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Parents who lose a child to suicide are at high risk for mental health problems and subsequent marital breakup, researchers found.

Rates of depression were more than doubled among parents of children who committed suicide in the 2 years after the death, with an adjusted rate ratio of 2.14 (95% CI 1.88 to 2.43, P<0.001) compared with the 2 years before the offspring's death, according to James M. Bolton, MD, of the University of Manitoba in Canada, and colleagues.

They also had a 40% increase in anxiety disorders (RR 1.41, 95% CI 1.24 to 1.60, P<0.001), and a 60% increase in any mental health disorder (RR 1.60, 95% CI 1.47 to 1.74, P<0.001), the researchers reported online in Archives of General Psychiatry.

Moreover, there was an 18% increase in marital breakup in just those 2 years (RR 1.18, 95% CI 1.13 to 1.23, P<0.001), Bolton and colleagues found.

"Clinicians should recognize grieving parents as a group in need and should facilitate the assessment and treatment of these individuals," they wrote.

The bereavement associated with suicide is complex, and possibly more severe than with other causes of death because of factors such as blame and stigma.

Previous studies examining this have had conflicting results and limited populations, with little focus on bereaved parents in particular.

The researchers analyzed data from a large health repository at the University of Manitoba, which includes nearly complete administrative data for the 1.2 million residents of that province.

They compared mental health among parents of children who committed suicide both before and after the death, and with control parents who had not lost a child.

In addition, they compared the suicide-bereaved parents with mental health among parents who had a child die in a motor vehicle accident.

The study population included 1,415 parents of children who committed suicide and an equivalent number of nonbereaved parents, as well as 1,132 parents of children who died in accidents.

Mean age of offspring who committed suicide was 30, and mean age of those killed in accidents was 25.

The rates of depression, anxiety, any mental health problem, and alcohol abuse were significantly higher among parents whose children committed suicide than in nonbereaved parents both before and after the death.

"Interestingly, suicide-bereaved parents appear to have mental and physical health vulnerability even prior to the death of their offspring," the researchers observed.

"These findings may be partially explained by the shared genetic or environmental factors between parent and offspring that predispose both to mental disorders," they added.

When the suicide-bereaved parents were compared with controls, they were found to have higher rates of depression, anxiety, and alcohol abuse during the 2 years after their child's death.

But the picture was somewhat different when the suicide-bereaved parents were compared with the accident-bereaved parents.

For instance, the prevalence of depression among suicide-bereaved parents was 14.6% in the 2 years before the death, compared with 11.1% in the accident group.

In both groups, the prevalence rose after the death, to 30.5% and 31%, respectively, giving an absolute increase of 15.9% in the suicide-bereaved group and 19.9% in the accident-bereaved group.

This greater increase in the nonsuicide group may be explained by greater shock among parents whose children died completely unexpectedly in motor vehicle accidents, whereas parents of children who commit suicide may have witnessed a period of deterioration before the suicide, predisposing them to earlier depression, according to the researchers.

Parental physical health also was affected by children's suicide.

Compared with nonbereaved controls, parents of children who committed suicide had significantly higher rates of chronic obstructive pulmonary disease (RR 1.46, 95% CI 1.09 to 1.97, P<0.05) and diabetes (RR 1.40, 95% CI 1.18 to 1.65, P<0.001).

And compared with parents whose children died in motor vehicle accidents, those whose children were victims of suicide had significantly higher rates of multiple physical disorders during the 2 years after the death:

• Cardiovascular disease, RR 1.63 (95% CI 1.23 to 2.16, P<0.001)
• Chronic obstructive pulmonary disease, RR 2.01 (95% CI 1.40 to 2.90, P<0.001)
• Hypertension, RR 1.32 (95% CI 1.15 to 1.52, P<0.001)
• Diabetes, RR 1.66 (95% CI 1.37 to 2, P<0.001)
• Any physical disorder, RR 1.28 (95% CI 1.17 to 1.41, P<0.001)

"These markers of poor health may be explained by factors associated with both mental and physical disorders, such as tobacco use, low levels of exercise, adverse childhood experiences, or poverty," Bolton and colleagues suggested.

The suicide-bereaved group also had higher rates of hospitalization for mental disorders (P<0.05) and marital breakup (P<0.001) compared with the accident-bereaved group.

"The findings of adverse health and social markers among parents even prior to the suicide of their offspring have potential implications for understanding, predicting, and possibly preventing youth suicide," they observed.

"The results of this study should help inform guidelines for public policy aimed at reducing the societal impact of suicide," they concluded.

Limitations of the study include the possibility of underreporting of suicide, sampling bias, and reliance on administrative data.

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