After a child dies: parents' mental health, mortality, work and family life

National registers in Denmark show that after a child dies, parents, and mothers especially, face a higher risk of mental illness and of dying earlier than other parents. The risk is highest in the first years and, for some outcomes, lasts for many years^[1][2]. Yet we found no country that routinely counts how many parents this happens to, and in parts of sub-Saharan Africa it has happened to more than half of mothers in their late forties^[3].

A child's death changes a parent's life in ways that reach well beyond grief. There may be other children to care for, a job to go back to and a partner grieving differently. And the relationship with the child does not end: they remain that child's parent. This study brings together what the research shows, from any country, about how the death of a child affects parents' mental and physical health, their work and their relationships, how that differs by the child's age and how the parent is supported. Deaths around birth are covered in our study of parents after stillbirth or neonatal death.

Millions of parents each year, but almost nowhere counted

Child deaths are counted carefully; bereaved parents are not. The World Health Organization estimates that "in 2024, an estimated 4.9 million children under the age of 5 years died worldwide", 2.8 million of them (58%) in sub-Saharan Africa^[4]. These are modelled estimates, and they leave out older children and adult children, whose parents are bereaved too. Each of those deaths leaves at least one parent, but we found no national statistics office that publishes a regular count of parents whose child has died.

Demographers have begun to measure it from the parent's side. Using data from 20 sub-Saharan African countries, Smith-Greenaway and Trinitapoli found that "in some African countries, more than one-half of 45- to 49-y-old mothers have experienced the death of a child under age 5", and "nearly two-thirds have experienced the death of any child, irrespective of age". Even among younger mothers, "in many countries, up to one-third have"^[3]. In those countries, being a bereaved mother is common, not rare.

Within rich countries, too, the risk is unequal. In the United States, research finds that "from young adulthood through later life, blacks are also more likely than whites to have experienced the death of a child"^[5], and that "black parents, especially black mothers, experience substantially higher child mortality compared with white parents"^[6]. Support for bereaved parents needs to reach the families who experience most of these deaths.

Mental illness is more common after a child dies, especially for mothers

Grief is a normal response to a child's death, not an illness. But whole-population data show that a minority of parents go on to need psychiatric care, at a higher rate than other parents. In Denmark, researchers followed 1,082,503 people through national registers. Compared with parents whose child had not died, bereaved parents had 1.67 times the risk of a first admission to hospital for a psychiatric disorder. The risk was higher for mothers (1.78 times) than for fathers (1.38 times), and it was still raised five years or more after the death^[1].

Prescriptions show more. In a register sample of 205,456 parents in Finland, including 902 whose child had died, "between 20-25% of bereaved mothers and 10-15% of bereaved fathers used antidepressants or anxiolytics" one year after the death, the point of highest use, against 5–10% of parents who were not bereaved. Use then fell steadily, but was still above the non-bereaved level four years after the death^[7]. In Sweden, a matched cohort study of bereaved people of all kinds found that "higher risks of incident psychiatric disorders were observed for loss of a child or spouse" than for the loss of a sibling or parent^[8].

The excess does not always last. A population-based Swedish study of parents whose child had died of cancer four to nine years earlier found a raised risk of anxiety (1.5 times that of parents whose children were alive), with higher risk four to six years after the death than seven to nine years after. By seven to nine years, "psychological morbidity in bereaved parents decreases to levels similar to those among non-bereaved parents", although distress was higher overall among bereaved mothers, and the death of a child aged nine or older raised the risk, particularly for fathers^[9]. In the United States, an analysis of 16,182 parents aged 50 and over found a "relatively long recovery time (e.g., 7 years)" in depressive symptoms after a child's death^[10], and a longitudinal study of middle-aged and older adults in Thailand found the same direction: child death was associated with more depressive symptoms^[11].

