Childhood Grief, Resilience to Stress, and Risk of Mental Disorders: What a Giant Swedish Study Has Found

When a child loses a parent or sibling, it is scary and painful – and it will not “go away” without leaving a trace. A new large-scale study from Sweden followed the lives of 1.73 million young people and showed that such a loss is associated with an increased risk of depression, anxiety and stress-related disorders, as well as problems with alcohol and drugs in adulthood. Part of this connection is explained by the fact that by the age of 18, those who have experienced a loss have lower stress tolerance – a skill that helps them cope with difficulties. But the important detail: only part. Even with the same “stress tolerance”, those who have experienced a loss remain at a higher risk. This means that both support in grief and systematic work on coping skills are needed.

Background of the study

The loss of a loved one in childhood is one of the most powerful stresses of early life and a stable predictor of mental health problems in adulthood (depression, anxiety and stress-related disorders, impaired control over substance use). However, the mechanisms of this connection remained unclear: does the loss itself have a direct effect or is part of the risk “transmitted” through low stress resilience formed by adolescence? This is the hypothesis that the authors are testing in their new work.

Sweden has a unique data source: a standard assessment of stress tolerance by a psychologist at the conscription medical board at ~18 years of age. This provides a rare opportunity to see whether the "stress reserve" becomes a mediator on the path from childhood loss to adult mental disorders - not on proxy scales, but on a single national measure comparable across the entire cohort. This material has previously been used to show that childhood loss is associated with lower stress tolerance in late adolescence.

The new work uses registries of 1.73 million military conscripts with long-term follow-up and applies time-to-event models plus causal mediation analysis to quantify what proportion of the risk of mental disorders after childhood loss is mediated by low resilience by age 18. This design helps to disentangle the direct effects of loss from those mediated through psychological vulnerability, making the findings relevant to population-based prevention.

The practical context is clear: if part of the effects of childhood loss are through the development of low resilience, then schools, mental health services, and social programs can target early support and coping skills training for bereaved children and adolescents with the expectation of mitigating the long-term risk of disorders in adulthood.

How the study works (and why you can trust it)

• Who was studied. Everyone who underwent mandatory psychological and medical examinations upon conscription in Sweden (usually at age 18) from 1969 to 2020. This gave 1,733,085 people (≈98.5% were men, as the conscription system is structured).
• What "exposure". Death of a parent or sibling before age 18. Data were taken from national registries of kinship and causes of death.
• What was compared with? For each person who experienced a loss, 10 “doubles” of the same gender, year and region of birth were selected who had not experienced a loss by that date.
• What were considered outcomes. First diagnosed in adulthood: depression, anxiety, stress-related disorders, and substance abuse (according to hospital and outpatient registries).
• Key mediator. Stress resistance at 18 years - standardized interview with a psychologist (scale 1-9; 1-3 - "low", 4-9 - "high").
• Statistics. Cox models (risks over time) and mediation analysis (what part of the loss effect “passes through” stress resistance). We took into account parental education, family income, family history of mental disorders, physical fitness, and cognitive test results.

Key figures in simple words

The risk of mental disorders is higher in those who experienced the death of a loved one in childhood:

• If a parent and/or sibling died: the risk of any of the disorders studied was ~21% higher (HR 1.21).
• In case of loss of a parent: +14% (HR 1.14) for “any” disorder; separately - depression +19%, anxiety +11%, substance abuse +15%, stress-related disorders +10%.
• In case of loss of a sibling: increased risk for “any” disorder (+12%) and for stress-related disorders (+27%).

Resilience does indeed “sag” after loss: the chance of ending up in the “low resilience” group by age 18 was 13-22% higher (depending on the type of loss), even after adjusting for family and social factors.

Low stress tolerance is a strong predictor of later problems: the risk of most disorders was approximately 1.6-2.1 times higher in people with low tolerance (after all adjustments).

How much exactly does it explain resilience? According to mediation analysis, part of the “loss → disorder” relationship goes through a decrease in stress resistance:

• loss of parent/or sibling: ≈11-19% effect;
• loss of a parent: ≈16-22%;
• loss of a sibling: ≈6-18% (across key outcomes).

