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The Impacts of Parental Loss and Adverse Parenting on Mental Health:

Findings From the National Comorbidity Survey-Replication

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DOI: 10.1037/a0025695

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Psychological Trauma: Theory, Research, Practice, and Policy © 2011 American Psychological Association
2013, Vol. 5, No. 2, 119 –127 1942-9681/13/$12.00 DOI: 10.1037/a0025695

The Impacts of Parental Loss and Adverse Parenting on Mental Health:

Findings From the National Comorbidity Survey-Replication

Angela Nickerson Richard A. Bryant

Massachusetts Veterans Epidemiology Research and Information University of New South Wales
Center and University of New South Wales

Idan M. Aderka Devon E. Hinton

Boston University Massachusetts General Hospital/Harvard Medical School, and
Arbour Counseling Services

Stefan G. Hofmann
Boston University

There has been much controversy regarding the psychological impact of the death of a parent, partly
arising from neglect of potential moderating factors. The present study uses data from the National
Comorbidity Survey Replication (NCS-R) to investigate the relative impacts of age at death of parent,
adverse parenting practices, and time since loss on mental health outcomes in 2,823 bereaved adults.
Logistic regression analyses controlling for sex and race revealed that younger age at the time of parental
death was associated with poorer mental health outcomes. Further, adverse parenting practices during
childhood were related to greater psychopathology in adulthood. Results also indicated that psychological
distress following the death of a parent reduces over time. Notably, each of these factors significantly
predicted psychopathology when controlling for all other variables. Findings are discussed in the context
of current theories of attachment and psychopathology.

Keywords: parent death, parenting, depression, anxiety, mental health

Much research has investigated the impact of the death of a
parent during childhood on psychological distress later in life
(Bowlby, 1961, Bowlby, 1980). Such studies have been guided by
theories of attachment that posit that the loss of a parent early in
life may disrupt attachment relationships in a way that impairs the
development of the secure self and compromises the ability of the
individual to effectively manage separations and stress (Clarkin,
Lenzenweger, Yeomans, Levy, & Kernberg, 2007). As the life
span progresses and the individual reaches adulthood, the psycho-
logical and interpersonal consequences of this disturbance may
manifest in long-term mental health problems (Bowlby, 1961,
Bowlby, 1980; Clarkin et al., 2007).
Despite strong theoretical frameworks guiding this research,
evidence regarding the long-term psychological impact of the
This article was published Online First October 17, 2011.
Angela Nickerson, Massachusetts Veterans Epidemiology Research and
Information Center, and School of Psychology, University of New South
Wales, Sydney, NSW, Australia; Richard A. Bryant, School of Psychol-
ogy, University of New South Wales; Idan M. Aderka and Stefan G.
Hofmann, Psychotherapy and Emotion Research Laboratory, Boston Uni-
versity; Devon E. Hinton, Massachusetts General Hospital/Harvard Med-
ical School and Arbour Counseling Services.
Correspondence concerning this article should be addressed to Angela
Nickerson, School of Psychology, University of New South Wales, Syd-
ney, NSW, Australia, 2052. E-mail: a.nickerson@unsw.edu.au
death of a parent in childhood has been mixed. While findings
from some studies have suggested that the early death of a parent
contributes to later psychological distress (Agid et al., 1999;
Barnes & Prosen, 1985; Bifulco, Brown, & Harris, 1987; Birtch-
nell, 1970; Dennehy, 1966; Kivelä, Luukinen, Koski, Viramo, &
Pahkala, 1998; Kunugi et al., 1995; Mack, 2001; Roy, 1978), other
research has indicated that this relationship is weak or even non-
existent (Birtchnell, 1980; Breier et al., 1988; Faravelli et al., 1986;
Kendler, Neale, Kessler, Heath, & Eaves, 1992; Perris, Holmgren,
von Knorring, & Perris, 1986; Roy, 1985; Schwartz et al., 1995;
Tennant, Hurry, & Bebbington, 1982; Tennant, Smith, Bebbing-
ton, & Hurry, 1981). Early studies have been criticized for failing
to discriminate between types of parental loss, with recent research
suggesting that separation from parents may have a stronger asso-
ciation with psychopathology than early parental death (e.g., Agid
et al., 1999; Hällström, 1987; Kendler et al., 1992; Kessler, Davis,
& Kendler, 1997; Maier & Lachman, 2000; Schwartz et al., 1995).
Methodological factors in the above studies have limited the
ability to draw conclusions regarding the extent to which the death
of a parent across the life span contributes to subsequent psycho-
pathology. For example, many of the studies cited have restricted
the examination of parental death to childhood, failing to investi-
gate the psychological impact of the loss of a parent later in life
(e.g., Birtchnell, 1980; Breier et al., 1988; Faravelli et al., 1986;
Roy, 1985). Other studies have compared participants who lost a
parent prior to a certain age (usually representing the end of

