Number of siblings and psychotropic medication purchases surrounding parental death in adulthood: a population-wide cohort study in Finland

BACKGROUND: Parental death has well-established adverse effects on the mental health of children and adolescents, but evidence on adults is scarce. Also, the role of siblings has not been assessed before, even though siblings might be an important source of support during parental death. METHODS: We conducted a national cohort study to examine psychotropic medication purchases (antidepressants, anxiolytics, hypnotics and sedatives) before and after parental death and assessed differences by sibship size and sex of the offspring. We estimated annual probabilities of psychotropic medication purchases for 6 years surrounding parental death and compared men and women experiencing parental death from 2006 to 2016 at ages 35-55 years to a synthetic control group not experiencing parental deaths. RESULTS: We showed increased psychotropic medication purchases in the year before and after parental death. These associations were strongest for those with no or fewer siblings and among women. For example, after mother's death, we observed an increase of 6.8 (95% CI 5.8 to 7.8) percentage points (pp) in psychotropic medication prevalence for women with no siblings in contrast to women whose mother did not die. For women with 1, 2 or 3 siblings, the respective differences were 6.1 (95% CI 5.5 to 6.8), 4.7 (95% CI 4.0 to 5.4) and 3.9 (95% CI 3.0 to 4.8) pp increases. The associations were also stronger after maternal than paternal death. CONCLUSIONS: The findings may indicate that the burden of parental death is less substantial when several siblings are present. The more pronounced association among women may reflect gendered differences in treatment-seeking.