“Suicide of a close family member brings the highest risk,” said researchers led by Professor Kathryn Abel of Manchester University, U.K. Her team reports there is evidence that maternal stress can adversely affect infants, adding that this has “important implications for both public health and mental health.”
The team looked at the impact of severe bereavement for the mother before conception until her child’s adolescence. Figures were taken from Swedish national registers including births from 1973 to 1985 and followed up to 2006. This included 946,994 births.
The definitions of psychosis used in this were non-affective psychosis (including schizophrenia) and affective psychosis (bipolar disorder with psychosis and unipolar depression with psychosis).
A third of the children were exposed to a family death before the age of 13 years. Of these deaths, 11,117 were from suicide, 15,189 from accidents, and 280,172 from natural causes.
Maternal bereavement in the period from six months before conception to birth did not affect the child’s future risk of a psychotic disorder. However, the risk rose after exposure to the loss of a close family member between birth and adolescence, being highest in children exposed from birth to three years. The risks reduced as age of exposure increased.
The risk of psychosis was not explained by a family history of mental illness or suicide. It also remained after taking into account year of birth, child’s sex, mother’s and father’s age, nationality, and socioeconomic status.
Risk was higher after a death in the nuclear family compared with extended family, and higher when the death occurred while the child was younger. It was particularly high after suicide, the team reports in the British Medical Journal. The researchers state, “It is reasonable to suppose the impact of bereavement of a baby or small child is mediated by stress felt by the primary caregiver.”
They conclude, “Severe antenatal maternal stress was not associated with an increased risk of later severe mental illness in offspring. But loss of a parent or sibling in early childhood, especially after sudden death, was associated with an increased risk of psychosis in offspring.
“This has important implications for the identification of children at risk. Structures must be put in place to develop appropriately timed and appropriately resourced interventions to support vulnerable children and their families.”
Abel commented, “Our research shows childhood exposure to death of a parent or sibling is associated with excess risk of developing a psychotic illness. This is particularly associated with early childhood. Further investigation is now required and future studies should consider the broader contexts of parental suicide and parental loss.”
They speculate that this association is probably explained to some extent by a link between the relative’s suicide and a genetic predisposition toward mental health problems.
But they add that it is also likely, in large part, “to include complex combinations of factors, creating more or less risk and resilience to future stressors.” This resilience is in turn influenced by the broader context of suicide and bereavement in non-Western, ethnically diverse populations, and during conflict.
In a related study, Abel and colleagues looked at the impact of maternal bereavement on future risk of suicide among 2,155,221 children born in Sweden from 1973 to 1997. This showed that children whose mothers experienced bereavement in the first year of life were at a 13 percent increased risk of suicide attempt and a 51 percent increased risk of completed suicide.
The team said, “Further research is needed regarding associations between preconception stress (maternal bereavement in this study) and psychopathological outcomes.” But they believe that larger participant numbers are crucial, as “smaller previous studies may have overestimated associations between early stress and psychopathological outcomes.”
Abel, K. M. et al. Severe bereavement stress during the prenatal and childhood periods and risk of psychosis in later life: population based cohort study. British Medical Journal, 22 January 2014, doi: 10.1136/bmj.f7679
Class, Q. A. et al. Offspring psychopathology following preconception, prenatal and postnatal maternal bereavement stress. Psychological Medicine, January 2014, doi: 10.1017/S0033291713000780
Young child and parent in cemetery photo by shutterstock.