119
120 NICKERSON, BRYANT, ADERKA, HINTON, AND HOFMANN
childhood) to all other participants regardless of when or if they
had experienced parental death (Perris et al., 1986; Tennant et al.,
1981). These strategies may be problematic, as they implicitly
suggest that individuals exhibit qualitatively different psycholog-
ical reactions to the death of parent before and after a certain age.
In contrast, theories and research indicate that attachment and
other important processes occur not only in childhood but through-
out the life span (Bowlby, 1969; Erikson, 1963). For example, late
adolescence and young adulthood are important periods in terms of
the evolution of child-parent relationships, and studies suggest that
the nature of these relationships may influence later interpersonal
and psychological functioning (e.g., Aquilino, 1997; Riggio, 2004;
Roberts & Bengtson, 1996; Srinivasa, Scholte, & Dubas, 2006). It
is also possible that the death of a parent later in life may be more
expected, with the adult having greater psychological resources to
facilitate coping. By limiting the examination of age of loss of a
parent to childhood, or using arbitrary cutoff points, important
information about the psychological effects of the loss across the
developmental span may be obscured. The present study addressed
this limitation by examining age at death of a parent continuously,
using a broader life span perspective.
In addition to the death of a parent during childhood, recent
research has investigated the impact of other factors that may
influence psychopathology later in life (Breier et al., 1988; Elizur
& Kaffman, 1983; Luecken, 2000, Luecken, 2008; Mack, 2001;
Saler & Skolnick, 1992). There is strong evidence that aspects of
the family environment, such as quality of parental care and
relationship with the surviving parent, are important in affecting
long-term psychological reactions following parental loss (Breier
et al., 1988; Harris, Brown, & Bifulco, 1986; Luecken, 2000;
Mickelson, Kessler, & Shaver, 1997; Saler & Skolnick, 1992).
This is consistent with attachment theories that suggest that the
quality of the care that a child receives in the aftermath of losing
a parent will have significant implications for attachment relation-
ships and subsequent mental health (Bowlby, 1980).
This perspective is supported by findings from a study by Saler
and Skolnick (1992), which suggested that the degree of warmth
and empathy displayed by the surviving parent, as well as the
extent to which he or she promoted autonomy in the child, was
associated with lower rates of adult depressive symptoms follow-
ing the death of a parent in childhood. Breier and colleagues
(1988) found that inadequate parenting was associated with adult
psychopathology in individuals who had experienced early paren-
tal loss; they hypothesized that the loss of a parent may increase
the likelihood of the remaining parent engaging in poor parenting
practices as a consequence of their own grief reactions. Together,
these findings suggest that family environment and caretaking
significantly impact on psychological adjustment following the
loss of a parent.
A second factor that may influence the mental health outcomes
following the death of a parent is the amount of time that has
elapsed since the parental death. To our knowledge, no study has
previously considered the impact of temporal proximity to the
death of a parent on psychopathology later in life. Research on the
trajectory of bereavement responses indicates that psychological
distress following loss typically abates over time (Bonanno,
Boerner, & Wortman, 2008; Bonanno & Kaltman, 2001). This
suggests that individuals who have experienced the death of a
parent more recently are likely to exhibit greater mental health
symptoms than those who lost a parent in the distant past. Time
since the death of a parent is potentially an important factor
influencing psychological distress following the loss of a parent,
and merits further research investigation.
In the present study, we used data collected from the National
Comorbidity Survey-Replication (NCS-R) to investigate the im-
pact of age at the death of a parent, time since the loss, and adverse
parenting practices on a variety of mental health outcomes in
adulthood. By examining the effects of these factors simultane-
ously, we sought to clarify whether each factor was related to
greater psychopathology when controlling for the other variables.
We hypothesized that poorer mental health would be associated
with (a) the death of a parent at a younger age, (b) the more recent
death of a parent, and (c) more adverse parenting practices.
Method
Participants
This study reports on findings from the NCS-R, which was
undertaken between February 2001 and April 2003 to assess the
mental health of persons residing in the United States. The method
and design of this survey have been described in detail elsewhere
(Kessler et al., 2004; Kessler & Merikangas, 2004). This survey
was designed to replicate the 1993 National Comorbidity Survey
(Wittchen, Zhao, Kessler, & Eaton, 1994). In the NCS-R, 11,222
households were initially screened, with individuals who were
institutionalized, did not speak English, or were living on military
bases being excluded from this survey. Part 1 of the NCS-R, which
focused on core psychological disorders, was administered to a
nationally representative sample consisting of 9,282 adults (18
years and older) residing in the United States (excluding Alaska
and Hawaii). This represented a 70.9% follow-up rate. Part 2 of the
NCS-R, which focused on certain types of psychopathology, risk
factors, and correlates of mental disorders, was administered to
5,692 persons. Only participants who had experienced the death of
a parent were included in the present analyses (N ⫽ 2,823).
Measures
The NCS-R employed the World Health Organization (WHO)
Composite International Diagnostic Interview (CIDI) developed
for the WHO World Mental Health (WMH) Survey Initiative,
known as the WMH-CIDI (Kessler & Ustun, 2004). In the current
study, we used demographic information, including age, sex, race,
and age at the time the first parent died. We created a variable
representing time since the death of a parent. This was achieved by
subtracting the age of the participant at the time of the first parental
death from his or her current age.
We utilized the lifetime mental disorders modules, encompass-
ing mood disorders (major depression, dysthymia, bipolar I disor-
der, and bipolar II disorder), anxiety disorders (panic disorder,
specific phobia, agoraphobia, generalized anxiety disorder [GAD],
posttraumatic stress disorder [PTSD], social anxiety disorder, and
separation anxiety disorder), substance abuse disorders (alcohol
abuse and dependence, and drug abuse and dependence), eating
disorders (anorexia, bulimia and binge eating disorder), and inter-
mittent explosive disorder [IED].
 EARLY PARENTAL LOSS AND ADULT MENTAL HEALTH 121

We used five items from the NCS-R to assess adverse parenting Table 2
practices. These items were “How often were you made to do chores Prevalence of Psychological Disorders Among Participants Who
that were too difficult or dangerous for someone your age?”; “How Had Lost a Parent
often were you left alone or unsupervised when you were too young
to be alone?”; “How often did you go without things you needed like Psychological Disorder N (%)
clothes, shoes or school supplies because your parents or caregivers Anxiety disorders
spent the money on themselves?”; “How often did your parents or Panic disorder with agoraphobia 71 (2.42)
caregivers make you go hungry or not prepare regular meals?”; and Agoraphobia 121 (4.12)
“How often did your parents or caregivers ignore or fail to get you Panic disorder without agoraphobia 232 (7.89)
Social anxiety disorder 526 (17.89)
medical treatment when you were sick or hurt?” Each item was rated
Generalized anxiety disorder 427 (14.53)
on a scale of 1 (often) to 4 (never). Items were reverse-scored and Specific phobia 574 (19.53)
summed to create an index of adverse childhood parenting experi- Separation anxiety disorder 256 (8.71)
ences (␣ ⫽ .77), with a higher score representing more childhood Posttraumatic stress disorder 319 (10.85)
adverse parenting experiences. Mood disorders
Major depression 788 (26.81)
Dysthymia 208 (7.08)
Procedure Bipolar disorder I 44 (1.50)
Bipolar disorder II 53 (1.80)
A four-stage area probability sample was used in this survey. First, Substance use
a representative probability sample of 62 primary sampling units was Alcohol abuse 512 (17.42)
identified and stratified for geographic variations. In the second stage, Alcohol dependence 219 (7.55)
Drug abuse 260 (8.85)
these primary sampling units were divided into areas consisting of Drug dependence 101 (3.44)
between 50 and 100 housing units. In the third stage, the addresses of Eating disorders
all residences in housing units were recorded. Finally, an informant Anorexia 8 (0.27)
visited each residence and obtained a household listing of occupants Bulimia 16 (0.54)
Binge eating disorder 54 (1.84)
who were over 18 years of age and spoke English. One or two
Other disorders
residents from each household were selected to be interviewed using Intermittent explosive disorder 249 (8.47)
a probability procedure. Weights were calculated to take into account Any anxiety disorder 1282 (43.62)
the probability of being selected to take part in the survey and to adjust Any mood disorder 913 (31.06)
for nonresponse bias. Any psychological disorder 1636 (55.67)
The interviews were administered using laptop computer-assisted
personal interview (CAPI) methods in participants’ homes. Study
procedures were outlined for participants and written informed con-
of interest. Part 2 was administered to a subsample of persons who
sent obtained. Interviews were administered by trained interviewers,
took part in Part 1 (N ⫽ 5,692), with those exhibiting psychopathol-
with a random sample being reinterviewed by supervisors for data
ogy being oversampled. Participants in Part 2 were drawn from three
validation. The interviews were administered in two parts, with Part 1,
strata based on their responses to Part 1. First, all participants who met
which was administered to all participants, investigating core psycho-
lifetime criteria for a disorder, had subclinical levels of psychopathol-
logical disorders. Part 2 focused on the assessment of additional
ogy for which they had sought treatment, and/or had experienced
disorders as well as other mental health correlates and other variables
significant suicidality were interviewed. Second, a probability sample
(59%) of participants who had lifetime subthreshold clinical symp-
Table 1 toms, had sought treatment for such problems, had ever experienced
Demographic Characteristics of Participants Who Had Lost at suicidal ideation, or had used psychotropic medications over the past
Least One Parent year were interviewed. Finally, 25% of all other participants were
administered Part 2. Data from both Parts 1 and 2 of the NCS-R were
Characteristic N (%) used in the current study.

