 DOI: 10.1177/00302228221129372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drug-related deaths constitute a significant challenge that strongly impacts the lives of the bereaved and the risks of mental and social problems are well-documented. This paper is the first one to explore how bereaved siblings experience informal support after drug-related deaths. Reflexive thematic analysis is used to analyze ten semi-structured interviews with bereaved siblings. Three main themes were identified: (1) valued support elaborates on the range of desired support and content of the support received; (2) barriers to support were connected to complex family relations, different grief reactions, and stigma, shame, and devaluation; (3) ways to promote support focus on openness and mutual closeness. The discussion revolves around the 'strong' sibling role, complex family relations, stigma, protective silence, and disenfranchised grief. Interactional aspects involved in social support and the importance of addressing this in clinical practice, to utilize the vital support potential for the bereaved experiencing drug-related death, are discussed.
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Affiliation(s)
- Kari Dyregrov
- Western Norway University of Applied Sciences, Bergen, Norway
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D'Alton SV, Ridings L, Williams C, Phillips S. The bereavement experiences of children following sibling death: An integrative review. J Pediatr Nurs 2022; 66:e82-e99. [PMID: 35660123 DOI: 10.1016/j.pedn.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/27/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
Abstract
PROBLEM Sibling bereavement is one of the most distressing adverse life events during childhood but has received less attention in research than other forms of childhood bereavement. This integrative review identifies potential risk and protective factors for maladaptive coping following sibling bereavement and the influence of these factors on adjustment to loss. ELIGIBILITY CRITERIA Articles were limited to peer-reviewed studies, published in English in 2000 and beyond. Target population was bereaved siblings 0-18 years, and outcomes examined grief experiences by child self-report or parent-proxy report. SAMPLE The Whittemore and Knafl integrative framework was applied. Multidimensional Grief Theory guided the review with twenty-five studies synthesized across its domains: Separation Distress, Existential/Identity Crisis, and Circumstance-Related Distress. RESULTS Adjustment following sibling death is a complex process associated with a host of risk and protective factors that contribute to the bereavement process for this population. Age, sex, circumstance-related factors, continuing bonds, parental distress, and limited social support were critical influencing factors. CONCLUSION Definitive predictor variables were not identified but a combination of variables that influence the adjustment of bereaved siblings are discussed. IMPLICATIONS Future research is needed to explore the risk and protective factors of maladaptive coping to inform intervention development to promote individual and family adjustment following sibling death.
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Affiliation(s)
- Shannon V D'Alton
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, United States of America.
| | - Leigh Ridings
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, United States of America.
| | - Conrad Williams
- Medical University of South Carolina, Department of Pediatrics, 125 Doughty Street, MSC 917, Charleston, SC 29425, United States of America.
| | - Shannon Phillips
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, United States of America.
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Rodway C, Ibrahim S, Tham SG, Turnbull P, Kapur N, Appleby L. Bereavement and suicide bereavement as an antecedent of suicide in children and young people: Prevalence and characteristics. J Affect Disord 2022; 300:280-288. [PMID: 34958813 DOI: 10.1016/j.jad.2021.12.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/11/2021] [Accepted: 12/19/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION There is limited research into bereavement and suicide bereavement as an antecedent of suicide in young people. METHODS We extracted information on the antecedents of suicide from official reports, primarily coroner inquests, on a 3-year national consecutive case series of all UK deaths by suicide in people aged 10-19. RESULTS Between 2014 and 2016, there were 595 suicides by young people. 134 (25%) had been previously or recently bereaved; 51 (9%) by suicide, mainly of a friend or acquaintance. This is equivalent to 1 in 4 and 1 in 11, respectively, of all young people who die by suicide. Bereavement added to existing adversities - many antecedents of suicide were more likely in young people who were bereaved compared to those who were not, but there were few differences in the experiences of young people bereaved by suicide compared to other causes. LIMITATIONS This was an observational, not a risk factor study, and we did not use a control group. It is difficult to obtain data on non-suicide controls due to the ethical implications in contacting families, and the fact of suicide itself, its impact on disclosure and the reluctance of potential controls distorting any comparisons. CONCLUSION Lasting bereavement support needs to be routinely and immediately available for young people, including those who have experienced the death of a friend or acquaintance. Vigilance of agencies for bereaved young people is required, especially if there is evidence of other adversities.
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Affiliation(s)
- Cathryn Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Oxford Road 2nd Floor Jean McFarlane Building, Manchester, M13 9PL, UK.
