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

Author summary Why was this study done? Experience of parental death during childhood has been associated with increased mortality in bereaved children. Bereavement in childhood has been associated with subsequent familial and behavioural difficulties and socioeconomic disadvantages over the life course. No study has examined which of these factors contribute to shaping a trajectory linking parental death to mortality in bereaved children. What did the researchers do and find? We followed a cohort of children born in Stockholm, Sweden, from birth to the age of 63. We conducted statistical analyses to assess the extent to which the association between childhood parental death (between age 0 and 12) and increased mortality in bereaved children by age 63 operated through familial and behavioural difficulties and socioeconomic disadvantages during adolescence and early adulthood. We found that childhood parental death was associated with an approximately 50% increased mortality risk in bereaved children. Delinquent behaviour in adolescence and low income during early adulthood appeared to mediate the association. What do these findings mean? When planning and providing support to bereaved children, it is particularly important to be aware of their increased susceptibility to delinquency and socioeconomic vulnerability that eventually lead to higher mortality. 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.

Automated summary

This study found that childhood parental death is associated with increased mortality in bereaved children, mainly mediated through delinquent behavior in adolescence and low income in early adulthood. Therefore, when supporting bereaved children, it is crucial to be aware of their heightened susceptibility to delinquency and socioeconomic vulnerability.