A Prospective Study of Parentally Bereaved Youth, Caregiver Depression, and Body Mass Index

Rebecca J. Weinberg, PsyD; Laura J. Dietz, PhD; Samuel Stoyak, MD; Nadine M. Melhem, PhD; Giovanna Porta, MS; Monica W. Payne, MA; and David A. Brent, MD

 

ABSTRACT

Objective: To examine the relationship between body mass index (BMI) in bereaved youth and nonbereaved controls 5 years after a parent’s death. The study was conducted from August 9, 2002, through December 31, 2013.

Design: A prospective, longitudinal, controlled study of the effects of sudden parental death on youth.

Setting: Bereaved families were recruited through coroner records and by advertisement. Nonbereaved families were recruited using random-digit dialing and by advertisement.

Participants: 123 parentally bereaved offspring were compared with 122 nonbereaved control offspring, all of whom were aged 11–25 years at the 5-year assessment.

Main Exposure: Bereavement status, type of parental death (accident, suicide, or sudden natural death), and history of depression in caregivers prior to parental death.

Outcome Measures: BMI categories (normal, overweight, and obese), according to International Obesity Task Force guidelines for adults and Centers for Disease Control and Prevention guidelines for children, and DSM-IV psychiatric disorder in offspring and caregivers before and after time of parental death.

Results: Bereaved offspring were more likely to have a BMI in the obese range compared to nonbereaved controls (χ22 = 7.13, P< .01). There were no differences in BMI category by death type among bereaved offspring. Caregiver history of depression was a significant correlate of offspring obesity in nonbereaved youth but had a protective effect on the BMI of bereaved youth.

Conclusions: Bereaved youth were more likely to be obese than nonbereaved youth 5 years after parental death, and caregiver history of depression was associated with increased risk for obesity in nonbereaved youth only. Future studies are necessary to identify mechanisms that increase risk for obesity in parentally bereaved youth.

J Clin Psychiatry 2013;74(8):834–840

© Copyright 2013 Physicians Postgraduate Press, Inc.

Submitted: November 13, 2012; accepted April 3, 2013

(doi:10.4088/JCP.12m08284).

Corresponding author: Laura J. Dietz, PhD, 3811 O’Hara St, Pittsburgh, PA 15213 (dietzlj@upmc.edu).

 

Approximately 4% of US children (2.5 million) will experience the death of one of their parents by the age of 18 years,1 an experience consistently rated as one of the most stressful life events for children2,3 and one associated with a number of adverse psychosocial sequelae. Retrospective, record-linkage, and prospective studies all show a significant relationship between parental death and internalizing and externalizing symptoms, impaired school performance, and sexual-risk behavior in children.4–12 The few prospective studies examining the impact of parental loss on children have found heightened risk for psychiatric disorder, most notably depression, posttraumatic stress disorder, alcohol or substance use, and prolonged grief disorders and impairment 5–12 years after the death.13–16 Family adversity, including parental bereavement, has been associated with health-risk behaviors and an abnormal physiologic response to stress.17,18 However, there are no retrospective or prospective studies that have examined the associations between parental bereavement and obesity.19

Parental bereavement may confer risk for obesity through several pathways. First, bereaved youth have an increased risk for depression, which in turn has been associated with a higher risk for obesity,20,21 particularly for females.22,23 Second, parental bereavement puts the surviving caregiver at increased risk of depression, complicated grief, and functional impairment.14–16 These conditions could lead to lower parental monitoring, which in turn has been associated with a range of poor health outcomes, including obesity.24–26 Because obesity is partially genetically determined, the type of parental death may also increase risk for obesity in bereaved offspring27whose parents died by cardiac events.

