The sudden death of a parent appears to increase risk of depression and post-traumatic stress disorder both in children and their surviving caregivers, according to an article in the May issue of Archives of Pediatrics & Adolescent Medicine.

Risks for children were in comparison for risks for children with two living parents.

About 4 percent of children in Western countries experience the death of a parent, according to background information in the article. Parents who have psychiatric disorders, including mood disorders and substance abuse, are more likely to die from suicide, accidents and heart disease. The same psychiatric factors that increase parents' risk of sudden death also predispose their children to similar mental health problems.

Nadine M. Melhem, PhD, of the University of Pittsburgh School of Medicine, and colleagues identified 140 families in which one parent died of suicide, accident or sudden natural death. They were compared with 99 control families in which two parents were living and no first-degree relatives had died within the past two years. The children, ages 7 to 25 years, underwent interviews and assessments for psychiatric disorders, as well as a review of their parents' psychiatric history.

Children whose parents had died, along with their surviving caregivers, were at roughly three times higher risk for depression and post-traumatic stress disorder than those in control families. This association remained after controlling for psychiatric disorders in the deceased parent.

Children and caregivers in families where a parent had died of suicide were no more likely than those in families where a parent died of other causes to develop post-traumatic stress disorder or other psychiatric disorders. Children's symptoms of depression, anxiety, post-traumatic stress disorder, suicidal behavior and complicated grief were associated with similar symptoms in surviving caregivers.

"Our findings have important clinical and public health implications," the authors concluded. "The best way to attenuate the effect of parental bereavement among offspring is to prevent early death in their parents by improving the detection and treatment of bipolar illness, substance and alcohol abuse and personality disorders, and by addressing the lifestyle correlates of these illnesses that lead to premature death."

When parents die, surviving caregivers should be monitored for depression and post-traumatic stress disorder because their psychiatric health affects that of the children. "Given the increased risk of depression and post-traumatic stress disorder, bereaved offspring should be monitored and, if needed, referred and treated for their psychiatric disorder," the authors wrote. "Further studies are needed to examine the course and long-term effect of bereavement on offspring and their surviving caregivers, to test the mechanisms by which parental bereavement exerts these effects and to identify the subset of bereaved families who may require treatment, which can then frame targets for intervention and prevention efforts."