Sex
Male 1184 (40.29) Statistical Analysis
Female 1755 (59.71)
Age M ⫽ 53.34 (SD ⫽ 14.99) We used the complex samples module of SPSS 17.0 to undertake
Race analyses while implementing weights to correct for selection and
African American 410 (3.95) nonresponse bias as described previously. Demographic frequencies
Asian 33 (1.12) and the prevalence of psychological disorders were calculated for
Hispanic 202 (6.87) participants, all of who had experienced the death of a parent. Logistic
White 2201 (74.89)
Other 93 (3.16) regressions were undertaken to examine the relationship between time
Mother died 1805 (61.42) since death, age at loss of parent, and adverse parenting practices on
Father died 2622 (89.21) psychological disorders. All analyses controlled for sex and race. In
Both parents died 1488 (50.63) order to render odds ratios interpretable in the context of hypothesized
Time since loss M ⫽ 21.83 (SD ⫽ 16.97)
Age at which parent died M ⫽ 31.31 (SD ⫽ 14.69)
relationships, older age and greater time since loss served as indica-
tors. Thus, odds ratios of greater than 1 would suggest that psycho-
Note. N ⫽ 2939. pathology was related to younger age and shorter time since loss.
122 NICKERSON, BRYANT, ADERKA, HINTON, AND HOFMANN

Similarly, higher scores on the parenting experiences scale repre-

Note. All analyses controlled for the effects of sex and race on psychological outcomes. To assist interpretability of odds ratios, time since death was coded so that shorter time since death was
represented by larger number. Thus odds ratios of greater than 1 suggest that shorter time since death was related to greater likelihood of developing psychopathology. Further, age at loss of parent
was coded so that earlier age was represented by larger numbers. Thus odds ratios of greater than 1 suggest that losing a parent at a younger age is related to greater likelihood of developing
Adverse parenting practices 1.11ⴱ (1.02–1.21) 1.12ⴱⴱⴱ (1.05–1.19) 1.09ⴱⴱⴱ (1.04–1.14) 1.11ⴱⴱⴱ (1.07 to 1.16) 1.12ⴱⴱⴱ (1.08–1.17) 1.11ⴱⴱⴱ (1.07–1.21) 1.16ⴱⴱⴱ (1.11–1.21) 1.16ⴱⴱⴱ (1.11–1.21)ⴱⴱⴱ
1.03ⴱⴱ (1.01–1.04) 1.03ⴱⴱⴱ (1.02–1.04) 1.03ⴱⴱⴱ (1.02 to 1.04) 1.02ⴱⴱⴱ (1.01–1.03) 1.02ⴱⴱⴱ (1.01–1.03) 1.04ⴱⴱⴱ (1.03–1.05) 1.04ⴱⴱⴱ (1.03 to 1.05)
Posttraumatic stress

1.02ⴱⴱ (1.01–1.04) 1.02ⴱⴱⴱ (1.01–1.04) 1.03ⴱⴱⴱ (1.02 to 1.04) 1.02ⴱⴱⴱ (1.02–1.03) 1.02ⴱⴱⴱ (1.01–1.03) 1.04ⴱⴱⴱ (1.02–1.05) 1.04ⴱⴱⴱ (1.03–1.05)
sented more adverse parenting, so an odds ratio of greater than 1 for

OR (95% CI)
this variable would indicate that psychopathology was related to more

disorder
adverse parenting experiences. For certain psychological disorders
(namely bipolar I disorder, bipolar II disorder, dysthymia, panic
disorder without agoraphobia, social anxiety disorder, anorexia ner-
vosa, bulimia nervosa, and binge eating disorder), maximum likeli-
hood estimates could not be calculated due to quasi-complete sepa-
Separation anxiety

OR (95% CI)
ration in the data, occurring as a result of the inclusion of the race
disorder

variable in analyses. For these disorders, race was removed from the
logistic regression model.1
Logistic Regression Examining Impact of Age at Death of Parent, Time Since Loss, and Adverse Parenting Practices on Anxiety Disorders

Results
Specific phobia
OR (95% CI)

Participant Characteristics
Demographic characteristics of participants are presented in
Table 1. Approximately 40% (N ⫽ 1184) of the sample was male,
and the mean age was 53.34 years (SD ⫽ 14.99). Most of the
Generalized anxiety

sample was White (N ⫽ 2201, 74.89%), with the next largest racial
OR (95% CI)

group being African American (N ⫽ 410, 13.95%). Nearly 90% of

disorder

participants had experienced the death of their father (N ⫽ 2622,

89.21%), and nearly two thirds had experienced the death of their
mother (N ⫽ 1805, 61.42%). Approximately half of the sample
had lost both of their parents (N ⫽ 1488, 50.63%). The mean age
of first death of a parent was approximately 31.31years (SD ⫽
Social anxiety

OR (95% CI)

14.69), and the mean time since the first death of a parent was
disorder

21.83 years (SD ⫽ 16.97).

