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Unresolved Grief in a National Sample of Bereaved Parents: Impaired Mental and Physical Health 4 to 9 Years Later
Open accessAbstract
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.
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“One previous study (Lannen et al., 2008) has reported that a majority (73.5%) of parents who had lost a child to cancer had sleep difficulties 4–9 years later.”
From Feasibility and preliminary efficacy of guided internet-delivered cognitive behavioral therapy for insomnia after the loss of a child to cancer: Randomized controlled trial (2021) · cites this paper as Lannen et al., 2008
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Costa, F. L., & Barbosa, M. (2025) · Family Medicine and Community Health · doi:10.1136/fmch-2025-003296 · Cited by 1
Grief and Historical Trauma Among American Indian and Alaska Native Populations: A Cluster Analysis
Gameon, J. A., Skewes, M. C., Counts, C. J., & John‐Henderson, N. A. (2025) · Transcultural Psychiatry · doi:10.1177/13634615251379451 · Cited by 2
“Among parents who had lost a child, dif fi culty with grief was associated with worse self-reported psychological and physical health, sleep dif fi culties, use of medical services, and use of sick leave (Lannen et al., 2008).”
Al‐Mamun, F., Mamun, M. A., ALmerab, M. M., Holroyd, S., Gozal, D., & Muhit, M. (2026) · Depression and Anxiety · doi:10.1155/da/9965609 · Cited by 1
Bereavement in paediatric oncology: programme evaluation
Podda, M. G., Nigro, O., Barretta, F., Schiavello, E., Grampa, P., Luksch, R., Terenziani, M., Ferrari, A., Casanova, M., Spreafico, F., et al. (2026) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2026-006115 · Cited by 1
Dealing with Depression: Communicating with Cancer Patients and Grieving Relatives
Grassi, L. G., Caruso, R., & Nanni, M. G. (2012) · Springer eBooks · doi:10.1007/978-1-4614-3369-9_6 · Cited by 1
Assistance to Palliative Pediatric Patients: Simulation Model
Romanin-Jacur, G., Mondin, G., Liguori, A., & Menegazzo, F. (2016) · International Symposium on Stochastic Models in Reliability Engineering, Life Science and Operations Management · doi:10.1109/smrlo.2016.77 · Cited by 1
“At last, if the final disease outcome coincides with the child death, the whole family shall face the difficult mourning path, which, if badly managed, may bring to a prolonged pathological state [16, 17].”
BackgroundPersistent Complex Bereavement Disorder as a Call to Action
Kaplow, J. B., & Layne, C. M. (2014) · Cited by 1
Everly, G. S., & Lating, J. M. (2019) · Springer eBooks · doi:10.1007/978-1-4939-9098-6_24 · Cited by 1
Bereavement in the Beginning Phase of Life
Cincotta, N. F. (2022) · doi:10.1093/med/9780197537855.003.0077 · Cited by 1
Zimmermann, M., & Papa, A. (2017) · Springer eBooks · doi:10.1007/978-3-319-70539-2_7 · Cited by 1
Keskinen, N., Helmi, S., Kaunonen, M., Huhtala, H., & Aho, A. L. (2023) · Mortality · doi:10.1080/13576275.2023.2208517 · Cited by 1
“The death of a loved one might bring negative changes to the lives of the bereaved, and the related emotions can manifest at physical, psychological, and social levels (Lannen et al., 2008; Snaman et al., 2020).”
Kim, M. A., Min, J., Sang, J., & Jee, H. (2024) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228241238385 · Cited by 1
“Furthermore, for bereaved parents, the quality of their child ’ s life during this end-of-life period signi fi cantly in fl uences all aspects of their well-being throughout the grieving process (Lannen et al., 2008).”
Spezifische Todesumstände und Trauergruppen
Wagner, B. (2013) · Springer eBooks · doi:10.1007/978-3-642-37359-6_3 · Cited by 1
Friedrichsdorf, S. J. (2019) · MDPI eBooks · doi:10.3390/books978-3-03897-351-5 · Cited by 2
Skrozic, A., & Kijamet, D. (2021) · Springer eBooks · doi:10.1007/978-3-662-62759-4_2 · Cited by 1
Yu, G.-Y., & Joeng, J.-R. (2021) · THE KOREAN JOURNAL OF COUNSELING AND PSYCHOTHERAPY · doi:10.23844/kjcp.2021.08.33.3.1315 · Cited by 1
Ethical and Clinical Aspects of Palliative Sedation in the Terminally Ill Child
Norman, G. A. V. (2021) · Springer eBooks · doi:10.1007/978-3-030-58406-1_46 · Cited by 1
Normale Trauer und Trauertheorien
Wagner, B. (2013) · Springer eBooks · doi:10.1007/978-3-642-37359-6_1
Chronic pain in widowers 4-5 years after loss
Ásgeirsdóttir, H. G. (2011)
Boldrini, E. (2015) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/t.5.2015.tde-09062015-123418
Metadata
- Authors
- Lannen, P. K., Wolfe, J., Prigerson, H. G., Onelov, E., & Kreicbergs, U. C.
- Affiliations
- 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
- University of Bern (CH)
- Venue
- Journal of Clinical Oncology
- Published
- 2008-12-20
- Volume
- 26
- Issue
- 36
- Pages
- 5870-5876
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC2645112
- OpenAlex
- W2129225171
- Cited by
- 246
- References
- 34
- Citations by year
- 2026: 12 · 2025: 14 · 2024: 13 · 2023: 12 · 2022: 13 · 2021: 24 · 2020: 19 · 2019: 15 · 2018: 19 · 2017: 18 · 2016: 17 · 2015: 14 · 2014: 8 · 2013: 13 · 2012: 13
- FWCI
- 7.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Funders
- Charles H. Hood Foundation
- Svenska Sällskapet för Medicinsk Forskning
- National Cancer Institute (K07CA096746)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- unresolved grief, parental bereavement, child cancer, bereaved parents, mental health, physical health, sleep disorders, health care utilization, sick leave, grief processing, parents
- MeSH terms
- Adaptation, Psychological, Adolescent, Adult, Bereavement, Fathers, Female, Grief, Health Services, Health Status, Humans, Male, Mental Health, Mothers, Neoplasms, Parents, Surveys and Questionnaires, Sweden, Time Factors
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