The impact of childhood parental loss on risk for mood, anxiety and substance use disorders in a population-based sample of male twins
Introduction
In “Mourning and Melancholia” Freud (1917) wrote about the relationship between object loss and depression. Since then, parental loss during childhood has been widely considered as an important risk factor for adult psychopathology such as depression (Brown et al., 1977, Roy, 1985, Kendler et al., 1992), anxiety disorders (Raskin et al., 1982, Faravelli et al., 1985, Torgersen, 1986, David et al., 1995), and alcohol dependence (Lewis and Bucholz, 1991, Isohanni et al., 1994, Kendler et al., 1996). Attachment theory proposed by Bowlby (1980) has postulated that loss experiences have both immediate and long-term consequences and serve as risk factors for adult psychopathology. The onset of depression is earlier for those who experience childhood adversities, suggesting recurrent psychopathology as a potential pathway for the associations (Widom et al., 2007). However, one study reported that childhood adversity was associated with onset but not with persistence of psychopathology (Kessler et al., 1997), while the other reported that the associations between childhood adversities and psychopathology did not greatly attenuate across the lifecourse from adolescence to mid-life (Clark et al., 2010).
Most early research has referred to parental loss without differentiating between parental death and separation. As Tennant (1988) emphasized, parental death and separation have different implications. He suggested that parental loss itself is not the critical factor but the consequence of parental loss such as inadequate parental care and family instability is more important as a risk factor for offspring psychopathology. In accordance with this view, several studies have indicated that parental separation, either from divorce or other factors, was strongly associated with increased risk of major depression (MD), while such association was less clear for parental death (Hällström, 1987, Kendler et al., 1992, Agid et al., 1999). Also, since most studies have focused on depression and related conditions, little is known about the relationship between parental loss and other specific types of psychopathology (Canetti et al., 2000, Jacobs and Bovasso, 2009).
Several studies suggest that gender may modify the relationship between parental loss and offspring psychopathology (Tieman et al., 2005, Lizardi et al., 2009). Maternal loss tends to be more strongly associated with offspring psychiatric disorders than paternal loss (Brown et al., 1977, Kunugi et al., 1995). Lloyd (1980) suggested that early permanent separation from the same-sex parent may have more detrimental impacts. Some research indicated that patients who had experienced the death of or separation from the same-sex parent in childhood reported more severe depressive symptoms (Takeuchi et al., 2003). One of the reasons why maternal separation has been observed to be detrimental more often than paternal separation might be because most previous studies have often been limited to female samples (Hällström, 1987, Kendler et al., 1992, Kendler et al., 1996). On the contrary, Donald et al. (2006) propose that parental loss may be particularly troublesome for males because it is typically the father who is absent. Therefore, more studies are needed to examine the effects of parental loss on psychopathology in male offspring.
The aim of the present study is to examine the impact of parental loss during childhood on risk for adult psychopathology using a large population-based sample of male twins. We tried to answer the following four questions: (1) Which type of parental loss (i.e., death or separation) has more significant effects on risk for adult psychopathology? (2) Does parental loss have any diagnostic specificity as a risk factor? (3) Is maternal loss more strongly associated with psychopathology than paternal loss in male offspring? (4) What is the relative strength of contribution of parental death and separation to adult psychopathology?
Section snippets
Subjects
We used twin data collected in first (1993–1996) and second (1994–1998) wave interviews with Caucasian adult male twins born between 1940 and 1974 from the population-based Virginia Adult Twin Study of Psychiatric and Substance Use Disorders (VATSPSUD) (Kendler and Prescott, 2006). Of 9417 eligible individuals for the first wave, interviews were completed, typically by telephone, with 6814 (72.4%). At least 1 year later, the twins were recontacted to schedule a second wave interview. This
Results
Of 2605 twins, 584 (22.4%) reported childhood parental loss. A total of 184 (7.1%) twins reported parental death in childhood, while 400 (15.4%) twins reported parental separation. Of those, 316 (79.0%) twins experienced parental divorce. Paternal loss (death or separation) occurred about three times as frequently as maternal loss. The reports of parental loss (both death and separation) during childhood and age at loss were perfectly concordant between twins.
Table 1 presents the impact of
Discussion
We examined the association between parental loss and risk for seven common psychiatric and substance use disorders in a population-based sample of male twins. We also estimated the degree to which specific environmental risk factors (parental death and separation) contribute to individual differences in adult psychopathology. We will review our findings in turn.
We first examined the association between parental loss prior to age 17 and risk for seven common psychiatric and substance use
Acknowledgments
This work was supported by NIH Grants MH-40828, AA-09095, AA-00236, DA-11287, and MH/AA/DA-49492. Carol A. Prescott provided critical help in the collection of the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders (VATSPSUD) sample. We acknowledge the contribution of the Virginia Twin Registry, now part of Mid-Atlantic Twin Registry (MATR), for the ascertainment of subjects for this study. MATR is supported by NIH grant UL1TR000058. Takeshi Otowa was supported by research
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