This study investigated the association between body mass index (BMI) and parental bereavement in a sample of 123 bereaved offspring and in 122 nonbereaved offspring. It was hypothesized that bereaved offspring would be more likely to have a BMI in the obese range compared to their nonbereaved counterparts. Exploratory analyses were conducted within the bereaved group to investigate differences in BMI by parental death type (parental death due to suicide [n = 45], accident [n = 27], or sudden natural death [n = 51]). Analyses were also conducted to examine whether offspring or caregiver depression moderated the effect of bereavement on offspring BMI. We predicted that bereaved offspring who experienced depression before or after parent death or who had caregivers with depression before or after parent death would be more likely than bereaved offspring without these psychiatric risks to have a BMI in the obese range.

 

METHOD

Study Sample

This report examines 245 bereaved and nonbereaved offspring, 57.4% of youth originally recruited for a longitudinal study of the effect of parental bereavement on offspring psychiatric outcomes,14,15 who completed psychiatric interviews and health measurements at the 5-year assessment. These offspring were from 86 parentally bereaved families and 70 nonbereaved families and were between the ages of 11 and 25 years at the 5-year assessment (offspring aged 6–20 years living with primary caretakers were enrolled into the original study). Deceased parents (probands) were between the ages of 28 and 63 years, were predominantly male (83%), and died within 24 hours of definite verdicts of suicide (n =30), accidental death (n = 20), or sudden natural death (n = 36). The nonbereaved offspring had 2 living biological parents, lived in the home of at least 1 parent (82.8% lived with both parents), and had no first-degree relatives who had died within the 2 years prior to recruitment.

 

• Physicians should be aware that bereaved children may be at increased risk for obesity.
• Bereaved youth may benefit from closer monitoring of diet and physical activity to prevent excessive weight gain.
• Bereaved youth and their caregivers may benefit from psychoeducation about the association between negative emotions, stress, and eating behavior.

 

Offspring who participated in this study (N =245) were similar to those lost to follow-up (n = 182) on baseline demographic and psychiatric characteristics, except that those lost to follow-up were more likely than those retained to be parentally bereaved (65.4% vs 50.0%), to be older (13.8 years vs 12.9 years), to be female (55.5% vs 45.3%), to have a history of abuse (9.9% vs 2.9%), and to have a proband with a lifetime history of alcohol or substance disorder (59.3% vs 49.2%). However, bereavement status was the only variable of the 5 identified that was related to BMI in the current report. Next, we examined differences in demographic and psychiatric characteristics between bereaved offspring included in this report and those lost to follow-up. Those bereaved offspring who were lost to follow-up were more likely than those retained to have a caregiver with a history of alcohol or substance disorder (32.1% vs 16.7%), to have a caregiver of minority status (28.4% vs 11.7%), and to have had a proband with a history of an anxiety disorder (28.3% vs 16.4%). Again, none of these variables were related to BMI in the overall sample or in the bereaved offspring included in the current report.

Participant Recruitment

Probands were identified from the coroner’s office or via advertisement, with an overall acceptance rate of 71%.14 Families in which there were multiple deaths or injuries, or ambiguous accidents, such as single-passenger vehicular accidents, were excluded. Control probands were recruited through random-digit dialing or newspaper advertisement with an overall acceptance rate of 55%14 and were frequency-matched to the deceased probands by neighborhood, age, and gender. The caregivers of bereaved offspring were the surviving parents, while the caregivers of the nonbereaved offspring were self-identified as the primary caregiver. This study was approved by the University of Pittsburgh Institutional Review Board, and all participants and parents/legal guardians gave written informed consent or assent.

Procedure

Offspring and caregivers completed a structured diagnostic interview and questionnaires assessing psychiatric symptoms, health-risk behaviors, and other measures of well-being at the 5-year assessment. Offspring height and weight were directly measured by a same-sex interviewer.

Measures

Psychiatric diagnostic status. Psychiatric disorders in adult offspring and caregivers were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I).28Offspring younger than 18 years were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version.29 At study entry, caregivers and offspring reported on their history of psychiatric disorders prior to the time of proband death. All psychiatric and physical health information before proband death was based on retrospective report. Psychiatric assessment of the proband was conducted using a psychological autopsy procedure30 and the caregiver’s retrospective report on the SCID-I.28The course of disorders after proband death in the offspring and caregivers was documented using the Longitudinal Interval Follow-Up Evaluation.31 High interrater reliability was maintained on psychiatric diagnoses (κ = 0.74–0.85).