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Oxford Road 2nd Floor Jean McFarlane Building, Manchester, M13 9PL, UK
| | - Su-Gwan Tham
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Oxford Road 2nd Floor Jean McFarlane Building, Manchester, M13 9PL, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Oxford Road 2nd Floor Jean McFarlane Building, Manchester, M13 9PL, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Oxford Road 2nd Floor Jean McFarlane Building, Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Oxford Road 2nd Floor Jean McFarlane Building, Manchester, M13 9PL, UK
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11
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Hiemeyer RB, Berger T, Braun T, Wagner B. Psychotherapists' rated working alliance in an internet-based intervention for bereaved siblings. DEATH STUDIES 2021; 46:2507-2516. [PMID: 34714217 DOI: 10.1080/07481187.2021.1995533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Bereaved siblings often receive insufficient social support and are at higher risk for mental disorders. This study aimed to examine the role of the therapist-rated working alliance in an online intervention for bereaved siblings. Clients (n = 74, 95% female), aged 17-59 received writing assignments and individual feedback by CBT trained therapists over 6 weeks. Working alliance (Working Alliance Inventory) and treatment outcomes (Inventory of Complicated Grief, Beck Depression Inventory-II) were assessed. Results revealed that the working alliance significantly increased during the course of the treatment and a significant association between working alliance and the change in depression was found.
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Affiliation(s)
- Rico-Benjamin Hiemeyer
- Department of Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tina Braun
- Department of Psychological Research Methods and Evaluation, University of the German Federal Armed Forces, Munich, Germany
| | - Birgit Wagner
- Department of Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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Syer S, Clarke M, Healy C, O'Donnell L, Cole J, Cannon M, McKay M. The association between familial death in childhood or adolescence and subsequent substance use disorder: A systematic review and meta-analysis. Addict Behav 2021; 120:106936. [PMID: 33975176 DOI: 10.1016/j.addbeh.2021.106936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Exposure to childhood adversity has been linked to long-term negative mental health consequences in adulthood. PURPOSE This review examined the association between exposure to the death of a family member (i.e., parent or sibling) during childhood or adolescence and the subsequent diagnosis of a substance use disorder. METHODS Electronic databases (Scopus, Medline (for Ovid), EMBASE, and PsychINFO) were searched for cohort and case-control studies in the English language. Studies were retained if it was demonstrable that exposure to death occurred before age 18, and that disorder was diagnosed subsequently. Sensitivity analyses were performed for the meta-analysis, and study quality assessed using the Newcastle-Ottawa Scale. RESULTS Nine studies, seven cohort and two case-control, were retained. Due to differential metrics (hazard ratios [HRs] versus odds/risk ratios [ORs/RRs]), only one meta-analysis was possible. Individuals experiencing familial death had 1.42 (95% CI = 0.96, 2.09) times the odds of developing a substance use disorder compared to those non-exposed. Where there was a statistically significant effect in other studies, these were mostly studies using National Registers (1.4 ≤ HR ≤ 2.51). LIMITATIONS Meta-analysis options were limited by the variety of study designs. CONCLUSIONS Evidence for a significant association between familial death and subsequent disorder appears to be an artefact of the study design. Implications of key findings. Further studies are required to better understand and estimate the association between familial death and substance use disorders. Registration and funding. The review was pre-registered (PROSPERO Reg No: CRD42020192892) and funded by the Irish Research Council (COALESCE/2019/61).
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Multifaceted Support Interventions for Siblings of Children With Cancer: A Systematic Review. Cancer Nurs 2021; 44:E609-E635. [PMID: 34406189 DOI: 10.1097/ncc.0000000000000966] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND When a child is given a diagnosis of cancer, the impact reverberates through the family unit. Siblings, in particular, experience an accumulation of distress. Siblings of children with cancer can experience both short- and long-term difficulties in psychosocial and physical functioning, and professional bodies have called for interventions targeted at their needs. OBJECTIVE The aim of this study was to describe outcomes, core components, and general characteristics of effective interventions intended to support sibling well-being and psychosocial health in pediatric oncology. METHODS MEDLINE (Ovid), EMBASE, CINAHL, PsycINFO, and Cochrane CENTRAL databases were searched in September 2019 and July 2020. Studies were included if they focused on interventions for siblings or family in pediatric cancer, had quantitative data to describe the effect or impact of the intervention, and were published in English. Included studies underwent quality appraisal, data extraction, and data synthesis. RESULTS Twenty articles fit inclusion criteria. Most interventions focused on 6- to 18-year-old siblings within a group setting. Most were theory based. Group format with multiple sessions was the most common approach. The most frequently assessed outcomes were depression, anxiety, posttraumatic stress symptoms, and health-related quality of life. CONCLUSIONS Understanding outcomes, core components, and characteristics of effective interventions is important to translate sibling-support interventions into standard practice. Such considerations are important in delivering equitable family-centered care to siblings of children with cancer. IMPLICATIONS FOR PRACTICE As institutions create mechanisms to support siblings, it may be important to target high-risk siblings initially, partner with community resources, attend to underrecognized populations of siblings, and more fully incorporate family into sibling support.