Prolonged grief: common in the parents who seek help

Prolonged grief disorder is a diagnosable condition in which intense grief stays disabling long after a death. There is no population-wide estimate of how many bereaved parents have it, only figures from particular groups, which cannot be added together or applied to all parents. In Germany, of 323 bereaved parents referred to a family rehabilitation programme, "160 (49.5%) parents showed symptoms of prolonged grief disorder", and many also had symptoms of depression (59.1%) or post-traumatic stress (74.9%)^[12]. These are parents who had been referred for help, so the figures describe high need, not typical grief. In Sweden, a study of 225 parents whose child had died of cancer one to five years before sorted them by their symptoms: 25.9% were in a "resilient" group, while the largest group (41.0%) had both prolonged grief and insomnia symptoms^[13].

A higher risk of suicide, especially soon after the death

Most bereaved parents do not take their own life, and a child's death is never the single cause when a parent does. But the risk is raised and is worth knowing about. A Danish register study, comparing everyone who died by suicide with matched controls, found that "parents of children who have died are at an increased risk for suicide", that the death of a child in early childhood had a strong effect, and that the risk was "particularly high in the first month after losing a child"^[14]. The first weeks, when parents are often in contact with hospitals, police, coroners and funeral arrangements, are when a check on how a parent is coping, and an open door to support, can matter most. Support does help, and people in crisis do come through it. Families bereaved by a suicide are covered in our study of adults bereaved by suicide.

Bereaved parents die earlier, and the strain may show in the heart

The clearest long-term evidence comes from Denmark. Researchers followed 21,062 parents whose child had died and 293,745 parents whose children were alive for up to 18 years. Mothers whose child had died had 1.43 times the death rate of other mothers, with excess deaths from unnatural causes throughout follow-up and from natural causes only in years 10 to 18. Among mothers, deaths from unnatural causes were highest in the first three years (3.84 times the rate), and mothers whose child had died an unnatural or unexpected death had 1.72 and 1.67 times the death rate respectively. Bereaved fathers had only an early excess of deaths from unnatural causes (1.57 times)^[2].

Sweden's registers, covering the whole population between 1980 and 2002 and children who died aged 10–49, show how the picture changes with the child's age. Mothers had a raised risk of death after the death of a child aged 10–17 (1.31 times the risk). Effects among fathers were weaker and were found mainly more than eight years after the death^[15]. The pattern is not confined to the Nordic countries. In a US national study, "parents who had experienced the death of a child had a 32% higher likelihood of early mortality", defined as dying before their life expectancy, than parents who had not, comparing 451 bereaved parents with 1,804 others^[16].

The heart is one place the strain may show. In a Swedish study of 3,924,237 parents of children born from 1973 to 2014, "parents who lost a child had a 15% higher risk" of atrial fibrillation, an irregular heart rhythm, than other parents. The risk was highest in the first week after the death (2.87 times) and "remained 10-40% elevated on the long term"^[17]. The authors describe the overall increase as modest, and suggest that stress-related mechanisms may contribute.

None of these studies can show that grief alone caused the deaths or illnesses. Register studies adjust for some differences between bereaved and comparison parents, but not for everything parents and children have in common, such as inherited conditions or the circumstances of the child's death. What they do show is a consistent pattern across countries: a period of real health risk for parents, largest in the early years and for mothers, that health services can watch for.

Work and family life carry the strain too

A child's death often comes after months or years of illness, or with no warning at all, and both can make work hard. In Denmark, registers followed 1,609 parents whose child had died with cancer before the age of 30, against 15,188 comparison parents. Bereaved mothers had a higher risk of long-term sick leave (hazard ratio 1.62) and of unemployment (1.53), and lower odds of working in the first two years after the death (odds ratio 0.44). Bereaved fathers also had lower odds of working (0.65)^[18]. A scoping review of parents' experiences of going back to work found that "bereaved parents benefit from a workplace offering individualized time off for bereavement", but that "some received insensitive comments by employer/coworkers"^[19]. Bereavement leave rules vary widely between countries; we look at them in our study of bereavement and work.

