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Morbidity, mortality, and parental grief: A review of the literature on the relationship between the death of a child and the subsequent health of parents

  • Karrie Cummings Hendrickson (a1)



This review was undertaken to analyze the research to date and identify areas for future research regarding the associations between parental grief after the death of a child and the subsequent health of the parents, including both their mortality and morbidity risks.


Relevant literature was identified through a search of OVID-Medline, CINAHL, and PsycINFO using variations of the terms “parental grief and bereaved parents” combined with “health,” “illness,” “morbidity,” and “mortality.” Additionally, bibliographies of selected articles were reviewed to identify additional sources. The final sample includes 17 articles.


The literature search revealed a paucity of publications on the topic. However, it also showed that the studies that have been done examining the relationship between parental grief and health outcomes have produced conflicting results in almost every disease state examined. Additionally, several concerns with the quality of existing studies came to light that may bring their results into question. Three primary areas of concern surfaced including lack of consistency in measurement for psychological variables and “soft” self-report health outcomes, questionable methodologies in bereavement research in general, and the lack of a uniform definition of bereaved parents.

Significance of results:

Based on these findings, it is clear that more methodologically sound research is necessary to clarify the relationship between parental grief after the death of a child and the parents' subsequent morbidity and mortality risks.


Corresponding author

Address correspondence and reprint requests to: Karrie Hendrickson, 470 Prospect Street, #39, New Haven, CT 06511. E-mail:


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Arnold, J., Gemma, P.B., & Cushman, L.F. (2005). Exploring Parental Grief: Combining Quantitative and Qualitative Measures. Archives of Psychiatric Nursing, 19(6), 245255.
Baum, A. & Grunberg, N. (1995). Measurement of stress hormones. In Strategies for Measuring Stress in Studies of Psyciatric and Physical Disorders, Cohen, S., Kessler, R., & Gorden, U. (eds.), pp. 175192. New York: Oxford University Press.
Bedford, A. & Foulds, G. (1977). Validation of the Delusions-Symptoms-States Inventory. British Journal of Medical Psychology, 50(2), 163171.
Birenbaum, L.K., Stewart, B.J., & Phillips, D.S. (1996). Health status of bereaved parents. Nursing Research, 45(2), 105109.
Brazil, K., Bedard, M., & Willison, K. (2002). Correlates of health status for family caregivers in bereavement. Journal of Palliative Medicine, 5(6), 849855.
Carter, B.S., Howenstein, M., Gilmer, M.J., et al. (2004). Circumstances surrounding the deaths of hospitalized children: Opportunities for pediatric palliative care. Pediatrics, 114(3), e361e366.
Charlton, R., Sheahan, K., Smith, G., et al. (2001). Spousal bereavement—Implications for health. Family Practice, 18(6), 614618.
Christakis, N.A. & Iwashyna, T.J. (2003). The health impact of health care on families: A matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses. Social Science & Medicine, 57(3), 465475.
Clayton, P.J. (1973). The clinical morbidity of the first year of bereavement: A review. Comprehensive Psychiatry, 14(2), 151157.
Cohen, S., Kessler, R., & Gorden, U. (1995). Strategies for measuring stress in studies of psychiatric and physical disorders. In Measuring Stress, Cohen, S., Kessler, R., & Gorden, U. (eds.), pp. 326. New York: Oxford University Press.
Costa, B.M., Hall, L., & Stewart, J. (2007). Qualitative exploration of the nature of grief-related beliefs and expectations. Omega, 55(1), 2756.
Davies, R. (2004). New understandings of parental grief: Literature review. Journal of Advanced Nursing, 46(5), 506513.
Davies, D.E. (2006). Parental suicide after the expected death of a child at home. BMJ, 332(7542), 647648.
Dyregrov, A. & Matthiesen, S.B. (1991). Parental grief following the death of an infant--a follow-up over one year. Scandinavian Journal of Psychology, 32(3), 193207.
Dyregrov, K. (2004). Bereaved parents' experience of research participation. Social Science & Medicine, 58(2), 391400.
Fletcher, P.N. (2002). Experiences in family bereavement. Family & Community Health, 25(1), 5770.
Gilliss, C.L., Moore, I.M., & Martinson, I.M. (1997). Measuring parental grief after childhood cancer: Potential use of the SCL-90R. Death Studies, 21(3), 277287.
Goodenough, B., Drew, D., Higgins, S., et al. (2004). Bereavement outcomes for parents who lose a child to cancer: Are place of death and sex of parent associated with differences in psychological functioning? Psycho-Oncology, 13(11), 779791.
Hart, C.L., Hole, D.J., Lawlor, D.A., et al. (2007). Effect of conjugal bereavement on mortality of the bereaved spouse in participants of the Renfrew/Paisley Study. Journal of Epidemiology & Community Health, 61(5), 455460.
Hasui, C. & Kitamura, T. (2004). Aggression and guilt during mourning by parents who lost an infant. Bulletin of the Menninger Clinic, 68(3), 245259.
Hinds, P.S., Oakes, L.L., Hicks, J., et al. (2005). End-of-life care for children and adolescents. Seminars in Oncology Nursing, 21(1), 5362.
Hoyert, D.L., Hsiang-Ching, K., & Smith, B.L. (2005). Deaths: Preliminary data for 2003. National Vital Statistics Reports, 53(15), 148.
Imara, M. (1983). Growing Through Grief. In C. a. C. Corr, D. (Ed.), Hospice care: principles and practice. New York: Springer Publishing Company.
Institute of Medicine. (2004). When children die: Improving palliative and end-of-life care for children and their families. Washington, DC: Author.
Jacobs, S. & Ostfeld, A. (1977). An epidemiological review of the mortality of bereavement. Psychosomatic Medicine, 39(5), 344357.
Johnson, L.C., Murphy, S.A., & Dimond, M. (1996). Reliability, construct validity, and subscale norms of the Brief Symptom Inventory when administered to bereaved parents. Journal of Nursing Measurement, 4(2), 117127.
Koop, P.M. & Strang, V. (1997). Predictors of bereavement outcomes in families of patients with cancer: A literature review. Canadian Journal of Nursing Research, 29(4), 3350.
Kreicbergs, U., Valdimarsdottir, U., Onelov, E., et al. (2004). Anxiety and depression in parents 4–9 years after the loss of a child owing to a malignancy: A population-based follow-up. Psychological Medicine, 34(8), 14311441.
Kubler-Ross, E. (1969). On Death and Dying. New York: Macmillan.
Kvikstad, A. & Vatten, L.J. (1996). Risk and prognosis of cancer in middle-aged women who have experienced the death of a child. International Journal of Cancer, 67(2), 165169.
Laakso, H. & Paunonen-Ilmonen, M. (2002). Mothers' experience of social support following the death of a child. Journal of Clinical Nursing, 11(2), 176185.
Lang, A., Gottlieb, L.N., & Amsel, R. (1996). Predictors of husbands' and wives' grief reactions following infant death: The role of marital intimacy. Death Studies, 20(1), 3357.
Lang, A., Goulet, C., & Amsel, R. (2004). Explanatory model of health in bereaved parents post-fetal/infant death. International Journal of Nursing Studies, 41(8), 869880.
Levav, I., Friedlander, Y., Kark, J.D., et al. (1988). An epidemiologic study of mortality among bereaved parents. New England Journal of Medicine, 319(8), 457461.
Levav, I., Kohn, R., Iscovich, J., Abramson, J. H., Tsai, W. Y. & Vigdorovich, D. (2000). Cancer incidence and survival following bereavement. American Journal of Public Health, 90(10), 16011607.
Li, J., Hansen, D., Mortensen, P.B., et al. (2002 a). Myocardial infarction in parents who lost a child: A nationwide prospective cohort study in Denmark. Circulation, 106(13), 16341639.