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Smith K, Langer S. The Impact of Parental Bereavement on Young People: A Thematic Analysis of Using Online Web Forums as a Method of Coping. OMEGA-JOURNAL OF DEATH AND DYING 2021:302228211024017. [PMID: 34275388 DOI: 10.1177/00302228211024017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A qualitative approach was used to explore how online web forums might facilitate recovery and the process of coping. Ten online web forums written by young people who have personally experienced the death of a parent formed the data of this study. Previous research suggests forum users do not receive the supportive reactions from face-to-face interactions that they desire. Thematic analysis found that forums created an environment where young people can process the bereavement of a parent. Forums allowed young people to use their experience of bereavement to positively support others with similar experiences. The findings imply that the process of using forums can positively impact individuals who have experienced the loss of a parent. This supports recommendations by professionals, to consider online forums as a coping strategy. This study presents one of the few analyses of web forums written by young people who have experienced parental bereavement.
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Affiliation(s)
- Kadie Smith
- HM Prison Service, Department of Mental Health, Doncaster, South Yorkshire, United Kingdom
| | - Susanne Langer
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, Greater Manchester, United Kingdom
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15
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del Carpio L, Paul S, Paterson A, Rasmussen S. A systematic review of controlled studies of suicidal and self-harming behaviours in adolescents following bereavement by suicide. PLoS One 2021; 16:e0254203. [PMID: 34242305 PMCID: PMC8270178 DOI: 10.1371/journal.pone.0254203] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/23/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Research suggests that being exposed to the suicide of others increases risk of subsequent suicidal or self-harming thoughts or behaviours. What is less clear is whether this applies to adolescents, and if the risk exceeds that following other causes of death, which has implications on suicide prevention approaches. This study aimed to systematically review the evidence on adolescent bereavement experiences by different causes to address this gap. METHODS A comprehensive literature search using four databases (MEDLINE, PsycInfo, Web of Science, and Embase) identified 21 studies which measured suicidal or self-harm outcomes among bereaved adolescents aged between 12 to 18 years old. The literature was screened, data was extracted using pre-piloted forms, and risk of bias was assessed using versions of the Newcastle-Ottawa Scale; a proportion of papers were double extracted and assessed for bias. The review has been registered with PROSPERO (CRD42016051125). RESULTS A narrative synthesis of the literature demonstrated divergent findings depending on the outcome being measured. Suicide bereavement appears to be strongly associated with suicide mortality among parentally bereaved youth, while self-harm or non-fatal suicide attempts (either presenting to hospital or self-reported) showed mixed evidence. Suicidal ideation was not uniquely associated with suicide bereavement. An exploration of circumstances surrounding the death, characteristics of the person who died, and characteristics of the young person across each outcome measure suggested that earlier experiences of loss, shorter timeframes following the death, and maternal death are associated with particularly elevated risk of suicidal outcomes. CONCLUSIONS Findings suggest that suicide loss is associated with subsequent suicide, and may be associated with non-fatal self-harm. A detailed account of the risk and protective factors surrounding suicide bereavement among young people is crucial to understand the pathways through which suicidal behaviours develop. Researchers, policy makers and practitioners with an interest in suicide prevention will benefit from clarity around the needs of young bereaved individuals.
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Affiliation(s)
- Laura del Carpio
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Sally Paul
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, United Kingdom
| | - Abigail Paterson
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Susan Rasmussen
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
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Hiyoshi A, Berg L, Grotta A, Almquist Y, Rostila M. Parental death in childhood and pathways to increased mortality across the life course in Stockholm, Sweden: A cohort study. PLoS Med 2021; 18:e1003549. [PMID: 33705393 PMCID: PMC7951838 DOI: 10.1371/journal.pmed.1003549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/27/2021] [Indexed: 01/03/2023] Open
Abstract
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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Affiliation(s)
- Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- * E-mail:
| | - Lisa Berg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Alessandra Grotta
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Ylva Almquist
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