Diagnostic data were collapsed into 2 time periods: (1) offspring, proband, and caregiver psychiatric disorders before proband death and (2) offspring and caregiver psychiatric disorders after proband death. Four categories of psychiatric disorders were investigated in offspring and caregivers: depression (major depressive disorder, dysthymia, and depressive disorder not otherwise specified), anxiety (generalized anxiety disorder, social phobia), posttraumatic stress disorder, and alcohol or substance use disorders. Table 1 outlines the demographic characteristics of offspring and caregivers in the 5 years after proband death, and Table 2outlines the psychiatric and physical health characteristics of offspring and caregivers in the 5 years after proband death. Because the psychiatric characteristics of the offspring, caregivers, and probands before death have been presented in previous articles,14,15 these data are included as supplemental material (see Supplementary eTable 1 at PSYCHIATRIST.COM).

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Body mass index. Offspring height was obtained using the Seca 214 portable stadiometer, and offspring weight was measured using the Seca 813 physician floor scale (Seca Corp; Hanover, Maryland). Height and weight measurements were obtained in stocking feet (without shoes). Body mass index was calculated, using weight in pounds and height in inches, as [(weight × 703)/height2].32 The BMI for adult offspring (≥ 21 years of age) was classified as normal weight (BMI of 18.5 to <25), overweight (BMI of 25 to < 30), or obese (BMI ≥ 30), in accordance with the International Obesity Task Force recommendations.33 The BMI classification for child offspring (< 21 years of age) was based on their BMI percentile, which was adjusted for age and sex in accordance with the Centers for Disease Control and Prevention guidelines.34 Normal weight was indicated by a BMI of less than the 85th percentile, overweight was indexed by a BMI in the 85th to < 95th percentile, and obese was indicated by a BMI ≥ 95th percentile. One participant in the nonbereaved group had a BMI in the underweight range and was not included in the analyses.

Covariate Measurements

Age, sex, minority status (ie, nonwhite), socioeconomic status (as indexed by the Hollingshead Four Factor Index of Social Status),35 and history of physical or sexual abuse were assessed via interview concurrent with the weight and height measurements. Offspring and caregivers also completed a health history questionnaire36,37 that assessed chronic medical illness. Chronic illness was operationalized as the presence of 1 of the following: epilepsy, asthma, diabetes, cardiac problems, hypertension, renal disease, thyroid problems, rheumatologic problems, and pulmonary problems.38,39

Analytic Strategy

Univariate analyses were conducted to compare bereaved and nonbereaved offspring on BMI, a dummy-coded variable with 2 categories: overweight versus normal weight and obese versus normal weight. A χ2 test or analysis of variance was conducted to examine associations between BMI category and (1) demographic variables; (2) psychiatric histories of offspring, caregivers, and probands prior to time of death; (3) presence of chronic medical illness in offspring and caregivers; and (4) psychiatric disorders in offspring and caregivers after proband death. Multinomial logistic regression was used to evaluate differences in BMI categories between bereaved and nonbereaved offspring, while controlling for other significant covariates. This study was powered to detect a small effect size (d = 0.36) between bereaved and nonbereaved groups. We used the mlogit procedure (multinomial logistic regression) in Stata 12.0,40 with subjects nested within families. Variables that were associated with offspring BMI category were included as covariates. Age and sex of offspring were not significantly associated with BMI category; however, these variables were accounted for when BMI percentiles were determined for offspring less than 21 years of age. Secondary analyses examined (1) differences in BMI category among the bereaved offspring based on proband death type with statistical power to detect a medium effect size (d = 0.65) and (2) the association between BMI and caregiver depression.

