Cited by 398Grief, Bereavement, and Mental HealthMental Health Treatment and AccessPosttraumatic Stress Disorder Research

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The Burden of Loss: Unexpected Death of a Loved One and Psychiatric Disorders Across the Life Course in a National Study

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Keyes, Katherine M., Pratt, Charissa, Galea, Sandro, McLaughlin, Katie A., Koenen, Karestan C., Shear, M. Katherine·2014·American Journal of Psychiatry

DOI 10.1176/appi.ajp.2014.13081132PMC PMC4119479

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Abstract

OBJECTIVE: Unexpected death of a loved one is common and associated with subsequent elevations in symptoms of multiple forms of psychopathology. Determining whether this experience predicts novel onset of psychiatric disorders and whether these associations vary across the life course has important clinical implications. The authors examined associations of a loved one's unexpected death with first onset of common anxiety, mood, and substance use disorders in a population-based sample. METHOD: The relation between unexpected death of a loved one and first onset of lifetime DSM-IV disorders was estimated by using a structured interview of adults in the U.S. general population (analytic sample size=27,534). Models controlled for prior occurrence of any disorder, other traumatic experiences, and demographic variables. RESULTS: Unexpected death of a loved one was the most common traumatic experience and most likely to be rated as the respondent's worst, regardless of other traumatic experiences. Increased incidence after unexpected death was observed at nearly every point across the life course for major depressive episode, panic disorder, and posttraumatic stress disorder. Increased incidence was clustered in later adult age groups for manic episode, phobias, alcohol use disorders, and generalized anxiety disorder. CONCLUSIONS: The bereavement period is associated with elevated risk for the onset of multiple psychiatric disorders, consistently across the life course and coincident with the experience of the loved one's death. Novel associations between unexpected death and onset of several disorders, including mania, confirm multiple case reports and results of small studies and suggest an important emerging area for clinical research and practice.

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“Though most who experience parental loss manifest resilience, 5 to 10 percent demonstrate problems that include higher rates of mental health diagnoses like depression and anxiety [1], [18]; [30], higher rates of alcohol and substance abuse disorders[12], worse peer relationships [2], higher rates of suicide, and lowe…”
Background
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Authors: Keyes, K. M., Pratt, C., Galea, S., McLaughlin, K. A., Koenen, K. C., & Shear, M. K.
Affiliations: Boston Children's Hospital (US)
ORCID: Keyes, Katherine M.
Pratt, Charissa
Galea, Sandro
McLaughlin, Katie A.
Koenen, Karestan C.
Shear, M. Katherine
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2014-08
Volume: 171
Issue: 8
Pages: 864-871
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.2014.13081132
PMC: PMC4119479
OpenAlex: W2111636212
Cited by: 398
References: 49
Citations by year: 2026: 28 · 2025: 33 · 2024: 47 · 2023: 55 · 2022: 45 · 2021: 50 · 2020: 41 · 2019: 30 · 2018: 25 · 2017: 15 · 2016: 14 · 2015: 10 · 2014: 5
FWCI: 17.31
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (5r01mh093612-03, MH093612)
National Institute on Alcohol Abuse and Alcoholism (AA-021511, K01AA021511)
National Institute of Mental Health (MH093612, MH-092526, R01MH070741, R01MH078928, MH60783, R01-MH093612, MH-078928, MH70741, R01MH060783, K01MH092526)
Topics: Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords: bereavement, life course, major depressive episode, manic episodes, panic disorder, post-traumatic stress disorder, phobia, generalized anxiety disorder, alcoholism, substance use disorders, traumatic events, DSM-IV disorders
MeSH terms: Age Factors, Mental Disorders, Bereavement, Death, Humans, United States, Incidence, Cost of Illness

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The Burden of Loss: Unexpected Death of a Loved One and Psychiatric Disorders Across the Life Course in a National Study

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