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Zylbersztejn A, Gilbert R, Hardelid P. Developing a national birth cohort for child health research using a hospital admissions database in England: The impact of changes to data collection practices. PLoS One 2020; 15:e0243843. [PMID: 33320878 PMCID: PMC7737962 DOI: 10.1371/journal.pone.0243843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/29/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND National birth cohorts derived from administrative health databases constitute unique resources for child health research due to whole country coverage, ongoing follow-up and linkage to other data sources. In England, a national birth cohort can be developed using Hospital Episode Statistics (HES), an administrative database covering details of all publicly funded hospital activity, including 97% of births, with longitudinal follow-up via linkage to hospital and mortality records. We present methods for developing a national birth cohort using HES and assess the impact of changes to data collection over time on coverage and completeness of linked follow-up records for children. METHODS We developed a national cohort of singleton live births in 1998-2015, with information on key risk factors at birth (birth weight, gestational age, maternal age, ethnicity, area-level deprivation). We identified three changes to data collection, which could affect linkage of births to follow-up records: (1) the introduction of the "NHS Numbers for Babies (NN4B)", an on-line system which enabled maternity staff to request a unique healthcare patient identifier (NHS number) immediately at birth rather than at civil registration, in Q4 2002; (2) the introduction of additional data quality checks at civil registration in Q3 2009; and (3) correcting a postcode extraction error for births by the data provider in Q2 2013. We evaluated the impact of these changes on trends in two outcomes in infancy: hospital readmissions after birth (using interrupted time series analyses) and mortality rates (compared to published national statistics). RESULTS The cohort covered 10,653,998 babies, accounting for 96% of singleton live births in England in 1998-2015. Overall, 2,077,929 infants (19.5%) had at least one hospital readmission after birth. Readmission rates declined by 0.2% percentage points per annual quarter in Q1 1998 to Q3 2002, shifted up by 6.1% percentage points (compared to the expected value based on the trend before Q4 2002) to 17.7% in Q4 2002 when NN4B was introduced, and increased by 0.1% percentage points per annual quarter thereafter. Infant mortality rates were under-reported by 16% for births in 1998-2002 and similar to published national mortality statistics for births in 2003-2015. The trends in infant readmission were not affected by changes to data collection practices in Q3 2009 and Q2 2013, but the proportion of unlinked mortality records in HES and in ONS further declined after 2009. DISCUSSION HES can be used to develop a national birth cohort for child health research with follow-up via linkage to hospital and mortality records for children born from 2003 onwards. Re-linking births before 2003 to their follow-up records would maximise potential benefits of this rich resource, enabling studies of outcomes in adolescents with over 20 years of follow-up.
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Grants
- MR/K006584/1 Medical Research Council
- Arthritis Research UK
- British Heart Foundation
- Cancer Research UK
- Chief Scientist Office
- Department of Health
- Wellcome Trust
- Awards to establish the Farr Institute of Health Informatics Research, London, from the Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Economic and Social Research Council, Engineering and Physical Sciences Research Council, National Institute for Health Research, National Institute for Social Care and Health Research, and Wellcome Trust
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Affiliation(s)
- Ania Zylbersztejn
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- NIHR Children and Families Policy Research Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ruth Gilbert
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- NIHR Children and Families Policy Research Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Health Data Research UK London, UCL, London, United Kingdom
| | - Pia Hardelid
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- NIHR Children and Families Policy Research Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Thimm JC, Kristoffersen AE, Ringberg U. The prevalence of severe grief reactions after bereavement and their associations with mental health, physical health, and health service utilization: a population-based study. Eur J Psychotraumatol 2020; 11:1844440. [PMID: 33408813 PMCID: PMC7748058 DOI: 10.1080/20008198.2020.1844440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Previous research has shown that bereaved individuals are at risk of developing physical and mental health problems. However, knowledge is scarce about the associations between severe grief reactions after bereavement and physical and mental health problems and the use of health services. Objectives: The present study sought to investigate the prevalence of severe grief reactions and to study the associations of severe grief reactions with mental and physical health and health care utilization. Method: The sample comprised 20,453 adults aged 40 and above (mean age = 57.2 years, SD = 11.3 years, 52.4% female) who participated in the seventh wave of the Tromsø study. Severe grief was assessed with one question asking whether the respondent has experienced the death of a loved one and currently has difficulty accepting the loss, yearns for the deceased, and experiences intense emotional pain related to the loss. Furthermore, participants answered questions about their current physical health, mental health (Hopkins Symptom Checklist - 10), and the use of health services in the past year. Results: Overall, 5.2% of the participants reported severe grief after a loss in childhood, 25.9% after bereavement in adulthood and 4.1% after bereavement in the previous year. Female gender, higher age, living without a partner, non-Norwegian ethnicity, and lower socio-economic status were associated with severe grief. Severe grief reactions were negatively related to self-reported health, predicted positively current levels of depression and anxiety, and were positively associated with the use of health services. Effect sizes were small. Gender differences in the use of health services were observed. Conclusion: Severe grief reactions are common in individuals aged 40 and older and associated with self-reported physical and mental health problems as well as increased use of health services. Health service providers should be attentive to possible severe grief in connection with health complaints.
