The authors have declared that no competing interests exist.
Conceived and designed the experiments: EMR TL. Performed the experiments: TL EMR. Analyzed the data: TL. Contributed reagents/materials/analysis tools: FR. Wrote the paper: EMR. Critically revised the manuscript for important intellectual content: EMR TL FR. Participated in the interpretation of the data: EMR TL FR. Approved the final version of the paper: EMR TL FR.
Research on the temporal relationship of parental risk factors with offspring’s suicide attempt is scarce and a life course approach has not been applied to date. We investigated the temporal relationship of parental morbidity and mortality with offspring’s suicide attempt and whether any such association was modified by offspring’s age at attempt.
We designed a case-control study through linkage of Swedish registers. Cases comprised all individuals in Sweden born 1973–1983 with inpatient care due to suicide attempt (15–31 years of age) and with information on both biological parents (N = 15 193). Ten controls were matched to each case (National Patient register with national complete coverage). Conditional logistic and spline regressions were applied.
Particularly for women, most parental markers showed the strongest effect sizes if exposure was short-term (within 2 years after exposure) and related to the mother. Especially short-term exposure to maternal inpatient care due to psychiatric diagnoses had a significantly stronger effect on suicide attempt risk in women compared to men. Regarding exposure to parental inpatient care due to psychiatric diagnoses, short-term as opposed to long-term (exceeding 2 years after exposure) effects were highest during adolescence and decreased significantly with age for female and male offspring, respectively.
Although limited by the fact that data on parental morbidity and the outcome of suicidality were based on in-patient data only, the data suggest that the high risks of suicide attempt in case of exposure to parental psychopathology and suicidal behavior particularly during adolescence and the strong short-term effects associated with maternal psychopathology for female offspring are of direct clinical importance.
Suicide attempt is a considerable and growing public health problem worldwide
There is abundant evidence on the effect of familial suicidal behavior and familial psychopathology on the offspring’s risk of suicide and suicide attempt
These patterns of increased risk of suicidal behavior in offspring with decreasing age at exposure were shown not to be equally consistent regarding exposure to all types of parental markers of morbidity and mortality
Suicide attempt is reported to be more common among young women than among young men
The aims of the present study were therefore three-fold: (i) to explore short- and long-term effects of parental markers of morbidity and mortality on the risk of suicide attempt in offspring; (ii) to investigate whether exposure to these parental markers before age 10 confers an increased risk of suicide attempt compared to exposure above this age; and (iii) to investigate whether any such effect is modified by age of offspring at attempted suicide. To the best of our knowledge, this study is the first to analyse these research questions using a very large database including more than 15 000 suicide attempters.
The study population was based on linkage of several public national registers. Ethical vetting is always required when using register data in Sweden. The ethical vetting is performed by regional ethical review boards and the risk appraisal associated with the Law on Public Disclosure and Secrecy is done by data owners. For this study, the ethical review board has however waived the requirement to consult the data subjects (and in case of minors/children the next of kin, careers or guardians) directly to obtain their informed consent, as the research is supported by the ethical review board and the data has already been collected in some other context. According to these standards in Sweden this project has been evaluated and approved by the Regional Ethical Review Board of Karolinska Institutet, Stockholm, Sweden.
The study applied a matched case control study design through record linkages. The study base consisted of all individuals, born in Sweden between January 1973 and December 1983, who were singletons and for whom information on both biological parents was available. The cases comprised individuals with inpatient care due to attempted suicide recorded in the National Patient Register (NPR) as (E950–E959 in the International Classification of Diseases ICD-8 and ICD-9, X60–X84 in ICD-10).
Even cases with inpatient care due to uncertainty about intention (E980–E989 in ICD-8 and ICD-9, Y10–Y34 in ICD-10) were considered. Uncertain and certain diagnoses were combined to limit temporal and regional variation in ascertainment routines and limit the underreporting of suicidal behavior
Up to 10 controls were randomly selected from a cohort covering all individuals born in Sweden between 1973 and 1983 and matched to cases by sex, month, year and county of birth. Only individuals who were alive and living in Sweden at the time of the index event were eligible to serve as controls. Suicide attempters were assessed from January 1, 1988 until December 31, 2006, and were between 15 and 31 years of age.
Individual information has been merged from eight different national registers using the unique identification number assigned to each resident in Sweden. Children were linked to their biological parents using the Multi-Generation Register (MGR). The MGR is held by Statistics Sweden and contains links of children to their parents.