The remaining, larger part of the effect is direct: grief, household and financial changes, the traumatic circumstances of death, chronic stress in the family, etc.

What is "stress resistance" and how is it useful?

In the study, this is not “characteristic heroism,” but a practical set of competencies: how a person experiences conflicts, recovers from failures, controls emotions, asks for help, plans steps. This is a measurable risk factor, similar to blood pressure: not a diagnosis in itself, but a good predictor of who and when will “break down” under stress.

The good news is that stress tolerance can be trained, like a muscle. And even if it doesn't eliminate all risk, it can significantly reduce it.

Why Childhood Loss "Resonates" for Years

Science sees several “bridges”:

• Biology of stress. Long-term reconfiguration of the cortisol system: the brain becomes more “sensitive” to threats, “dampens” stress worse.
• Psychology. Attachment and ways of regulating emotions change; even “normal” stresses (exams, quarrels) are more difficult for a child to endure.
• Wednesday. Income falls, the remaining parent has less energy and time, housing/school changes - the workload increases everywhere and at once.
• Familial risk: Some families have a higher baseline risk of mental disorders (genetics + environment), and loss "pushes" the vulnerable.

What to do about it

Family and loved ones

• An early visit to a specialist (child/adolescent psychologist skilled in grief approaches). Better preventatively than "when everything is burning."
• Routine and predictability. Sleep, nutrition, rituals - boring, but this is the foundation of self-regulation.
• Talk honestly. Name feelings (and anger too), allow the child to grieve in his own way, do not devalue.
• Plan with school. One "trusted" adult at school, academic leeway, flexible deadlines.
• Marker "need to increase assistance". Sharp isolation, self-destructive behavior, coming home drunk, giving up favorite activities, prolonged insomnia - a signal to see a doctor/psychotherapist.

School and primary health care

• Screening for loss and current distress. A few questions already increase the chance of a timely response.
• Quick "micro-tools" for the classroom: 4-7-8 breathing, progressive muscle relaxation, "plan A-B-C" for stressful situations.
• Routing path. It is clear where to direct - and free options too.

Policy/Program Level

• Subsidized psychotherapy for children after loss.
• Support for the surviving parent (grief leave, flexible hours, financial arrangements).
• Training school psychologists in methods of working with grief and trauma.

Frequently asked questions

Is this "doom"? No. Most childhood bereavement survivors do not develop a clinical disorder. It's about probabilities and how support does reduce risk.

If the child is "holding up well", is everything ok? Sometimes yes, and sometimes it is a "freeze" of feelings. Observation and gentle checking of how he experiences the loss is more important than grades in the diary.

But what if many years have passed? Help works later, too. Stress management skills can be learned at any age.

Strengths and limitations of the work

Strengths: huge national sample, independent registers (no “memory error”), long horizon (up to 34 years), careful comparison of “exposed” and “control” subjects, analysis of the mechanism through mediation analysis.

Limitations: almost all participants were men; resistance was measured once (it changes); this is an observational study - there are unobservable factors (including genetics), so it is impossible to talk about 100% causality; mainly clinical diagnoses were taken into account - "mild" symptoms could remain behind the scenes.

Where to go next

• Check which resilience programs provide the greatest “gain” for children after loss (school? Family? Individual therapy?).
• Studying women and different cultures: transferability of results is not clear.
• Monitor the sustainability trajectory (multiple measurements), not one point at 18 years.
• To understand how the circumstances of death (suddenness, violence, suicide) and the level of support around the family influence each other.

Conclusion

Child loss is not only about today's pain, but also about an increased long-term risk of mental disorders. Part of this risk goes through reduced stress resistance, which means we have a point of application: early support for the family and child, teaching self-regulation skills and working with the environment (school, everyday life, money). This is not a magic button, but one of the few proven ways to reduce the likelihood of problems tomorrow.

Source: Bjørndal LD et al. Stress Resilience and Risk of Psychiatric Disorders After Childhood Bereavement. JAMA Network Open, 2025 Jul 9; 8(7): e2519706. doi:10.1001/jamanetworkopen.2025.19706