Parents Susceptible to Suicide After Death of Ill Child at Home

NEW YORK MAR 16, 2006 (Reuters Health) - In addition to prolonged anxiety and depression, parents who have a child who dies at home may be at increased risk of suicide, according to a report published in the British Medical Journal for March 18th.  Accessibility to the child"s opioid medication after the death may provide an easy avenue of self-harm.

Dr. Dawn E. Davies, from the University of Alberta in Edmonton, Canada, describes two case reports that illustrate the potential risks to the parent caregiver.

The first case was an infant with congenital rhabdoid tumor of the face, treated at home with morphine to control pain and with lorazepam for symptoms of respiratory distress.  He died the day before his first birthday.

Following his death, the mother refused for 2 days to have his body released to a funeral home or to return leftover drugs to the pharmacy, but she denied any plans of suicide.  The involved physicians and nurses decided to wait until the next day to intervene again with the parents.  However, the next morning, the mother was found unconscious and she died.  Toxicology tests showed high concentrations of opioids and benzodiazepines.

The second case involved an 8-year-old girl receiving palliative care for advanced metastatic Wilms"s disease with multiple painful bony metastases, for which she was treated with enteral methadone. 

After the girl died, the parents stopped answering phone calls.  Several days later, the mother was found unconscious after taking the methadone.  She survived after treatment in a hospital ICU.

Dr. Davies cites research findings that parents make more suicide attempts after the death of a young child than do other parents, and that the risk is highest the first month after the death.  She notes that there are no laws or policies regarding the handling of remaining opioid drugs after a patient"s death in the home.  Occasionally, parents use the residual drugs for self-harm, despite denial of suicidal intentions.

In a related editorial, Dr. Beverley Raphael, from the University of Western Sydney in Parramatta, Australia, comments that "looking after the caregiver, both before, during, and in the aftermath of the death is an integral part of comprehensive care" for parents whose children suffered a prolonged illness.

She suggests that pediatric oncology units provide bereavement support for families, and that parents be put in contact with support groups such as Compassionate Friends.

SOURCE:

• BMJ 2006;332:620-621,647-648.