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Risk of Parental Dissolution of Partnership Following the Loss of a Child to Cancer: A Population-Based Long-term Follow-up

Risk of Parental Dissolution of Partnership Following the Loss of a Child to Cancer: A... A common belief is that bereaved parents are more likely to separate than others, but previous research has been unable to settle this issue owing to conflicting findings.1,2 Parents of a child with cancer are at increased risk of psychological distress3 and possibly also marital strain.4,5 Sirki et al5 studied parents who lost a child during active cancer treatment or terminal care and found that divorce was significantly more common among couples with a child in terminal care compared with a child in active cancer therapy. No conclusive studies on long-term marital status in parents having lost a child to cancer have been conducted. Therefore, we assessed parental dissolution of a partnership 4 to 9 years following the loss of a child to cancer compared with parents from the general population. Methods We identified 368 children in the Swedish National Register of Causes of Death linked to the Swedish Population Register of Cancer. All children had malignancies diagnosed before the age of 17 years and had died before the age of 25 years from 1992 to 1997. The children's parents were identified in the Swedish Population Register. Parents were eligible if they were the guardians of the child, born in any of the Nordic countries, had a listed telephone number, and understood Swedish. Parents with a living child matched for a deceased child's date of birth, sex, and region of residence were identified from the general population and served as controls. We found 561 bereaved and 659 control parents who met the inclusion criteria. An introduction letter was mailed to mothers and fathers separately. After the parents agreed to participate, an anonymous questionnaire was sent to them in the mail. Parents chose one of the following responses to the prompt “Are you currently . . . ”: (1) “married to/or living together with your (deceased/living) child's other parent,” (2) “married to/or living together with someone else,” (3) “single and living alone in a partner relationship,” or (4) “single, living alone.” Version 17 of SPSS (SPSS Inc, Chicago, Illinois) was used. The ethics committee of the Karolinska Institute approved the study. Results Of 561 bereaved parents, 449 participated (80%), and of 659 parents with a matched living child, 457 participated (69%). There were 112 (20%) and 202 (31%) nonrespondents, respectively. Most parents responded to the questions about marital status: 442 of 449 (98%) in the bereaved group and 452 of 457 (99%) among the controls. Demographic factors were similarly distributed between the groups, except for age (Table). At follow-up, 329 of the bereaved parents (74%) were married to or living with the child's other parent compared with 312 of the controls (68%). Among the bereaved parents, 11 (3%) had lost an additional child and 89 (27%) had lost a parent. Among the controls, 19 (6%) reported that they had lost a child, 94 (30%) a parent. Bereaved parents were found to be significantly more likely than controls to be married to or living with their child's other parent (relative risk, 1.1; 95% confidence interval, 1.0-1.1; age-adjusted relative risk, 1.1; 95% confidence interval, 1.0-1.1). Table. View LargeDownload Characteristics of Parents Comment This article does not support the prevailing notion that dissolution of partnership is more likely among parents who have lost a child to cancer than others. The strength of this study is its nationwide sample of parents, population-based control group, and high response rate. Still, there are limitations, such as the lack of information on when parents got married or began living together. Nonetheless, we believe our findings will permit the conclusion that parents who have lost a child to cancer are not more likely to separate than others. Correspondence: Ms Eilegård, Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Karolinska Hospital, Bldg Z5:U1, 171 76 Stockholm, Sweden (alexandra.eilegard@ki.se). Author Contributions:Study concept and design: Eilegård and Kreicbergs. Acquisition of data: Kreicbergs. Analysis and interpretation of data: Kreicbergs. Drafting of the manuscript: Eilegård and Kreicbergs. Critical revision of the manuscript for important intellectual content: Eilegård and Kreicbergs. Obtained funding: Kreicbergs. Administrative, technical, and material support: Eilegård and Kreicbergs. Study supervision: Kreicbergs. References 1. Shudy Mde Almeida MLLy S et al. Impact of pediatric critical illness and injury on families: a systematic literature review. Pediatrics 2006;118 ((suppl 3)) S203- S218PubMedGoogle ScholarCrossref 2. Rogers CHFloyd FJSeltzer MMGreenberg JHong J Long-term effects of the death of a child on parent's adjustment in midlife. J Fam Psychol 2008;22 (2) 203- 211PubMedGoogle ScholarCrossref 3. Kreicbergs UValdimarsdottir UOnelöv EHenter JLSteineck G Anxiety and depression in parents 4-9 years after the loss of a child owing to a malignancy: a population-based follow-up. Psychol Med 2004;34 (8) 1431- 1441PubMedGoogle ScholarCrossref 4. Grootenhuis MALast BF Adjustment and coping by parents of children with cancer: a review of the literature. Support Care Cancer 1997;5 (6) 466- 484PubMedGoogle ScholarCrossref 5. Sirki KSaarinen-Pihkala UMHovi L Coping of parents and siblings with the death of a child with cancer: death after terminal care compared with death during active anticancer therapy. Acta Paediatr 2000;89 (6) 717- 721PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Risk of Parental Dissolution of Partnership Following the Loss of a Child to Cancer: A Population-Based Long-term Follow-up