A common belief is that most couples separate after a child dies. The best data do not support it. A Finnish register study of more than 100,000 married couples from 1971 to 2003 found that "child loss only modestly influences the divorce risk", while it had a considerable effect on whether couples went on to have another child^[20]. An earlier Australian study of parents whose baby had died did find "an increased marital break-up rate" compared with parents whose baby survived^[21]. Strain on a relationship is real, but separation is not the usual outcome.

What the evidence asks of us

Parents themselves have said what helps. A systematic review covering 52 papers and about 4,000 bereaved parents after a child's sudden death found that "parents wish to be able to say goodbye to them at the hospital or Emergency Department", want to understand why their child died, and "would like follow-up appointments from health care professionals after the death"^[22]. The American Academy of Pediatrics' 2023 guidance says that "the pediatrician has an important role in supporting the family unit after the death of a child", including the siblings^[23]. Taken together with the register evidence, the figures point to a few practical things:

• Make the first weeks count. Suicide risk is highest in the first month^[14], heart-rhythm risk in the first week^[17], and unnatural-cause deaths among mothers in the first three years^[2]. Hospitals, primary care and the professionals involved after a death are best placed to make contact and offer follow-up.
• Keep the door open for years, not months. Raised psychiatric risk was still present five years or more after the death in Denmark^[1], and depressive symptoms took around seven years to recover among older US parents^[10]. Support that ends after a fixed number of sessions or months will miss many parents.
• Notice fathers as well as mothers. Mothers carry the larger measured risk, but fathers show raised risks too, sometimes later^[15].
• Back peer support. In Finland, "two-thirds of the parents regarded the peer support provided during the family weekend as supportive or very supportive"^[24]. Organisations run by bereaved parents offer exactly this, and deserve stable funding.
• Give parents room at work. Individual, flexible time off helps parents return^[19]; the Danish data on sick leave and unemployment^[18] show what happens when work and grief collide.
• Count bereaved parents. Where registers or surveys can identify parents whose child has died, statistics offices could publish how many there are. Without that, services cannot plan for them, least of all in the countries where a child's death is most common^[3].

Language: this piece uses plain words such as “died” rather than euphemisms, because they are clearer. Where it discusses suicide, it follows the Samaritans’ media guidelines.

Why we're publishing this

Organisations of bereaved parents have long said, from experience, that a child's death affects parents' health for years and that support often stops too soon. The registers of several countries now back them up. We publish this so that those organisations, and the health services, employers and policymakers they speak to, have the international evidence in one place to cite, with the limits stated plainly.

How to read this data

The figures come from different kinds of study, and each has limits.

• Population registers (Denmark, Sweden, Finland) cover whole populations, so they avoid self-selection, but they only record what registers hold, such as deaths, hospital diagnoses, prescriptions and employment. They adjust for some differences between groups, not all, and show associations, not proof that the child's death caused an outcome.
• Survey and cohort studies (the United States, Thailand, Sweden) add measures such as depressive symptoms, but depend on who takes part.
• Clinical and referred samples (Germany, Sweden), including the prolonged grief figures, describe parents who were in contact with services or a particular study. Their percentages are not the share of all bereaved parents.
• Global figures. WHO's child death numbers and the sub-Saharan African mothers' figures are estimates from models and household surveys, not counts.
• Gaps. Most outcome evidence comes from the Nordic countries and the United States. We found very little from low- and middle-income countries on parents' health after a child's death, little on fathers specifically, and no country that regularly counts bereaved parents.

"Times the risk" and "times the rate" compare two groups over the same period (relative risks and hazard ratios). Odds ratios, used for the Danish employment figures, compare odds, and are not the same as risks. Grief is not a disorder; prolonged grief disorder, depression and anxiety disorders are diagnosable conditions.

Use this data

Free to cite with attribution to Understanding Bereavement. Charities, schools, services and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This study summarises published research about groups of people for general information. It is not medical advice or bereavement support, and it cannot describe or predict anything about an individual or family. If you are worried about yourself or someone close to you, please speak to a GP or another qualified professional.

Sources

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