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Affiliation(s)
- Jens C Thimm
- Center for Crisis Psychology, University of Bergen, Bergen, Norway.,Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Agnete Egilsdatter Kristoffersen
- The National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Unni Ringberg
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Smith-Greenaway E, Weitzman A. Sibling mortality burden in low-income countries: A descriptive analysis of sibling death in Africa, Asia, and Latin America and the Caribbean. PLoS One 2020; 15:e0236498. [PMID: 33052952 PMCID: PMC7556453 DOI: 10.1371/journal.pone.0236498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/07/2020] [Indexed: 11/25/2022] Open
Abstract
In high-income countries, emerging research suggests sibling bereavement can have significant health and life course consequences for young people. Yet, we know far less about its burden in lower-income countries. Due to higher fertility and mortality in lower-income countries, the level, timing, intensity, and circumstances surrounding sibling mortality are likely to follow patterns distinct from those in higher-income settings. Thus, in this study, we offer a descriptive overview of sibling death in 43 countries across sub-Saharan Africa, South and Southeast Asia, and Latin America and the Caribbean. Specifically, we analyze Demographic and Health Survey data from nationally representative samples of 352,930 15- to 34-year-old women, born between 1985 and 2003, to document experiences of sibling death before age 25. On average, roughly one-third of individuals report a deceased sibling in these countries; estimates reach 40-50% of respondents in multiple African countries, particularly those that have experienced conflict and war. Although some sibling deaths occurred before the focal respondent was born, most bereaved individuals recalled a death during their lifetime-often in late childhood/early adolescence. High proportions of bereaved respondents report multiple sibling deaths, highlighting the clustering of deaths within families. Even so, bereaved individuals tend to come from large families and thus frequently have a comparable number of surviving siblings as people who never experienced a sibling die. Together, the results offer a window into global inequality in childhood experiences, and they attest to the need for research that explores the implications of sibling mortality for young people in world regions where the experience is concentrated.
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Affiliation(s)
- Emily Smith-Greenaway
- Department of Sociology, University of Southern California, Los Angeles, CA, United States of America
| | - Abigail Weitzman
- Department of Sociology, University of Texas at Austin, Austin, TX, United States of America
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20
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Rod NH, Bengtsson J, Budtz-Jørgensen E, Clipet-Jensen C, Taylor-Robinson D, Andersen AMN, Dich N, Rieckmann A. Trajectories of childhood adversity and mortality in early adulthood: a population-based cohort study. Lancet 2020; 396:489-497. [PMID: 32798491 DOI: 10.1016/s0140-6736(20)30621-8] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/25/2020] [Accepted: 03/06/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Childhood is a sensitive period with rapid brain development and physiological growth, and adverse events in childhood might interfere with these processes and have long-lasting effects on health. In this study, we aimed to describe trajectories of adverse childhood experiences and relate these to overall and cause-specific mortality in early adult life. METHODS For this population-based cohort study, we used unselected annually updated data from Danish nationwide registers covering more than 1 million children born between 1980 and 1998. We distinguished between three different dimensions of childhood adversities: poverty and material deprivation, loss or threat of loss within the family, and aspects of family dynamics such as maternal separation. We used a group-based multi-trajectory clustering model to define the different trajectories of children aged between 0 and 16 years. We assessed the associations between these trajectories and mortality rates between 16 and 34 years of age using a Cox proportional hazards model and an Aalen hazards difference model. FINDINGS Between Jan 1, 1980 and Dec 31, 2015, 2 223 927 children were included in the Danish Life Course cohort. We excluded 1 064 864 children born after 1998, 50 274 children who emigrated before their 16th birthday, and 11 161 children who died before their 16th birthday, resulting in a final sample of 1 097 628 children. We identified five distinct trajectories of childhood adversities. Compared with children with a low adversity trajectory, those who had early-life material deprivation (hazard ratio 1·38, 95% CI 1·27-1·51), persistent deprivation (1·77, 1·62-1·93), or loss or threat of loss (1·80, 1·61-2·00) had a moderately higher risk of premature mortality. A small proportion of children (36 081 [3%]) had multiple adversities within all dimensions and throughout the entire childhood. This group had a 4·54 times higher all-cause mortality risk (95% CI 4·07-5·06) than that of children with a low adversity trajectory, corresponding to 10·30 (95% CI 9·03-11·60) additional deaths per 10 000 person-years. Accidents, suicides, and cancer were the most common causes of death in this high adversity population. INTERPRETATION Almost half of Danish children in our study experienced some degree of adversity, and this was associated with a moderately higher risk of mortality in adulthood. Among these, a small group of children had multiple adversities across social, health, and family-related dimensions. This group had a markedly higher mortality risk in early adulthood than that of other children, which requires public health attention. FUNDING None.
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Affiliation(s)
- Naja H Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Jessica Bengtsson
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Esben Budtz-Jørgensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Clara Clipet-Jensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - David Taylor-Robinson
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nadya Dich
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Rieckmann
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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21
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Broussard K, Weitzman A. Sibling loss and fertility desires in the high-mortality context of Peru. POPULATION STUDIES 2020; 74:179-195. [PMID: 32228204 PMCID: PMC7282944 DOI: 10.1080/00324728.2020.1737188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 02/01/2020] [Indexed: 10/24/2022]
Abstract
Despite demographers' long-standing preoccupation with the effects of child mortality on women's fertility desires, scholars continue to know little about the consequences of other pervasive mortality exposures. We use nationally representative data from the high-mortality context of Peru to examine whether the desire to have a(nother) child varies as a function of sibling loss and to assess heterogeneity in this association by women's current number of children and a range of conditions related to siblings' deaths. Women who have experienced sibling bereavement and have two or more children report higher odds of desiring another child. These effects are not contingent on the age or sex of the deceased sibling but are only significant if the sibling died during the respondent's lifetime (not before). These findings highlight the theoretical and empirical import of investigating the relationship between fertility desires and a wider range of familial mortality exposures beyond own child mortality.