Multivariate analyses were conducted using an imputed data set. The Stata ICE command-line package41 was used to generate an imputed dataset for the 245 participants by the chained equations method, with unique equations generated for each variable using all significant correlates of the variable to be imputed.

 

RESULTS

Table 1 illustrates the significant difference between bereaved and nonbereaved offspring for BMI category. Post hoc comparisons indicate that bereaved offspring were more likely than nonbereaved offspring to have a BMI in the obese rather than the normal weight category (31.7% vs 18.9%; χ22 = 7.13, P < .01). Among bereaved offspring, no significant differences in BMI categories based on proband death type were found (χ23 = 2.88, P = .58).

Table 3 presents the demographic, psychiatric, and physical health characteristics of offspring by BMI category, and Table 4 outlines these characteristics in the probands and caregivers of offspring on the basis of offspring BMI category. Two covariates, history of chronic illness in caregivers (χ22 = 6.16, P = .045) and caregiver depression after proband death (χ22 =9.15, P = .010), were associated with offspring BMI category. Post hoc pairwise comparisons indicated that caregiver chronic medical illness (χ22 = 6.11, P = .004) and caregiver depression after proband death (χ22 = 7.00, P = .003) were significantly related to offspring obesity. Contrary to our hypotheses, offspring depression after bereavement was not related to BMI category (χ22 = 3.78, P = .151). Proband, offspring, and caregiver history of depression before proband death were not significantly related to BMI category, but these variables were included in the final model because of the well-documented relationship in the literature between depression and obesity21 and between parental depression and child obesity.42,43

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A multinomial logistic regression that included bereavement status, covariates (history of offspring, caregiver, and proband depression prior to proband death; history of chronic illness in caregiver; caregiver depression after proband death), and interaction terms for bereavement status and each of the covariates was conducted. Backward stepwise regression was utilized to identify the most parsimonious set of correlates of offspring BMI category. In the final model, bereavement status continued to be significantly associated with offspring obesity (Table 5). Caregiver history of depression was also significantly related to offspring obesity for the entire sample, indicating that offspring whose caregiver had a history of depression were more likely to have a BMI in the obese compared to normal category.

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A significant interaction between bereavement status and caregiver history of depression before proband death was related to offspring obesity, although not in the expected direction (see Table 5). The relative risk ratio (RRR) < 1 suggests that bereaved offspring with caregivers who had a history of depression before proband death were more likely to have a BMI in the normal versus obese category. Conversely, nonbereaved offspring with caregivers who had a history of depression were more likely to have a BMI in the obese as compared to normal category. These differences are illustrated in Figure 1. Post hoc logistic regression also confirmed that, among nonbereaved offspring, caregiver age at first onset of depression was negatively associated with offspring obesity (RRR =0.996, z = −2.53, P = .01), suggesting that nonbereaved offspring with caregivers who experienced depression at younger ages were more likely to have a BMI in the obese as compared to normal category.

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DISCUSSION

Parentally bereaved offspring were more likely to be obese compared to nonbereaved offspring. Within the bereaved group, there were no differences among BMI categories between offspring whose parent died by sudden natural death, accident, or suicide. In the overall sample (bereaved and nonbereaved), offspring whose caregiver had a history of depression prior to proband death were more likely to have a BMI in the obese compared to normal category. Unexpectedly, bereaved offspring with caregivers who had a history of depression before proband death were more likely to have a BMI in the normal versus obese category. Nonbereaved offspring with caregivers with a history of depression, however, were more likely to have a BMI in the obese rather than normal range.

