Childhood Bereavement and Lower Stress Resilience in Late Adolescence

doi:10.1016/j.jadohealth.2018.02.002

Journal of Adolescent Health

Volume 63, Issue 1, July 2018, Pages 108-114

https://doi.org/10.1016/j.jadohealth.2018.02.002 Get rights and content

Abstract

Purpose

Although childhood traumatic experiences are recognized as important determinants for adolescent psychiatric health in general, our objective was to explore the specific influence of childhood bereavement on the stress resilience development trajectory.

Methods

In this national register-based cohort study, we identified 407,639 men born in Sweden between 1973 and 1983, who underwent compulsory military enlistment examinations in late adolescence, including measures of psychological stress resilience. We defined exposure as loss of a first-degree family member in childhood, and estimated relative risk ratios (RRRs) for reduced (moderate or low), compared with high, stress resilience with 95% confidence intervals (CIs) using multinomial logistic regression.

Results

Loss of a parent or sibling in childhood conferred a 49% increased risk of subsequent low stress resilience (RRR, 1.49, 95% CI, 1.41–1.57) and an 8% increased risk of moderate stress resilience (RRR, 1.08, 95% CI, 1.03–1.13) in late adolescence. There was also a graded increase in risk with increasing age at loss; teenagers were at higher risk for low resilience (RRR, 1.64, 95% CI, 1.52–1.77) than children aged 7–12 (RRR, 1.47, 95% CI, 1.34–1.61) and ≤6 years (RRR, 1.16 95% CI, 1.02–1.32). The excess risk was observed for all causes of death, including suicide and unexpected deaths as well as deaths due to other illnesses. The associations remained after exclusion of parents with a history of hospitalization for psychiatric diagnoses.

Conclusions

The long-term consequences of childhood bereavement may include lower stress resilience in late adolescence.

Section snippets

National registers

All residents in Sweden have a unique National Registration Number, recorded at birth or immigration, which enables record linkages in national registers. We acquired birth date, sex, country of birth, and child-parent linkages from the Swedish Multi-Generation Register, socioeconomic information from The Education Register and the Swedish Population and Household Census, and data on birth variables from the Medical Birth Register. Date and causes of death were obtained from the Causes of Death

Results

The characteristics of the young men participating in the study are presented in Table 1. Overall, 21.6% were classified as having high stress resilience, 56.3% moderate stress resilience, and 22.1% low stress resilience. Men with low stress resilience were more likely to be underweight or obese, and perform poorer with regard to cognitive ability and physical fitness, compared with individuals with moderate or high stress resilience. A lower proportion of parents with university level

Discussion

In this large population-based study, based on prospectively collected data, we found an association between loss of a close relative in childhood and low stress resilience in late adolescence. We observed higher magnitude associations for losses occurring beyond preschool age, after loss of a father, and for losses caused by external causes (such as accidents and suicide). In contrast, no association was observed for children of women who experienced loss during pregnancy.

Overall, our results

Funding Sources

This work was supported by the Swedish Society for Medical Research (SSMF) and the Karolinska Institutet through a Research Associate Position and the Strategic Research Program in Epidemiology to F.F., and by a China Scholarship Council (No. 201206100002) to R.C. The funders have not had any role, neither in study design, in the collection, analysis, and interpretation of data, in the writing of the report, nor in the decision to submit the article for publication. All authors have worked

References (42)

E. Brann et al.
Declining well-being in young Swedes born in 1990 versus 1974
J Adolesc Health
(2017)
H.E. Stevens et al.
Risk and resilience: Early manipulation of macaque social experience and persistent behavioral and neurophysiological outcomes
J Am Acad Child Adolesc Psychiatry
(2009)
N.P. Daskalakis et al.
The three-hit concept of vulnerability and resilience: Toward understanding adaptation to early-life adversity outcome
Psychoneuroendocrinology
(2013)
N.M. Bosch et al.
Timing matters: Long term effects of adversities from prenatal period up to adolescence on adolescents' cortisol stress response. The TRAILS study
Psychoneuroendocrinology
(2012)
J. Robertson et al.
Mental disorders and stress resilience in adolescence and long-term risk of early heart failure among Swedish men
Int J Cardiol
(2017)
C. Heim et al.
The role of childhood trauma in the neurobiology of mood and anxiety disorders: Preclinical and clinical studies
Biol Psychiatry
(2001)
J. Dray et al.
Systematic review of universal resilience-focused interventions targeting child and adolescent mental health in the school setting
J Am Acad Child Adolesc Psychiatry
(2017)
M. Rutter
Implications of resilience concepts for scientific understanding
Ann N Y Acad Sci
(2006)
G.A. Bonanno
Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events?
Am Psychol
(2004)
LongE.C. et al.
Resilience and risk for alcohol use disorders: A Swedish twin study
Alcohol Clin Exp Res
(2017)

P.M. Nilsson et al.

