Parental death during childhood and subsequent school performance

Investigation of Childhood Traumas of Individuals Who Experienced Parental Death in Childhood or Adolescence in Turkey

This study investigates the childhood traumas of individuals who experienced parental death in childhood or adolescence in Turkey. Participants (n = 382; 63.1% female and 36.9% male; MAGE=29.41, SD = 9.6) are composed of individuals who lost either or both of their parents before the age of 18. The findings indicated that there is a significant difference between the subdimensions of Childhood Trauma Questionaire and the study variables including gender, marital status, educational status, number of siblings, gender of the deceased parent, the caregiver after the parental death, relationship with the surviving parent and the age at the time of parental death (p < .05). The results further show that individuals who lost their parents before the age of 10, who lost their mothers, and who received care from other relatives instead of parents are exposed to more neglect and abuse. By identifying childhood traumas in individuals and examining related variables, the findings contribute trauma-informed social work practices. Based on the results, it is recommended that school social work programs focus on monitoring the relationship between caregivers and children, as well as enhancing the psychosocial well-being of students. These programs can also serve as a means to raise awareness among professionals and students.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-024-00629-2.

The influence of actors on the content and execution of a bereavement programme: a Bourdieu-inspired ethnographical field study in Sweden

Introduction

The death of a parent can have profound negative impacts on children, and a lack of adequate support can exacerbate negative life experiences.

Aim

To explore the influences of various actors on the content and execution of a bereavement programme within a Swedish context, considering relational and contextual perspectives.

Methods

An ethnographic field study involving six children, their parents, and eight volunteers. A theory-inspired thematic analysis was conducted, methodically inspired by Braun and Clarke, theoretically inspired by Bourdieu's concepts of position, power, and capital.

Results

Confidentiality obligation was an essential element in the programme, however, the premisses varied depending on actors' positions. Volunteers and researchers had different outlets to express their experiences in the program. The programme offered the children an exclusive space for talking about and sharing experiences and feelings. Simultaneously, the programme restricted the children by not allowing them to share their experiences and feelings outside the physical space. The physical settings shaped the different conditions for interactions among the actors. The sessions adopted loss-oriented approaches, where communication between volunteers and children was guided by the volunteers. However, children created strategies for additional, voiceless communication with their peers or themselves. During breaks and mingles, shared interests or spaces connected children (and adults) more than their common experience of parental bereavement.

Conclusion

The participants in the programme were significantly influenced by the structural framework of the programme, and their positions within the programme provided them with different conditions of possibility for (inter)acting. Children's daily activities and interests were both ways to cope with parental bereavement and connect them to other people.

Balancing roles: Teaching staff's dilemma in supporting bereaved college students

This study examines the challenges faced by teaching staff in supporting bereaved college students. A three-year study was conducted in Danish colleges, involving focus groups and 1-on-1 interviews with 18 teachers from five collaborating colleges, situated in all main regions of Denmark. The research aimed to understand the role of college teaching staff in providing support during critical illness and death. Findings reveal an absence of clear structures, leaving teaching staff uncertain about their responsibilities. Challenges include inconsistent engagement, difficulty identifying bereaved students, and the need for more time, support structures, and training. Clear guidelines are essential to empower teaching staff in effectively assisting bereaved students. Providing support, resources, and training will enhance student well-being and enable teachers to fulfill their support roles confidently.

Long-Term Health Benefits of Occupational Licensing: Evidence from Midwifery Laws

During the late 19th and early 20th century, several states mandated midwifery licensing requirements to improve midwives' knowledge, education, and quality. Previous studies point to the health benefits of midwifery quality improvements for maternal and infant health outcomes. This paper exploits the staggered adoption of midwifery laws across states using event-study and difference-in-difference frameworks. We use the universe of death records in the US over the years 1979-2020 and find that exposure to a midwifery licensing law at birth is associated with a 2.5 percent reduction in cumulative mortality rates and an increase of 0.6 months in longevity during adulthood and old age. The effects are concentrated on deaths due to infectious diseases, neoplasm diseases, and suicide mortality. We also show that the impacts are confined among blacks and are slightly larger among males. Additional analyses using alternative data sources suggest small but significant increases in educational attainments, income, measures of socioeconomic status, employment, and measures of height as potential mechanism channels. We provide a discussion on the economic magnitude and policy implication of the results.

Adolescents' primary care consultations before and after parental suicide: evidence from population-wide data

Parental bereavement is associated with distress and poorer long-term outcomes among adolescents. Adolescents who lose a parent to suicide fare worse than their peers even before bereavement. Based on the current literature, we cannot distinguish such initial differences from the medium and long-term effect of parental suicide. We study the impact of parental suicide on adolescents' General Practitioner visits for mental health or psychosocial reasons. Within-individual models account for time-invariant differences between the bereaved and non-bereaved. We investigate if effects differ from the impact of parental death from other causes, and vary with sex and socioeconomic background. Full population data on Norwegian residents aged 10-19 in the period 2006-2015 are drawn from registers (N = 1 405 suicide bereaved, 12 982 bereaved by other causes, and 1 182 819 non-bereaved controls). Records include data on use of health services, parental mortality, and sociodemographic characteristics of parent and child. Mental health consultations increase gradually in the quarters leading up to the parental suicide, significantly more for girls than for boys. Two years prior to bereavement, 2.4% of the subsequently suicide bereaved have a mental health consultation in any given quarter. In the year of bereavement, this increases with 6% points. Health care workers should be aware that boys are less likely to turn to their GP for support before parental bereavement from suicide.

Caring Existentially and Spiritually for Young Children and Close Grandchildren of Life-Threatened Cancer Patients in Secularized Denmark

PURPOSE

When children are given opportunities to talk about their existential and spiritual concerns and needs, different health risks related to parents' illness and death may be reduced. The existential and spiritual care and conversations provided during parents' and close grandparents' cancer illness are insufficient. This article presents a practical and theoretical perspective on how to care for the existential and spiritual needs of children at three different age stages.

DATA SOURCES

Data from a research project guided the process of synthesizing the theoretical aspects with the practical. The theoretical perspective comprises Majbrit Guldin's theory of children's age-related grief reactions and James Fowler's three stages about children's spiritual and cognitive development. The empirical study is based on qualitative interviews with 16 children or close grandchildren of cancer patients at hospice.

CONCLUSION

The theoretical and practical perspective function as a guide for existential and spiritual care and conversation with children at three different ages. The preschool child needs adults to support their growing spirituality and help them show, express, and understand their feelings. The school-aged child needs adults who listen to and acknowledge the child's understandings, experiences, and feelings as well as challenge their rigid thinking. The young adult needs adults who are willing to be there for them physically, mentally, socially, and spiritually in a genuine relationship.

IMPLICATIONS FOR NURSING PRACTICE

The perspective might function well for nurses and other health professionals as it is generic and addresses barriers for communication with children found in different healthcare contexts.

