Tay Djin L, Thygesen Lau C, Kozlov Elissa, Ornstein Katherine A
College of Nursing, University of Utah, Salt Lake City, UT, USA.
National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Clin Epidemiol. 2022 Sep 20;14:1065-1077. doi: 10.2147/CLEP.S372936. eCollection 2022.
The death of a close family member is commonly accompanied by intense grief, stress, and loss of social support. We hypothesized that recent bereavement would be associated with an increase in symptom exacerbations among adults with serious mental illness (SMI) whose partners or parents had died.
Adults whose partners and parents had died in Denmark between January 1, 2010, and June 30, 2016, were identified using linked population-based registries. History of SMI was defined as having a diagnosis of schizophrenia and schizoaffective disorders, major depression, and bipolar disorder in the five years preceding their family member's death in the Danish Psychiatric Central Research Register using International Classification of Diseases-10 codes. The odds of SMI exacerbation (ie, attempt or completion of suicide or psychiatric hospitalization) among partners and children in the first two years after death in 3-month intervals were estimated with generalized estimating equations.
12.8% of partners and 15.0% of adult children with a history of SMI experienced any SMI exacerbation two years after bereavement. Among bereaved partners, older age (80+ years) was associated with a lower risk of experiencing an SMI exacerbation compared with partners aged 18-49 years (OR=0.29, [0.18-0.45]). Partners with a history of SMI had significantly increased odds of SMI exacerbations three months after their partners' death compared to prior to their partners' death (ORadj = 1.43, [1.13-1.81]). There was no evidence that adult children with SMI experience increased SMI exacerbations after the death of their parents compared to prior to death.
Adults with a history of SMI whose partners had died are at increased risk for an SMI exacerbation post bereavement. Additional bereavement resources and support should be provided to those with a history of SMI, especially in the period immediately after death.
亲密家庭成员的死亡通常伴随着强烈的悲痛、压力和社会支持的丧失。我们假设，近期丧亲会与患有严重精神疾病（SMI）的成年人症状加重有关，这些成年人的伴侣或父母已经去世。
利用基于人群的关联登记系统，识别出2010年1月1日至2016年6月30日期间在丹麦其伴侣和父母去世的成年人。SMI病史定义为在其家庭成员于丹麦精神病学中央研究登记处去世前五年内，使用国际疾病分类第10版编码诊断为精神分裂症、分裂情感性障碍、重度抑郁症和双相情感障碍。使用广义估计方程估计在死亡后的头两年中，每隔3个月伴侣和子女出现SMI加重（即自杀未遂或自杀成功或精神科住院）的几率。
有SMI病史的伴侣中有12.8%以及成年子女中有15.0%在丧亲两年后经历了任何SMI加重情况。在丧偶伴侣中，与18 - 49岁的伴侣相比，年龄较大（80岁及以上）的人经历SMI加重的风险较低（比值比=0.29，[0.18 - 0.45]）。有SMI病史的伴侣在其伴侣去世三个月后出现SMI加重的几率相比其伴侣去世前显著增加（调整后的比值比=1.43，[1.13 - 1.81]）。没有证据表明患有SMI的成年子女在其父母去世后比去世前经历更多的SMI加重情况。
有SMI病史且伴侣已去世的成年人在丧亲后出现SMI加重的风险增加。应向有SMI病史的人提供额外的丧亲资源和支持，尤其是在死亡后的 immediately 时期。 （注：原文中“immediately”翻译为“立即”，但放在这里语义不太明确，可能是文档录入有误，推测这里想表达的是“immediate”，即“紧接着的”“刚去世后的那段时期” ）
应向有SMI病史的人提供额外的丧亲资源和支持，尤其是在丧亲后的紧接时期。 （修正后的完整译文）
总之，有SMI病史且伴侣已去世的成年人在丧亲后出现SMI加重的风险增加。应向有SMI病史的人提供额外的丧亲资源和支持，尤其是在丧亲后的紧接时期。 （完整译文总结）