Fetal growth predicts stress susceptibility independent of parental education in 161991 adolescent Swedish male conscripts

J Epidemiol Community Health

(2004)

J.P. Shonkoff et al.

Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention

JAMA

(2009)

B.S. McEwen

In pursuit of resilience: Stress, epigenetics, and brain plasticity

Ann N Y Acad Sci

(2016)

E.P. Espejo et al.

Stress sensitization and adolescent depressive severity as a function of childhood adversity: A link to anxiety disorders

J Abnorm Child Psychol

(2007)

C. Hammen et al.

Depression and sensitization to stressors among young women as a function of childhood adversity

J Consult Clin Psychol

(2000)

K.S. Kendler et al.

Childhood sexual abuse, stressful life events and risk for major depression in women

Psychol Med

(2004)

K.A. McLaughlin et al.

Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: A test of the stress sensitization hypothesis in a population-based sample of adults

Psychol Med

(2010)

G. Bandoli et al.

Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: A test of the stress sensitization hypothesis

Psychol Med

(2017)

E.E. Werner

What can we learn about resilience from large-scale longitudinal studies?

L. Berg et al.

Parental death during childhood and depression in young adults—a national cohort study

J Child Psychol Psychiatry

(2016)

M. Rostila et al.

Experience of sibling death in childhood and risk of death in adulthood: A national cohort study from Sweden

Am J Epidemiol

(2017)

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: Conflicts of Interest: The authors have no conflicts of interest to disclose.

: Author Contributions: All authors together developed the study concept, participated in the design of the study, interpreted the data, critically revised the manuscript for intellectual content, and approved the final version. B.K. acquired ethical permission together with K.F., reviewed the literature, and wrote the initial draft. R.C. performed the statistical analysis. K.F. and F.F. supervised the project. B.K. and R.C. are equal contributors.

: Poster Presentation: The abstract was presented at the 2017 Annual Meeting for the American Psychosomatic Society in March 2017, Sevilla, Spain.

¹: These authors contributed equally to this work.

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Original articleChildhood Bereavement and Lower Stress Resilience in Late Adolescence

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

National registers

Results

Discussion

Funding Sources

J Adolesc Health

J Am Acad Child Adolesc Psychiatry

Psychoneuroendocrinology

Psychoneuroendocrinology

Int J Cardiol

Biol Psychiatry

J Am Acad Child Adolesc Psychiatry

Implications of resilience concepts for scientific understanding

Ann N Y Acad Sci

Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events?

Am Psychol

Resilience and risk for alcohol use disorders: A Swedish twin study

Alcohol Clin Exp Res

Fetal growth predicts stress susceptibility independent of parental education in 161991 adolescent Swedish male conscripts

J Epidemiol Community Health

Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention

JAMA

In pursuit of resilience: Stress, epigenetics, and brain plasticity

Ann N Y Acad Sci

Stress sensitization and adolescent depressive severity as a function of childhood adversity: A link to anxiety disorders

J Abnorm Child Psychol

Depression and sensitization to stressors among young women as a function of childhood adversity

J Consult Clin Psychol

Childhood sexual abuse, stressful life events and risk for major depression in women

Psychol Med

Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: A test of the stress sensitization hypothesis in a population-based sample of adults

Psychol Med

Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: A test of the stress sensitization hypothesis

Psychol Med

What can we learn about resilience from large-scale longitudinal studies?

Parental death during childhood and depression in young adults—a national cohort study

J Child Psychol Psychiatry

Experience of sibling death in childhood and risk of death in adulthood: A national cohort study from Sweden

Am J Epidemiol

Original article
Childhood Bereavement and Lower Stress Resilience in Late Adolescence