Supportive and psychosocial peer-group interventions for children and adolescents of parents with cancer: A systematic review

OBJECTIVE

Children and adolescents are highly affected by their parents` cancer disease. This review aims to summarize peer-group interventions for children and adolescents of cancer patients, where those affected have the opportunity to exchange and normalize their feelings among equals.

METHODS

A systematic review searching four different databases (MEDLINE, PsycInfo, CINAHL and Web of Science) was conducted. We included studies investigating psychosocial peer-group interventions for offspring of cancer patients. A narrative synthesis summarised the characteristics of the interventions and the findings on effects and evaluation.

RESULTS

Ten articles on seven different peer-group interventions were analysed. Research designs and intervention concepts were heterogeneous. Overall, high acceptance, feasibility and positive effects of peer-group support were reported. Significant effects were found in six studies, e.g. in relation to psychological well-being, quality of life and coping skills.

CONCLUSION

Peer-group interventions are an accepted and helpful form of support. Providing children and adolescents of cancer patients for example with psychoeducation, community and coping strategies, thereby impacting on psychological well-being.

PRACTICE IMPLICATIONS

For comprehensive care, it seems to be important to offer support throughout the parent's cancer journey and to offer support flexibly as needed through group services as well as individual sessions.

Adverse childhood experiences and their impacts on subsequent depression and cognitive impairment in Chinese adults: A nationwide multi-center study

BACKGROUND

Adverse childhood experiences (ACE_S) are prevalent and have long-lasting effects. This study explored how ACE exposure is associated with subsequent depression and cognitive impairment and whether sociodemographic characteristics modify that association.

METHOD

This study used data on 14,484 participants of the 2015 China Health and Retirement Longitudinal Study (CHARLS) and 2014 CHARLS life history survey. Depression was assessed using the 10-item Center for Epidemiologic Studies Depression scale. Cognitive performance was evaluated via three composite measures: episodic memory, mental intactness, and global cognition. Twelve ACE indicators were measured using a validated questionnaire. Multiple regression models and stratified analyses explored the relationship between ACE_S and subsequent depression and cognitive impairment, as well as potential modifiers.

RESULTS

Compared with individuals without ACE_S, those who experienced four or more ACE_S had a higher risk of subsequent depression (adjusted odds ratio, aOR = 2.65, 95 % confidence intervals [CIs]: 2.21 to 3.16), poorer mental intactness (β = -0.317 [-0.508 to -0.125]), and worse global cognition (-0.437 [-0.693 to -0.181]). Trend analyses showed a dose-response association between accumulated ACE_S and subsequent depression and cognitive impairment. No modifications of those associations by age, sex, educational level, or family's financial status during childhood were observed.

LIMITATIONS

Self-reported measures could favour recall bias.

CONCLUSION

Our study suggests that ACE_S increase the risk of subsequent depression and cognitive impairment in Chinese adults regardless of sociodemographic characteristics. These findings provide important implications for mitigating the adverse effects of early-life stress and promoting health in adulthood.

"I Don't Know What to Say": Teachers' Perspectives on Supporting Bereaved Students After the Death of a Parent

This qualitative study examined teachers' experiences dealing with bereaved students following the death of a parent. The researchers conducted in-depth, semi-structured, face-to-face interviews with 25 teachers in Israeli schools who had counseled one of their students after the death of a parent. The interviews were recorded and transcribed and underwent content analysis. Analysis of the findings revealed that the teachers felt helpless, confused, overloaded emotionally and anxious when counseling students who had lost a parent. In addition, the teachers discussed the complex nature of their relationship with the remaining parent, ranging from a desire to support the family through avoidance for fear of hurting the parent to fears of being overwhelmed by the child's problems. Many teachers mentioned their need for support from school officials.

Potential effects of adverse childhood experiences on school engagement in youth: a dominance analysis

Background

Adverse childhood experiences (ACEs) can have severe negative impacts on childhood and adult health via worsened school engagement and educational outcomes. This study seeks to identify the relative importance of various ACEs in predicting school engagement.

Methods

We analyzed data from the National Survey of Children’s Health for school-aged children (ages 6-17) for 2018 and 2019. The primary outcome was school engagement, measured through three variables: repeating a grade, doing required homework, and caring about doing well in school. We conducted three logistic regression models with dominance analyses to identify the relative importance of ACE variables in predicting school engagement outcomes.

Results

In unadjusted and adjusted dominance analyses, parental incarceration was the most important ACE in predicting repeating a grade. Living in a household in which it was hard to cover basics like food or housing was the most important ACE in predicting doing required homework and caring about doing well in school.

Discussion

Our study points toward the large influence of out-of-school factors on school engagement. Parental incarceration and economic hardship, the most important predictors of engagement, are issues that can be addressed and mitigated through policy interventions. With limited funds available for education and public health interventions, it is crucial that these two ACEs be priority considerations when developing policy. A multi-faceted approach that reduces the incarcerated population, encourages economic well-being, and emphasizes early-childhood education has the potential to significantly improve school engagement in vulnerable populations and ultimately advance social equity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14524-8.

The Effect of Parental Loss on Social Mobility in Early Twentieth-Century Sweden

Parents are assumed to play a crucial role in the socioeconomic attainment of children. Through investments of both time and resources, they promote the ability, human capital, networks, and motivation of their children to advance socially, or at least to maintain their social position. Consequently, losing a parent in childhood could be detrimental to adult socioeconomic outcomes. We use full-count linked census data and a comprehensive death register to study the effect of parental loss on socioeconomic outcomes in adulthood in Sweden during the first half of the twentieth century. We employ sibling fixed-effects models and the Spanish flu as an exogenous mortality shock to assess the importance of endogeneity bias in associations between parental loss and socioeconomic outcomes. Maternal death led to worse socioeconomic outcomes in adulthood in terms of occupational and class attainment, as well as for social mobility. The effects seem to be causal but the magnitudes were small. For paternal death, we find no consistent pattern, and in most models there was no effect on sons' socioeconomic outcomes. The patterns were similar for sons and daughters and do not support the theory that parental loss had important negative effects on socioeconomic outcomes in adulthood.

School Outcomes Among Children Following Death of a Parent

IMPORTANCE

To better support children with the experience of parental death, it is crucial to understand whether parental death increases the risk of adverse school outcomes.

OBJECTIVES

To examine whether parental death is associated with poorer school outcomes independent of factors unique to the family, and whether children of certain ages are particularly vulnerable to parental death.

DESIGN, SETTING, AND PARTICIPANTS

This population-based sibling cohort study used Swedish national register-based longitudinal data with linkage between family members. Register data were collected from January 1, 1990, to December 31, 2016. Data analyses were performed on July 14, 2021. The participants were all children born between 1991 and 2000 who lived in Sweden before turning age 17 years (N = 908 064).

EXPOSURE

Parental death before finishing compulsory school.