Prevalence of Psychological Disorders

Table 2 reports prevalence of psychological disorders in partic-
Panic disorder

ipants who had lost a parent. Over half of these participants had
OR (95% CI)
agoraphobia
without

experienced a psychological disorder at some point in their lives

(N ⫽ 1636, 55.67%), with 1282 reporting a lifetime anxiety
disorder (43.62%) and 913 reporting a lifetime mood disorder
(31.06%). The most commonly experienced disorder was major
depression (N ⫽ 788, 26.81%), followed by specific phobia (N ⫽
574, 19.53%) and alcohol abuse (N ⫽ 512, 17.42%). Relatively
OR (95% CI)
Agoraphobia

few participants reported a history of eating disorders, bipolar

disorders, or drug dependence.

Multivariate Analyses
Panic disorder
OR (95% CI)

Multivariate logistic regressions were conducted to examine the

impact of age at death of parent, time since loss, and adverse
—
—

p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ p ⬍ .001.

parenting practices on anxiety disorders (Table 3), mood disorders

(Table 4), alcohol and substance use disorders (Table 5), eating
disorders and intermittent explosive disorder (Table 6), and overall
Age at loss of parent

1
Three two-way (Age ⫻ Time Since Loss; Age ⫻ Adverse Parenting
Practices; and Time Since Loss ⫻ Adverse Parenting Practices) and one
psychopathology.
Time since death

three-way (Age ⫻ Time Since Loss ⫻ Adverse Parenting Practices)

interaction terms were constructed and entered into the multivariate logistic
Table 3

regression model. While each of the interaction terms emerged as a

significant predictor for a small number of disorders, no interpretable
pattern of results emerged, so these will not be reported.
ⴱ
 EARLY PARENTAL LOSS AND ADULT MENTAL HEALTH
Table 4
Logistic Regression Examining Impact of Age at Death of Parent, Time Since Loss and Adverse Parenting Practices on Mood
Disorders
Major depression
OR (95% CI)
Time since death 1.03ⴱⴱⴱ (1.02 to 1.03)
Age at loss of parent 1.02ⴱⴱⴱ (1.01 to 1.03)
Adverse parenting practices 1.09ⴱⴱⴱ (1.05 to 1.14)
ⴱ ⴱⴱ ⴱⴱⴱ
p ⬍ .05. p ⬍ .01. p ⬍ .001.
psychological disorders (Table 7).2,3 Even after controlling for sex
and race, time since death, age at loss of parent, and adverse
parenting practices, all significantly predicted the presence of each
of the investigated anxiety and mood disorders, with the exception
of panic disorder with agoraphobia, which was predicted only by
adverse parenting practices. For example, the odds ratios reported
for the outcome variable of agoraphobia indicated that, for every
year closer to the death of a parent, a participant was 2% more
likely to evidence a diagnosis of agoraphobia. Similarly, for every
year younger at the time of parental death, a participant was 3%
more likely to be diagnosed with agoraphobia. For every unit
increase in adverse parenting practices, the participant was 12%
more likely to have a diagnosis of agoraphobia. Drug abuse and
drug dependence evidenced the highest odds ratios in relation to
time since loss and age at loss of parent, while PTSD, separation
anxiety disorder, dysthymia, and intermittent explosive disorder
evidenced the highest odds ratios in relation to adverse parenting
practices.
Age at loss of parent did not predict any of the eating disorders;
however, time since death and adverse parenting practices were
associated with a higher likelihood of experiencing bulimia and
binge eating disorder.
Discussion
The results of the current study challenge previous research that
has failed to find a link between early parent death and later
psychopathology (e.g., Birtchnell, 1980; Breier et al., 1988; Fara-
velli et al., 1986; Kendler et al., 1992; Schwartz et al., 1995;
Tennant et al., 1982). In contrast, and consistent with numerous
previous studies (Agid et al., 1999; Barnes & Prosen, 1985; Bi-
fulco et al., 1987; Birtchnell, 1970; Dennehy, 1966; Kivelä et al.,
1998; Kunugi et al., 1995; Mack, 2001; Roy, 1978), these findings
indicate that the loss of a parent earlier in life significantly predicts
the presence of most anxiety and mood disorders, as well as
alcohol and substance use and intermittent explosive disorder.
Further, consistent with our hypotheses, shorter time since the
death of a parent and adverse parenting practices also emerged as
strong predictors of psychopathology in adulthood, even after
controlling for age at loss of parent.
The finding that younger age at the time of parental death was
associated with greater psychopathology is consistent with results
from early studies that documented a relationship between the loss
of a parent in childhood and adult depression (e.g., Barnes &
Prosen, 1985; Bifulco et al., 1987; Birtchnell, 1970; Dennehy,
1966). The current findings further suggest that the early death of
a parent is associated with a variety of adult psychopathology
123
Dysthymia Bipolar disorder I Bipolar disorder II
OR (95% CI) OR (95% CI) OR (95% CI)
1.02ⴱⴱ (1.01 to 1.04) 1.04ⴱⴱ (1.02 to 1.07) 1.05ⴱⴱⴱ (1.03 to 1.07)
1.02ⴱⴱⴱ (1.01 to 1.03) 1.06ⴱⴱⴱ (1.03 to 1.09) 1.03ⴱ (1.01 to 1.06)
1.16ⴱⴱⴱ (1.10 to 1.21) 1.10ⴱ (1.01 to 1.20) 1.15ⴱⴱⴱ (1.07 to 1.23)
including anxiety, mood, and substance-use disorders. This is in
accordance with recent models that highlight the transdiagnostic
aspects of psychopathology, focusing on similarities in maintain-
ing factors and treatment of various disorders (Brown & Barlow,
2009; Fairholme, Boisseau, Ellard, Ehrenreich, & Barlow, 2010).
It is possible that the early death of a parent serves as a nonspecific
risk factor for later psychological distress, transcending categorical
distinctions between psychological disorders.
The discrepancy between results from the current study and
past research that has failed to find a link between age at loss
of a parent and subsequent mental disorders may be partially
accounted for by a differential focus on age across investiga-
tions. While previous studies have restricted the investigation
of parental loss to childhood (e.g., Agid et al., 1999; Hällström,
1987; Kendler et al., 1992; Kessler et al., 1997; Kunugi et al.,
1995; Roy, 1978) or compared participants who had lost a
parent in childhood with those who had not (e.g., Bifulco et al.,
1987; Kendler et al., 1992; Kivelä et al., 1998; Perris et al.,
1986; Tennant et al., 1981), the present study examined parental
death continuously across the life span. The finding that age at
the death of a parent predicted psychopathology suggests at-
tachment processes continue beyond childhood throughout the
life span. The imposition of a numerical cutoff representing the
“end” of childhood may thus obscure the relationship between
early age and later psychological distress by truncating the age
range that can be investigated. The exclusion of late adoles-
cence and early adulthood in such analyses may be particularly
problematic as research has suggested that parent– child rela-
tionships during this period have a substantial influence on later
relationships and psychological health (Aquilino, 1997; Riggio,
2004; Roberts & Bengtson, 1996; Srinivasa et al., 2006).
Viewed from an attachment perspective, the findings from
the current study suggest that the loss of a primary caregiver at
a young age may disrupt attachment processes and predispose
the person to greater psychological distress in adulthood
2
Multivariate logistic regressions examining the impact of age at death
of parent, time since loss, and adverse parenting practices on psychopa-
thology separately for the death of mother and father were undertaken. The
pattern of results was very similar to those seen for analyses focusing on
earliest death of a parent, so only results related to the earliest death of a
parent are reported here.
3
Initially, a variable examining the extent to which the death of one
parent compared to the death of both parents was included in the logistic
regression models. This variable was not a significant predictor of any
psychological disorder and thus was not included in the final analysis.
124 NICKERSON, BRYANT, ADERKA, HINTON, AND HOFMANN

