The association between familial death in childhood or adolescence and subsequent substance use disorder: A systematic review and meta-analysis

• Published in: Addictive behaviors Vol. 120; p. 106936
• Main Authors: Syer, Sarah, Clarke, Mary, Healy, Colm, O'Donnell, Laurie, Cole, Jon, Cannon, Mary, McKay, Michael
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2021
• Subjects: Alcohol; Drug; Meta-analysis; Parental death; Sibling death; Substance use disorder; Substance use disorder; Drug; Alcohol; Parental death; Sibling death; Meta-analysis
• ISSN: 0306-4603; 1873-6327
• DOI: 10.1016/j.addbeh.2021.106936

•Investigated association of family death and substance use disorder.•Four major databases were searched.•A total of nine studies met inclusion criteria.•Where meta-analysis was possible, there was no significant association.•Studies showing significant association tended to be large register studies. Exposure to childhood adversity has been linked to long-term negative mental health consequences in adulthood. This review examined the association between exposure to the death of a family member (i.e., parent or sibling) during childhood or adolescence and the subsequent diagnosis of a substance use disorder. Electronic databases (Scopus, Medline (for Ovid), EMBASE, and PsychINFO) were searched for cohort and case-control studies in the English language. Studies were retained if it was demonstrable that exposure to death occurred before age 18, and that disorder was diagnosed subsequently. Sensitivity analyses were performed for the meta-analysis, and study quality assessed using the Newcastle-Ottawa Scale. Nine studies, seven cohort and two case-control, were retained. Due to differential metrics (hazard ratios [HRs] versus odds/risk ratios [ORs/RRs]), only one meta-analysis was possible. Individuals experiencing familial death had 1.42 (95% CI = 0.96, 2.09) times the odds of developing a substance use disorder compared to those non-exposed. Where there was a statistically significant effect in other studies, these were mostly studies using National Registers (1.4 ≤ HR ≤ 2.51). Meta-analysis options were limited by the variety of study designs. Evidence for a significant association between familial death and subsequent disorder appears to be an artefact of the study design. Implications of key findings. Further studies are required to better understand and estimate the association between familial death and substance use disorders. Registration and funding. The review was pre-registered (PROSPERO Reg No: CRD42020192892) and funded by the Irish Research Council (COALESCE/2019/61).