There is no greater loss than the loss of a child. It is like losing your future, says Wayne Loder, whose only two children died in a car accident 14 years ago last Sunday.

“Your children are your legacy. They are your contribution to the future,” Loder tells WebMD. “If there is any grief that you live with for the rest of your life, it is the death of your child.”

Research from Denmark has shown that the loss of a child increases a parent’s own risk of dying, with the risk of death for mothers increasing fourfold in the first years following the event.

Now the same research team is reporting that the risk of mental illness is much greater among parents who have lost a child. And once again the risk was greater for bereaved moms than dads.

Risk Greatest in First Year

The investigators reviewed the health records of more than a million Danish citizens to compare the rate of psychiatric hospitalizations among parents.

Bereaved parents were 70 percent more likely to be hospitalized for a first psychiatric admission compared with parents that had not lost a child.

They found that for any psychiatric disorder, bereaved mothers had an almost 80 percent increase in hospitalization risk compared with an almost 40 percent increase in bereaved fathers.

The risk of hospitalization due specifically to depression-related causes was almost double for bereaved mothers and 60 percent higher for bereaved dads.

The risk of being hospitalized for any psychiatric problem was greatest in the year following the loss of a child, but it remained elevated for five years. And parents who lost their only child were more likely to be hospitalized than those with surviving children.

The study was published in the March 24 issue of The New England Journal of Medicine.

Pain Feels Unbearable

San Francisco grief and loss counselor Gloria Horsley, PhD, RN, says she is not surprised that hospitalizations were highest during the first year after the loss of a child. In addition to depression, parents tend to exhibit manic symptoms during that first year. They don’t eat or sleep well, and they may not fully accept that their child is gone.

“I think of that first year as something like a tantrum,” she says. “We are all taught that we can get what we want if we just go for it. But when a child dies you are powerless. You can’t change it.”

Horsley knows only too well. She says her training as a psychiatric nurse and therapist did not make it easier when her 17-year-old son died in a car wreck in 1983.

“When Scott died I watched myself go through the process kind of like a fly on the wall,” she says. “I knew exactly what I was doing but couldn’t stop myself.”

Early on she experienced unbearable pain and shortness of breath and often caught herself looking for her son in a crowd. She also experienced guilt, consumed with thoughts that she could have somehow done something to change what happened.

Parents Can Recover

While she is impressed with the size of the Danish study, Horsley says she is troubled by the fact that there was no information about the parents’ psychiatric history before the loss of a child. The researchers also failed to include information on how the children died, which can greatly influence a parent’s mental state, she says.

“If a child commits suicide a parent is likely to feel guilt, whereas if they are murdered they are more likely to be angry,” she says.

Loder worries that studies like this one give people the idea that parents can’t recover from the death of a child. He says the message is reinforced by erroneous statistics showing a very high rate of divorce among couples who lose a child.

“That is just not true,” he says. “But the message is that this is something you can’t get over. You certainly never forget, but you can move on.”

Blink of an Eye

Loder’s life changed forever on the first day of spring in 1991 when he got the news that a motorcyclist had smashed into the car carrying his wife, Pat, his 8-year-old daughter, Stephanie, and his 5-year-old son, Stephen.

Although his wife was not badly injured, his two children died within hours of each other later that day.

In the blink of an eye Wayne and Pat Loder were transformed from the proud parents of two beautiful children to a grieving couple facing life alone.

“At the time I felt like we were the only people in the world that this had ever happened to,” he says. “Intellectually, I knew this wasn’t true, but you just feel so alone.”

Several months later the couple found the support group Compassionate Friends for families who have lost children. Pat is now executive director for the organization and Wayne is the group’s public awareness coordinator.

Remembering the Children

Loder says knowing that there are other people who have been through what you have been through and survived can make a huge difference.

For both the Loders and Horsley, recovering involved not letting go of their dead children but finding functional ways to keep them in their lives.

For Horsley that means mentioning Scott at the beginning of all of her public speeches. For the Loders it means making Stephanie and Stephen part of the lives they now share with their young daughter and son who were born after the tragic car accident.

And each year during the holidays, Compassionate Friends has worldwide candle lighting for families that have lost children.

“This is one day during a very difficult time of year that we can devote to remembering the children we had and what they meant to us,” Wayne Loder says. “And we know that there are tens of thousands of people around the world who will be doing the same thing.”

By Salynn Boyles, reviewed by Brunilda Nazario, MD

SOURCES: The New England Journal of Medicine, March 24, 2005; vol 352: pp 1190-1196. Jorn Olsen, MD, PhD, department of epidemiology, School of Public Health, UCLA. Wayne Loder, public awareness coordinator, Compassionate Friends. Gloria Horsley, PhD, RN, marriage and family therapist, psychiatric nursing consultant, San Francisco.