Adolescents who experience psychological stress following bereavement are at increased risk for asthma hospitalization, according to new research out of Denmark.

The study’s findings support the biopsychosocial model of stress, which suggests that psychological stress may have an effect on the immune system, altering cytokine production in the direction of Th-2 response and thus may evoke asthma exacerbation. Researchers also found that the bereaved children in the study were less likely to be prescribed asthma medication.

“It is also possible that the threshold for hospitalization is changed by the bereavement [and that] depressed caregivers may feel unable to cope with childhood asthma and ask for hospitalization,” the study notes.

Investigators analyzed data of 5,202,576 children born in Denmark or Sweden from 1977 to 2008, and 1973 to 2006, respectively. A total of 168,649 children experienced the death of a parent or sibling before the age of 18 years and were assigned to the bereaved cohort.

Bereaved children had a modestly but significantly increased risk for asthma hospitalization over a mean follow-up of 12.9 years. After adjusting for confounders, including birthweight, maternal social status, and family history of asthma, these children had a 10% greater risk for asthma hospitalization than children in the non-bereaved cohort.