Table 5
Logistic Regression Examining Impact of Age at Death of Parent, Time Since Loss and Adverse Parenting Practices on Alcohol and
Substance Use Disorders

Alcohol abuse Alcohol dependence Drug abuse Drug dependence

OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)

Time since death
Age at loss of parent
Adverse parenting practices
ⴱ ⴱⴱ
p ⬍ .05. p ⬍ .01.
1.03ⴱⴱⴱ (1.03 to 1.04)
1.03ⴱⴱⴱ (1.02 to 1.04)
1.14ⴱⴱⴱ (1.08 to 1.20)
ⴱⴱⴱ
p ⬍ .001.
1.04ⴱⴱⴱ (1.02 to 1.05) 1.07ⴱⴱⴱ (1.06 to 1.08) 1.06ⴱⴱⴱ (1.05 to 1.08)
1.02ⴱⴱ (1.01 to 1.04) 1.06ⴱⴱⴱ (1.05 to 1.08) 1.06ⴱⴱⴱ (1.04 to 1.08)
1.15ⴱⴱⴱ (1.09 to 1.21) 1.12ⴱⴱⴱ (1.06 to 1.18) 1.08ⴱ (1.01 to 1.15)

(Bowlby, 1961, Bowlby, 1980). It is possible that, consistent
with attachment theories, the death of a parent at a young age
may be especially disruptive to both attachment relationships
and psychological health due to the heavy reliance of the child
or adolescent on his or her parents during this life period. As the
person progresses through the life span, attachment may be-
come more internalized, rendering the individual more resilient
in the face of loss, and reducing the capacity of parental death
to exert long-term negative effects on mental health (Bowlby,
1969, Bowlby, 1980). While some research has examined the
psychological impact of loss of parent in adulthood (Douglas,
1990; Scharlach, 1991; Scharlach & Fredriksen, 1993; Schar-
lach & Fuller-Thomson, 1994; Umberson, 1995; Umberson &
Chen, 1994), a more detailed examination of factors that affect
psychological functioning following later loss of a parent is
warranted. Expanding examination of the effects of loss of a
parent to encompass other critical life periods, such as young
and later adulthood, may facilitate the identification of conse-
quent mental health difficulties and needs at other life stages.
The finding that adverse parenting practices were strongly re-
lated to psychopathology further highlights the centrality of family
relationships and childhood environment in influencing later psy-
chological functioning. Models of attachment suggest that the
quality of care received by a child after losing a parent is of key
importance in contributing to long-term psychological outcomes
(Bowlby, 1980). Findings from the current study suggest that
adverse childhood parenting experiences are indeed associated
with negative adult mental health outcomes, with poor parenting
significantly predicting all types of psychopathology examined in
this study, including anxiety, mood, and substance use disorders.
This is consistent with previous research indicating that quality of
parental care, particularly after the death of a parent, plays a strong
role in predicting the subsequent psychosocial outcomes (Bifulco,
Harris, & Brown, 1992; Breier et al., 1988; Luecken, 2000; Oliver
& Paull, 1995; Saler & Skolnick, 1992). An alternative possibility
is that individuals with psychological disorders may retrospec-
tively perceive parenting during their childhood as being negative.
Further research is required to investigate these two hypotheses.
While not specifically examined in this study, the potential
relationship between the loss of a parent and adverse parenting
practices merits comment. Breier and colleagues (1988) have
suggested that, following the death of a parent, grief may com-
promise the surviving parent’s ability to engage in good caretaking
behaviors. If this is the case, the psychological distress experi-
enced by the young person after losing a parent may be com-
pounded by an aversive postloss environment. Further, the disrup-
tion of the attachment relationship between the child and the
surviving parent may negatively impact on the capacity of the
young person to manage high levels of distress, which may con-
tribute to psychopathology later in life. While the current study
focused on the impact of adverse parenting practices on psycho-
logical distress, it is possible that positive family relationships and
good parenting practices may act as a protective factor against
psychopathology following the loss of a parent (Luecken, 2000).
Further longitudinal research is necessary to determine the mech-
anisms by which various parenting practices contribute to later
psychopathology following the death of a parent.
The present study is novel in considering the impact of time since
the death of a parent on mental health outcomes. Findings revealed
that more recent parental death was associated with greater likelihood
of exhibiting lifetime psychopathology for all disorders except panic
disorder without agoraphobia and anorexia nervosa. This is consistent
with research outlining the trajectory of psychological symptoms
following loss and other adverse life events in adulthood. Recent
research on grief and bereavement reactions has suggested that the
majority of people experience acute grief reactions in the first 6 to 12
months following the death of someone close to them (Bonanno &
Kaltman, 2001). If grief responses do not begin to alleviate within this

Table 6
Logistic Regression Examining Impact of Age at Death of Parent, Time Since Loss and Adverse Parenting Practices on Eating
Disorders and Intermittent Explosive Disorder

Anorexia Binge eating Intermittent

OR Bulimia disorder explosive disorder
(95% CI) OR (95% CI) OR (95% CI) OR (95% CI)

