May 29, 2014 -- The sudden loss of a loved one can trigger a variety of psychiatric disorders in people with no history of mental illness, according to researchers at Columbia University's Mailman School of Public Health and colleagues at Columbia's School of Social Work and Harvard Medical School. While previous studies have suggested there is a link between sudden bereavement and an onset of common psychiatric disorders, this is the first study to show the association of acute bereavement and mania in a large population sample. Findings are published online in the American Journal of Psychiatry.
In people aged 30 years or older, the unexpected death of a loved one roughly doubled the risk for new-onset mania after controlling for prior psychiatric diagnoses, other traumatic experiences, and certain demographic variables like sex, race, income, education, and marital status. For those <50 years of age or ≥70 years, the risk increase was more than fivefold. There was no significant effect in people younger than 30 years.
The researchers analyzed data from 27,534 participants in the National Epidemiologic Survey on Alcohol and Related Conditions. Between about 20% and 30% of these participants identified the unexpected death of a loved one as the most traumatic event in their lives. This was still the case among those reporting 11 or more lifetime traumatic events, where losing a loved one unexpectedly was most traumatic for 22%.
"Our findings should alert clinicians to the possible onset of a wide range of psychiatric disorders, including disorders such as mania, after an unexpected death in otherwise healthy individuals," says Katherine Keyes, PhD, assistant professor of Epidemiology at the Mailman School of Public Health, and principal investigator. "However, it is also notable that the majority of individuals in the present study did not develop mental health issues in the wake of an unexpected death of a loved one."
Losing a loved one suddenly also raised the risk of major depression, excessive use of alcohol, and anxiety disorders, including panic disorder, post-traumatic stress disorder, and phobias. The largest risk increases were for post-traumatic stress disorder, which was seen across age groups with an increased risk as high as 30-fold. Most other disorders were concentrated in the older age groups.
While developing a psychiatric disorder for the first time in old age is relatively rare, these data indicate that psychiatric disorder onset in older age is commonly associated with the death of a loved one, according to the authors.
"Clinically, our results highlight the importance of considering a possible role for loss of close personal relationships through death in assessment of psychiatric disorders. When someone loses a close personal relationship, even late in life, there is a profound effect on sense of self and self reflection. These data indicate that, even in adults with no history of psychiatric disorders, it is also a vulnerable risk period for the onset of a potentially disabling psychiatric disorder," says Dr. Keyes.
Co-authors are Mailman School Department of Epidemiology's Charissa Pratt, MPH, and Sandro Galea, MD, DrPH; Katie A. McLaughlin, PhD, Harvard Medical School; Karestan C. Koenen, PhD, Mailman School Department of Epidemiology; and M. Katherine Shear, MD, Columbia School of Social Work.
Dr. Shear received a contract from Guilford Press to write a grief treatment manual. The other authors report no financial relationships with commercial interests.
This study was supported by NIMH grants MH-092526, MH-093612, MH-078928, MH-60783, MH-70741, and grant AA-021511 from the National Institute on Alcohol Abuse and Alcoholism.
About Columbia University's Mailman School of Public Health
Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP (formerly the International Center for AIDS Care and Treatment Programs) and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu
American Journal of Psychiatry