Boys more vulnerable to effects of premature parental death than girls, study finds

The cumulative health and economic consequences of the premature loss of a parent may be greater for boys than for girls, suggest the findings of a large long term study published online in the Journal of Epidemiology & Community Health.

Experiencing the death of a parent before the age of 21, however, is strongly linked to poor mental health and lower earnings/unemployment in adulthood for both sexes, the data indicate.

Previously published research has pointed to a link between premature parental death and the child's subsequent health and prosperity. But no studies have drawn on high quality registry data, and few have looked at the cumulative effects or the potential impact of gender, say the researchers.

They therefore used nationwide registry data from Finland to work out if experiencing the death of a parent before the age of 21 was associated with any of several measures of poor mental health and labour market outcomes between the ages of 26-30, and what influence, if any, gender might have.

They included nearly 1 million Finns (962,350) born between 1971 and 1986, who had reached at least the age of 30 by 2016.

The relevant registry data included parental death certificates; and medical and educational records, periods of sick leave, and tax returns for their children, nearly all of whom had completed their education and entered the labour market by the age of 30.

Around 1 in 6 (15%; 145,673) people had lost a parent before the age of 31. Less than 5% had experienced the death of their mother; nearly 12% had experienced the death of their father.

The likelihood of a parental death rose sharply with age, from under 1% before the child had reached the age of 6 to just under 5% when they were aged between 26 and 30. Fathers were nearly 3 times as likely as mothers to die before their children turned 21.

Some 65,797 people lost a parent before the age of 21, and this was associated with greater odds of a hospital admission for mental ill health than it was for those who experienced this after the age of 30.

Men seemed to be more vulnerable than women. They were 70% more likely to be admitted to hospital; the equivalent figure for women was 52%. Substance use disorders and intentional self-harm were the most common reasons for hospital admission. But this varied by gender.

Boys and young men who lost their mothers prematurely had nearly 2.5 times the odds of a hospital admission for intentional self-harm as those who lost their mothers in their 30s.

Similarly, girls and young women who lost their father prematurely were around twice as likely to have a substance use disorder than those who hadn't experienced this. Early maternal death was also associated with a substantial (88%) increase in stress disorders.

The use of medication for mental health disorders among those who lost a parent prematurely was between 18% and 33% higher for both sexes than for those who hadn't experienced this. Sick leave was also more likely among both sexes.

Losing a parent before the age of 21 was also associated with fewer years of schooling, lower annual earnings, and more periods of unemployment at ages 26-30 for both sexes.

The largest reduction in years of schooling (4%)—equivalent to more than half an academic year—was among girls who had lost their mothers prematurely.

The estimated effects on earnings and employment were generally larger for men, among whom the early death of a father was associated with an almost 16.5% reduction in annual earnings and 6% lower likelihood of regular employment. The corresponding estimates for women were 11% and 4%, respectively.

The key strengths of the study lie in the use of nationwide population data, comprehensive monitoring, and both secondary and primary care psychiatric health records, say the researchers.

But they acknowledge that this is an observational study, which can't account for all potentially influential factors, such as personality traits that may have affected the associations found.

And the analysis didn't capture mild mental health issues nor account for (shared) genetic and environmental factors in childhood, all of which may have been influential, they admit.

Nevertheless they conclude: "Early parental death is strongly associated with a higher risk of children's poor mental health in adulthood for both males and females, but the estimated odds ratios are usually quantitatively larger for males."

Similarly, losing a parent prematurely "is negatively associated with children's labour market outcomes (ie, employment and earnings) in adulthood, and these associations are quantitatively larger for males."