Parental death during childhood and depression in young adults - a national cohort study
Parental death during childhood and depression in young adults - a national cohort study
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DOI：
10.1111/jcpp.12560
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发表时间：
2016-09-01
影响因子：
7.6
通讯作者：
Hjern, Anders
中科院分区：
文献类型：
--
作者：
Berg, Lisa;Rostila, Mikael;Hjern, Anders
背景关于儿童期父母死亡和成年后精神障碍的前瞻性、基于人群的研究很少，以前的发现也没有定论。这项研究调查了18岁以前父母因自然和外部原因(自杀、事故或他杀)死亡与青少年临床抑郁症风险之间的关系，以及儿童和父母的年龄和性别。方法在这项基于登记册的研究中，跟踪调查了1973-1982年间出生于瑞典的全国队列(n=862,554)2006-2013年间因抑郁症住院和门诊治疗的情况。结果母亲自然死亡与门诊抑郁症的危险比(HR)相关，男性为1.19[95%可信区间(CI)，1.02~1.40]，女性为1.15(1.01~1.31)，调整社会人口学混杂因素后，母亲自然死亡与父亲自然死亡的影响相似。与自然死亡相比，外部原因死亡的影响大小一直更高，特别是在抑郁症住院风险方面，男性高达3.23(2.38-4.38)，女性在失去母亲后高达1.79(1.30-2.47)。与青少年时期失去父母相比，在学龄前失去父母，患抑郁症的住院(p=.006)和门诊(p=.001)的风险都更高。结论本研究表明，儿童时期因自然原因死亡的父母与心理健康长期后果风险的小增加有关。然而，因外部原因，即自杀、事故或凶杀而失去父母的儿童和在幼年失去父母的儿童面临的风险特别大，在父母失去父母后，应优先采取预防措施。
BackgroundThere are few prospective, population-based studies on childhood parental death and psychiatric disorders in adulthood, and previous findings are inconclusive. This study investigated the association between parental death from natural and external (suicides, accidents or homicides) causes before 18years and the risk of clinical depression in young adults, in relation to age at loss and gender of both child and parent.MethodsIn this register-based study, a national cohort born in Sweden during 1973-1982 (n=862,554) was followed with regard to hospital admissions and outpatient care for depression during 2006-2013. Multivariate Cox proportional hazards models were used to estimate the impact of parental death, taking sociodemographic and parental psychosocial covariates into account.ResultsMaternal death from natural causes was associated with a hazard ratio (HR) of outpatient care for depression of 1.19 [95% confidence interval (CI), 1.02-1.40] in men and 1.15 (1.01-1.31) in women, after adjustment for sociodemographic confounders, with similar effect sizes for paternal natural death. Death from external causes consistently had higher effect size compared with natural deaths, in particular in relation to risk of hospital admissions for depression where they were as high as HR 3.23 (2.38-4.38) for men, and 1.79 (1.30-2.47) for women after a loss of a mother. Losing a parent in preschool age, compared with losing a parent as a teenager, was associated with higher risks of both hospitalization (p=.006) and outpatient care (p=.001) for depression.ConclusionsThis study indicates that parental loss to death from natural causes during childhood is associated with a small increased risk of long-term consequences for psychological health. Children who lose their parents to death from external causes, that is suicides, accidents or homicides, and children losing a parent in young ages are, however, at particular risk and should be given priority in preventive interventions after parental loss.