Li, J., Johansen, C., Bronnum-Hansen, H., et al. (2004 a). The risk of multiple sclerosis in bereaved parents: A nationwide cohort study in Denmark. Neurology, 62(5), 726729.
Li, J., Johansen, C., Hansen, D., et al. (2002 b). Cancer incidence in parents who lost a child: A nationwide study in Denmark. Cancer, 95(10), 22372242.
Li, J., Johansen, C., & Olsen, J. (2003 a). Cancer survival in parents who lost a child: a nationwide study in Denmark. British Journal of Cancer, 88(11), 16981701.
Li, J., Johnsen, S.P., & Olsen, J. (2003 b). Stroke in parents who lost a child: A nationwide follow-up study in Denmark. Neuroepidemiology, 22(3), 211216.
Li, J., Norgard, B., Precht, D.H., et al. (2004 b). Psychological stress and inflammatory bowel disease: A follow-up study in parents who lost a child in Denmark. American Journal of Gastroenterology, 99(6), 11291133.
Martinson, I.M., Davies, B. & McClowry, S. (1991). Parental depression following the death of a child. Death Studies, 15(3), 259267.
McAliley, L.G., Hudson-Barr, D.C., Gunning, R.S., et al. (2000). The use of advance directives with adolescents. Pediatric Nursing, 26(5), 471480.
McClowry, S.G., Davies, E.B., May, K.A., et al. (1987). The empty space phenomenon: The process of grief in the bereaved family. Death Studies, 11(5), 361374.
McCorkle, R., Robinson, L., Nuamah, I., et al. (1998). The effects of home nursing care for patients during terminal illness on the bereaved's psychological distress. Nursing Research, 47(1), 210.
Middleton, W., Raphael, B., Burnett, P., et al. (1998). A longitudinal study comparing bereavement phenomena in recently bereaved spouses, adult children and parents. Australian & New Zealand Journal of Psychiatry, 32(2), 235241.
Murphy, S.A., Lohan, J., Braun, T., et al. (1999). Parents' health, health care utilization, and health behaviors following the violent deaths of their 12- to 28-year-old children: A prospective longitudinal analysis. Death Studies, 23(7), 589616.
Murphy, S.A., Tapper, V.J., Johnson, L.C., et al. (2003). Suicide ideation among parents bereaved by the violent deaths of their children. Issues in Mental Health Nursing, 24(1), 525.
Neidig, J.R. & Dalgas-Pelish, P. (1991). Parental grieving and perceptions regarding health care professionals' interventions. Issues in Comprehensive Pediatric Nursing, 14(3), 179191.
Ott, C.H., Lueger, R.J., Kelber, S.T., et al. (2007). Spousal bereavement in older adults: Common, resilient, and chronic grief with defining characteristics. Journal of Nervous & Mental Disease, 195(4), 332341.
Parkes, C.M. (1998). Bereavement: Studies of Grief in Adult Life. New York: International Universities Press.
Phillips, A.C., Carroll, D., Burns, V.E., et al. (2006). Bereavement and marriage are associated with antibody response to influenza vaccination in the elderly. Brain, Behavior, & Immunity, 20(3), 279289.
Prigerson, H.G., Bierhals, A.J., Kasl, S.V., et al. (1997). Traumatic grief as a risk factor for mental and physical morbidity. American Journal of Psychiatry, 154(5), 616623.
Prigerson, H.G., Maciejewski, P.K., & Rosenheck, R.A. (2000). Preliminary explorations of the harmful interactive effects of widowhood and marital harmony on health, health service use, and health care costs. Gerontologist, 40(3), 349357.
Qin, P. & Mortensen, P.B. (2003). The impact of parental status on the risk of completed suicide. Archives of General Psychiatry, 60(8), 797802.
Rallison, L. & Moules, N.J. (2004). The unspeakable nature of pediatric palliative care: Unveiling many cloaks. Journal of Family Nursing, 10(3), 287301.
Romesberg, T.L. (2004). Understanding grief: A component of neonatal palliative care. Journal of Hospice and Palliative Nursing, 6(3), 161170.
Rubin, S.S. (1993). The death of a child is forever: The life course impact of child loss. New York, NY: Cambridge University Press.
Rubin, S.S. (1999). The two-track model of bereavement: Overview, retrospect, and prospect. Death Studies, 23(8), 681714.
Sanders, C.M. (1979). A comparison of adult bereavement in the death of a spouse, child, and parent. Omega, 10(4), 303322.
Schulz, R., Beach, S.R., Lind, B., et al. (2001). Involvement in caregiving and adjustment to death of a spouse: Findings from the caregiver health effects study. JAMA, 285(24), 31233129.
Seecharan, G.A., Andresen, E.M., Norris, K., et al. (2004). Parents' assessment of quality of care and grief following a child's death. Archives of Pediatrics & Adolescent Medicine, 158(6), 515520.
Sirki, K., Saarinen-Pihkala, U.M., & Hovi, L. (2000). 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 Paediatrica, 89(6), 717721.
Talbot, K. (1996). Transcending a devastating loss: The life attitude of mothers who have experienced the death of their only child. Hospice Journal, 11(4), 6782.
Theut, S.K., Pedersen, F.A., Zaslow, M.J., et al. (1989). Perinatal loss and parental bereavement. American Journal of Psychiatry, 146, 635639.
Vance, J.C., Najman, J.M., Boyle, F.M., et al. (1994). Alcohol and drug usage in parents soon after stillbirth, neonatal death or SIDS. Journal of Paediatrics & Child Health, 30(3), 269272.
Vance, J.C., Najman, J.M., Thearle, M.J., et al. (1995). Psychological changes in parents eight months after the loss of an infant from stillbirth, neonatal death, or sudden infant death syndrome—A longitudinal study. Pediatrics, 96(5), 933938.
Woolley, M.M. (1997). The death of a child—The parent's perspective and advice. Journal of Pediatric Surgery, 32(1), 7374.
Zisook, S., Chentsova-Dutton, Y., & Shuchter, S.R. (1998). PTSD following bereavement. Annals of Clinical Psychiatry, 10(4), 157163.
Znoj, H. & Keller, D. (2002). Mourning parents: Considering safeguards and their relation to health. Death Studies, 26(7), 545565.



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