MAIN OUTCOMES AND MEASURES

Mean school grades (year-specific z scores) and ineligibility for upper secondary education on finishing compulsory school at age 15 to 16 years. Population-based cohort analyses were conducted to examine the association between parental death and school outcomes using conventional linear and Poisson regression models, after adjustment for demographic and parental socioeconomic and health indicators measured before childbirth. Second, using fixed-effect linear and Poisson regression models, children who experienced parental death before finishing compulsory school were compared with their siblings who experienced the death after. Third, the study explored the age-specific associations between parental death and school outcomes.

RESULTS

In the conventional population-based analyses, bereaved children (N = 22 634; 11 553 boys [51.0%]; 11 081 girls [49.0%]; mean [SD] age, 21.0 [2.8] years) had lower mean school grade z scores (adjusted β coefficient, -0.19; 95% CI, -0.21 to -0.18; P < .001) and a higher risk of ineligibility for upper secondary education than the nonbereaved children (adjusted risk ratio, 1.36; 95% CI, 1.32-1.41; P < .001). Within-sibling comparisons using fixed-effects models showed that experiencing parental death before finishing compulsory school was associated with lower mean school grade z scores (-0.06; 95% CI, -0.10 to -0.01; P = .02) but not with ineligibility for upper secondary education (adjusted risk ratio, 1.07; 95% CI, 0.93-1.23; P = .34). Independent of birth order, losing a parent at a younger age was associated with lower grades within a family.

CONCLUSIONS AND RELEVANCE

In this cohort study, childhood parental death was associated with lower school grades after adjustment for familial confounders shared between siblings. Children who lost a parent may benefit from additional educational support that could reduce the risk of adverse socioeconomic trajectories later in life.

Effects of parental health shocks on children's school achievements: A register-based population study

This paper studies how a severe parental health shock affects children's school achievements using a rich longitudinal dataset of Danish children. We use coarsened exact matching to control for potential endogeneity between parental health and children's school outcomes and employ cancer specific survival rates to measure the size of the health shock. We find robust negative (albeit small) effects of a parental health shock on children's basic school grades as well as their likelihood of starting and finishing secondary education, especially for poor prognosis cancers. We observe different outcomes across children's gender and age and gender of the ill parent, but no effects of family-related resilience factors such as parental education level. The effects appear to be driven by non-pecuniary costs rather than by pecuniary costs. Moreover, we find that the negative effects on school performance increase in the size of the health shock for both survivors and non-survivors.

Bereavement and educational outcomes in children and young people: A systematic review

Experiencing bereavement due to the death of a close person is rife in the lives of young people. This review aimed to investigate how bereavement affects educational outcomes of students at various educational levels and what factors may be involved in moderating these outcomes. The systemic review was conducted according to the PRISMA guidelines with searches of peer-reviewed literature in Embase, Emcare, Medline, PsycINFO and Scopus. Twenty-two studies (17 quantitative and 5 qualitative) were included. In general, bereavement can constitute a barrier to educational achievement in young people compromising academic performance, and educational engagement and attainment. Several factors can place young people at greater risk of experiencing this disadvantage and further research into these mechanisms and interventions to mitigate short- and long-term consequences, especially among high-risk groups, is warranted.

Description and evaluation of a French grief workshop for children and adolescents bereaved of a sibling or parent

Background

Childhood bereavement is common, and is associated with elevated symptoms of grief with distress and impairment. However, few developmentally appropriate interventions to support grieving children are available to date. In Toulouse, France we developed an innovative four-session group intervention to support grieving families and evaluated its feasibility and acceptability.

Methods

The workshop consists of four sessions over 4 months, open to children bereaved of a sibling or parent, and co-facilitated by two mental health professionals. After an intake assessment, children were placed into closed groups according to age and relation to the deceased. The session content was balanced between creative activities and grief-related discussions. Overall satisfaction was evaluated in March-April of 2020 by an 8-question online survey of children and parents having participated between 2011 and 2019. Freeform commentaries were analysed using the thematic synthesis process.

Results

Of the 230 emails sent in March 2020, 46 children and 81 parents agreed to participate (55% response rate). The families reported an overall high level of satisfaction regarding the intervention that was rated as good to excellent. A majority of respondents considered their participation in the workshop helpful and in accordance with their expectations. Most would recommend the workshop to a friend, and would participate again in the group if needed. The group intervention helped reduce social isolation, facilitated grief expression, and supported the creation of a sense of community among bereaved families.

Conclusions

Encouraging community and mutual support among grieving families is fundamental in bereavement care. Our four-session workshop held over 4 months and led by mental health professionals aimed to help reduce social isolation and foster coping skills through artistic creation and group discussion. Our results highlight the potential need for family bereavement support over a longer period and a provision of a variety of services. Our intervention model is feasible for families, and further studies examining its efficacy are warranted.

Neurological development of children who are HIV-exposed and uninfected

Widespread use of antiretroviral drugs for pregnant/breastfeeding females with human immunodeficiency virus (HIV) has led to declining vertical transmission. Despite being HIV-uninfected, the increasing number of children who are HIV-exposed and uninfected (CHEU) often present with developmental alterations. We review seminal and recent evidence on the neurological development of CHEU and associations with early life HIV/antiretroviral exposure. Our conceptual model highlights the numerous exposures and universal risk factors for CHEU developmental disorders. Early studies suggest a significant association between HIV exposure and neurological abnormalities, varying according to the burden of HIV-specific exposures and other risk factors. More recent observations from the modern era are inconsistent, although some studies suggest specific antiretrovirals may adversely affect neurological development of CHEU. As the CHEU population continues to grow, alongside simultaneous increases in types and combinations of antiretrovirals used in pregnancy, long-term monitoring of CHEU is necessary for understanding the effects of HIV/antiretroviral exposure on CHEU developmental outcomes. What this paper adds Evidence on the neurological development of children who are human immunodeficiency virus (HIV)-exposed and uninfected (CHEU) is synthesized. Comparisons are made to children who are HIV-unexposed, across treatment eras and settings, and by antiretroviral drug regimens and drug classes. CHEU exposures are complex and include HIV-specific and universal risk factors which may affect development during the early years of life.

Consequences of serious parental health events on child mental health and educational outcomes

I show that serious, yet common, parental health events in childhood have immediate and lasting effects on mental health and educational outcomes for children. Following a parental health event, the children are more likely to receive therapy and consume anti-depressant (AD) medication. More so, the children achieve lower test scores and have lower school enrollment rates. The effect immediately occurs following the event and persists at least into early adulthood. I find that the effect on test scores doesn't differ significantly across family income, but that children from low-income families are more likely to be prescribed ADs following the event, while children from high-income families are more likely to receive therapy. Exploiting differences in general practitioners' behavior in prescribing AD and referring children to therapy, I find suggestive evidence that children who are more exposed to medical treatment of mental health issues have lower educational attainments in early adulthood.

'Living in parallel worlds' - bereaved parents' experience of family life when a parent with dependent children is at end of life from cancer: A qualitative study

BACKGROUND

When a parent of dependent children (<18 years old) is at end of life from cancer, this has a profound impact on the family. Children less prepared for the death of a parent are more susceptive to poorer psychosocial adjustment in later life. There is a lack of understanding from the literature surrounding what support parents require, and how they navigate this end of life experience.

