The death of a child is one of the most life-changing events parents can experience. The grief reactions are often both intense and long-lasting. New research shows, however, that the effects can be physical. Parents experiencing the death of a child have a 35% higher risk of heart failure than those without this adverse experience. The researchers think that stress-related mechanisms probably contribute to the increased risk of heart failure.
A catastrophe rated 6 on a 6-point scale. This is how severe the stress of experiencing one’s child die is. The grief reactions such as anxiety, anger and despair caused by this are well known, as are mental and behavioural manifestations such as depression and substance abuse. The fact that a child’s death is also associated with an increased risk of heart failure among parents had never been documented until researchers examined population data covering about 130,000 parents in Denmark and Sweden whose child unexpectedly died between 1973 and 2016. Heart failure means that the heart cannot pump enough blood to meet the person’s needs.
“Parents whose child died had a 35% increased risk of heart failure. Parents with no remaining children at the time of the loss and those with more than two surviving children had higher risks than those with one or two surviving children. The relative risk of heart failure also appears to be unchanged over time. So it is important to be aware of the increased risk – not just immediately after the child’s death – but also long term,” explains the main author, Dang Wei, PhD student at the Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
U-shaped associations
The population-based cohort study used linkage between the Danish Medical Birth Registry (1973–2016), the Swedish Medical Birth Registry (1973–2014) and several other population-based registries, which enabled the researchers to analyse data from 6.7 million parents of live-born children. Of these, the 129,829 parents (1.9%) who experienced at least one child dying during follow-up had a 35% higher risk of heart failure than other parents.
“We found that this increased risk applies regardless of whether the child died from cardiovascular or other natural causes or from unnatural external causes such as accidents. The increased risk of heart failure among parents does not seem to be explained by a family history of cardiovascular disease,” says Dang Wei.
The researchers found two U-shaped curves. The first was related to the age of the child who died, with parents who lost an infant and parents whose children died after reaching adulthood having greater risks of heart failure than those with a non-infant child dying.
“The slightly stronger association observed for infants dying compared with older children might be attributed to pregnancy complications, which are likely to increase both the risks of infant mortality and of a mother developing cardiovascular disease. The stronger ties to older children and the need to care for grandchildren whose parent has died may explain the stronger associations with the loss of an adult child,” explains Dang Wei.
The researchers found another U-shaped association related to how many surviving children the parents had at the time of the loss. Parents with one or two surviving children had the least increased risk of heart failure, whereas parents with either three or more or no surviving children had the greatest risk.
“The death of the only child can be especially stressful, since it deprives the affected parents of their role as parents. Having three or more surviving children after the loss can be associated with high stress because of the difficulties in combining coping with their own grief and caring for and supporting several grieving children,” says last author Krisztina László, Associate Professor of Epidemiology, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Greater awareness required
Although the researchers cannot conclude about the exact mechanisms behind the trends based on the study data, they interpret them as a possible sign that the mental stress of a child dying increases the risk of heart failure among the parents.
“Prolonged stress involves the activation and the dysregulation of the hypothalamus-pituitary-adrenal axis and the autonomic nervous system and may induce adverse changes in mental health and lifestyle. These changes may contribute to the development of and may worsen the prognosis of hypertension, coronary heart disease or atrial fibrillation, which are well-known risk factors for or causes of heart failure. Further studying the underlying mechanisms for the observed associations would be important,” explains Krisztina László.
Previous studies on the effects of the death of a spouse or partner have shown similar and even more marked associations, generally with mortality or other cardiovascular diseases. Heart failure represents an important public health concern and affects more than 60 million individuals worldwide. Despite significant advances in treatment, mortality from heart failure continues to be very high. One in 20 die after one month and almost half do not survive for 5 years.
“Bereaved parents and their environment might find it important to know about the potential health effects of their loss, including the risk of cardiovascular diseases. Some bereaved parents may be very much immersed in their grief and may have difficulty in paying attention to health behaviour, seeking care for mental ill health, participating in regular health check-ups or noticing certain cardiac symptoms. Support from family, friends and health professionals is important, because they can encourage the bereaved parents to pay attention to these factors and to double-check early with a doctor any symptoms of cardiovascular disease,” concludes Krisztina László.