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Publisher
American Medical Association
Copyright
Copyright © 2010 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpediatrics.2009.247
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Abstract

A common belief is that bereaved parents are more likely to separate than others, but previous research has been unable to settle this issue owing to conflicting findings.1,2 Parents of a child with cancer are at increased risk of psychological distress3 and possibly also marital strain.4,5 Sirki et al5 studied parents who lost a child during active cancer treatment or terminal care and found that divorce was significantly more common among couples with a child in terminal care compared with a child in active cancer therapy. No conclusive studies on long-term marital status in parents having lost a child to cancer have been conducted. Therefore, we assessed parental dissolution of a partnership 4 to 9 years following the loss of a child to cancer compared with parents from the general population. Methods We identified 368 children in the Swedish National Register of Causes of Death linked to the Swedish Population Register of Cancer. All children had malignancies diagnosed before the age of 17 years and had died before the age of 25 years from 1992 to 1997. The children's parents were identified in the Swedish Population Register. Parents were eligible if they were the guardians of the child, born in any of the Nordic countries, had a listed telephone number, and understood Swedish. Parents with a living child matched for a deceased child's date of birth, sex, and region of residence were identified from the general population and served as controls. We found 561 bereaved and 659 control parents who met the inclusion criteria. An introduction letter was mailed to mothers and fathers separately. After the parents agreed to participate, an anonymous questionnaire was sent to them in the mail. Parents chose one of the following responses to the prompt “Are you currently . . . ”: (1) “married to/or living together with your (deceased/living) child's other parent,” (2) “married to/or living together with someone else,” (3) “single and living alone in a partner relationship,” or (4) “single, living alone.” Version 17 of SPSS (SPSS Inc, Chicago, Illinois) was used. The ethics committee of the Karolinska Institute approved the study. Results Of 561 bereaved parents, 449 participated (80%), and of 659 parents with a matched living child, 457 participated (69%). There were 112 (20%) and 202 (31%) nonrespondents, respectively. Most parents responded to the questions about marital status: 442 of 449 (98%) in the bereaved group and 452 of 457 (99%) among the controls. Demographic factors were similarly distributed between the groups, except for age (Table). At follow-up, 329 of the bereaved parents (74%) were married to or living with the child's other parent compared with 312 of the controls (68%). Among the bereaved parents, 11 (3%) had lost an additional child and 89 (27%) had lost a parent. Among the controls, 19 (6%) reported that they had lost a child, 94 (30%) a parent. Bereaved parents were found to be significantly more likely than controls to be married to or living with their child's other parent (relative risk, 1.1; 95% confidence interval, 1.0-1.1; age-adjusted relative risk, 1.1; 95% confidence interval, 1.0-1.1). Table. View LargeDownload Characteristics of Parents Comment This article does not support the prevailing notion that dissolution of partnership is more likely among parents who have lost a child to cancer than others. The strength of this study is its nationwide sample of parents, population-based control group, and high response rate. Still, there are limitations, such as the lack of information on when parents got married or began living together. Nonetheless, we believe our findings will permit the conclusion that parents who have lost a child to cancer are not more likely to separate than others. Correspondence: Ms Eilegård, Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Karolinska Hospital, Bldg Z5:U1, 171 76 Stockholm, Sweden (alexandra.eilegard@ki.se). Author Contributions:Study concept and design: Eilegård and Kreicbergs. Acquisition of data: Kreicbergs. Analysis and interpretation of data: Kreicbergs. Drafting of the manuscript: Eilegård and Kreicbergs. Critical revision of the manuscript for important intellectual content: Eilegård and Kreicbergs. Obtained funding: Kreicbergs. Administrative, technical, and material support: Eilegård and Kreicbergs. Study supervision: Kreicbergs. References 1. Shudy Mde Almeida MLLy S et al. Impact of pediatric critical illness and injury on families: a systematic literature review. Pediatrics 2006;118 ((suppl 3)) S203- S218PubMedGoogle ScholarCrossref 2. Rogers CHFloyd FJSeltzer MMGreenberg JHong J Long-term effects of the death of a child on parent's adjustment in midlife. J Fam Psychol 2008;22 (2) 203- 211PubMedGoogle ScholarCrossref 3. Kreicbergs UValdimarsdottir UOnelöv EHenter JLSteineck G Anxiety and depression in parents 4-9 years after the loss of a child owing to a malignancy: a population-based follow-up. Psychol Med 2004;34 (8) 1431- 1441PubMedGoogle ScholarCrossref 4. Grootenhuis MALast BF Adjustment and coping by parents of children with cancer: a review of the literature. Support Care Cancer 1997;5 (6) 466- 484PubMedGoogle ScholarCrossref 5. Sirki KSaarinen-Pihkala UMHovi L Coping of parents and siblings with the death of a child with cancer: death after terminal care compared with death during active anticancer therapy. Acta Paediatr 2000;89 (6) 717- 721PubMedGoogle ScholarCrossref

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Jan 4, 2010

Keywords: cancer,child,follow-up,parent,dissolution

References