AIM

To explore bereaved parents' experience and needs for families when a parent is at end of life from cancer with dependent children.

DESIGN

In-depth, semi-structured qualitative interviews were conducted with 21 bereaved mothers and fathers, identified from the general public, a family support service and hospice. Data were analysed thematically.

RESULTS

Parents often live in 'parallel worlds' throughout the end of life period. In one world, 'living in the moment', cherishing the ordinariness of family life, remaining hopeful treatment will prolong life, whilst adapting as the illness unfolds. The other world presents as 'intermitted glimpses that death is approaching', shadowed with painful emotional concerns surrounding their children and the future. At the end, death rapidly approaches, characterised as suddenly 'falling off the cliff'; placing significant demands on the well-parent.

CONCLUSIONS

Amidst challenges, clinicians should provide parents with clear information surrounding a poor prognosis, so families can plan and prepare for parental death. There is a need for healthcare professionals to engage, encourage and equip parents, as they prepare their children throughout the end of life experience for the inevitable death of a parent.

Death of a parent during childhood and blood pressure in youth: a population-based cohort study of Swedish men

OBJECTIVE

Compelling evidence suggests that childhood adversities are associated with an increased risk of hypertension in middle age and old age. The link between childhood adversities and blood pressure in youth is less clear. In this cohort study, we examined the association between death of a parent during childhood and blood pressure in early adulthood in men.

SETTING

Sweden.

PARTICIPANTS

We studied 48 624 men born in 1949-1951 who participated in the compulsory military conscription in 1969/1970 in Sweden. Information on death of a parent during childhood was obtained from population-based registers. Information on covariates was obtained from the questionnaire and the clinical examination completed at conscription and from population-based registers.

OUTCOME MEASURES

Blood pressure was measured at conscription according to standard procedures.

RESULTS

The multivariable least square means of systolic and diastolic blood pressure did not differ between bereaved (128.25 (127.04-129.46) and 73.86 (72.89-74.84) mm Hg) and non-bereaved study participants (128.02 (126.86-129.18) and 73.99 (73.06-74.93) mm Hg). Results were similar when considering the cause of the parent's death, the gender of the deceased parent or the child's age at loss. Loss of a parent in childhood tended to be associated with an increased hypertension risk (OR and 95% CI: 1.10 (1 to 1.20)); the association was present only in case of natural deaths.

CONCLUSION

We found no strong support for the hypothesis that stress following the loss of a parent during childhood is associated with blood pressure or hypertension in youth in men.

Role of SES on the association between childhood parental death and adulthood suicidal ideation: a mediation analysis using longitudinal dataset in South Korea

BACKGROUND

We sought to examine the association between childhood experience of parental death (CEPD) and adulthood suicidal ideation, and the mediating role of adulthood SES in the association.

METHODS

We analyzed a nationally representative dataset of 8609 adults from the Korea Welfare Panel Study, which is a longitudinal cohort dataset in South Korea. CEPD was measured using a question: "During your childhood (0-17 years old), have you experienced the death of parents?" We classified responses of CEPD during 2006-2011 into 'yes,' and the others into 'no.' Suicidal ideation over the past year was assessed annually during 2012-2019. As a potential mediator, adulthood educational attainment and household income in 2011 were included in the analysis. Logistic regression was applied to examine the association of CEPD with adulthood suicidal ideation across age groups (early adulthood, 19-39 years old; middle adulthood, 40-59 years old; late adulthood, ≥60 years old), after excluding people who reported lifetime suicidal ideation in 2011. Causal mediation analysis using a parametric regression model was applied to examine the mediating role of adulthood SES in the association between CEPD and adulthood suicidal ideation.

RESULTS

After adjusting for potential confounders including childhood SES, CEPD was significantly associated with adulthood suicidal ideation among the late adulthood group (OR: 1.43; 95% CI: 1.13-1.81), while the association was not statistically significant among the early; and middle adulthood groups. In mediation analysis of adulthood household income, both indirect association (OR^NIE: 1.05; 95% CI: 1.02-1.09) and direct association (OR^NDE: 1.37; 95% CI: 1.09-1.73) were statistically significant among the late adulthood group. In the mediation analysis of adulthood education attainment among the late adulthood, only a direct association was statistically significant (OR^NDE: 1.43; 95% CI: 1.14-1.80).

CONCLUSIONS

These results suggest that CEPD could be a risk factor for adulthood suicidal ideation. Furthermore, the findings imply that income security policy might be necessary to reduce suicide among the late adulthood group.

Co-occurrence of psychosocial sequelae in bereaved offspring

BACKGROUND

Previous studies have found that people who have lost a parent to external causes of death during childhood and adolescence have increased risks of psychosocial sequelae. However, we lack information on the potential co-occurrence of these problems. This study aims to investigate the co-occurrence of psychiatric disorders, deliberate self-harm (DSH) hospitalization, and high school non-completion in people who have lost a parent to external causes of death during childhood and adolescence compared to people who have not experienced such loss.

METHODS

The study cohort comprised 655 477 individuals born 1970-2012 with a link to both parents. Data on psychiatric disorders, DSH hospitalization, high school completion and parental death were retrieved from four longitudinal Norwegian registers. Chi-square tests of independence investigated potential differences in co-occurrence between bereaved and non-bereaved people.

RESULTS

Altogether, 4756 people had experienced the death of a parent due to external causes of death before their 18th birthday. These bereaved offspring had a significantly higher likelihood of having one, two and three adverse outcomes compared to people who had not experienced such loss. Specifically, bereaved offspring had a significantly higher co-occurrence of psychiatric disorders and high school non-completion, but not significantly higher co-occurrences of DSH hospitalization and high school non-completion or DSH hospitalization and psychiatric disorders.

LIMITATIONS

Information concerning DSH hospitalization and psychiatric disorders was only available from 2008 onwards CONCLUSIONS: : The significantly higher co-occurrence in bereaved offspring suggests that the relatively small group of people suffering from extensive sequelae should be particularly targeted for postvention measures.

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

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.

The perspectives of children and young people affected by parental life-limiting illness: An integrative review and thematic synthesis

BACKGROUND

Although the death of a parent during childhood is relatively commonplace, the voices of children affected by parental life-limiting illness are under-represented in research evidence. Guidance for healthcare professionals is largely based upon professional opinion rather than the experience of children themselves.

AIM

To synthesise and appraise the literature from primary research with children about their experience of having a parent with a life-limiting illness.

DESIGN

Integrative review and thematic synthesis. Registered on PROSPERO (CRD42019094581).

DATA SOURCES

PsychINFO, Medline, Embase, Scopus and Web of Science were searched, supplemented by searches of grey literature and systematic reviews. There were no restrictions on publication date, and study quality was appraised using the Hawker checklist. Studies reporting the findings of primary research with participants under 18, whose parent has a life-limiting illness, were eligible for inclusion.

