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Depression among Parents Two to Six Years Following the Loss of a Child by Suicide: A Novel Prediction Model
Karolinska instituet.ORCID iD: 0000-0002-9436-0626
Karolinska institutet.
Ersta Sköndal University College, Department of Health Care Sciences.ORCID iD: 0000-0003-1835-1960
Karolinska instituet & Sahlgrenska akademin Göteborgs universitet.
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 10, e0164091Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Parents who lose a child by suicide have elevated risks of depression. No clinical prediction tools exist to identify which suicide-bereaved parents will be particularly vulnerable; we aimed to create a prediction model for long-term depression for this purpose.

METHOD: During 2009 and 2010 we collected data using a nationwide study-specific questionnaire among parents in Sweden who had lost a child aged 15-30 by suicide in years 2004-2007. Current depression was assessed with the Patient Health Questionnaire (PHQ-9) and a single question on antidepressant use. We considered 26 potential predictors assumed clinically assessable at the time of loss, including socio-economics, relationship status, history of psychological stress and morbidity, and suicide-related circumstances. We developed a novel prediction model using logistic regression with all subsets selection and stratified cross-validation. The model was assessed for classification performance and calibration, overall and stratified by time since loss.

RESULTS: In total 666/915 (73%) participated. The model showed acceptable classification performance (adjusted area under the curve [AUC] = 0.720, 95% confidence interval [CI] 0.673-0.766), but performed classification best for those at shortest time since loss. Agreement between model-predicted and observed risks was fair, but with a tendency for underestimation and overestimation for individuals with shortest and longest time since loss, respectively. The identified predictors include female sex (odds ratio [OR] = 1.84); sick-leave (OR = 2.81) or unemployment (OR = 1.64); psychological premorbidity debuting during the last 10 years, before loss (OR = 3.64), or more than 10 years ago (OR = 4.96); suicide in biological relatives (OR = 1.54); with non-legal guardianship during the child's upbringing (OR = 0.48); and non-biological parenthood (OR = 0.22) found as protective.

CONCLUSIONS: Our prediction model shows promising internal validity, but should be externally validated before application. Psychological premorbidity seems to be a prominent predictor of long-term depression among suicide-bereaved parents, and thus important for healthcare providers to assess.

Place, publisher, year, edition, pages
2016. Vol. 11, no 10, e0164091
National Category
Other Medical Sciences not elsewhere specified
Identifiers
URN: urn:nbn:se:esh:diva-5685DOI: 10.1371/journal.pone.0164091ISI: 000385553100089PubMedID: 27695063OAI: oai:DiVA.org:esh-5685DiVA: diva2:1063997
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2006-1099Stockholm County Council, 20110338
Available from: 2017-01-11 Created: 2017-01-11 Last updated: 2017-01-13Bibliographically approved

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