Unresolved grief and its consequences. A nationwide follow-up of teenage loss of a parent to cancer 6–9 years earlier
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The early loss of a parent is a tragedy and a serious life event. This study investigated grief resolution and morbidity in cancer-bereaved teenagers 6 to 9 years after the loss of a parent to cancer.
In a nationwide population-based study of 622 of 851 (73 %) youths who as teenagers 6 to 9 years earlier had lost a parent to cancer, we explored the magnitude of unresolved grief and its association with psychological and physiological morbidity. Participants answered a study-specific anonymous questionnaire including questions about if they had worked through their grief and about their current health.
Six to nine years post-loss 49 % reported unresolved grief (8 % no and 41 % a little grief resolution). They had, in comparison with youths reporting resolved grief, statistically significantly elevated risks, e.g. for insomnia (sons’ relative risk (RR) 2.3, 95 % CI 1.3–4.0; daughters’ RR 1.7, 95 % CI 1.1–2.7), fatigue (sons’ RR 1.8, 95 % CI 1.3–2.5; daughters’ RR 1.4, 95 % CI 1.1–1.7) and moderate to severe depression, i.e. score >9, PHQ-9 (sons’ RR 3.6, 95 % CI 1.4–8.8; daughters’ RR 1.8, 95 % CI 1.1–3.1). Associations remained for insomnia in sons, exhaustion in daughters and fatigue in both sons and daughters when depression, negative intrusive thoughts and avoiding reminders of the parents’ disease or death were included in a model.
Approximately half of cancer-bereaved youth report no or little grief resolution 6 to 9 years post-loss, which is associated with fatigue, sleeping problems and depressive symptoms.
KeywordsGrief Bereavement Adolescents Young adults Cancer Depression Insomnia
Patient Health Questionnaire
Complicated grief inventory
We thank Else Lundin and Susanne Castells for the assistance with data collection, Lawrence Lundgren for the language review and all cancer-bereaved youth for sharing their experiences with us.
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. Ethical approval was obtained from the Regional Ethics Review Board, Karolinska Institute and all participants provided informed consent.
This work was supported by the Swedish Research Council (grant number 2008–4428) and the Gålö Foundation.
Conflict of interest
All authors have nothing to declare. All authors have full control over primary data.
- 1.Christ GH, Siegel K, Christ AE (2002) Adolescent grief: “It never really hit me...until it actually happened”. JAMA 288: 1269–1278Google Scholar
- 2.Stroebe W, Schut H (2001) Risk factors in bereavement outcome: a methodological and empirical review. In: Stroebe MS, Hansson RO, Stroebe W, Schut H (eds) Handbook of bereavement research: consequences, coping, and care. American Psychological Association, Washington, pp. 349–371CrossRefGoogle Scholar
- 9.Freud S (1961) Mourning and melancholia. In: Strachey J (ed) The standard edition of the complete psychological works of Sigmund Freud. Basic Books, New YorkGoogle Scholar
- 11.Bowlby J (1980) Loss: sadness and depression. Hogarth, LondonGoogle Scholar
- 12.Worden JW (2008) Grief counseling and grief therapy: a handbook for the mental health practitioner, 4th edn. Springer Publishing Company, New YorkGoogle Scholar
- 16.Parkes CM (1993) Bereavement. In: MacDonald N (ed) Derek Doyle GWCH. Oxford Textbook of Palliative Medicine. Oxford University Press, London, pp. 995–1012Google Scholar
- 20.Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, Goodkin K, Raphael B, Marwit SJ, Wortman C, Neimeyer RA, Bonanno G, Block SD, Kissane D, Boelen P, Maercker A, Litz BT, Johnson JG, First MB, Maciejewski PK (2009) Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Med 6:e1000121CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Worden JW, Silverman, P.R. (1996) Parental death and the adjustment of school-age children. Omega 33: 91–102Google Scholar