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22
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Plana-Ripoll O, Basso O, László KD, Olsen J, Parner E, Cnattingius S, Obel C, Li J. Reproduction after the loss of a child: a population-based matched cohort study. Hum Reprod 2020; 33:1557-1565. [PMID: 30010921 DOI: 10.1093/humrep/dey233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/01/2018] [Accepted: 06/11/2018] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is the death of a child associated with higher subsequent fertility? SUMMARY ANSWER Women who had lost a child had higher fertility both shortly after the loss and throughout the entire follow-up, independent of the child's age at the time of death. WHAT IS KNOWN ALREADY Women who lose a child in the perinatal period often have another child shortly after. However, to our knowledge no previous study has investigated if the death of an older child affects reproductive behavior. STUDY DESIGN, SIZE, DURATION The source population for this matched cohort study consisted of all women who gave birth in Denmark from 1978 to 2004 and in Sweden from 1973 to 2002 (N = 1 979 958). Women were followed through to the end of 2008 in Denmark and the end of 2006 in Sweden. PARTICIPANTS/MATERIALS, SETTING, METHODS Women who had lost a child before the age of 45 years during the study period (exposed group; n = 36 511) were matched with up to five women who were from the same country and of similar age and family characteristics and had not lost a child at the time of matching (unexposed group; n = 182 522). MAIN RESULTS AND THE ROLE OF CHANCE During follow-up, 74% of exposed and 46% of unexposed women had another birth (live- or stillbirth) after a gestation of 28 weeks or more. Compared with unexposed women, exposed women had a shorter interpregnancy interval and, consequently, a higher rate of conception leading to a birth (HR = 5.5 [95% CI: 5.4-5.6]). Rates for exposed women were higher from the first month following the child's death, but the largest difference was between 2 and 3 months after the event. This pattern was independent of the age of the deceased child. Exposed women had more subsequent children than unexposed, leading to a comparable number of living children at the end of follow-up. LIMITATIONS, REASONS FOR CAUTION The use of population-based registers allows for the inclusion of virtually all eligible women and nearly complete follow-up; the potential for selection bias is thus negligible. However, only pregnancies that led to a live birth or a stillbirth could be identified, thus fetal losses occurring before week 28 of gestation were missing. WIDER IMPLICATIONS OF THE FINDINGS Our findings corroborate the previous evidence suggesting that women try to conceive again shortly after a perinatal death, and many succeed. In addition, this is the first study to investigate the reproductive trajectory after losing an older child. The current study indicates that most women who lose a child between the ages of 6 months and 5 years conceive shortly after the loss, and they have a comparable number of living children at the end of the follow-up compared to those who do not lose a child. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by Grant ERC-2010-StG-260242 from the European Research Council, 176673 and 186200 from the Nordic Cancer Union, DFF-6110-00019 from the Danish Council for Independent Research, 904414 and 15199 from TrygFonden, Karen Elise Jensens Fond (2016), and the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation. The authors do not declare any conflicts of interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- O Plana-Ripoll
- National Center for Register-based Research, Aarhus University, Fuglesangs allé 26, Aarhus V, Denmark
| | - O Basso
- Department of Obstetrics and Gynecology, McGill University Health Centre, Royal Victoria Hospital, Glen Site, 1001 Decarie Blvd, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, Canada
| | - K D László
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, pl. 3, Stockholm, Sweden
| | - J Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, Denmark.,Department of Epidemiology, Fielding School of Public Health, University of California, 650 Charles E. Young Dr. South, Center for Health Sciences, Los Angeles, CA, USA
| | - E Parner
- Section of Biostatistics, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus, Denmark
| | - S Cnattingius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - C Obel
- Section of General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, Denmark
| | - J Li
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, Denmark
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Finnegan A. Effects of a sister's death in childbirth on reproductive behaviors: Difference-in-difference analyses using sisterhood mortality data from Indonesia. Soc Sci Med 2020; 250:112795. [PMID: 32145482 DOI: 10.1016/j.socscimed.2020.112795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 10/08/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
RATIONALE Risk of maternal mortality increases rapidly during the intrapartum period making skilled care at delivery an effective intervention to reduce the risk of maternal death. Demand generation for skilled care typically focuses on institutional channels; however, much less attention has been paid to whether what women may learn through their social networks can potentially influence their choice of delivery care. OBJECTIVE The objective of this study was to analyze whether a sister's death in childbirth has the potential to improve delivery care choices for women who experience this event. METHODS This study uses retrospective reports of sister deaths - either in childbirth or from some other cause - reported in the sisterhood moratlity module from five waves of the Indonesia Demographic and Health Surveys (IDHS) spanning 1989 to 2012. A cross-sectional, difference-in-difference strategy compares delivery care behavior of women before and after losing a sister in childbirth to women before and after losing a sister of reproductive age from some other cause in an intent-to-treat framework. RESULTS Women are less likely to give birth at home after losing a sister in childbirth relative to women who lose a sister from some other cause. Losing a sister in childbirth may trigger behaviors that help usher women of lower socioeconomic status into formal delivery care. CONCLUSION This study extends the literature on health behavior change through social networks to improve delivery care. Public health campaigns should consider social networks when designing messages around maternal mortality in order to help women at risk of maternal mortality make decisions that reduce their risk of and ultimately avoid maternal death.