RESULTS

Twenty-one papers met the inclusion criteria (n = 13 qualitative; n = 8 quantitative), reporting on n = 18 studies from high-income countries. Findings reveal that throughout parental life-limiting illness, children strive for agency, but are often shielded and excluded by adults. The experience of living with a dying parent is emotionally demanding for children and involves significant caregiving responsibilities. However these children are not passive, developing strategies to cope with the situation and wanting to be involved.

CONCLUSIONS

The review has enabled the voices of children affected by parental life-limiting illness to be heard and will inform the development of guidance for parents and professionals.

Alcohol-related mortality and all-cause mortality following bereavement in two successive generations

Background and aim

Bereavement affects the health of the bereaved both emotionally and physically. Bereavement resulting from alcohol-related death of the previous generation (parents-first generation) may increase the risk of alcohol abuse and consequently alcohol-related mortality as well as all-cause mortality in the next generation (offspring-second generation). Furthermore, these associations can be bi-directional. However, there is no conclusive evidence of these effects, and studies exploring these intergenerational effects are rare. This study investigates these associations.

Methods

A longitudinal data were constructed by linking participants from the Adolescent Health and Lifestyle Surveys (AHLS) from 1979 to 1997 with census and registry-based data from Statistics Finland containing the socioeconomic status of the survey participants and their parents (N = 78610) to investigate these associations. Multivariate Cox proportional hazards models were used to calculate hazard ratios with 95% confidence intervals to determine the effect of bereavement with alcohol-related mortality and all-cause mortality.

Results

The findings suggest that bereavement following the death of an offspring increases the risk of both alcohol-related and all-cause mortality among both parents. The magnitude of the risk of mortality following the death of an offspring is higher for mothers than for fathers. There were no clear associations of a parent’s death with an offspring’s alcohol-related or all-cause mortality. However, generally, a father’s death seems to be protective of the risk of mortality among the offspring while a mother’s alcohol-related death slightly increased the risk of alcohol-related mortality among their offspring.

Conclusions

These findings emphasise the role of bereavement, particularly resulting from the death of an offspring, on alcohol-related and all-cause mortality and therefore inequalities in mortality. Furthermore, the findings highlighting the need for alcohol abuse intervention and emotional support for bereaved persons following the death of an offspring.

Adverse childhood experiences during childhood and academic attainment at age 7 and 11 years: an electronic birth cohort study

OBJECTIVES

Adverse childhood experiences (ACEs) have a negative impact on childhood health, but their impact on education outcomes is less well known. We investigated whether or not ACEs were associated with reduced educational attainment at age 7 and 11 years.

STUDY DESIGN

The study design used in the study is a population-based electronic cohort study.

METHODS

We analysed data from a total population electronic child cohort in Wales, UK. ACEs (exposures) were living with an adult household member with any of (i) serious mental illness, (ii) common mental disorder (CMD), (iii) an alcohol problem; (iv) child victimisation, (v) death of a household member and (vi) low family income. We used multilevel logistic regression to model exposure to these ACEs and not attaining the expected level at statutory education assessments, Key Stage (KS) 1 and KS2 separately, adjusted for known confounders including perinatal, socio-economic and school factors.

RESULTS

There were 107,479 and 43,648 children included in the analysis, with follow-up to 6-7 years (KS1) and 10-11 years (KS2), respectively. An increased risk of not attaining the expected level at KS1 was associated with living with adult household members with CMD (adjusted odds ratio [aOR]: 1.13 [95% confidence interval [CI]: 1.09-1.17]) or an alcohol problem (adjusted odds ratio [aOR]: 1.16 [95% confidence interval [CI]: 1.10-1.22]), childhood victimisation (adjusted odds ratio [aOR]: 1.58 [95% confidence interval [CI]: 1.37-1.82]), death of a household member (adjusted odds ratio [aOR]: 1.14 [95% confidence interval [CI]: 1.04-1.25]) and low family income (adjusted odds ratio [aOR]: 1.92 [95% confidence interval [CI]: 1.84-2.01]). Similar results were observed for KS2. Children with multiple adversities had substantially increased odds of not attaining the expected level at each educational assessment.

CONCLUSION

The educational potential of many children may not be achieved due to exposure to adversity in childhood. Affected children who come in to contact with services should have relevant information shared between health and care services, and schools to initiate and facilitate a coordinated approach towards providing additional support and help for them to fulfil their educational potential, and subsequent economic and social participation.

Early parental death and psychosocial risk factors for dementia: A case-control study in Europe

OBJECTIVES

To assess the association between early parental death and the risk of dementia in adult life and to examine the risk factors associated with early parental death in people with and without dementia.

METHODS/DESIGN

A population-based case-control study of a sample of 65 997 participants from the Survey of Health, Ageing and Retirement in Europe study. Early parental death was operationalized as parental death at the age of ≤16 years. Main analyses were conducted using bivariate and multivariate logistic regression analyses.

RESULTS

The odds ratio (OR) for dementia in individuals who experienced early parental death (father or mother) at the age of ≤16 years was 1.83 (95%CI 1.61-2.09) and 1.54 (95%CI 1.35-1.76) adjusted for age, gender and education. In the multivariate logistic regression analysis carried out with the whole sample, early parental death increased the risk of dementia (OR = 1.50, 95%CI 1.31-1.72), along with older age (OR = 5.92, 95%CI 4.86-7.17), neuroticism (OR = 2.94, 95%CI 2.61-3.31), low education level (OR = 1.84, 95%CI 1.64-2.05) and low income (OR = 1.49, 95%CI 1.34-1.67).

DISCUSSION

Early parental death (≤16 years) was associated with an increased risk of dementia. We discuss the neurobiological markers associated with adverse childhood experiences (ACEs) and dementia as well as interventions to counteract the negative health effects on adults. J Am Geriatr Soc 68:-, 2020.

Cause of parental death and child's health and education: The role of parental resources

Early parental death has been linked to problems in health and educational path. We added to the literature by examining disability pension and various educational outcomes after external (accident, violence, suicide) or natural parental death during childhood or adolescence, taking into account possible heterogeneous associations by parental resources. Using Finnish register data and linear random-effects models, we analysed outcomes of 90,620 and 88,859 children (paternal and maternal death samples, respectively) born between 1982 and 1990. Results indicated lower educational performance and attainment, and a higher probability of disability pension in the bereaved offspring, especially after external parental death. Half of these connections were explained after adjusting for childhood family characteristics. Having a highly educated surviving parent might protect from negative educational and health outcomes. The findings were partly similar for father's and mother's deaths. We demonstrated that the negative associations between parental death and child wellbeing differ by cause of death and parental resources. Cause of death and overall family circumstances should both be considered when analysing child outcomes after parental loss.

