Childhood deaths are significantly higher among children who lose a parent to drug overdose, homicide or suicide compared to the general child population, a new University of Michigan study found.
The research, published in JAMA Network Open , investigated the link between specific types of parental loss and the subsequent risk of mortality for children in Michigan, said study lead author Sean Esteban McCabe , professor at the U-M School of Nursing.
The study found that bereaved children who experienced a parental death from one of the three preventable causes accounted for 150 excess childhood deaths in the state over the 14-year study period.
"There are early preventive interventions and childhood bereavement services that have been shown to improve children's health following the death of a parent that need to be made more widely available so no Michigan child grieves alone," McCabe said. "Protecting vulnerable children with proven ways of helping must be a priority for all of us to save more lives because there is no greater failure as a community or state than failing to protect our children."
U.S. parental mortality has reached historic highs in recent years, increasingly associated with these three leading preventable causes of death. Previous research has shown that Michigan has higher parental mortality rates than the national average, said McCabe, who's also the director of the U-M Center for the Study of Drugs, Alcohol, Smoking and Health.
The U-M team wanted a more complete picture of how these kinds of parental deaths impacted childhood mortality, to help evaluate the need for preventive interventions for bereaved children. It's believed to be the first study of its kind.
Key findings:
Children bereaved by parental drug overdose face a mortality rate by age 17 or younger that was 700% higher than the average Michigan child. The mortality rates were even higher for children bereaved by parental suicide (1,200% higher) or homicide (2,000% higher).
The study found that the loss of a biological parent reduces a child's "level of protection against harm," increasing risk of early death. The metrics from the study can be used to evaluate bereavement services.
Children bereaved by a homicide death had the highest rate of childhood mortality (about 106 deaths per 10,000), followed by suicide (more than 66 per 10,000) and drug overdose (nearly 37 per 10,000). That's compared to the roughly 5 deaths per 10,000 for children in Michigan overall.
Researchers partnered with the Michigan Department of Health and Human Services to link birth and death records from parents and children from 1992-2023, to identify 32,262 children aged 17 or younger who had lost a biological parent to homicide, suicide or overdose. By comparing this group's mortality rate to the state average of 5.22 deaths per 10,000 children, the study calculated excess deaths attributed to those causes, to measure how these specific parental losses increased a child's own risk of mortality.
McCabe said that while the study provided critical insights, it's limited by a focus solely on biological parents and an underreporting of paternal deaths, which means the actual impact is likely much higher.
Next steps for statewide prevention strategies include creating a statewide bereavement collaborative and evaluating bereavement services, McCabe said.
"There is an urgent need to develop performance metrics and eliminate bereavement service deserts, mental health deserts, and addiction medicine and psychiatry treatment shortages in our state," he said. "A child's zip code should not dictate whether they receive evidence-based bereavement services and treatment."
McCabe has a deep personal and a professional interest in this research.
"I have had several close friends and loved ones die due to overdose, suicide and homicide leaving behind many children," he said. "I work as a volunteer children's bereavement group facilitator at a nonprofit in Southeast Michigan and I've worked with many children who've experienced parental death from overdose, suicide and homicide.
"Bereaved children often experience friends at school who have no clue what to say when they talk about their parent who died from a drug overdose, homicide or suicide."
McCabe said friends often change the subject, so grieving children don't want to discuss their deceased parent, and this isolation and lack of understanding speaks to the need for more awareness, education and support.
McCabe also co-leads the Michigan-based research collaborative HopeHQ , which offers technical assistance to help children bereaved by their parent or significant person's overdose death.
Co-authors include: Luisa Kcomt, Wayne State University; Rececca Evans-Polce, U-M School of Nursing; Glenn Radford, Michigan Department of Health and Human Services; Samuel Tennant, U-M School of Public Health; Eric Hulsey, Institute for Research, Education and Training in Addictions; and Vita McCabe, Michigan Medicine.
Study: Childhood mortality by parental cause of death (free full text of research letter available when embargo lifts)
JAMA Network Open