Time since death
Age at loss of parent
Adverse parenting practices
ⴱ ⴱⴱ
p ⬍ .05. p ⬍ .01.
— 1.05ⴱⴱⴱ (1.02 to 1.08) 1.03ⴱⴱ (1.01 to 1.04) 1.05ⴱⴱⴱ (1.03 to 1.06)
— — — 1.05ⴱⴱⴱ (1.04 to 1.06)
— 1.17ⴱⴱ (1.05 to 1.30) 1.19ⴱⴱⴱ (1.11 to 1.27) 1.17ⴱⴱⴱ (1.11 to 1.22)
ⴱⴱⴱ
p ⬍ .001.
 EARLY PARENTAL LOSS AND ADULT MENTAL HEALTH 125

Table 7
Logistic Regression Examining Impact of Age at Death of Parent, Time Since Loss and Adverse Parenting Practices on Overall
Psychological Disorders

Any psychological
Any anxiety disorder Any mood disorder disorder
OR (95% CI) OR (95% CI) OR (95% CI)

Time since death
Age at loss of parent
Adverse parenting practices
ⴱ ⴱⴱ
p ⬍ .05. p ⬍ .01.
1.03ⴱⴱⴱ (1.02 to 1.04)
1.03ⴱⴱⴱ (1.02 to 1.04)
1.12ⴱⴱⴱ (1.06 to 1.18)
ⴱⴱⴱ
p ⬍ .001.
1.03ⴱⴱⴱ (1.02 to 1.03) 1.03ⴱⴱⴱ (1.02 to 1.04)
1.02ⴱⴱⴱ (1.01 to 1.03) 1.03ⴱⴱⴱ (1.02 to 1.04)
1.09ⴱⴱⴱ (1.05 to 1.14) 1.14ⴱⴱⴱ (1.07 to 1.21)

