An analysis of the effect of bereavement on mental health McCann M, - - PowerPoint PPT Presentation

THE MOURNING AFTER: An analysis of the effect of bereavement on mental health

McCann M, Maguire A, Moriarty J Institute of Child Care Research, Queen’s University Belfast

Institute of Child Care Research

INTRODUCTION

• Bereavement is a significant life event which most people will

be exposed to in their lifetime

• Involves major life transition and can have negative implications

for health and well-being

• The Grief Study aims to investigate how factors such as age,

gender, family environment, employment and religion affect how people cope after bereavement.

• The study will also look at how people become bereaved - for

example, after illness, sudden death or after suicide - to see if how people react and the factors that help people cope differ depending on how they lost their loved ones.

• This presentation focuses on some preliminary findings

RESEARCH QUESTIONS

1. Does bereavement lead to an increased risk of poor mental health – as measured by use of hypnotic, anxiolytic and antidepressant medication? 2. Does the likelihood of poor mental health following bereavement vary according to the cause of death? 3. To what extent do individual, household, and area characteristics mitigate or compound the risk of poor mental health following bereavement? 4. Does the ‘risk profile’, in terms of the magnitude of risk conferred by individual, household and area characteristics, differ between those bereaved following an expected death, sudden death, violent death or suicide. 5. To what extent does bereavement confer an increased risk of mortality, particularly when accompanied by poor mental health?

METHOD

Northern Ireland Longitudinal Study (NILS)

Census data and vital events data for c.28% NI pop. Contains: Census ID, Household ID, HCN

Northern Ireland Mortality Study (NIMS)

Census data for 100% NI pop. linked to mortality data Contains: Census ID, Household ID

Enhanced Prescribing Database (EPD)

Prescription Drug data for 100% NI pop. Contains: HCN

Grief Study Dataset

• 2001 Census data for

NILS members and members of their household

• Info on relationship of

NILS member to others in their household

• Deaths 2001-2011 of

NILS members and members of their household

• Psychotropic drug

uptake NILS members 2009-2011

NISRA Data

• Census data for NILS

members and members of their household

• Deaths of NILS members

and members of their household

• HCN number of NILS

members only*

BSO Data

Prescription Drug data for 100% NI pop. and HCN*

Data merged to create dataset of NILS members characteristics and that of their other house members from 2001 Census returns Deaths of NILS members and their household members captured Information on all antidepressant, anxiolytic and hypnotic medication prescribed in NI from 2009-2013 NISRA and BSO data Merged on HCN and all personal identifiers removed

Figure 1: Description of Datasets used in linkage to create Grief Study Dataset

Grief Study Dataset

• 2001 Census data for

NILS members and members of their household

• Info on relationship of

NILS member to others in their household

• Deaths 2001-2009 of

NILS members and members of their household

• Psychotropic drug

uptake NILS members 2009-2013

ANALYTICAL STRATEGY

• 1. Characteristics of study cohort and descriptive analysis of

the bereaved

• 2. Construct Cox Regression models to determine risk of

death post bereavement

• 3. Construct Cox Regression models to determine risk of

poor mental health (as measured by antidepressant drug uptake) post bereavement

• 4. Investigate long-term effects of bereavement by

constructing logistic regression looking at risk of poor mental health in January 2009 given bereavement experiences from 2001-2008

RESULTS

Table 1: Descriptive Characteristics of the Cohort of 346,850 NI residents

Category % n Gender

Male Female 48.8 51.2 169,269 177,581

Age (in 2009)

16-24 years 25-64 years 65 years+ 18.5 62.1 19.4 64,138 215,342 67,370

Marital Status

Never Married Married Co-habiting Separated/Divorced Widowed 38.7 51.1 3.8 3.9 2.6 134,050 177,191 13,262 13,380 8,967

Religion

Protestant Catholic Other 53.9 43.8 2.3 187,069 151,955 7,826

General Health

Good Fair Not good 71.7 19.3 10.0 245,064 66,893 34,893

Limiting Long Term Illness

LLTI 19.0 65,821

Area of residence

Rural Intermediate Urban 28.4 33.2 38.5 98,352 155,049 133,449

Bereavement Status

Not Bereaved Bereaved 92.2 7.8 319,936 26,914

Bereavement Type

Not Bereaved Bereaved by illness Bereaved sudden Bereaved by suicide 92.2 7.3 0.3 0.2 319,936 25,248 972 694

Age Group 16-24 years (n=64,138) 25-64 years (n=215,342) 65 years+ (n=67,370) Bereavement Status Bereaved 4.2 6.0 16.7 Bereaved of whom Spouse Died Parent Died Child Died Other bereavement 0.0 57.1 0.0 42.9 19.4 52.6 4.5 23.5 79.1 3.9 3.1 13.9 Bereavement Type Not Bereaved Bereaved by illness Bereaved sudden Bereaved by suicide 95.5 3.6 0.4 0.3 93.9 5.7 0.3 0.2 80.1 19.6 0.3 0.1

