Mental Health After a Parent Dies in Childhood: What Population Studies Show

Grief after a parent dies is not a mental illness, and most bereaved children do not go on to develop one. But across the large studies that have followed children for years, a parent's death in childhood goes with a raised risk of depression, anxiety and other diagnosable conditions later on^[1]. On average the increase is modest; it is larger after sudden or violent deaths and when children are very young^[2].

When a child's mum or dad dies, sadness, anger, worry, poor sleep and trouble concentrating are ordinary parts of grief, and they can come and go for a long time. None of that is a disorder. Researchers ask a different question: across whole populations, are bereaved children more likely than other children to be diagnosed with, or treated for, a mental health condition months or years later? This study sets out what that research shows, worldwide, and where it is silent. Most of the strongest evidence comes from Nordic national registers, which can follow every child for decades, and from a few long-running US studies.

For most children, grief eases with time

The clearest picture of how children's grief changes over time comes from a US study that followed 182 children and teenagers aged 7 to 18 for up to three years after a parent died suddenly, including from accidents and sudden natural causes. Families were recruited through coroners' records and a newspaper advertisement^[3]. The researchers found three distinct patterns, and concluded that for most children grief reactions eased over time. In a second group, 30.8% of the sample, grief grew stronger over the first nine months and then gradually lessened. In a third group, 10.4%, grief had not changed 33 months after the death^[3].

That smaller group matters. Children whose grief stayed intense were more likely to have had depression before the death, and prolonged grief, in the child and in the surviving parent, went with a higher chance of a new episode of depression and with more difficulty managing everyday life^[3]. Grief that stays intense and disabling for a long time can now be diagnosed as prolonged grief disorder; we cover what is known about it in children in a separate study of prolonged grief disorder.

Depression in bereaved children is real depression, not just "grief by another name". The same US research group compared children who became depressed within two months of a parent's death with bereaved children who became depressed later and with depressed children who were not bereaved. The episodes were similar in number of symptoms, severity, how much they affected daily life, how long they lasted and the chance of coming back^[4]. The authors concluded that depression soon after a parent's death deserves the same assessment and care as any other depression. They also found that the surviving caregivers of these children had higher rates of depression and post-traumatic stress disorder^[4].

In an earlier study from the same group, comparing 140 families bereaved by a sudden death with 99 families in which both parents were alive, bereaved children and young people had three times the risk of depression (95% confidence interval 1.3 to 7.0), after controlling for risk factors present before and around the death^[5]. These are small samples, so the estimate is imprecise, and they cover sudden deaths only.

Across whole populations, the raised risk is real but modest

Small clinical studies can show what happens to individual children, but they cannot say how common an outcome is across a country. For that, the best evidence comes from national population registers in Sweden, Denmark, Norway and Finland, which link every child's records to their parents' deaths and to later hospital and specialist care. They capture diagnosed and treated conditions only: distress that never reaches a specialist service is invisible to them.

A 2021 meta-analysis brought together 15 cohort studies of a parent's death before 18 and later anxiety, mood (affective) or psychotic disorders^[1]. Studies reporting hazard ratios gave a pooled estimate of 1.48, and studies reporting incidence rate ratios 1.37: roughly a third to a half higher than in people whose parents had not died. Studies reporting odds ratios showed no significant association (0.87), which the authors judged was likely an artefact of study design. Pooling all the odds, rate and risk ratios together gave 1.22^[1]. The authors noted that the data were clustered in four countries, that studies adjusted for different confounders, and that follow-up after the death varied widely^[1].

Sweden's national study of depression shows what "modest" means in practice. Among 862,554 people born in Sweden in 1973–1982, followed for hospital and outpatient care for depression in 2006–2013, a mother's death from natural causes before 18 went with 1.19 times the rate of outpatient care for depression in men and 1.15 times in women, after adjusting for sociodemographic factors. A father's natural death showed similar effects^[2]. The authors called this "a small increased risk"^[2].

The raised risk is not limited to depression. In Norway, a register study of 655,477 people born 1970–2012 found that those whose parent had died from external causes, such as accidents, had a raised risk of depressive disorders, stress reactions, anxiety disorders and substance use disorders, among other conditions, though not eating disorders^[6].

Outside the Nordic countries and the US, long-term evidence on diagnosed conditions is thin. We found no comparable long-term studies from Africa, South Asia or Latin America, where many children's parents die young.

Risks are higher after sudden or violent deaths, and when children are young

Averages hide differences. Two stand out across the register studies: how the parent died, and how old the child was.

In the Swedish depression study, deaths from external causes, such as accidents and violence, consistently showed larger effects than natural deaths. Effects were largest for hospital admission for depression after a mother's death from external causes: 3.23 times the rate in men and 1.79 times in women^[2]. In Norway, the raised risk of psychiatric disorders after a parent's death from external causes was found regardless of whether the mother or father had died, or how old the child was^[6].

Age seems to matter in most, though not all, of the studies. In Sweden, a parent's death in the preschool years was linked with higher risks of both hospital and outpatient care for depression than a death in the teenage years^[2]. A Danish register study of 1,698,821 people born 1970–2000, discussed below, found the same gradient for later hospital-treated self-harm: the risk was highest when the parent died before the child was 7 and lowest when the death came at 13–14^[7]. The registers show the pattern but cannot explain it.

The measures in this table are not directly comparable: they come from different countries, outcomes, adjustment sets and follow-up periods. A ratio of 1.0 means no difference from people whose parents had not died.

Self-harm and suicide: a higher relative risk, a low absolute risk

Self-harm and suicide are the outcomes families and services most fear, and they need to be reported with care. The relative risks are raised; the absolute numbers remain small; and no study shows that a parent's death on its own causes either.

