Serious Mental Illness Exacerbation Post-Bereavement: A Population-Based Study of Partners and Adult Children

Djin L Tay,1 Lau C Thygesen,2 Elissa Kozlov,3 Katherine A Ornstein4 1College of Nursing, University of Utah, Salt Lake City, UT, USA; 2National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; 3Department of Health Behavior, Society and Policy, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA; 4School of Nursing, Johns Hopkins University, Baltimore, MD, USACorrespondence: Djin L Tay, College of Nursing, University of Utah, 10S 2000 E, Salt Lake City, UT, 84112, USA, Tel +1 801-882-3037, Email Djin.Tay@nurs.utah.eduPurpose: The death of a close family member is commonly accompanied by intense grief, stress, and loss of social support. We hypothesized that recent bereavement would be associated with an increase in symptom exacerbations among adults with serious mental illness (SMI) whose partners or parents had died.Patients and Methods: Adults whose partners and parents had died in Denmark between January 1, 2010, and June 30, 2016, were identified using linked population-based registries. History of SMI was defined as having a diagnosis of schizophrenia and schizoaffective disorders, major depression, and bipolar disorder in the five years preceding their family member’s death in the Danish Psychiatric Central Research Register using International Classification of Diseases-10 codes. The odds of SMI exacerbation (ie, attempt or completion of suicide or psychiatric hospitalization) among partners and children in the first two years after death in 3-month intervals were estimated with generalized estimating equations.Results: 12.8% of partners and 15.0% of adult children with a history of SMI experienced any SMI exacerbation two years after bereavement. Among bereaved partners, older age (80+ years) was associated with a lower risk of experiencing an SMI exacerbation compared with partners aged 18– 49 years (ORadj=0.29, [0.18– 0.45]). Partners with a history of SMI had significantly increased odds of SMI exacerbations three months after their partners’ death compared to prior to their partners’ death (ORadj = 1.43, [1.13– 1.81]). There was no evidence that adult children with SMI experience increased SMI exacerbations after the death of their parents compared to prior to death.Conclusion: Adults with a history of SMI whose partners had died are at increased risk for an SMI exacerbation post bereavement. Additional bereavement resources and support should be provided to those with a history of SMI, especially in the period immediately after death.Keywords: severe mental disorders, bereavement, population register, suicide, emergency psychiatric services