Background

Parental death and its anniversaries, including anticipation of these dates, might cause distress and increase the risk of substance use disorder and suicide-related behaviour in bereaved adolescents and young adults. We examined whether the risk of substance use disorder and suicide-related behaviour increases around the date of parental death and subsequent anniversaries.

Methods

Using Swedish national registers, we conducted a cohort study of individuals aged 12–24 years. We included individuals aged 12–24 years between Jan 1, 2001, and Dec 31, 2014, whose parents were alive at entry (n=1 858 327) and followed up with them until the end of age 24 years. We excluded individuals with a half-sibling, a history of emigration, a previous record of the outcome events, a parental death before study entry, two parental deaths on the same day during the follow-up, or missing data for relevant variables. Follow-up ended on the day of an outcome event or on Dec 31, 2014; at age 25 years, emigration, or death; or a year before the second parental death. We studied substance use disorder and suicide-related behaviour outcomes separately and included non-fatal and fatal events in both outcomes. We used Cox regression to estimate hazard ratios (HRs), controlling for baseline psychiatric, demographic, and socioeconomic characteristics. Parental death was modelled as a time-varying exposure over 72 monthly periods, starting from 1 year before the parental death to the fifth year and later after the death. Unmeasured confounding was also addressed in within-individual comparisons using a case-crossover design.

Findings

During follow-up (median 7·5 [IQR 4·3–10·6] years), there were 42 854 substance use disorder events, with a crude rate of 3·1 per 1000 person-years. For suicide-related behaviour, there were 19 827 events, with a crude rate of 1·4 per 1000 person-years. Most of the events studied were non-fatal. In the month of parental death, the HR for substance use disorder risk was 1·89 (95% CI 1·07–3·33) among male participants, and, for suicide-related behaviour, was 3·76 (1·79–7·89) among male participants and 2·90 (1·61–5·24) among female participants. In male participants, there was an increased risk around the first anniversary (substance use disorder: HR 2·64 [95% CI 1·56–4·46] during the anniversary month; 2·21 [1·25–3·89] for the subsequent month; and for suicide-related behaviour: 3·18 [1·32–7·66] for the subsequent month). Among female participants, an increased risk of substance use disorder recurred around every year consistently in the month before the anniversary of the death and there was an increased risk for suicide-related behaviour in the months of the first and second anniversaries.

Interpretation

Although effect sizes were large in this cohort study, the number of individuals who had the outcomes was small. Nevertheless, adolescents and young adults, especially women and girls, who had the death of a parent showed increased risk of substance use disorder and suicide-related behaviour around the first few death anniversaries. Adolescents and young adults, especially women and girls, who had the death of a parent could benefit from preventive measures to reduce distress around the first few years of death anniversaries.

Funding

Swedish Research Council.

中文翻译：

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父母死亡日期及其纪念日前后的物质使用障碍和自杀相关行为：一项基于登记的队列研究

背景

父母去世及其纪念日，包括对这些日期的预期，可能会导致痛苦，并增加失去亲人的青少年和年轻人出现物质使用障碍和自杀相关行为的风险。我们检查了物质使用障碍和自杀相关行为的风险是否在父母死亡日期和随后的周年纪念日前后增加。

方法

使用瑞典国家登记册，我们对 12-24 岁的个体进行了队列研究。我们纳入了 2001 年 1 月 1 日至 2014 年 12 月 31 日期间 12-24 岁的个体，其父母在入境时还活着（n=1 858 327），并对其进行随访直至 24 岁。我们排除了具有同父异母兄弟姐妹、有移民史、先前的结果事件记录、进入研究前父母死亡、随访期间同一天有两次父母死亡或相关变量数据缺失的个体。随访于结果事件当天或 2014 年 12 月 31 日结束；25 岁时，移民或死亡；或第二次父母去世前一年。我们分别研究了物质使用障碍和与自杀相关的行为结果，并在两种结果中都包括了非致命和致命事件。我们使用 Cox 回归来估计风险比 (HR)，控制基线精神病学、人口统计和社会经济特征。父母死亡被建模为 72 个月内随时间变化的暴露，从父母死亡前 1 年开始，到第 5 年和死亡后。未测量的混杂因素也在使用案例交叉设计的个体内比较中得到解决。

发现

在随访期间（中位数 7·5 [IQR 4·3–10·6] 年），共有 42 854 起物质使用障碍事件，粗略率为每 1000 人年 3·1 起。对于与自杀相关的行为，有 19 827 起事件，粗略率为每 1000 人年 1·4 起。所研究的大多数事件都是非致命的。在父母死亡当月，男性参与者物质使用障碍风险的 HR 为 1·89（95% CI 1·07-3·33），而自杀相关行为的 HR 为 3·76（1·79 –7·89) 男性参与者和 2·90 (1·61–5·24) 女性参与者。在男性参与者中，一周年左右的风险增加（物质使用障碍：一周年期间 HR 2·64 [95% CI 1·56–4·46]；2·21 [1·25–3·89 ] 下个月；以及与自杀相关的行为：下个月 3·18 [1·32–7·66]）。在女性参与者中，

解释

尽管该队列研究中的效应量很大，但获得结果的个体数量很少。然而，父母去世的青少年和年轻人，尤其是妇女和女孩，在最初的几个死亡纪念日前后表现出物质使用障碍和自杀相关行为的风险增加。父母去世的青少年和年轻人，尤其是妇女和女孩，可以从预防措施中受益，以减少在死亡纪念日前后的痛苦。

资金

瑞典研究委员会。