A hidden crisis: Associations between overdose bereavement, substance use, and mental health

Bereavement following an opioid overdose death (OOD) is a particularly disturbing circumstance of sudden, unexpected loss. Despite epidemic proportions, little is known about grief in the wake of an OOD. We collected cross-sectional survey data from N=158 individuals grieving an OOD, supporting someone actively using opioids, or grieving while supporting similar others, to better understand the mental health impacts of these experiences. Study participants completed assessments of depression, anxiety, posttraumatic stress disorder (PTSD), substance use disorder (SUD), and prolonged grief disorder (PGD). Regression models examined associations between learning of a close other's opioid use, the OOD of a child, the OOD of a contemporary, increases in substance use following the event, and current mental health symptoms. Post-hoc path modeling evaluated mediated relationships between losing a child or contemporary to OOD and current mental health symptoms. Losing a child to OOD was associated with increased overall substance use (OR=4.10) during the following year and increased current symptoms of PGD (β=0.46). Increasing substance use following the event was significantly associated with greater current symptoms of PGD (β=0.24), PTSD (β=0.28), SUD (β=0.29), and depression (β=0.27). Indirect effects mediated by increased substance use after the event were observed between both types of bereavement and current symptoms of depression, PTSD, and SUD. Substance use post-loss appears to contribute to adverse outcomes and future research should address ways to reduce substance use and promote adaptive coping in OOD bereavement.