Department of Psychology, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
Department of Psychiatry, Beaumont Hospital, Dublin, Ireland.
Acta Psychiatr Scand. 2021 Jun;143(6):472-486. doi: 10.1111/acps.13289. Epub 2021 Mar 4.
To systematically review evidence for an association between parental death in childhood, and the subsequent development of an anxiety, affective or psychotic disorder.
Electronic databases (Scopus, Medline (for Ovid), EMBASE and PsychINFO) were searched for peer-reviewed, cohort studies in the English language. Meta-analyses were performed for studies reporting hazard ratios, incidence rate ratios and odds ratios. Two studies reported risk ratios, and these were included in an overall pool of odds, risk and incidence rate ratios. Sensitivity analyses were performed (removal of one study at a time) for all meta-analyses, and study quality assessed using the Newcastle-Ottawa Scale.
Fifteen studies were retained, and where required, data were averaged in advance of pooling. Significant results were observed in studies reporting hazard ratios (k = 4, 1.48 [95% CI = 1.32-1.66]), incidence rate ratios (k = 3, 1.37 [95% CI = 1.01-1.85]), but not odds ratios (k = 4, 0.87 [95% CI = 0.72, 1.05]). However, the overall pooled effect (using odds, incidence rate and risk ratios) was statistically significant (k = 9, 1.22 [95% CI = 1.03-1.44]).
Overall, the evidence suggests that there is a positive association between the death of a parent before age 18, and the subsequent development of an anxiety, affective or psychotic disorder. The lack of a significant pooled effect in studies reporting results as odds ratios is likely an artefact of study design.
Data were clustered in four countries making generalizability uncertain. Studies adjusted for a variety of possible confounders, and follow-up after death varied considerably.
系统回顾儿童期父母死亡与随后发生焦虑、情感或精神病障碍之间关联的证据。
检索了英文同行评审队列研究的电子数据库（Scopus、Medline（Ovid）、EMBASE 和 PsychINFO）。对于报告危害比、发病率比和优势比的研究进行了荟萃分析。有两项研究报告了风险比，这些研究被纳入了一个总的优势、风险和发病率比的集合中。对所有荟萃分析进行了敏感性分析（每次删除一项研究），并使用纽卡斯尔-渥太华量表评估了研究质量。
保留了 15 项研究，在汇总之前，如有需要，对数据进行了平均处理。在报告危害比（k=4，1.48 [95%CI=1.32-1.66]）、发病率比（k=3，1.37 [95%CI=1.01-1.85]）的研究中观察到显著结果，但在报告优势比（k=4，0.87 [95%CI=0.72,1.05]）的研究中未观察到显著结果。然而，总体汇总效果（使用优势、发病率和风险比）具有统计学意义（k=9，1.22 [95%CI=1.03-1.44]）。
总体而言，证据表明，18 岁之前父母一方的死亡与随后发生的焦虑、情感或精神病障碍之间存在正相关。在报告优势比结果的研究中，汇总效果不显著可能是研究设计的一种人为产物。
数据集中在四个国家，因此难以推广。研究调整了多种可能的混杂因素，并且死亡后的随访时间差异很大。