This study is limited by having an assessment of youth BMI only at 5 years after parental death. Therefore, it is unknown which youth were obese prior to parental death, what was the extent of change in BMI after parental death, and whether stressors leading to a parent’s sudden death (psychiatric or chronic illness) were more important determinants of future obesity in offspring than the traumatic experience of parental sudden death. Future studies that examine changes in offspring BMI after bereavement are necessary to validate the findings in this report. Similarly, this study did not collect information about caregiver BMI, parenting style, parental monitoring, diet, physical activity, or food preferences, all of which are implicated in the development of obesity.26,44–48 Results from this study need to be interpreted cautiously because a high percentage of bereaved offspring were lost to follow-up. However, none of the variables that differentiated those lost to follow-up from those retained in the current study were related to BMI, except bereavement status. As such, it is possible that our results may underestimate the association between parental bereavement and obesity.

In this study, parentally bereaved offspring were more likely to be obese than nonbereaved offspring. Importantly, the relationship between bereavement and obesity remained significant even after controlling for offspring and caregiver psychiatric history before and after proband death. This finding suggests that psychiatric disorders occurring in offspring and in their caregivers after parental death did not account for the relationship between bereavement and obesity. However, the specific pathways by which bereaved youth are at risk for obesity remain unclear. Other factors such as parenting style and parental monitoring of diet, physical activity, or screen time may be important to consider since caregivers of parentally bereaved youth are often single parents. Future studies that explore parenting style and parenting behavior, such as preparing healthful meals, monitoring children’s screen time and activity level, and setting limits on children’s consumption of high-fat low-nutrient food, may elucidate the pathway between parental bereavement and obesity.

It is well established in the literature that parental depression has a negative impact on a broad range of child outcomes.42,43 Indeed, the current study found a relationship between caregiver history of depression and offspring obesity in the overall sample, and it found that caregiver history of depression was associated with increased risk for obesity in nonbereaved youth. However, it was surprising to find that having a caregiver with a history of depression increased the likelihood among bereaved offspring of having a BMI in the normal rather than obese range. One interpretation is that a history of caregiver depression may be associated with increased social support and/or increased use of psychiatric services that may subsequently decrease the risk for negative health outcomes in bereaved offspring. In control families, caregiver history of depression may not be related to increased social support or service utilization in the absence of an acute negative life event, such as the death of a spouse. With the data available to us, we conducted post hoc analyses to test the hypothesis regarding whether bereaved families with caregivers with a history of depression may have more social support than those with caregivers with no history of depression. In the bereaved offspring group, caregivers with a history of depression reported higher levels of social support than caregivers with no history of depression before proband death (F1,117 = 2.71, P = .005). However, there was no significant interaction between caregiver history of depression and social support in predicting offspring BMI category. As expected, there were no differences in social support between caregivers with or without a history of depression in the nonbereaved group. Although future studies are necessary to identify the pathways by which caregiver history of depression may promote normal weight in bereaved offspring, these data suggest an association between social support and caregiver history of depression in the families of parentally bereaved youth.

This study supports parental bereavement and caregiver depression as potential risk factors in the development of childhood obesity. Because of the lack of information about prebereavement BMI and consideration of parental monitoring of food and physical activity, it is possible that parental bereavement is not causally associated with youth obesity. Future studies are necessary to replicate our findings. Still, physicians should be aware that bereaved children may be at increased risk for obesity and may benefit from closer monitoring of diet and physical activity. Similarly, bereaved youth may benefit from support groups that focus on the associations between negative emotions, stress, and eating behavior. Caregivers of bereaved youth may also benefit from psychoeducation regarding physical activity as a coping strategy for bereaved children and suggestions for monitoring bereaved children’s daily caloric intake.

 

Author affiliations: Department of Psychiatry, University of Pittsburgh School of Medicine (Drs Weinberg, Dietz, Stoyak, Melhem, and Brent), and Western Psychiatric Institute and Clinic (Mss Porta and Payne and Dr Brent), Pittsburgh, Pennsylvania.

Potential conflicts of interest: Drs Dietz and Melhem have each received research support from the National Institute of Mental Health (NIMH). Dr Brent has received research support from NIMH, has received royalties from Guilford Press, and has served as UpToDate Psychiatry Editor. Drs Weinberg and Stoyak andMss Porta and Payne report no conflicts of interest relative to the subject of this article.