Law and mental health: A bridge between individual neurobiology and the collective organization of behaviors

Mental disorders (MD) or mental symptoms (MS) have multifactorial causes. Today we know much more about the variables that cause individual MD\MS, but in our opinion these characterizations, although essential, are not sufficient to account for the complexity in which we live. For example, they do not explain in a coherent and empirically verifiable way how the biological individual relates to the social architecture in which he lives. This article presents a hypothesis that connects social and organizational structures to the emergence of symptoms and mental disorders in the population. It is our belief that some of these structures fundamentally impact the distribution of MD/MS in a population and the medical and psychological communities must consider this impact seriously. Laws aim at directing the behavior of groups of people, whose behavior is strictly interdependent with their neurobiology. Given the ability of laws to direct the behaviors that regulate social interactions, traumatic factors may be considered capable of linking a non-material object (e.g., a law) to a real effect (e.g., MS/MD). We discuss, as a paradigmatic example, the laws that regulate the use of psychotropic substances.

Does losing a parent early influence the education you obtain? A nationwide cohort study in Denmark

BACKGROUND

Health inequalities are rooted in education and we investigate the association between early parental death and attainment across the educational spectrum.

METHODS

Using total population data on Danes born between 1982 and 2000 (n = 1 043 813), we assess incidence rate ratios (RRs) by gender for attainment of each educational level (basic school, high school or vocational training, bachelor degree or professional programme, and university graduate degree) according to loss of a parent before the age of 18 years. We adjust for family income, education and psychiatric illness and examine parent's gender, cause of death and child's age at time of death as potential moderators.

RESULTS

Bereaved people had significantly lower attainment rates than non-bereaved people: basic school (RR = 0.95; 95% CI: 0.93-0.97 for men and 0.96; 0.94-0.98 for women), high school or vocational training (0.78; 0.76-0.80 for men and 0.82; 0.80-0.84 for women), bachelor degree or professional programme (0.74; 0.70-0.79 for men and 0.83; 0.79-0.86 for women) and university graduate degree (0.77; 0.68-0.86 for men and 0.77; 0.69-0.86 for women). Parent's gender, cause of death and child's age at the death did not modify the associations.

CONCLUSIONS

As education impacts population health, support for bereaved school children may be more important than realized.

Educational attainment in offspring bereaved by sudden parental death from external causes: a national cohort study from birth and throughout adulthood

PURPOSE

Previous research has linked loss of a parent during childhood to reduced educational aspirations, school performance, and educational attainment later in life. The potential effect of maternal and paternal bereavement on attainment at all educational levels is, however, unknown. The present study aimed to investigate the potential influence of parental death by external causes on completion of compulsory education, high school, vocational education, and University or College education.

METHODS

The study was based on data from three national longitudinal registers in Norway. The study population comprised 373,104 individuals born between January 1st 1970 and December 31st 1994. Information concerning deceased parents' cause and date of death and offspring's education and sociodemographic data were retrieved. Data were analysed with Cox regression.

RESULTS

Children who had experienced parental death by external causes had a significantly reduced hazard ratio (HR) of completing all educational levels compared to children who did not have such experiences. The largest effects were evident for completion of high school (HR 0.68, 95% CI 0.65-0.71) and University or College education (HR 0.75, 95% CI 0.70-0.80). No differences were evident for different causes of death, genders of deceased or ages at bereavement, and generally no significant interactions between gender of the bereaved offspring and predictor variables were evident for completion of all educational levels.

CONCLUSION

Parental death by external causes has vast and long-lasting impacts on offspring's educational attainment at all levels. Health care interventions aimed at supporting bereaved children and adolescents should focus on challenges related to educational progress.

Self-harm and violent criminality linked with parental death during childhood

BACKGROUND

Adverse health and social outcomes are known to occur more frequently following parental death during childhood, but evidence is lacking for comparing long-term risks of internalised v. externalised harm.

METHODS

This national register-based cohort study consisted of Danish persons born 1970-2000. The Civil Registration System and National Causes of Death Register were linked to ascertain parental deaths by cause before cohort members' 15th birthdays. From age 15 years, hospital-treated self-harm episodes were ascertained through linkage to the National Patient Register and the Psychiatric Central Research Register, and violent crimes were identified via linkage to the National Crime Register. Hazard ratio and cumulative incidence values were estimated.

RESULTS

Self-harm and violent criminality risks were elevated following parental death during childhood. Covariate adjustment for gender, birth year and first-degree relatives' mental illnesses attenuated these associations, although significantly heightened risks persisted. The estimated hazard ratios did not differ greatly according to which parent died, but losing both parents conferred particularly large risk increases. Risks for both adverse outcomes were higher in relation to unnatural v. natural parental death; violent criminality risk was especially raised among individuals exposed to parental death by unnatural causes other than suicide. The association was strongest when pre-school age children experienced parental death.

CONCLUSIONS

Effective early intervention is needed to help youngsters who have experienced the death of one or both parents to develop immediate and sustained coping strategies. Enhanced cooperation between health and social services and criminal justice agencies may mitigate risks for these two destructive behaviours.

Bereavement Accommodations in the Classroom: Experiences and Opinions of School Staff

BACKGROUND

Bereaved children often struggle in the school environment and school personnel often feel inadequately prepared to support them. This pilot study explored the experiences and opinions of school staff regarding approaches to addressing the needs of bereaved students in the classroom.

METHODS

Teachers/school personnel (N = 29) completed written open-ended questions about their experiences with bereaved students and opinions regarding a bereavement-focused accommodation (ie, 504) plan. Responses were summarized using qualitative content analysis.

RESULTS

Most participants (93%) reported interacting with bereaved students and: (1) providing emotional support; (2) making classroom accommodations; (3) collaborating with the family/community; and (4) referring the student for counseling. Many (72%) expressed interest in a templated bereavement plan (21% did not respond; 7% said no) with education/resources for school personnel and suggested accommodations for students.

CONCLUSIONS

Teachers encountering grieving students would welcome a templated bereavement plan to help meet students' needs. Such a plan would allow staff to become more knowledgeable about grief and provide guidance for developing specific strategies to accommodate grieving students both emotionally and academically.

Risk of childhood mortality associated with death of a mother in low-and-middle-income countries: a systematic review and meta-analysis

Background

Death of a mother at an early age of the child may result in an increased risk of childhood mortality, especially in low-and-middle-income countries. This study aims to synthesize estimates of the association between a mother’s death and the risk of childhood mortality at different age ranges from birth to 18 years in these settings.

Methods

Various MEDLINE databases, EMBASE, and Global Health databases were searched for population-based cohort and case-control studies published from 1980 to 2017. Studies were included if they reported the risk of childhood mortality for children whose mother had died relative to those whose mothers were alive. Random-effects meta-analyses were used to pool effect estimates, stratified by various exposures (child’s age when mother died, time since mother’s death) and outcomes (child’s age at risk of child death).

