Thanks for your comment! Grief is a thorny issue, and we have different priors about it as a team.
The reason I’m a little skeptical of this is first that it seems likely to me (disclaimer that I have not done a deep dive) that losing a child would increase the likelihood of depression and other mental illnesses, alongside other things like marriage disruption (e.g. Rogers et al. 2008, which highlights effects lasting to the 18 year mark). I don’t think these effects will be accounted for by pulling out the estimate coming from Oswald & Powdthavee according to the Clark paper.
Could you clarify why you think the effects aren’t accounted for? Is it because we aren’t specifically looking at evidence that captures the long-term effects of grief for the loss of a child?
If so I’m not sure that child-loss will have a different temporal dynamic than spouse-loss. I’d assume that spouse-loss, if anything, would persist longer. However, this was a shallow estimate that could be improved upon with more research—but we haven’t prioritized further research because we don’t expect it to make much of a difference.
Rather than underestimate grief, I’m inclined to think our grief estimate is relatively generous for several reasons.
We assume grief is equal for each household member. But do we expect a 2 year old child, if their sibling dies after childbirth, to be as sad as being depressed for 5 years? The effects on parents are probably larger.
We use evidence from high income countries. Will the effect on grief be large or smaller in low income countries? I’d guess that the effect of grief is less intense when death is less surprising and death is less surprising where it’s more common which is the case in low income countries. To be clear, I’m not claiming how much less intense it is.
The team differs on this, but some of us think that if we account for the counterfactual value of grief, we’d decrease its effect. The reasoning from the pro-counterfactualists is that everyone dies at some point, so presumably one will still be grieved for if they die at 50 instead of 5-years old. This is could get complex, because presumably the intensity of grief and number of people experiencing grief changes with the age of the person dying.
All of this being said, I don’t think it would change our priorities even if we had a sizeable change to the grief numbers, eg doubled or halved them, so we aren’t sure how much effort it’s worth to do more work.
Hi Joel, thanks for this detailed + helpful response! To put in context for anyone skimming comments, I found this report fascinating, and I personally think StrongMinds are awesome (and plan to donate there myself).
Yep, my primary concern is that I’m not sure the longterm effects of grief from the loss of a child have been accounted for. I don’t have access to the Clark book that I think the 5 year estimate comes from- maybe there is really strong evidence here supporting the 5 year mark (are they estimating for spouse loss in particular?). But 5 years for child loss intuitively seems wrong to me, for a few reasons:
Again, idk how good the Clark 5 year finding is so I could be wrong! But the data that I’m aware of suggests that the effect of childhood bereavement is considerably longer than this. Rogers et al (2008) finds that parents still report poorer wellbeing at the 18 year mark, Song et al. (2011) finds that older bereaved couples still had lower quality of lives in their 60s relative to unbereaved couples, etc. From a quick scan (just from looking up ‘long term effects child berevement’) the estimates that I’m seeing pop up are higher than 5 years.
People may develop depression/ anxiety etc in response to the loss of a child. From a quick look (there may well be a better data source than this) there’s an NEJM article from Li et al. 2005 that puts the relative risk ratio (for psychiatric hospitalisation, relative to unbereaved parents) at 1.67. I assume that’s going to be a longlasting effect, and I see an argument to ‘treat key sources of depression’.
I do realise there may be confounding variables in the analyses above (aka so they’re overestimating grief as a result)- this might be where i’m mistaken. However, this does fit with my general sense that people tend to view the death of a child as being *especially* bad.
My secondary concern is that I think the spillover effects here might go considerably beyond immediate household members. In response to your points;
Thanks, that makes sense to me! I do think there’s some way in which this is an overestimate (aka maybe v young children are less affected by the death of a sibling). However, idk if this enough to compensate for not having accounted for non-household spillover effects; my sense is that the friends of the kid would be affected, plus other members of the village, parents who get rightly scared that their kid will fall ill, and so on. Aka I could see effects along the line of ‘my childhood best friend died, this adverse childhood experience contributed to my adult battle with depression’.
That also makes sense to me, cheers. I don’t have a strong sense either way on this.
This would make sense to me if it was adult versus adult deaths, but it seems worse to me for a parent to lose a kid (relative to counterfactual). I can see how this is a super thorny issue! Maybe it ameliorates the problem somewhat?
