Unexpected death may trigger mania in loved ones

The unexpected loss of a loved one can trigger a range of psychiatric disorders, including mania, in patients with no history of mental illness, a study shows.

Previous case studies have suggested a link between sudden bereavement and mania onset, but this study is the first to show the association in a large population sample, say researcher Katherine Keyes (Columbia University, New York, USA) and co-workers.

The unexpected death of a loved one roughly doubled the risk for new-onset mania in people aged 30 years or older, after accounting for factors including previous psychiatric diagnoses. For some age groups (50–54 years and ≥70 years) the risk increase was more than fivefold, but there was no significant effect in people younger than 30 years.

The data were drawn from 27,534 participants of the National Epidemiologic Survey on Alcohol and Related Conditions. Between about 20% and 30% of these participants identified the unexpected death of a loved one as the most traumatic event in their lives; even among those reporting 11 or more lifetime traumatic events, this was still the most traumatic for 21.6%.

“Our findings should alert clinicians to the possible onset of mania after an unexpected death in otherwise healthy individuals”, the researchers write in The American Journal of Psychiatry.

But they add: “However, it is also notable that the majority of individuals in the present study did not have the onset of any disorder in the wake of an unexpected death of a loved one.”

Unexpectedly losing a loved one also raised the risk of major depression, dysthymia, alcohol use disorder, generalised anxiety disorder, panic disorder, posttraumatic stress disorder and phobias. The largest risk increases were for posttraumatic stress disorder, with an increase of more than 30-fold in some age groups, and the increased risk was present irrespective of age, whereas for most other disorders it was concentrated in the older age groups.

“The first incidence of a psychiatric disorder in old age is relatively rare; these data indicate that psychiatric disorder onset in older age is commonly concomitant with the death of a loved one”, say Keyes et al.

They conclude: “Clinically, our results highlight the importance of considering a possible role for loss of close personal relationships through death in assessment of psychiatric disorders, especially among older adults without a prior history of mental disorder.”

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