Psychotropic medication trajectories around parental bereavement and their association with suicide mortality among adolescents and young adults, a Swedish nationwide cohort study

Abstract Purpose Parental death during adolescence or young adulthood (AYA) is a significant life event with profound psychological consequences and may initiate or escalate psychotropic medication use. This study identified distinct psychotropic medication use trajectories around parental bereavement, their associations with suicide mortality, and factors characterizing trajectory membership. Methods Using Swedish national registers, we identified individuals born in Sweden between 1977 and 2010 who experienced parental death for the first time between the ages of 10 and 29 years ( n = 141,006). Psychotropic medication use was modeled from two years before to four years after bereavement using zero-inflated Poisson group-based trajectory modeling. Associations with suicide mortality were examined using Cox regression, and factors characterizing trajectory membership were assessed using multinomial logistic regression. Results Four trajectories emerged: low/no use (80.6%), post-loss increasing (8.4%), post-loss declining (5.7%), and persistent high use (5.3%). Compared with the low/no use group, all other trajectories, including the post-loss declining group, were associated with elevated suicide mortality (HRs 2.81–3.13; 95% CIs: 1.65─5.30). Associations were stronger following natural parental death (HRs 3.26–4.07; 95% CIs: 1.77─7.57) and among those predominantly using sedatives (HRs 5.20–7.70; 95% CIs: 1.78─21.7). Pre-loss psychiatric history, female sex, lower socioeconomic background, and unnatural parental death were the strongest factors associated with membership in psychotropic medication use trajectory groups. Conclusion Psychotropic medication trajectories around parental bereavement may serve as markers of suicidal vulnerability among AYAs. The higher risk of suicide mortality in the post-loss declining group suggests that reductions in treatment intensity may not always reflect mental health recovery. Post-bereavement monitoring should integrate medication use patterns with clinical and sociodemographic indicators of vulnerability.