|
Study: Bereaved
parents at risk for mental illness
(June
2005 Issue)
By Nan Shnitzler
A recent study from Denmark validates what clinicians already know:
the death of a child is such a significant stressor for parents,
especially mothers, that it can increase the risk of psychiatric
hospitalization. Psychologists welcomed the study but say it has
flaws.
The study appeared in the March 24 New England Journal of Medicine.
Jiong Li, M.D., Ph.D., of the Danish Epidemiology Science Center,
University of Aarhus and colleagues analyzed records from Danish
registries to correlate the deaths of children with psychiatric
hospitalizations of parents. Out of more than a million records,
17,033 parents lost children under 18 and 495 were hospitalized
for depression, schizophrenia or substance abuse for the first time
within five years of the deaths.
Compared to parents who did not lose a child over the same period,
1970 through 1999, results showed the risk of hospitalization increased
67 percent overall. Mothers had greater risk than fathers, 78 versus
38 percent. For depression, risk increased 91 versus 61 percent,
respectively.
"They [the researchers] engaged in some data mining and came up
with an interesting observation that tells us, historically, something
happened to Danish women who lost a child," says Gerald Koocher,
Ph.D, ABPP, dean and professor of the School of Health Studies at
Simmons College in Boston. "Does it have implications for the U.S.?
I have no clue."
"Having said that," Koocher continues, "my personal perspective
is to some extent reflected in the study. It [bereavement] disrupts
the family and marital dyad. Preventative intervention in the death
of a child could probably head off lots of problems."
Denmark has a comprehensive, national health care system, Koocher
says, and its "gate keeping" for hospitalization is different from
the U.S., where outpatient treatment is exhausted before admission.
The Danish study did not address outpatient mitigation.
"The question is, in Denmark, is there a lower trigger for hospitalization
when someone is depressed?" asks Andrea Farkas Patenaude, Ph.D.,
former director of psychology, now director of psychooncology research
at Dana-Farber's Division of Pediatric Oncology in Boston.
In her 20 years at Dana-Farber, first-year bereaved mothers with
symptoms of clinical depression were seldom hospitalized, Patenaude
says, although she acknowledges the mothers anticipated the deaths.
"My worry is that it will make every mother who has lost a child
think she's going to be hospitalized," Patenaude says.
As for schizophrenia and substance abuse, Patenaude finds them
"suspect in a cause and effect issue."
"That correlation feels, to me, not clear that substance abuse
or schizophrenia was due to a child's death," Patenaude says. For
example, "schizophrenic parents have a harder time taking care of
kids." She notes the study lacked information on family history
and socioeconomic status, omissions the researchers acknowledged
as flaws in the study.
Therese A. Rando's first reaction to the study was similar to Patenaude's,
would it scare patients? On the other hand, "If it leads to paying
better attention to parents who lose kids, then it's a good thing,"
says Rando, Ph.D., BCETS, BCBT, clinical director of the Institute
for the Study and Treatment of Loss in Warwick, R.I.
Rando and Patenaude thought interesting the study's finding that
parents who lost their only child were at greater risk for hospitalization.
Rando says it opposed research that shows parents struggling to
"let go" of a dead child can find it overwhelming to have to still
function as parents. Conversely, Patenaude says, the presence of
other children can have a healing effect, to give parents a reason
to get up in the morning.
Rando believes the study did not encompass the most recent thinking,
verified by her 35 years experience, that anxiety disorders are
more prominent than depression in the bereaved, especially after
sudden death. The study did not look at types of death or specify
anxiety as an outcome. Rando considers such omissions "huge flaws."
"Yes, depression is a measure of loss. But in more cases, depression
comes after anxiety," Rando says.
Jane Grayson, Ph.D., agrees. A licensed clinical psychologist practicing
in Burlington, Vt., she lost her 23-year-old daughter to suicide
four years ago.
The sudden, unexpected death of a child is worse than anticipated
death from illness, Grayson says, certain to bring on post traumatic
stress, an anxiety disorder. But hospitalization would depend on
genetic predisposition.
"I don't think the death of child would create a psychiatric disorder,"
Grayson says. "But certain things could put you over the edge so
a gene is triggered and an underlying psychiatric disorder is expressed."
She was not surprised the study showed mothers more susceptible
than fathers. "I believe both suffer equally but have different
ways of handling it," Grayson says. "Women are bigger help seekers
and allow themselves to experience more. Men are more into distraction."
|
