Childhood bereavement contributes to future psychosis risk

By Eleanor McDermid, Senior medwireNews Reporter

The death of a close family member during childhood is associated with an increased risk for future psychosis, research shows.

The effect was stronger the younger the child was at the time of the death, reveal the findings, which are based on data for 946,994 Swedish people born between 1973 and 1985.

After accounting for confounders, the risk for psychosis was increased by 84% for people who lost a nuclear family member between birth and the age of 2.9 years, and by 47% and 32% for those who experienced a death at the ages of 3.0 to 6.9 years and 7.0 to 12.9 years, respectively.

“We offer two non-mutually exclusive explanations,” write lead researcher Kathryn Abel (University of Manchester, UK) and colleagues in BMJ.

“First, the higher risk could reflect a greater vulnerability of brain development in early childhood to adverse effects from children’s environment and care. Secondly, the higher risk may reflect a greater duration of exposure to adverse social effects associated with the death of a close family member.”

However, maternal bereavement stress before or during pregnancy was not associated with psychosis risk in the offspring. Although some previous research has suggested an association, Abel et al say that the “accumulated evidence is predominantly negative.”

Among people exposed to a death during childhood, the increased risk for psychosis was particularly marked if the death was a suicide, and this persisted after accounting for history of mental illness in the family. The risk was stronger for affective than nonaffective psychosis and, again, it rose further with earlier age at exposure, such that the risk for affective psychosis was increased 3.33-fold among people who lost a nuclear family member to suicide between birth and the age of 2.9 years.

Death by fatal injury or accident also had a significant effect, but only if they occurred when children were less than 3 years old. Deaths by causes other than suicide or accident/injury had no significant effect on the risk for either affective or nonaffective psychosis, regardless of age at the time of the event.

In all, 33.9% of the children experienced death in the family (nuclear or extended) before the age of 13 years. Although it had a large effect, suicide was the least common cause of death, with just 1.2% of children exposed to this. However, it was much more likely to occur in a nuclear than extended family member.

The team concludes that more detailed evidence is needed “before appropriately timed and appropriately resourced interventions can be developed to protect vulnerable families and children.”

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