Data on suicide and other causes of death were drawn from the Causes of Death Register (CDR). Suicide was defined through the same codes in ICD as suicide attempt. Information on the dates and diagnoses of hospital care due to psychiatric diagnoses were derived from the National Patient Register (NPR). The NPR has complete national coverage on inpatient care due to psychiatric diagnoses and suicide attempt derived from general and psychiatric hospitals since 1987, and close to complete national coverage since 1973
The Population and Housing Censuses (PHC) provided data on parental socio-economic status in 1980 and 1985 and on parental civil status in 1975, 1980 and 1985. Data on these covariates in 1990 were retrieved from the Longitudinal Integration Database for Health Insurance and Labor Market Studies (LISA). Information on emigration and immigration was extracted from the Register of the Total Population. Details of the registers as well as quality evaluations have been reported elsewhere
The exposure variables include parental markers of morbidity, namely inpatient care dut to suicide attempt and/or due to psychiatric disorders and diagnosis-specific disability pension as well as mortality (suicide and other causes of death). We considered only the main diagnosis, and the first date of hospital inpatient care or granting of disability pension. Data on all exposure variables were available from birth of the offspring until the end of follow-up.
Categories for parental socio-economic status were unskilled workers, skilled workers, low level salaried employees, intermediate or high level salaried employees (reference category), and others (
Girls, women, N, % | Boys/men, N, % | |||||||
Parental factors | Cases | Controls | Cases | Controls | ||||
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Married/cohabiting | 5 588 | (57.32) | 67 465 | (72.65) | 3 011 | (55.30) | 38 849 | (72.80) |
Other | 4 117 | (42.23) | 25 216 | (27.15) | 2 397 | (44.02) | 14 381 | (26.95) |
Missing | 43 | (0.44) | 181 | (0.19) | 37 | (0.68) | 132 | (0.25) |
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Unskilled workers | 2 086 | (21.40) | 14 913 | (16.06) | 1 291 | (23.71) | 8 443 | (15.82) |
Skilled workers | 2 130 | (21.85) | 18 714 | (20.15) | 1 187 | (21.80) | 10 769 | (20.18) |
Low salary |
1 479 | (15.17) | 15 753 | (16.96) | 793 | (14.56) | 8 752 | (16.40) |
Med./high salary |
3 155 | (32.37) | 39 035 | (42.04) | 1 641 | (30.14) | 22 993 | (43.09) |
Other | 889 | (9.12) | 4 429 | (4.77) | 527 | (9.68) | 2 388 | (4.48) |
Missing | 9 | (0.09) | 18 | (0.02) | 6 | (0.11) | 17 | (0.03) |
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Suicide | 223 | (2.29) | 861 | (0.93) | 138 | (2.53) | 513 | (0.96) |
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Suicide ettempt | 736 | (7.55) | 2 043 | (2.20) | 418 | (7.68) | 1 196 | (2.24) |
Psych. diagnosis |
1 550 | (15.90) | 5 477 | (5.90) | 882 | (16.20) | 3 370 | (6.32) |
Death non-suicide | 220 | (2.26) | 1 510 | (1.63) | 160 | (2.94) | 921 | (1.73) |
DP psychiatr. | 582 | (5.97) | 2 204 | (2.37) | 395 | (7.25) | 1 489 | (2.79) |
DP somatic | 1 126 | (11.55) | 6 993 | (7.53) | 738 | (13.55) | 4 807 | (9.01) |
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Suicide attempt | 481 | (4.93) | 1 691 | (1.82) | 332 | (6.10) | 993 | (1.86) |
Psych. diagn. |
1 469 | (15.07) | 6 283 | (6.77) | 963 | (17.69) | 3 768 | (7.06) |
Death non-suicide | 454 | (4.66) | 2 955 | (3.18) | 338 | (6.21) | 1 970 | (3.69) |
DP psychiatr. | 439 | (4.50) | 1 786 | (1.92) | 308 | (5.66) | 1 166 | (2.19) |
DP somatic | 855 | (8.77) | 5 338 | (5.75) | 552 | (10.14) | 3 575 | (6.70) |
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Psych. diagnosis |
5 197 | (53.3) | 2 966 | (3.2) | 2 943 | (54.1) | 1 859 | (3.5) |
DP…disability pension (psychiatric/somatic diagnoses);
Inpatien care due to a psychiatric diagnosis;
employees.
Parental civil status was dichotomized into married and/or cohabiting versus other status (reference category), using the same procedure as for socio-economic status with regard to the choice of census data. Information on offspring’s own inpatient care due to psychiatric diagnoses preceding the suicide attempt was dichotomized. Data on covariates were retrieved in the same way for both cases and controls. There were missing data on covariates in 0.5% of cases of attempted suicide. A sensitivity analysis showed similar patterns of suicide attempt risks in cases with complete information and in cases with missing data. Cases with missing data were included and coded as a separate category.
Data processing was performed using R version 2.12.2. The analyses were based on conditional logistic regressions. The risk of different parental exposures (short- and long-term and exposure during childhood) in relation to suicide attempt in offspring was estimated comparing cases and controls. Short term was defined as less than 2 years from exposure to occurrence, long term exceeding 2 years since exposure, and exposure during childhood was defined as exposure occurring before the 10th birthday of the offspring. The cut-off of 2 years has been chosen in accordance with other studies in this field
To accommodate that the effect of a given exposure might be modified by age of offspring at time of attempted suicide, we applied spline regression with four knots (on 17, 21, 25 and, 29 years of age) for both baseline risk and exposures.