time, it may indicate the presence of a prolonged or complicated grief
reaction (Prigerson, Vanderwerker, & Maciejewski, 2008). Similarly,
studies exploring psychological reactions following traumatic events
suggest that immediately following a trauma, the majority of people
will experience acute posttraumatic symptoms, which will usually
decrease in the months following the trauma (Blanchard, Hickling,
Barton, & Taylor, 1996; Bryant, 2003; Riggs, Rothbaum, & Foa,
1995). Findings from the present study provide further support for the
assertion that psychological distress reduces following the loss of a
loved one—in this case, extending these findings to the loss of a
parent.
There are a number of limitations associated with the current
study. First, analyses were based on cross-sectional, self-reported
data, which may have introduced recall bias with regard to child-
hood experiences and lifetime disorder prevalence. Accordingly, it
is not possible to establish causality; a longitudinal, prospective
design would provide more information about the progression by
which the variables examined in this study contribute to adult
psychopathology. For example, as we examined age across the life
span, it is possible that psychopathology preceded the loss of a
parent for some participants. Second, there are several other fac-
tors that may have influenced the development of adult psycho-
pathology following parental death that were not investigated in
the current study, including relationship with the remaining parent,
the manner in which the parent died (e.g., accident, suicide, or after
long illness), parental psychopathology, childhood socioeconomic
status, and exposure to other childhood adverse events. Third, only
adult psychological distress was examined in this study. It is
possible that childhood psychological disorders may play a key
role in mediating the relationship between loss of parent at an early
age and later psychopathology. Fourth, parenting practices were
indexed by reports of respondents rather than direct observation of
assessment of parents directly. While this study focused on the
specific impact of parental death on subsequent psychological
functioning, recent research has documented the negative effects
of other childhood aversive events on mental health (Green et al.,
2010; McLaughlin et al., 2010a, McLaughlin et al., 2010b). Future
studies should examine the relationship of age at the time of such
events, in addition to temporal proximity to the event and negative
parenting practices, on psychological outcomes.
In summary, findings from this study indicated that the death of
a parent at an early age had a significant negative effect on adult
mental health outcomes, including mood, anxiety, substance use,
and other disorders. Further, childhood adverse parenting experi-
ences and the more recent death of a parent were associated with
increased risk of developing adult psychopathology. These find-
ings have important implications for theoretical conceptualizations
of psychological reactions following the loss of a parent across the
life span. Further research should be undertaken to elucidate these
relationships and investigate potential clinical implications of the
psychological effects of parental loss.
References
Agid, O., Shapira, B., Zislin, J., Ritsner, M., Hanin, B., Murad, H., . . . Le-
rer, B. (1999). Environment and vulnerability to major psychiatric ill-
ness: A case control study of early parental loss in major depression,
bipolar disorder and schizophrenia. Molecular Psychiatry, 4, 163–172.
doi:10.1038/sj.mp.4000473
Aquilino, W. S. (1997). From adolescent to young adult: A prospective
study of parent-child relations during the transition to adulthood. Journal
of Marriage & the Family, 59, 670 – 686. doi:10.2307/353953
Barnes, G. E., & Prosen, H. (1985). Parental death and depression. Journal
of Abnormal Psychology, 94, 64 – 69. doi:10.1037/0021-843X.94.1.64
Bifulco, A., Harris, T., & Brown, G. W. (1992). Mourning or early
inadequate care? Reexamining the relationship of maternal loss in child-
hood with adult depression and anxiety. Development and Psychopa-
thology, 4, 433– 449. doi:10.1017/S0954579400000882
Bifulco, A. T., Brown, G. W., & Harris, T. O. (1987). Childhood loss of
parent, lack of adequate parental care and adult depression: A replica-
tion. Journal of Affective Disorders, 12, 115–128. doi:10.1016/0165-
0327(87)90003-6
Birtchnell, J. (1970). Depression in relation to early and recent parent
death. British Journal of Psychiatry, 116, 299 –306. doi:10.1192/
bjp.116.532.299
Birtchnell, J. (1980). Women whose mothers died in childhood: An out-
come study. Psychological Medicine: A Journal of Research in Psychi-
atry and the Allied Sciences, 10, 699 –713. doi:10.1017/
s0033291700054994
Blanchard, E. B., Hickling, E. J., Barton, K. A., & Taylor, A. E. (1996).
One-year prospective follow-up of motor vehicle accident victims. Be-
haviour Research and Therapy, 34, 775–786. doi:10.1016/0005-
7967(96)00038-1
Bonanno, G. A., Boerner, K., & Wortman, C. B. (2008). Trajectories of
grieving. In M. S. Stroebe, R. O. Hansson, H. Schut & W. Stroebe
(Eds.), Handbook of bereavement research and practice: Advances in
theory and intervention (pp. 287–307). Washington DC: American Psy-
chological Association.
Bonanno, G. A., & Kaltman, S. (2001). The varieties of grief experience.
Clinical Psychology Review, 21, 705–734. doi:10.1016/S0272-
7358(00)00062-3
Bowlby, J. (1961). Childhood mourning and its implications for psychiatry.
American Journal of Psychiatry, 118, 481– 498.
Bowlby, J. (1969). Attachment and Loss. Vol. 1. Attachment. New York,
NY: Basic Books.
126 NICKERSON, BRYANT, ADERKA, HINTON, AND HOFMANN
Bowlby, J. (1980). Attachment and loss. Vol. 3. Loss: Sadness and depres-
sion. New York, NY: Basic Books.
Breier, A., Kelsoe, J. R., Kirwin, P. D., Beller, S. A., Wolkowitz, O. M.,
& Pickar, D. (1988). Early parental loss and development of adult
psychopathology. Archives of General Psychiatry, 45, 987–993.
Brown, T. A., & Barlow, D. H. (2009). A proposal for a dimensional
classification system based on the shared features of the DSM–IV anx-
iety and mood disorders: Implications for assessment and treatment.
Psychological Assessment, 21, 256 –271. doi:10.1037/a0016608
Bryant, R. A. (2003). Acute stress disorder: Is it a useful diagnosis?
Clinical Psychologist, 7, 67–79. doi:10.1080/13284200410001707523
Clarkin, J. F., Lenzenweger, M. F., Yeomans, F., Levy, K. N., & Kernberg,
O. F. (2007). An object relations model of borderline pathology. Journal
of Personality Disorders, 21, 474 – 499. doi:10.1521/pedi.2007.21.5.474
Dennehy, C. M. (1966). Childhood bereavement and psychiatric illness.
British Journal of Psychiatry, 112, 1049 –1069. doi:10.1192/
bjp.112.491.1049
Douglas, J. D. (1990). Patterns of change following parent death in midlife
adults. Omega: Journal of Death and Dying, 22, 123–137. doi:10.2190/
EU8P-UTG6 – 05HB-LJAG
Elizur, E., & Kaffman, M. (1983). Factors influencing the severity of
childhood bereavement reactions. American Journal of Orthopsychiatry,
53, 668 – 676. doi:10.1111/j.1939-0025.1983.tb03410.x
Erikson, E. H. (1963). Childhood and society (2nd ed.). New York, NY:
Norton.
Fairholme, C. P., Boisseau, C. L., Ellard, K. K., Ehrenreich, J. T., &
Barlow, D. H. (2010). Emotions, emotion regulation and psychological
treatment. In A. M. Kring & D. M. Sloan (Eds.), Emotion regulation and
psychopathology: A transdiagnostic approach to etiology and treatment
(pp. 283–309). New York, NY: Guilford Press.
Faravelli, C., Sacchetti, E., Ambonetti, A., Conte, G., Pallanti, S., & Vita,
A. (1986). Early life events and affective disorder revisited. British
Journal of Psychiatry, 148, 288 –295. doi:10.1192/bjp.148.3.288
Green, J. G., McLaughlin, K. A., Berglund, P. A., Gruber, M. J., Sampson,
N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and
adult psychiatric disorders in the national comorbidity survey replication I:
Associations with first onset of DSM–IV disorders. Archives of General
Psychiatry, 67, 113–123. doi:67/2/113[pii]10.1001/archgenpsychiatry.2009.186
Hällström, T. (1987). The relationships of childhood socio-demographic
factors and early parental loss to major depression in adult life. Acta
Psychiatrica Scandinavica, 75, 212–216. doi:10.1111/j.1600-
0447.1987.tb02777.x
Harris, T., Brown, G. W., & Bifulco, A. (1986). Loss of parent in child-
hood and adult psychiatric disorder: The role of lack of adequate
parental care. Psychological Medicine: A Journal of Research in Psy-
chiatry and the Allied Sciences, 16, 641– 659. doi:10.1017/
s0033291700010394
Kendler, K. S., Neale, M. C., Kessler, R. C., Heath, A. C., & Eaves,
L. J. (1992). Childhood parental loss and adult psychopathology in
women: A twin study perspective. Archives of General Psychiatry,
49, 109 –116.
Kessler, R. C., Berglund, P., Chiu, W. T., Demler, O., Heeringa, S., Hiripi,
E., . . . Zheng, H. (2004). The US National Comorbidity Survey Repli-
cation (NCS-R): Design and field procedures. International Journal of
Methods in Psychiatric Research, 13, 69 –92. doi:10.1002/mpr.167
Kessler, R. C., Davis, C. G., & Kendler, K. S. (1997). Childhood adversity
and adult psychiatric disorder in the US National Comorbidity Survey.
Psychological Medicine: A Journal of Research in Psychiatry and the
Allied Sciences, 27, 1101–1119. doi:10.1017/s0033291797005588
Kessler, R. C., & Merikangas, K. R. (2004). The National Comorbidity
Survey Replication (NCS-R): Background and aims. International Jour-
nal of Methods in Psychiatric Research, 13, 60 – 68. doi:10.1002/
mpr.166
Kessler, R. C., & Ustun, T. B. (2004). The World Mental Health (WMH)
Survey Initiative Version of the World Health Organization (WHO)
Composite International Diagnostic Interview (CIDI). International
Journal of Methods in Psychiatric Research, 13, 93–121. doi:10.1002/
mpr.168
Kivelä, S.-L., Luukinen, H., Koski, K., Viramo, P., & Pahkala, K. (1998).
Early loss of mother or father predicts depression in old age. International
Journal of Geriatric Psychiatry, 13, 527–530. doi:10.1002/
(SICI)1099-1166(199808)13:8⬍527::AID-GPS814⬎3.0.CO;2-8
Kunugi, H., Sugawara, N., Aoki, H., Nanko, S., Hilrose, T., & Kazamat-
suri, H. (1995). Early parental loss and depressive disorder in Japan.
European Archives of Psychiatry and Clinical Neuroscience, 245, 109 –
113. doi:10.1007/BF02190737
Luecken, L. J. (2000). Attachment and loss experiences during childhood
are associated with adult hostility, depression, and social support. Jour-
nal of Psychosomatic Research, 49, 85–91. doi:10.1016/S0022-
3999(00)00151-3
Luecken, L. J. (2008). Long-term consequences of parental death in child-
hood: Psychological and physiological manifestations. In M. Stroebe, L.
Hansson, H. Schut, & W. Stroebe (Eds.), Handbook of bereavement
research and practice: Advances in theory and intervention (pp. 397–
416). Washington, DC: American Psychological Association.
Mack, K. Y. (2001). Childhood family disruptions and adult well-being:
The differential effects of divorce and parental death. Death Studies, 25,
419 – 443. doi:10.1080/074811801750257527
Maier, E. H., & Lachman, M. E. (2000). Consequences of early parental
loss and separation for health and well-being in midlife. International
Journal of Behavioral Development, 24, 183–189. doi:10.1080/
016502500383304
McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky,
A. M., & Kessler, R. C. (2010a). Childhood adversities and adult psychiatric
disorders in the national comorbidity survey replication II: Associations
with persistence of DSM–IV disorders. Archives of General Psychiatry, 67,
124 –132. doi:67/2/124[pii]10.1001/archgenpsychiatry.2009.187
McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A.,
Zaslavsky, A. M., & Kessler, R. C. (2010b). Childhood adversities and
adult psychopathology in the National Comorbidity Survey Replication
(NCS-R) III: Associations with functional impairment related to
DSM–IV disorders. Psychological Medicine: A Journal of Research in
Psychiatry and the Allied Sciences, 40, 847– 859. doi:10.1017/
s0033291709991115
Mickelson, K. D., Kessler, R. C., & Shaver, P. R. (1997). Adult attachment
in a nationally representative sample. Journal of Personality and Social
Psychology, 73, 1092–1106. doi:10.1037/0022-3514.73.5.1092
Oliver, J. M., & Paull, J. C. (1995). Self-esteem and self-efficacy; perceived
parenting and family climate; and depression in university students. Journal of
Clinical Psychology, 51, 467– 481. doi:10.1002/1097-4679(199507)51:
4⬍467::AID-JCLP2270510402⬎3.0.CO;2-0
Perris, C., Holmgren, S., von Knorring, L., & Perris, H. (1986). Parental
loss by death in the early childhood of depressed patients and of their
healthy siblings. British Journal of Psychiatry, 148, 165–169. doi:
10.1192/bjp.148.2.165
Prigerson, H. G., Vanderwerker, L. C., & Maciejewski, P. K. (2008).
Prolonged grief disorder: A case for inclusion in DSM-V. In M. S.
Stroebe, R. O. Hansson, H. Schut, & W. Stroebe (Eds.), Handbook of
bereavement research and practice: Advances in theory and intervention
(pp. 165–186). Washington DC: American Psychological Association.
Riggio, H. R. (2004). Parental marital conflict and divorce, parent-child
relationships, social support, and relationship anxiety in young adult-
hood. Personal Relationships, 11, 99 –114. doi:10.1111/j.1475-
6811.2004.00073.x
Riggs, D. S., Rothbaum, B. O., & Foa, E. B. (1995). A prospective
examination of symptoms of posttraumatic stress disorder in victims of
nonsexual assault. Journal of Interpersonal Violence, 10, 201–214.
doi:10.1177/0886260595010002005
 EARLY PARENTAL LOSS AND ADULT MENTAL HEALTH 127