Results

A total of 62 stratified risk estimates were extracted from 12 original studies. Childhood mortality was associated with child’s age at time of death of a mother and time since a mother’s death. For children whose mother died when they were ≤ 42 days, the relative risk (RR) of dying within the first 1–6 months of the child’s life was 35.5(95%CI:9.7–130.5, p [het] = 0.05) compared to children whose mother did not die; by 6–12 months this risk dropped to 2.8(95%CI:0.7–10.7). For children whose mother died when they were ≤ 1 year, the subsequent RR of dying in that year was 15.9(95%CI:2.2–116.1,p [het] = 0.02), compared to children whose mother lived. For children whose mother died when they were ≤ 5 years of age, the RR of dying before aged 12 was 4.1(95%CI:3.0–5.7),p [het] = 0.83. Mortality was also elevated in specific analysis  among children whose mother died when child was older than 42 days. Overall, for children whose mother died < 6 and 6+ months ago, RRs of dying before reaching adulthood (≤18 years) were 4.7(95%CI:2.6–8.7,p [het] = 0.2) and 2.1(95%CI:1.3–3.4,p [het] = 0.7), respectively, compared to children whose mother lived.

Conclusions

There is evidence of an association between the death of a mother and childhood mortality in lower resource settings. These findings emphasize the critical importance of women in family outcomes and the importance of health care for women during the intrapartum and postpartum periods and throughout their child rearing years.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7316-x) contains supplementary material, which is available to authorized users.

The Impact of Parental Death in Childhood on Sons' and Daughters' Status Attainment in Young Adulthood in the Netherlands, 1850-1952

Previous research on the impact of parental loss on labor market outcomes in adulthood has often suffered from low sample sizes. To generate further insights into the long-term consequences of parental death, I use the Historical Sample of the Netherlands (HSN). The HSN contains occupational information on life courses of a sample of more than 8,000 males and almost 7,000 females born between 1850 and 1922, a period of important labor market transformations. Roughly 20 % of the sample population experienced parental death before age 16. Linear regression models show that maternal loss is significantly associated with lower occupational position in adulthood for both men and women, which points to the crucial importance of maternal care in childhood for socioeconomic outcomes in later life. This interpretation is supported by the finding that a stepmother's entry into the family is positively related with sons' occupational position later in life. In contrast to expectations, the loss of economic resources related to the father's death is generally not associated with lower status attainment in adulthood for men or for women. The results indicate, however, that the negative consequences of paternal death on men's socioeconomic outcomes decreased over time, illustrating the complex interaction between individual life courses and surrounding labor market transformations.

Challenges and support needs of parents and children when a parent is at end of life: A systematic review

BACKGROUND

Preparing children for the death of a parent is challenging. Parents are often uncertain if and how to communicate and support their children. Many parents feel it is protecting their children by not telling them about the prognosis. Children less prepared for parental death from a terminal illness are more susceptive to later adversities. To facilitate coping and moderate for such adversities, there is a need to gain insight and understand the experience and challenges confronted by families.

AIM

This review synthesised evidence on the experiences of parents and children when a parent is at end of life to discern their challenges, support needs and factors that facilitated good practice.

DESIGN

Mixed-methods systematic review.

DATA SOURCES

Four electronic databases (CINAHL, PubMed, PsycINFO and Ovid MEDLINE) using MeSH terms and word searches in October 2018. Studies were not limited by year of publication, language or country. Grey literature searches were also completed on Google Scholar and OpenGrey.

RESULTS

In all, 7829 records were identified; 27 qualitative and 0 quantitative studies met the inclusion criteria. Eight descriptive themes were identified, further categorised into two broad themes: (1) barriers and facilitators in sharing the news that a parent is dying and (2) strategies to manage the changing situation.

CONCLUSION

Lack of understanding in relation to the parent's prognosis, denial and feeling ill-equipped were suggested as barriers for parents to share the news with their children. Engagement with social networks, including extended family relatives and peers, and maintaining routines such as attending school were suggested supportive by parents and children. Findings are limited primarily to White, middle-class two-parent families. A number of areas for future research are identified.

Environmental harshness and unpredictability, life history, and social and academic behavior of adolescents in nine countries

Safety is essential for life. To survive, humans and other animals have developed sets of psychological and physiological adaptations known as life history (LH) tradeoff strategies in response to various safety constraints. Evolutionarily selected LH strategies in turn regulate development and behavior to optimize survival under prevailing safety conditions. The present study tested LH hypotheses concerning safety based on a 6-year longitudinal sample of 1,245 adolescents and their parents from 9 countries. The results revealed that, invariant across countries, environmental harshness, and unpredictability (lack of safety) was negatively associated with slow LH behavioral profile, measured 2 years later, and slow LH behavioral profile was negatively and positively associated with externalizing behavior and academic performance, respectively, as measured an additional 2 years later. These results support the evolutionary conception that human development responds to environmental safety cues through LH regulation of social and learning behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Father’s Repeat Migration and Children’s Educational Performance

Repeat migration is a common, but unstudied, pattern of migration. This study examines the potential intergenerational consequences of this behavior. To investigate this, we estimate the effect of fathers’ repeat migration on their children’s grade point averages using population-level register data from Sweden. We find that the children of fathers who repeat migrate have a significantly lower grade point average, even after controlling for individual and family characteristics, than children of permanent migrants. Results suggest selection and delayed integration may exert negative pressure on the GPA of children of repeat migrants.

Assessing within- and between-family variations in an expanded measure of childhood adversity

Previous measures of childhood adversity have enabled the identification of powerful links with later-life wellbeing. The challenge for the next generation of childhood adversity assessment is to better characterize those links through comprehensive, fine-grained measurement strategies. The expanded, retrospective measure of childhood adversity presented here leveraged analytic and theoretical advances to examine multiple domains of childhood adversity at both the microlevel of siblings and the macrolevel of families. Despite the fact that childhood adversity most often occurs in the context of families, there is a dearth of studies that have validated childhood adversity measures on multiple members of the same families. Multilevel psychometric analyses of this childhood adversity measure administered to 1,194 siblings in 500 families indicated that the additional categories of childhood adversity were widely endorsed, and increased understanding of the sources and sequalae of childhood adversity when partitioned into within- and between-family levels. For example, multilevel confirmatory factor analyses (MCFAs) indicated that financial stress, unsafe neighborhood, and parental unemployment were often experienced similarly by siblings in the same families and stemmed primarily from family wide (between-family) sources. On the other hand, being bullied and school stressors were often experienced differently by siblings and derived primarily from individual (within-family) processes. Multilevel structural equation modeling (MSEM) further illuminated differential criterion validity correlations between these categories of childhood adversity with midlife psychological, social, and physical health. Expanded, multidomain, and multilevel measures of childhood adversity appear to hold promise for identifying layered causes and consequences of adverse childhood experiences. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Predictive Values of Early Parental Loss and Psychopathological Risk for Physical Problems in Early Adolescents

Background: Several studies have suggested that the early loss of parents is a potentially traumatic experience, exposing adolescents to a higher risk for the onset of psychopathological symptoms. Furthermore, research has shown an association between the loss of a parent in childhood and subsequent physical illnesses, but much less attention has been given to the predictive role of loss in the development of physical illness in adolescence. Methods: From a larger normative sample, we selected 418 early adolescents (and their surviving parents) each of whom had lost a parent in their first 3 years of life. We evaluate the offspring's and parents' psychopathological symptoms, dissociation, and physical problems over a 6-year period. Univariate and multivariate Cox proportional hazard regression analyses with time-dependent variables were used to examine the predictive values of the adolescents' and surviving parents' psychopathological symptoms, and youths' demographic characteristics (sex and age) for the occurrence of physical illness during a 6-year period of follow-up. Results: Independently of sex, the psychopathological risk of the surviving parents' and adolescents' affective problems and dissociation has been found to predict the occurrence of physical illnesses. Furthermore, dissociation was the most significant predictor of significant physical problems. Conclusion: These results may be relevant and an addition to the previous literature, opening up new possibilities for prevention and intervention that are oriented toward greater support for children who have experienced the loss of one parent and for surviving parents.

