Mortality in parents after death of a child in Denmark: a nationwide follow-up study

Lancet. 2003 Feb 1;361(9355):363-7. doi: 10.1016/S0140-6736(03)12387-2.


Background: Little is known about the effect of parental bereavement on physical health. We investigated whether the death of a child increased mortality in parents.

Methods: We undertook a follow-up study based on national registers. From 1980 to 1996, we enrolled 21062 parents in Denmark who had a child who had died (exposed cohort), and 293745 controls--ie, parents whose children were alive, and whose family structure matched that of the exposed cohort. Natural deaths were defined with ICD8 codes 0000-7969 and ICD10 codes A00-R99, and unnatural deaths with codes 8000-9999 and V01-Y98. We used Cox's proportional-hazards regression models to assess the mortality rate of parents up to 18 years after bereavement.

Findings: We observed an increased overall mortality rate in mothers whose child had died (hazards ratio 1.43, 95% CI 1.24-1.64; p<0.0001). An excess mortality from natural causes (1.44, 1.15-1.78; p<0.0001) was noted in mothers only during the 10th-18th year of follow-up. Mothers had increased mortality rates from unnatural causes throughout follow-up, with the highest rate recorded during the first 3 years (3.84, 2.48-5.88; p<0.0001). Bereaved fathers had only an early excess mortality from unnatural causes (1.57, 1.06-2.32; p=0.04). Mothers who lost a child due to an unnatural death or an unexpected death had a hazard ratio of 1.72 (1.38-2.15; p=0.0040) and 1.67 (1.37-2.03; p=0.0037), respectively.

Interpretation: The death of a child is associated with an overall increased mortality from both natural and unnatural causes in mothers, and an early increased mortality from unnatural causes in fathers.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Bereavement*
  • Cause of Death
  • Child*
  • Child, Preschool
  • Death*
  • Denmark / epidemiology
  • Female
  • Follow-Up Studies
  • Health Status*
  • Humans
  • Incidence
  • Infant
  • Life Change Events
  • Male
  • Mortality*
  • Parents / psychology*
  • Population Surveillance
  • Proportional Hazards Models
  • Registries
  • Risk Factors
  • Sex Distribution
  • Time Factors