Roberts, R. E. L., & Bengtson, V. L. (1996). Affective ties to parents in
early adulthood and self-esteem across 20 years. Social Psychology
Quarterly, 59, 96 –106. doi:10.2307/2787121
Roy, A. (1978). Vulnerability factors and depression in women. British
Journal of Psychiatry, 133, 106 –110. doi:10.1192/bjp.133.2.106
Roy, A. (1985). Early parental separation and adult depression. Archives of
General Psychiatry, 42, 987–991.
Saler, L., & Skolnick, N. (1992). Childhood parental death and depression
in adulthood: Roles of surviving parent and family environment. Amer-
ican Journal of Orthopsychiatry, 62, 504 –516. doi:10.1037/h0079372
Scharlach, A. E. (1991). Factors associated with filial grief following the
death of an elderly parent. American Journal of Orthopsychiatry, 61,
307–313. doi:10.1037/h0079240
Scharlach, A. E., & Fredriksen, K. I. (1993). Reactions to the death of a
parent during midlife. Omega: Journal of Death and Dying, 27, 307–
319. doi:10.2190/N2GW-N9WE-UEUP-9H4D
Scharlach, A. E., & Fuller-Thomson, E. (1994). Coping strategies follow-
ing the death of an elderly parent. Journal of Gerontological Social
Work, 21, 85–100. doi:10.1300/J083V21N03_06
Schwartz, J. E., Friedman, H. S., Tucker, J. S., Tomlinson-Keasey, C.,
Wingard, D. L., & Criqui, M. H. (1995). Sociodemographic and
psychosocial factors in childhood as predictors of adult mortality.
American Journal of Public Health, 85, 1237–1245. doi:10.2105/
AJPH.85.9.1237
Srinivasa, P., Scholte, R. H. J., & Dubas, J. S. (2006). Marital and
parent-child relationships, and problem behaviours in children in ado-
lescence and young adulthood. In D. M. Devore (Ed.), New develop-
ments in parent-child relations (pp. 111–128). Hauppauge, NY: Nova
Science Publishers.
Tennant, C., Hurry, J., & Bebbington, P. (1982). The relation of childhood
separation experiences to adult depressive and anxiety states. British
Journal of Psychiatry, 141, 475– 482. doi:10.1192/bjp.141.5.475
Tennant, C., Smith, A., Bebbington, P., & Hurry, J. (1981). Parental
loss in childhood: Relationship to adult psychiatric impairment and
contact with psychiatric services. Archives of General Psychiatry, 38,
309 –314.
Umberson, D. (1995). Marriage as support or strain: Marital quality fol-
lowing the death of a parent. Journal of Marriage & the Family, 57,
709 –723. doi:10.2307/353925
Umberson, D., & Chen, M. D. (1994). Effects of a parent’s death on adult
children: Relationship salience and reaction to loss. American Sociolog-
ical Review, 59, 152–168. doi:10.2307/2096138
Wittchen, H. U., Zhao, S., Kessler, R. C., & Eaton, W. W. (1994).
DSM–III–R generalized anxiety disorder in the National Comorbidity
Survey. Archives of General Psychiatry, 51, 355–364.
Received March 18, 2011
Revision received July 6, 2011
Accepted August 22, 2011 䡲

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