The forgotten griever: a nationwide follow-up study of mortality subsequent to the death of a sibling

Jan M. Saarela, Åbo Akademi University
Mikael Rostila, Centre for Health Equity Studies
Ichiro Kawachi, Harvard School of Public Health

Previous findings suggest that the loss of a family member is associated with mortality among bereaved family members. The least studied familial relationship in the bereavement literature is that of siblings although loss of a sibling may also involve health consequences. The authors conducted a follow-up study based on data from the Swedish total population register, covering the period 1981 to 2002. Using Cox regressions, mortality risk ratios of bereaved and non-bereaved persons aged 18-69 years were estimated. All-cause and cause-specific mortality (unnatural causes, natural causes, cardiovascular disease, cancer, suicides, accidents, and all other causes) were examined. In men, the mortality risk of bereaved persons was 1.26 (95% CI: 1.22-1.30) that of non-bereaved persons, and in women it was 1.33 (1.28-1.39). An elevated mortality risk associated with a sibling’s death was found in all age groups studied, but the association was generally stronger at younger ages and could be observed predominantly after more than one year of follow-up. There was an increased death risk also if the sibling died from a discordant main cause, which may strengthen the possibility that the association observed is not due to confounding alone.