Does childhood trauma influence offspring's birth characteristics?

Background

: A recent epigenetic hypothesis postulates that 'a sex-specific male-line transgenerational effect exists in humans', which can be triggered by childhood trauma during 'the slow growth period' just before puberty. The evidence is based on a few rather small epidemiological studies. We examine what response childhood trauma predicts, if any, in the birth size and prematurity risk of almost 800 000 offspring.

Methods

Children of parity 1, 2 or 3, born 1976-2002 in Sweden, for whom we could trace both parents and all four grandparents, constituted generation 3 (G3, n = 764 569). Around 5% of their parents, G2, suffered parental (G1) death during their own childhood. The association of such trauma in G2 with G3 prematurity and birthweight was analysed, while controlling for confounders in G1 and G2. We examined whether the slow growth period was extra sensitive to parental loss.

Results

Parental (G1) death during (G2) childhood predicts premature birth and lower birthweight in the offspring generation (G3). This response is dependent on G2 gender, G2 age at exposure and G3 parity, but not G3 gender.

Conclusions

The results are compatible with the Pembrey-Bygren hypothesis that trauma exposure during boys' slow growth period may trigger a transgenerational response; age at trauma exposure among girls seems less important, suggesting a different set of pathways for any transgenerational response. Finally, parental death during childhood was not important for the reproduction of social inequalities in birthweight and premature birth.

Psychopathological dimensions in subjects with hereditary ATTR V30M amyloidosis and their relation with life events due to the disease

BACKGROUND

Chronic physical illness has been associated with emotional distress. Chronic diseases may change usual family patterns with economic, social and family losses. Hereditary ATTR V30M amyloidosis is a rare, fatal inherited systemic amyloidosis, with chronic evolution and beginning in adulthood.

AIMS AND METHODS

To evaluate psychopathological dimensions and how they correlated with disease-related life events, 209 symptomatic and asymptomatic carriers, participated in the study. Sociodemographic and Family and Personal History Disease questionnaires and brief symptom inventory (BSI) were applied.

RESULTS

BSI indices, global severity index (GSI), positive symptom index (PSI) and positive symptom total (PST) scored higher than general population. Independent predictors for GSI >0.83 were female sex (OR = 3.46, p = .005) and being symptomatic carriers (OR = 3.03, p = .039). Independent predictors of a PST >26.99 were female sex (OR = 3.74, p = .012) symptomatic carrier (OR = 5.32, p = .025), age between 15 and 24 years at affected parent's death (OR = 5.26, p = .04). Independent predictors of a PSI >1.56 were being asymptomatic carrier (OR = 6.3, p = .036); to have children (OR = 3.19, p = .043) and have ≤14 years at parent's disease onset (OR = 6.39, p = .05).

CONCLUSIONS

Results point to an important vulnerability of this population for psychological distress and psychiatric disease. Early life events related to disease, being sick and sex are associated with psychopathological distress.

Association between childhood adversity and a diagnosis of personality disorder in young adulthood: a cohort study of 107,287 individuals in Stockholm County

Childhood adversity (CA) may increase the risk for later developing of personality disorder (PD). However, less is known about the association between cumulative CA and PD, and the role of childhood psychopathology and school performance. The current study examined the relationship between a range of CAs and a diagnosis of PD in young adulthood, and the roles of childhood psychopathology and school performance in this relationship. All individuals born in Stockholm County 1987–1991 (n = 107,287) constituted our cohort. Seven CAs were measured between birth and age 14: familial death, parental criminality, parental substance abuse and psychiatric morbidity, parental separation and/or single-parent household, household public assistance and residential instability. Individuals were followed from their 18th birthday until they were diagnosed with PD or until end of follow-up (December 31st 2011). Adjusted estimates of risk of PD were calculated as hazard ratios (HR) with 95% confidence intervals (CI). Associations were observed between cumulative CA and PD. During the follow-up 770 individuals (0.7%) were diagnosed with PD. Individuals exposed to 3+ CAs had the highest risks of being diagnosed with PD (HR 3.0, 95% CI 2.4–3.7). Childhood psychopathology and low school grades further increased the risk of PD among individuals exposed to CA. Cumulative CA is strongly associated with a diagnosis of PD in young adulthood. Our findings indicate that special attention should be given in schools and health services to children exposed to adversities to prevent decline in school performance, and to detect vulnerable individuals that may be on negative life-course trajectories.

Towards a model of loss navigation in adolescence

Researchers today consider childhood bereavement one of the most traumatic experiences that can befall a child. Nevertheless, most models of bereavement currently limit themselves to dealing with adult grief and primarily explores the internal processes associated with recovery. Based on a study which conducted focus groups with 39 Danish adolescents (aged 9-17), this article presents The Model of Loss Navigation in Adolescence. Centered on the three factors-Being Different, Being in Control, and Being in Grief-the model highlight the social conventions children have to navigate and how these influences both their day-to-day lives and their road to recovery.

Does death really make us equal? Educational attainment and resource compensation after paternal death in Finland

Attempts to explain the persistent importance of family background for children's educational attainment typically highlight the ways in which parents pass down educational, economic and social resources to their children. However, parental resources may also play a crucial role for preventing family crises from spiraling into cumulative disadvantage. To study such compensation processes, we examine the consequences of a father's death on children's educational trajectories, using a Finnish register-based sample of children born between 1982 and 1987. The results based on multilevel linear probability models both support and contradict our compensation hypothesis. Children who lost their father were not more likely to drop out of upper secondary school, as long as their surviving mother had high levels of socioeconomic resources. Similar compensation processes were visible in the case of entering polytechnic higher education. However, with regard to university attendance, bereavement noticeably reduced the traditional advantage of children with high-resource parents.

Examining longer-term effects of parental death in adolescents and young adults: Evidence from the national longitudinal survey of adolescent to adult health

Using longitudinal data spanning a 7-year period, we investigated the behavioral and psycho-social effects resulting from a parent's death during early childhood or teenage years on adolescent and early adulthood functioning. Findings confirmed previous work demonstrating various behavioral problems and social-psychological adjustment deficits during adolescence. Results suggested that most detrimental adjustment behaviors among parentally bereaved youth fade as they entered into young adulthood. Yet, premature school withdrawals and diminished interests in college attendance at Wave 1 left many of these young adults with diminished academic accomplishments, lingering economic disadvantages and for females a hesitancy to marry as their lives progressed into adulthood.