Originally published as JCO Early Release 10.1200/JCO.2007.14.6738 on November 24 2008

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Unresolved Grief in a National Sample of Bereaved Parents: Impaired Mental and Physical Health 4 to 9 Years Later

Patrizia K. Lannen, Joanne Wolfe, Holly G. Prigerson, Erik Onelov, Ulrika C. Kreicbergs

From the Phyllis F. Cantor Center; the Department of Psychooncology and Palliative Care Research; and the Department of Pediatric Oncology and the Center for Outcomes and Policy Research, Dana-Farber Cancer Institute; and the Department of Medicine, Children's Hospital, Boston, MA; the Department of Psychology, Universität Bern, Bern, Switzerland; the Division of Clinical Cancer Epidemiology; and the Department of Women and Child's Health, Karolinska Institutet, Stockholm, Sweden

Corresponding author: Patrizia Lannen, PhD, Institute of Social and Preventive Medicine, Universität Bern, 3012 Bern, Switzerland; e-mail: plannen{at}ispm.unibe.ch

Purpose To assess unresolved parental grief, the associated long-term impact on mental and physical health, and health service use.

Patients and Methods This anonymous, mail-in questionnaire study was performed as a population-based investigation in Sweden between August 2001 and October 2001. Four hundred forty-nine parents who lost a child as a result of cancer 4 to 9 years earlier completed the survey (response rate, 80%). One hundred ninety-one (43%) of the bereaved parents were fathers, and 251 (56%) were mothers. Bereaved parents were asked whether or not, and to what extent, they had worked through their grief. They were also asked about their physical and psychological well-being. For outcomes of interest, we report relative risk (RR) with 95% CIs as well as unadjusted odds ratios and adjusted odds ratios.

Results Parents with unresolved grief reported significantly worsening psychological health (fathers: RR, 3.6; 95% CI, 2.0 to 6.4; mothers: RR, 2.9; 95% CI, 1.9 to 4.4) and physical health (fathers: RR, 2.8; 95% CI, 1.8 to 4.4; mothers: RR, 2.3; 95% CI, 1.6 to 3.3) compared with those who had worked through their grief. Fathers with unresolved grief also displayed a significantly higher risk of sleep difficulties (RR, 6.7; 95% CI, 2.5 to 17.8). Mothers, however, reported increased visits with physicians during the previous 5 years (RR, 1.7; 95% CI, 1.1 to 2.6) as well as a greater likelihood of taking sick leave when they had not worked through their grief (RR, 2.1; 95% CI, 1.2 to 3.5).

Conclusion Parents who have not worked through their grief are at increased risk of long-term mental and physical morbidity, increased health service use, and increased sick leave.

published online ahead of print at www.jco.org on November 24, 2008

Supported by grants from the Swedish Children's Cancer Foundation, grants from the Swedish Society for Medical Research, Grant No. KLS-01645-02-2005 from the Swiss Cancer League, Grant No. CA096746 from the National Cancer Institute, and a Child Health Research Grant No. NCI 5 K07 CA096746 from the Charles H. Hood Foundation.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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