Funding/support: This work was supported by NIMH grants R01 MH-65638 (Dr Brent, principal investigator) and K23 MH-079353 (Dr Dietz, principal investigator).

Role of the sponsor: NIMH and its affiliates played no role in collecting or analyzing the data or in interpreting the results presented in this article.

Acknowledgments: We thank William McKenna, BS; Emily Hogan, MS; Veronica Wahula, BS; and Irina Puchkareva, MS, for acquiring and managing study data (all are employed by the University of Pittsburgh Medical Center and received compensation from NIMH grant MH-65638). We also thank Robin Martin, BA, and Mary Carter, PhD (both employed by the University of Pittsburgh Medical Center), for help in preparing the manuscript for submission, and Satish Iyengar, PhD (employed by the University of Pittsburgh), for consultation regarding the analytical plan for the study. Drs Carter and Iyengar and Ms Martin report no potential conflicts of interest. In addition, we thank all the families for their participation in the study.

Supplementary material: Supplementary eTable 1 is available at PSYCHIATRIST.COM.

 

REFERENCES

  

1. Haine RA, Ayers TS, Sandler IN, et al. Evidence-based practices for parentally bereaved children and their families. Prof Psychol Res Pr. 2008;39(2):113–121. PubMeddoi:10.1037/0735-7028.39.2.113 Show Abstract

2. Harrison L, Harrington R. Adolescents’ bereavement experiences: prevalence, association with depressive symptoms, and use of services. J Adolesc. 2001;24(2):159–169.PubMed doi:10.1006/jado.2001.0379 Show Abstract

3. Yamamoto K, Davis OL Jr, Dylak S, et al. Across six nations: stressful events in the lives of children. Child Psychiatry Hum Dev. 1996;26(3):139–150. PubMeddoi:10.1007/BF02353355 Show Abstract

4. Rutter M. Stress, coping and development: some issues and some questions. In: Garmezy N, Rutter M, eds. Stress, Coping and Development in Children. New York, NY: McGraw-Hill; 1983.

5. Cerel J, Fristad MA, Verducci J, et al. Childhood bereavement: psychopathology in the 2 years postparental death. J Am Acad Child Adolesc Psychiatry. 2006;45(6):681–690. PubMeddoi:10.1097/01.chi.0000215327.58799.05 Show Abstract

6. Mortensen PB, Pedersen CB, Melbye M, et al. Individual and familial risk factors for bipolar affective disorders in Denmark. Arch Gen Psychiatry. 2003;60(12):1209–1215.PubMed doi:10.1001/archpsyc.60.12.1209 Show Abstract

7. Abdelnoor A, Hollins S. How children cope at school after family bereavement. Educ Child Psychol. 2004;21(3):85–94.

8. Dowdney L, Wilson R, Maughan B, et al. Psychological disturbance and service provision in parentally bereaved children: prospective case-control study. BMJ. 1999;319(7206):354–357. PubMed doi:10.1136/bmj.319.7206.354 Show Abstract

9. Thompson MP, Kaslow NJ, Kingree JB, et al. Psychological symptomatology following parental death in a predominantly minority sample of children and adolescents. J Clin Child Psychol. 1998;27(4):434–441. PubMed doi:10.1207/s15374424jccp2704_7 Show Abstract

10. Weller RA, Weller EB, Fristad MA, et al. Depression in recently bereaved prepubertal children. Am J Psychiatry. 1991;148(11):1536–1540. PubMed Show Abstract

11. Stoppelbein L, Greening L. Posttraumatic stress symptoms in parentally bereaved children and adolescents. J Am Acad Child Adolesc Psychiatry. 2000;39(9):1112–1119.PubMed doi:10.1097/00004583-200009000-00010 Show Abstract

12. Bowser BP, Word CO, Stanton MD, et al. Death in the family and HIV risk-taking among intravenous drug users. Fam Process. 2003;42(2):291–304. PubMed doi:10.1111/j.1545-5300.2003.42207.x Show Abstract

