Alcohol and substance abuse in parentally bereaved youth

Objective: Little is known about the role of parental bereavement regarding alcohol and substance abuse. Our aim was to examine whether the incidence of alcohol and substance abuse is higher in parentally bereaved youth and, if so, what might explain this increased incidence. Method: In a longitudinal population-based study conducted between November 2002 and December 2012, the incidence of alcohol and substance abuse or dependence (ASAD) during a period of 5 years was examined (using DSMIV criteria) in 235 youth whose parents died of suicide, accident, or sudden natural death and 178 demographically similar nonbereaved youth. Results: In a period that covered 5 years subsequent to the death, bereaved youth had an increased incidence and earlier time to onset of ASAD relative to nonbereaved controls (incident rate ratio = 2.44; 95% CI, 1.17-5.56). Additionally, youth over the age of 13 years (hazard ratio [HR] = 6.68; 95% CI, 3.22-13.89; P < .001), those who developed a disruptive behavior disorder (HR = 7.55; 95% CI, 1.83-31.22; P = .005), and those who had greater functional impairment (HR = 0.93; 95% CI, 0.90-0.95; P < .001) were at increased risk for ASAD. However, after adjusting for the abovenoted variables, the relationship between parental bereavement and pathological youth alcohol and substance use was not statistically significant (HR = 1.73; 95% CI, 0.79-3.81; P = .17). Conclusions: Bereaved youth are at greater risk for ASAD than their nonbereaved counterparts, especially adolescent boys with disruptive behavior disorders. The effect of bereavement was explained by its overall impact on greater functional impairment in bereaved offspring. Interventions that help to improve offspring functioning and that prevent or attenuate the development of disruptive behavior disorders have the potential to prevent ASAD in bereaved youth.