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Affiliation(s)
- Amy Finnegan
- Duke Global Health Institute (DGHI), 310 Trent Drive Durham, NC, 27710, United States; IntraHealth International, 6340 Quadrangle Drive, Suite 200, Chapel Hill, NC 27517, United States.
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Online-group intervention after suicide bereavement through the use of webinars: study protocol for a randomized controlled trial. Trials 2020; 21:45. [PMID: 31915044 PMCID: PMC6951011 DOI: 10.1186/s13063-019-3891-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction The death of a significant person through suicide is a very difficult experience and can have long-term impact on an individual’s psychosocial and physical functioning. However, there are only few studies that have examined the effects of interventions in suicide survivors. In the present study, we examine an online-group intervention for people bereaved by suicide using a group-webinar. Methods The intervention was developed based on focus groups with the target group. The cognitive-behavioral 12-module webinar-based group intervention focuses on suicide bereavement-related themes such as feelings of guilt, stigmatization, meaning reconstruction and the relationship to the deceased. Further, the webinar includes testimonial videos and psychoeducation. The suicide survivors are randomized to the intervention or the waiting list in a group-cluster randomized controlled trial. Primary outcomes are suicidality (Beck Scale for Suicide Ideation) and depression (Beck Depression Inventory-II) and secondary outcomes are symptoms of prolonged grief disorder (Inventory of Complicated Grief-German Version ), posttraumatic stress disorder ( Revised Impact of Event Scale ), stigmatization (Stigma of Suicide and Suicide Survivor ) and posttraumatic cognitions (Posttraumatic Cognitions Inventory). Discussion Previous studies of Internet-based interventions for the bereaved were based on writing interventions showing large treatment effects. Little is known about the use of webinars as group interventions. Advantages and challenges of this novel approach of psychological interventions will be discussed. Trial registration German Clinical Trials Register, DRKS00014426. Registered on 12 April 2018. Protocol Version 3, 21.10.2019.
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van Dijk IK, Janssens A, Smith KR. The Long Harm of Childhood: Childhood Exposure to Mortality and Subsequent Risk of Adult Mortality in Utah and The Netherlands. EUROPEAN JOURNAL OF POPULATION = REVUE EUROPEENNE DE DEMOGRAPHIE 2019; 35:851-871. [PMID: 31832028 PMCID: PMC6882779 DOI: 10.1007/s10680-018-9505-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 11/09/2018] [Indexed: 01/26/2023]
Abstract
How do early-life conditions affect adult mortality? Research has yielded mixed evidence about the influence of infant and child mortality in birth cohorts on adult health and mortality. Studies rarely consider the specific role of mortality within the family. We estimated how individuals' exposure to mortality as a child is related to their adult mortality risk between ages 18 and 85 in two historical populations, Utah (USA) 1874-2015 and Zeeland (The Netherlands) 1812-1957. We examined these associations for early community-level exposure to infant and early (before sixth birthday) and late (before eighteenth birthday) childhood mortality as well as exposure during these ages to sibling deaths. We find that that exposure in childhood to community mortality and sibling deaths increases adult mortality rates. Effects of sibling mortality on adult all-cause mortality risk were stronger in Utah, where sibling deaths were less common in relation to Zeeland. Exposure to sibling death due to infection was related to the surviving siblings' risk of adult mortality due to cardiovascular disease (relative risk: 1.06) and metabolic disease (relative risk: 1.42), primarily diabetes mellitus, a result consistent with an inflammatory immune response mechanism. We conclude that early-life conditions and exposure to mortality in early life, especially within families of origin, contribute to adult mortality.