13. Reinherz HZ, Giaconia RM, Hauf AM, et al. Major depression in the transition to adulthood: risks and impairments. J Abnorm Psychol. 1999;108(3):500–510. PubMeddoi:10.1037/0021-843X.108.3.500 Show Abstract

14. Melhem NM, Walker M, Moritz G, et al. Antecedents and sequelae of sudden parental death in offspring and surviving caregivers. Arch Pediatr Adolesc Med. 2008;162(5):403–410.PubMed doi:10.1001/archpedi.162.5.403 Show Abstract

15. Brent D, Melhem N, Donohoe MB, et al. The incidence and course of depression in bereaved youth 21 months after the loss of a parent to suicide, accident, or sudden natural death. Am J Psychiatry. 2009;166(7):786–794. PubMeddoi:10.1176/appi.ajp.2009.08081244 Show Abstract

16. Melhem NM, Porta G, Shamseddeen W, et al. Grief in children and adolescents bereaved by sudden parental death. Arch Gen Psychiatry. 2011;68(9):911–919. PubMeddoi:10.1001/archgenpsychiatry.2011.101 Show Abstract

17. Hamdan S, Melhem NM, Porta G, et al. The phenomenology and course of depression in parentally bereaved and non-bereaved youth. J Am Acad Child Adolesc Psychiatry. 2012;51(5):528–536. PubMed doi:10.1016/j.jaac.2012.02.021 Show Abstract

18. Davis DA, Luecken LJ, Zautra AJ. Are reports of childhood abuse related to the experience of chronic pain in adulthood? a meta-analytic review of the literature. Clin J Pain. 2005;21(5):398–405. PubMed doi:10.1097/01.ajp.0000149795.08746.31 Show Abstract

19. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245–258. PubMed doi:10.1016/S0749-3797(98)00017-8 Show Abstract

20. Daniels SR. The consequences of childhood overweight and obesity. Future Child. 2006;16(1):47–67. PubMed doi:10.1353/foc.2006.0004 Show Abstract

21. Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220–229. PubMed doi:10.1001/archgenpsychiatry.2010.2 Show Abstract

22. Sanderson K, Patton GC, McKercher C, et al. Overweight and obesity in childhood and risk of mental disorder: a 20-year cohort study. Aust N Z J Psychiatry. 2011;45(5):384–392.PubMed doi:10.3109/00048674.2011.570309 Show Abstract

23. McElroy SL, Kotwal R, Malhotra S, et al. Are mood disorders and obesity related? a review for the mental health professional. J Clin Psychiatry. 2004;65(5):634–651, quiz 730.PubMed doi:10.4088/JCP.v65n0507 Show Abstract

24. DiClemente RJ, Wingood GM, Crosby R, et al. Parental monitoring: association with adolescents’ risk behaviors. Pediatrics. 2001;107(6):1363–1368. PubMeddoi:10.1542/peds.107.6.1363 Show Abstract

25. Borawski EA, Ievers-Landis CE, Lovegreen LD, et al. Parental monitoring, negotiated unsupervised time, and parental trust: the role of perceived parenting practices in adolescent health risk behaviors. J Adolesc Health. 2003;33(2):60–70. PubMeddoi:10.1016/S1054-139X(03)00100-9 Show Abstract

26. Duarte CS, Shen S, Wu P, et al. Maternal depression and child BMI: longitudinal findings from a US sample. Pediatr Obes. 2012;7(2):124–133. PubMed doi:10.1111/j.2047-6310.2011.00012.x Show Abstract

27. Fernandez JR, Klimentidis YC, Dulin-Keita A, et al. Genetic influences in childhood obesity: recent progress and recommendations for experimental designs. Int J Obes (Lond). 2012;36(4):479–484. PubMed doi:10.1038/ijo.2011.236 Show Abstract

28. First MB, Spitzer RL, Gibbon M. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Washington DC: American Psychiatric Press; 1996.