In Denmark, 52,589 of 1,698,821 people born 1970–2000 (3.1%) had a parent die before their 15th birthday. From age 15 they had 1.43 times the rate of hospital-treated self-harm, after adjusting for sex, birth year and mental illness in close family members^[7]. In absolute terms, by age 40 an estimated 5.9% of men whose parent died had been treated in hospital for self-harm, against 3.4% of men whose parents were both alive; for women, 6.7% against 4.0%^[7]. Put the other way, more than nine in ten bereaved people in Denmark had not been treated in hospital for self-harm by 40.

A study across Denmark, Sweden and Finland followed 189,094 people whose parent died before they were 18, each matched with ten people of the same sex and age whose parents had not, for up to 40 years. Of the bereaved group, 0.14% died by suicide, against 0.07% of the comparison group: an incidence rate ratio of 2.02, after accounting for family history of psychiatric illness and socioeconomic status^[8]. The ratio was higher where the parent had died by suicide (3.44) than from other causes (1.76), but was raised whatever the cause. Over 25 years of follow-up the absolute risk was about 4 in 1,000 for bereaved boys and 2 in 1,000 for bereaved girls^[8]. An earlier Swedish register study found a raised risk of suicide only among children whose parent had died by suicide (1.9 times the rate of children whose parents were alive), not after accidents or other causes^[9]. The studies differ in design and adjustment, so their results are not directly comparable.

Outside the Nordic countries, a national panel of 8,609 adults in South Korea found that a parent's death in childhood was linked with suicidal thoughts in later life (age 60 and over), at 1.43 times the odds after adjusting for childhood socioeconomic status, but not in younger or middle-aged adults^[10]. We look at children whose parent died by suicide in a separate study of children bereaved by suicide. Suicide has many causes, and these figures describe groups, not any one young person. Help is available, and, as the final section shows, family-focused support has reduced later mental health problems in a trial.

The circumstances around the death matter

A parent's death rarely happens in isolation. Long illness, money worries, a parent's mental illness or substance use, and the grief of the surviving parent can all shape how a child fares. In the Danish study, adjusting for mental illness in close family members (with sex and birth year) reduced the self-harm hazard ratio from 1.75 to 1.43, though a raised risk remained^[7].

A 2026 analysis of a US national survey of 36,309 adults compared people whose parent died in childhood with and without a parent's substance use problems. Those who had experienced both had 2.06 to 3.59 times the odds of a suicide attempt and of each of six diagnosable substance use and mental health disorders, compared with bereaved people whose parents had not had such problems^[11]. In the US sudden-death studies, grief and mental health in the surviving caregiver were tied to children's outcomes^[3][4]. This is not about blame: surviving parents are bereaved too, and their support needs are part of the family's. We cover this in our study of the surviving parent's wellbeing.

What the evidence asks of us

The evidence points in one direction: most bereaved children will not develop a mental health condition, but a minority will, and some groups face clearly higher risks. That calls for support that is available to every bereaved family, with closer attention where risks are greatest.

• Treat grief as normal, and depression as depression. Grief needs understanding, not a diagnosis. But when a bereaved child does become depressed, US research found the depression was like any other and warranted the same care, with attention to the surviving parent's mental health too^[4].
• Prioritise children bereaved by sudden or violent deaths and very young children. The Swedish depression study's authors concluded that these children "should be given priority in preventive interventions after parental loss"^[2].
• Support the whole family. The US Family Bereavement Program, a 12-session programme with sessions for caregivers and for children, was tested in a randomised trial with 244 children aged 8 to 16 from 156 families. Fifteen years later, with 80% still taking part, it had reduced major depression (odds ratio 0.33, compared with a comparison group that received written materials)^[12], and young adults who had taken part used fewer mental health services and less psychiatric medication^[13]. It is one trial in one country; we review the wider evidence in what helps bereaved children.
• Count and follow up. Almost all long-term evidence comes from a handful of high-income countries with population registers. Elsewhere, including most of the world where parents die young, researchers and governments have no way of knowing how bereaved children fare. Linking deaths to dependent children in official data, and funding long-term studies outside the Nordic countries, would close that gap.

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

Bereaved children are often told, kindly, that children are resilient, and many are. Others need more help than they get. Both things are true, and the evidence supports both. We publish this so that childhood bereavement charities, hospice family-support teams, schools and health services can make the case for timely support with figures they can check, and so that grief itself is never mistaken for illness. Our library on children bereaved of a parent brings together the evidence on how many children are affected, how they fare and what helps.

How to read this data

Most figures here come from national population registers in Sweden, Denmark, Norway and Finland. They cover everyone, but record only conditions diagnosed or treated in hospital or specialist care, so they miss distress treated in primary care or not treated at all. Each study adjusted for some confounders, such as family income, education or parents' mental illness, but not all; they show associations, not proof that the death caused the outcome. The US studies are much smaller: the sudden-death cohorts recruited families through coroners' records and advertisements, and the Family Bereavement Program trial was a single US trial. The South Korean and US survey studies rely on adults recalling childhood events.

Hazard ratios, incidence rate ratios and odds ratios are different measures and are not interchangeable. We report each as the study did. A ratio describes risk relative to people whose parents did not die; where studies give absolute risks (the share of people affected), we report those too, because they show how many bereaved children are not affected. Figures from different countries, birth years and outcomes are not directly comparable and should not be read as a trend. Almost no long-term evidence exists from low- and middle-income countries.

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 child or family. If you are worried about a child or about yourself, please speak to a GP or another qualified professional.

Sources

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