I do want to highlight the potential ‘duration of effect’ plus ‘negative spillover might be higher than (positive) spillover effects from GD’ issues because I think those might change the numbers around a fair bit. I.e. if we assume that effects last 10 years rather than 5 (and I see an argument that child bereavement could be like 20+) , and spillover is maybe 1.5X as big as assumed here, that would presumably make AMF 3X as good.
Hi Rosie,
Thanks for your comment! Grief is a thorny issue, and we have different priors about it as a team.
Could you clarify why you think the effects aren’t accounted for? Is it because we aren’t specifically looking at evidence that captures the long-term effects of grief for the loss of a child?
If so I’m not sure that child-loss will have a different temporal dynamic than spouse-loss. I’d assume that spouse-loss, if anything, would persist longer. However, this was a shallow estimate that could be improved upon with more research—but we haven’t prioritized further research because we don’t expect it to make much of a difference.
Rather than underestimate grief, I’m inclined to think our grief estimate is relatively generous for several reasons.
We assume grief is equal for each household member. But do we expect a 2 year old child, if their sibling dies after childbirth, to be as sad as being depressed for 5 years? The effects on parents are probably larger.
We use evidence from high income countries. Will the effect on grief be large or smaller in low income countries? I’d guess that the effect of grief is less intense when death is less surprising and death is less surprising where it’s more common which is the case in low income countries. To be clear, I’m not claiming how much less intense it is.
The team differs on this, but some of us think that if we account for the counterfactual value of grief, we’d decrease its effect. The reasoning from the pro-counterfactualists is that everyone dies at some point, so presumably one will still be grieved for if they die at 50 instead of 5-years old. This is could get complex, because presumably the intensity of grief and number of people experiencing grief changes with the age of the person dying.
All of this being said, I don’t think it would change our priorities even if we had a sizeable change to the grief numbers, eg doubled or halved them, so we aren’t sure how much effort it’s worth to do more work.
Hi Joel, thanks for this detailed + helpful response! To put in context for anyone skimming comments, I found this report fascinating, and I personally think StrongMinds are awesome (and plan to donate there myself).
Yep, my primary concern is that I’m not sure the longterm effects of grief from the loss of a child have been accounted for. I don’t have access to the Clark book that I think the 5 year estimate comes from- maybe there is really strong evidence here supporting the 5 year mark (are they estimating for spouse loss in particular?). But 5 years for child loss intuitively seems wrong to me, for a few reasons:
Again, idk how good the Clark 5 year finding is so I could be wrong! But the data that I’m aware of suggests that the effect of childhood bereavement is considerably longer than this. Rogers et al (2008) finds that parents still report poorer wellbeing at the 18 year mark, Song et al. (2011) finds that older bereaved couples still had lower quality of lives in their 60s relative to unbereaved couples, etc. From a quick scan (just from looking up ‘long term effects child berevement’) the estimates that I’m seeing pop up are higher than 5 years.
People may develop depression/ anxiety etc in response to the loss of a child. From a quick look (there may well be a better data source than this) there’s an NEJM article from Li et al. 2005 that puts the relative risk ratio (for psychiatric hospitalisation, relative to unbereaved parents) at 1.67. I assume that’s going to be a longlasting effect, and I see an argument to ‘treat key sources of depression’.
I do realise there may be confounding variables in the analyses above (aka so they’re overestimating grief as a result)- this might be where i’m mistaken. However, this does fit with my general sense that people tend to view the death of a child as being *especially* bad.
My secondary concern is that I think the spillover effects here might go considerably beyond immediate household members. In response to your points;
Thanks, that makes sense to me! I do think there’s some way in which this is an overestimate (aka maybe v young children are less affected by the death of a sibling). However, idk if this enough to compensate for not having accounted for non-household spillover effects; my sense is that the friends of the kid would be affected, plus other members of the village, parents who get rightly scared that their kid will fall ill, and so on. Aka I could see effects along the line of ‘my childhood best friend died, this adverse childhood experience contributed to my adult battle with depression’.
That also makes sense to me, cheers. I don’t have a strong sense either way on this.
This would make sense to me if it was adult versus adult deaths, but it seems worse to me for a parent to lose a kid (relative to counterfactual). I can see how this is a super thorny issue! Maybe it ameliorates the problem somewhat?
I do want to highlight the potential ‘duration of effect’ plus ‘negative spillover might be higher than (positive) spillover effects from GD’ issues because I think those might change the numbers around a fair bit. I.e. if we assume that effects last 10 years rather than 5 (and I see an argument that child bereavement could be like 20+) , and spillover is maybe 1.5X as big as assumed here, that would presumably make AMF 3X as good.