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Affiliation(s)
- Ingrid K. van Dijk
- Department of History, Radboud University Nijmegen, Erasmusplein 1, 6500 HD Nijmegen, The Netherlands
| | - Angelique Janssens
- Department of History, Radboud University Nijmegen, Erasmusplein 1, 6500 HD Nijmegen, The Netherlands
- Faculty of Arts and Social Sciences, Maastricht University, Maastricht, The Netherlands
| | - Ken R. Smith
- Department of Family and Consumer Studies and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
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Rostila M, Berg L, Saarela J, Kawachi I, Hjern A. Experience of sibling death in childhood and risk of psychiatric care in adulthood: a national cohort study from Sweden. Eur Child Adolesc Psychiatry 2019; 28:1581-1588. [PMID: 30937545 PMCID: PMC6861357 DOI: 10.1007/s00787-019-01324-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
Studies have found that sibling loss is associated with an increased risk of death from external causes (i.e. suicides, accidents and homicides). Increased psychiatric health problems following bereavement could underlie such an association. We studied the influence of sibling loss during childhood on psychiatric care in young adulthood, adjusting for psychosocial covariates shared by siblings in childhood. A national cohort born in Sweden in 1973-1982 (N = 701,270) was followed prospectively until 2013. Cox proportional hazards models were used to analyse the association between sibling loss during childhood and psychiatric inpatient and outpatient care identified by the Hospital Discharge Register. After adjustment for confounders, the HRs of psychiatric care in men who experienced sibling loss were 1.17 (95% CI 1.07-1.27) while the associations turned non-significant in women after adjustment for family-related psychosocial covariates, HR 1.07 (95% CI 0.99-1.16). An increased risk was found in men bereaved in early childhood (1.22 95% CI 1.07-1.38) and adolescence (1.27 95% CI 1.08-1.48). Among women, loss of a sibling during adolescence was significantly associated with psychiatric care (1.19 95% CI 1.03-1.36). Increased psychiatric health problems following bereavement could underlie the previously found association between sibling loss and mortality from external causes. Family-related psychosocial conditions shared by siblings in childhood may account for the association between sibling death and psychiatric care in adulthood.
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Affiliation(s)
- Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden. .,Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, 10691, Stockholm, Sweden.
| | - Lisa Berg
- grid.10548.380000 0004 1936 9377Department of Public Health Sciences, Stockholm University, Stockholm, Sweden ,grid.10548.380000 0004 1936 9377Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, 10691 Stockholm, Sweden
| | - Jan Saarela
- grid.13797.3b0000 0001 2235 8415Demography Unit, Åbo Akademi University, Turku, Finland
| | - Ichiro Kawachi
- grid.38142.3c000000041936754XHarvard T.H. Chan School of Public Health, Boston, USA
| | - Anders Hjern
- grid.10548.380000 0004 1936 9377Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, 10691 Stockholm, Sweden ,grid.38142.3c000000041936754XHarvard T.H. Chan School of Public Health, Boston, USA ,grid.4714.60000 0004 1937 0626Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Hulsey EG, Hill RM, Layne CM, Gaffney DA, Kaplow JB. Calculating the incidence rate of sibling bereavement among children and adolescents across the United States: A proposed method. DEATH STUDIES 2018; 44:303-311. [PMID: 30513272 DOI: 10.1080/07481187.2018.1541946] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/04/2018] [Accepted: 09/26/2018] [Indexed: 06/09/2023]
Abstract
This study proposes a method for calculating the annual incidence rate of sibling bereavement among US youth using national epidemiological data. The proposed model combines data on family household size with national death statistics to calculate the number of siblings affected by the death of a child annually. From 2012 to 2015, an average of 61,389 children per year experienced the death of a sibling, resulting in an estimate of 0.0832% of children bereaved by the death of a sibling annually. Data indicate a need for greater awareness and dialog concerning the frequency with which children experience the death of a sibling.
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Affiliation(s)
- Eric G Hulsey
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Allegheny County Department of Human Services Office of Data Analysis, Research, and Evaluation, Pittsburgh, PA, USA
| | - Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Christopher M Layne
- UCLA/Duke University National Center for Child Traumatic Stress, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Donna A Gaffney
- Family Bereavement Program, Arizona State University, Tempe, AZ, USA
| | - Julie B Kaplow
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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Dynamic and heterogeneous effects of sibling death on children's outcomes. Proc Natl Acad Sci U S A 2017; 115:115-120. [PMID: 29255028 DOI: 10.1073/pnas.1709092115] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This paper explores the effects of experiencing the death of a sibling on children's developmental outcomes. Recent work has shown that experiencing a sibling death is common and long-term effects are large. We extend understanding of these effects by estimating dynamic effects on surviving siblings' cognitive and socioemotional outcomes, as well as emotional and cognitive support by parents. Using the Children of the National Longitudinal Survey of Youth 1979 (CNLSY79), we find large initial effects on cognitive and noncognitive outcomes that decline over time. We also provide evidence that the effects are larger if the surviving child is older and less prominent if the deceased child was either disabled or an infant, suggesting sensitive periods of exposure. Auxiliary results show that parental investments in the emotional support of surviving children decline following the death of their child.
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