RESULTS

Table 2: Breakdown of Bereavement Type by Age Group, % of population

Model 1 Model 2 Model 3 Model 4 Bereaved Illness Bereaved sudden Bereaved Suicide 1.00 1.23 (0.94,1.62) 1.64 (1.15,2.34) 1.00 1.22 (0.92,1.60) 1.63 (1.14,2.33) 1.00 1.22 (0.93,1.61) 1.61 (1.13,2.31) 1.00 1.34 (1.02,1.76) 1.70 (1.19,2.43)

RESULTS

Table 3: Cox Proportional Hazards model calculating risk of death following a bereavement by bereavement type. RR (95% CI)

Model 1: unadjusted Model 2: further adjusted for age and sex Model 3: further adjusted for marital status Model 4: further adjusted for Antidepressant Medication

Bereaved 2001-2008 Model 1 Model 2 Model 3 Model 4 Non-bereaved Bereaved illness Bereaved Sudden Bereaved Suicide 1.00 1.34 (1.27,1.41) 1.67 (1.32,2.12) 2.02 (1.55,2.62) 1.00 1.22 (1.15,1.29) 1.71 (1.35,2.17) 2.15 (1.65,2.81) 1.00 1.28 (1.21,1.35) 1.69 (1.31, 2.13) 1.97 (1.50,2.58) 1.00 1.24 (1.18,1.32) 1.67 (1.30,2.14) 1.89 (1.43,2.50)

Model 1: unadjusted Model 2: further adjusted for age and sex Model 3: further adjusted for marital status and economic activity Model 4: further adjusted for level of deprivation Model 5: based on DAG adjusted for illness, living arrangement and deprivation Model 6: based on DAG adjusted for age, gender, illness, living arrangement, religion, education, carer status and deprivation Model 7: based on DAG adjusted for age, gender, illness, living arrangement, religion, carer status and deprivation

RESULTS

Table 4: Logistic Regression calculating likelihood of antidepressant treatment given bereavement status. OR (95% CI)

Model 5 Model 6 Model 7 Age 16-24yrs Age 25-64yrs Age 65yrs+ Non-bereaved Bereaved illness Bereaved Sudden Bereaved Suicide 1.00 1.49 (1.01,2.21) 2.27 (0.91,5.45) 2.08 (0.76,5.65) 1.00 1.16 (1.07,1.26) 1.52 (1.14,2.03) 1.73 (1.27,2.37) 1.00 1.30 (1.19,1.42) 1.72 (1.00,2.97) 1.64 (0.78,3.47)

RESULTS

Figure 2: Graph showing risk of Antidepressant Rx after a bereavement by bereavement type OR(95% CI) - Unadjusted

0.5 1 1.5 2 2.5 3 3.5 4 Spouse ill Spouse Sudden Spouse Suicide Parent ill Parent Sudden Parent Suicide Child ill Child Sudden Child Suicide Other ill Other Sudden Other Suicide

REF CAT Likelihood of receiving AD Rx in Jan 2009

Who died how

RESULTS

Figure 3: Graph showing risk of Antidepressant Rx after a bereavement by bereavement type OR(95% CI) – Fully Adjusted

0.5 1 1.5 2 2.5 3 Spouse ill Spouse Sudden Spouse Suicide Parent ill Parent Sudden Parent Suicide Child ill Child Sudden Child Suicide Other ill Other Sudden Other Suicide

REF CAT

Who died how

Likelihood of receiving AD Rx in Jan 2009

CONCLUSIONS

• Being bereaved increases your risk of dying,

especially if bereaved by suicide

• Ever having been bereaved increases risk of poor

mental health, especially if bereaved by suicide

• Effect seems most significant in 25-64years
• Relationship to bereaved affects risk of poor mental

health with worst outcomes observed in those bereaved of a child by suicide

THE GRIEF STUDY

• Preliminary analysis shows that reactions to grief are complicated

and vary depending on type of bereavement and relationship to bereaved

• The Grief Study will continue to tease apart these associations
• Main future questions relating to which other factors best predict

mental health outcome post bereavement

• Also focus on prescription uptake post bereavement and time to

prescriptions in relation to the bereavement exclusion criteria and the notion of medicalising sadness

It is important to identify the people who are in greatest need after bereavement, so that professionals, family and friends can make sure to offer the care and support that they need.

Questions?

Acknowledgements

“The help provided by the staff of the Northern Ireland Longitudinal Study/Northern Ireland Mortality Study (NILS/NIMS)and the NILS Research Support Unit is

• acknowledged. The NILS/NIMS is funded by the Health

and Social Care Research and Development Division of the Public Health Agency (HSC R&D Division) and NISRA. The NILS-RSU is funded by the ESRC and the Northern Ireland Government. The authors alone are responsible for the interpretation of the data and any views or

• pinions presented are solely those of the author and do

not necessarily represent those of NISRA/NILS.”

Bereavement Prescription Female Age Living Arrangements Religion Education NSSEC Carer Health LLTI House Value Urban/Rural Area Deprivation AGES 16 – 24 YEARS Not used GP Practice Housing Tenure Cars

Bereavement Prescription Female Age Religion Education NSSEC Carer G Health LLTI House Value Urban/Rural Area Deprivation AGES 25-64 YEARS Not used GP Practice Living arrangements

Bereavement Prescription Female Age Religion Education NSSEC Carer G Health LLTI House Value Urban/Rural Area Deprivation AGES 65 YEARS+ Not used GP Practice Living arrangements