Poor family cohesion is associated with long-term psychological impacts in bereaved teenagers

Swedish study suggests a link between family cohesion after parental loss and mental health.


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The death of a parent can affect the health and well-being of children and adolescents, including a higher risk of depression. A study published in PLOS ONE by Dröfn Birgisdóttir at Lund University, Lund, Sweden, and colleagues suggests poor family cohesion is associated with long-term psychological symptoms among bereaved youth.

Parentally bereaved children are at increased risk for mental illness, including depression, anxiety, suicide attempts, and self-injurious behaviors. However, the relationship between family cohesion and the long-term emotional well-being of bereaved teenagers is not well-studied.

In order to better understand contributing factors to the long-term health and well-being of bereaved adolescents, researchers conducted a nationwide, population-based study of 622 young adults living in Sweden, aged 18-26, who had lost a parent to cancer at the age of 13-16.

Participants enrolled voluntarily and responded to a study-specific questionnaire aimed at measuring their perception of their surviving family’s cohesiveness. The survey included questions about mental health, emotional well-being, and quality of life.

The researchers found that self-reported poor family cohesion by participants who had lost a parent as a teenager was strongly associated with negative psychological effects six to nine years after the loss. Future studies are needed, however, to deepen the knowledge of what mechanisms might lie behind the results and what factors can support good family cohesion when a parent with teenage children is dying.

Other limitations include self-reported data on psychological health, and not knowing exactly what the concept of family cohesion means to the participants, as it was measured directly with a global single-item question. Future studies are needed to look deeper into what constitutes good family cohesion among families with teenage offspring facing the death of a parent and develop accurate measurement instruments that can be applied in different cultural contexts.

According to the authors, “If supporting families during the period of parental illness and immediately after the loss will contribute to a better family function and cohesion that might improve long-term health and well-being among bereaved adolescents, then this fact should be highlighted for those working in palliative care and with bereaved families. New efforts could be put in place to create routines in clinical practice that support health-care personnel identifying when there are minor children in a family facing the loss of a parent and recognizing their need for information and support.”

The authors add: “Poor family cohesion the first year after losing a parent to cancer as a teenager was found to be associated with a greater risk for long-term psychological health-related problems among young adults who lost a parent to cancer 6–9 years earlier. To identify families at risk of poor cohesion and to provide the support that can strengthen family cohesion might be a health prevention worth the effort, possibly preventing long-term suffering in teenage offspring facing the death of a parent.”

Journal Reference:

  1. Birgisdóttir D, Grenklo TB, Kreicbergs U, Steineck G, Fürst CJ, Kristensson J (2023) Family cohesion predicts long-term health and well-being after losing a parent to cancer as a teenager: A nationwide population-based study. PLoS ONE 18(4): e0283327. DOI: 10.1371/journal.pone.0283327


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