29. Kaufman J, Birmaher B, Brent D, et al. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997;36(7):980–988. PubMeddoi:10.1097/00004583-199707000-00021 Show Abstract

30. Hawton K, Appleby L, Platt S, et al. The psychological autopsy approach to studying suicide: a review of methodological issues. J Affect Disord. 1998;50(2–3):269–276. PubMedShow Abstract

31. Keller MB, Lavori PW, Friedman B, et al. The Longitudinal Interval Follow-up Evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies. Arch Gen Psychiatry. 1987;44(6):540–548. PubMed doi:10.1001/archpsyc.1987.01800180050009Show Abstract

32. Centers for Disease Control and Prevention. Adult BMI Calculator: English. 2011.http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html. Accessed March 19, 2012.

33. Cole TJ, Bellizzi MC, Flegal KM, et al. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320(7244):1240–1243.PubMed doi:10.1136/bmj.320.7244.1240 Show Abstract

34. Centers for Disease Control and Prevention. About BMI for Children and Teens. 2011.http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html. Accessed March 19, 2012.

35. Hollingshead AB. Four Factor Index of Social Status. Yale J Sociol. 2011;8:21–51.

36. Ware JE Jr, Kosinski M, Bayliss MS, et al. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care. 1995;33(suppl):AS264–AS279. PubMedShow Abstract

37. Ware JE Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–233.PubMed doi:10.1097/00005650-199603000-00003 Show Abstract

38. Krause N. Early parental loss, recent life events, and changes in health among older adults. J Aging Health. 1998;10(4):395–421. PubMed doi:10.1177/089826439801000401Show Abstract

39. Liang J. Self-reported physical health among aged adults. J Gerontol. 1986;41(2):248–260. PubMed doi:10.1093/geronj/41.2.248 Show Abstract

40. Stata Statistical Software, Release 12. College Station, TX: StataCorp LP; 2011.

41. ICE: Stata module for multiple imputation of missing values. Chestnut Hill, MA: Boston College Department of Economics; 2006.

42. Goodman SH, Gottlib IH, eds. Children of Depressed Parents: Mechanisms of Risk and Implications for Treatment. Washington, DC: American Psychological Association; 2002.doi:10.1037/10449-000

43. Goodman SH, Rouse MH, Connell AM, et al. Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev. 2011;14(1):1–27.PubMed doi:10.1007/s10567-010-0080-1 Show Abstract

44. Gubbels JS, Kremers SPJ, Stafleu A, et al. Association between parenting practices and children’s dietary intake, activity behavior, and development of body mass index: the KOALA Birth Cohort Study. Int J Behav Nutr Phys Act. 2011;8(1):18. PubMed doi:10.1186/1479-5868-8-18 Show Abstract

45. Faith MS, Berkowitz RI, Stallings VA, et al. Parental feeding attitudes and styles and child body mass index: prospective analysis of a gene-environment interaction. Pediatrics. 2004;114(4):e429–e436. PubMed doi:10.1542/peds.2003-1075-L Show Abstract

46. McConley RL, Mrug S, Gilliland MJ, et al. Mediators of maternal depression and family structure on child BMI: parenting quality and risk factors for child overweight. Obesity (Silver Spring). 2011;19(2):345–352. PubMed doi:10.1038/oby.2010.177 Show Abstract

47. Sleddens EF, Gerards SM, Thijs C, et al. General parenting, childhood overweight and obesity-inducing behaviors: a review. Int J Pediatr Obes. 2011;6(2–2):e12–e27. PubMeddoi:10.3109/17477166.2011.566339 Show Abstract

48. Zeller MH, Reiter-Purtill J, Modi AC, et al. Controlled study of critical parent and family factors in the obesigenic environment. Obesity (Silver Spring). 2007;15(1):126–136. PubMeddoi:10.1038/oby.2007.517 Show Abstract

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