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Early Parental Death and Risk of Hospitalization for Affective Disorder in Adulthood

Appel, Charlotte Weiling; Johansen, Christoffer; Deltour, Isabelle; Frederiksen, Kirsten; Hjalgrim, Henrik; Dalton, Susanne Oksbjerg; Dencker, Annemarie; Dige, Jes; Bøge, Per; Rix, Bo Andreassen; Dyregrov, Atle; Engelbrekt, Preben; Helweg, Eva; Mikkelsen, Ole Abildgaard; Høybye, Mette Terp; Bidstrup, Pernille Envold

doi: 10.1097/EDE.0b013e3182915df8

Background: Early parental death is one of the most stressful childhood life events and may influence subsequent psychological health. We investigated the association between early parental loss and risk of hospitalization for an affective disorder in adulthood.

Methods: Our nationwide register-based cohort study comprises 1,225,660 people born in Denmark in 1970–1990, of whom 138,893 experienced the death of a parent before the age of 30 years. Follow-up for hospitalization for an affective disorder in the period 1990–2009 yielded 15,261,058 person-years and 19,867 hospitalizations for affective disorder (bereaved n = 2,644; nonbereaved n = 17,223). A Cox proportional hazards model was used to assess hazard ratios (HRs) for hospitalization with an affective disorder according to early parental death.

Results: People who experienced early parental death had an increased risk of hospitalization for a unipolar disorder (men: HR= 1.33; 95% confidence interval [CI] = 1.23–1.44; women: 1.23; 1.17–1.30). Stronger associations were observed for parental death caused by suicide than for other causes. For bipolar affective disorder, an increased risk of hospitalization was observed only after suicide.

Conclusions: People who had lost a parent had an increased risk of hospitalization for unipolar affective disorder. Although this was particularly true for bereavement due to parental suicide, it was also found for parental death from other causes. In contrast, an increased risk of hospitalization for bipolar affective disorder was observed only after parental suicide.

From the aSurvivorship, Danish Cancer Society Research Center, Copenhagen, Denmark; bStatistics, Bioinformatics, and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark; cSection of Environment and Article Radiation, International Agency for Research on Cancer, Lyon, France; dDepartment of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark; eDepartment of Patient Support & Community, Dealing with Bereavement, Danish Cancer Society, Copenhagen, Denmark; fCenter for Crisis Psychology, Bergen, Norway; gDanish Counselling and Research Center for Grieving Children, Teens and Young Adults, Copenhagen, Denmark; and hChildren’s Welfare, Valby, Denmark.

A.D. is a Director of Center for Crisis Psychology (Bergen) and has received financial support from the Center for Crisis Psychology for travelling from Bergen to Copenhagen to participate in study meetings. The other authors have no conflicts to report.

Supported by a grant from TrygFonden ( 7134-08).

Editors’ note: A commentary on this article appears on page 616.

Correspondence: Charlotte W. Appel, Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen, Denmark. E-mail:

Received October 22, 2012

Accepted January 18, 2013

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