The dotted line represents the ORs after controlling for offspring’s own inpatient care due to psychiatric diagnoses; *adjusted for parental socioeconomic status, civil status, suicidal behaviour, inpatient care due to psychiatric diagnoses, death due to other reasons than suicide and parental disability pension; DP…disability pension; “young”: refers to exposure to parental markers of morbidity and mortality occurring before the 10th birthday of the offspring; “short”: Short-term was defined as an offspring’s suicide attempt occurring less than 2 years after exposure to parental markers of morbidity and mortality; “long”: Long-term was defined as an offspring’s suicide attempt occurring later than 2 years after exposure to parental markers of morbidity and mortality; “Attempt”: Inpatient care due to suicide attempt; “Parent psychiatric”: At least one parent in inpatient care due to a psychiatric diagnosis.
Exposure | N | Crude | Model I | Model II | Model III | ||||
Parental factors | OR (95% CI) | ||||||||
Suicide early | 102 | 2.57 (2.07–3.21) | 1.59 (1.27–1.99) | 1.37 (1.09–1.73) | 0.99 (0.73–1.33) | ||||
Suicide short | 39 | 2.89 (2.02–4.15) | 2.48 (1.72–3.57) | 1.60 (1.11–2.33) | 1.91 (1.21–3.00) | ||||
Suicide long | 184 | 2.45 (2.08–2.88) | 1.70 (1.44–2.01) | 1.38 (1.16–1.63) | 1.03 (0.82–1.28) | ||||
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Attempt early | 453 | 3.49 (3.13–3.89) | 2.64 (2.36–2.95) | 1.59 (1.41–1.80) | 1.57 (1.35–1.83)* | ||||
Attempt short | 235 | 4.10 (2.92–5.76) | 3.66 (2.59–5.17) | 1.98 (1.39–2.82)* | 1.98 (1.26–3.12) | ||||
Attempt long | 48 | 3.53 (3.04–4.11) | 2.87 (2.46–3.34) | 1.55 (1.32–1.82) | 1.54 (1.25–1.89) | ||||
Psych. early | 981 | 3.02 (2.80–3.25) | 2.41 (2.23–2.59) | 1.72 (1.58–1.88) | 1.29 (1.16–1.44)* | ||||
Psych. short | 132 | 3.38 (2.77–4.13) | 3.17 (2.58–3.88) | 2.58 (2.09–3.18) | 2.38 (1.84–3.09) | ||||
Psych. long | 437 | 2.45 (2.21–2.73) | 2.10 (1.89–2.34) | 1.52 (1.36–1.70) | 1.31 (1.14–1.52) | ||||
Death short | 66 | 1.64 (1.26–2.13) | 1.49 (1.15–1.95) | 1.28 (0.97–1.67) | 1.16 (0.82–1.63) | ||||
Death long | 154 | 1.35 (1.14–1.59) | 1.13 (0.94–1.35) | 1.01 (0.84–1.21) | 0.88 (0.70–1.11) | ||||
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Attempt early | 335 | 3.03 (2.68–3.44) | 2.18 (1.92–2.48) | 1.46 (1.28–1.67)* | 1.34 (1.13–1.59) | ||||
Attempt short | 111 | 3.17 (2.16–4.64) | 2.65 (1.79–3.91) | 1.63 (1.10–2.43) | 1.67 (1.02–2.74) | ||||
Attempt long | 35 | 2.13 (1.73–2.62) | 1.71 (1.38–2.10) | 1.07 (0.89–1.36) | 1.03 (0.78–1.36) | ||||
Psych. early | 992 | 2.75 (2.55–2.96) | 2.05 (1.89–2.21) | 1.67 (1.53–1.82) | 1.41 (1.26–1.56) | ||||
Psych. short | 92 | 1.94 (1.55–2.43)* | 1.68 (1.34–2.11)* | 1.53 (1.22–1.92)* | 1.49 (1.12–1.97)* | ||||
Psych. long | 385 | 1.78 (1.59–1.99) | 1.51 (1.35–1.69) | 1.27 (1.14–1.43) | 1.22 (1.06–1.41)* | ||||
Death short | 111 | 1.62 (1.32–1.98) | 1.44 (1.17–1.76) | 1.20 (0.98–1.48) | 1.29 (1.00–1.66) | ||||
Death long | 343 | 1.48 (1.31–1.66) | 1.08 (0.96–1.22) | 1.01 (0.89–1.14) | 0.88 (0.76–1.02) |
Model I: adjusted for parental socioeconomic and civil status; Model II: like Model I and additionally adjusted for parental suicidal behaviour, parental inpatient care due to psychiatric diagnoses, disability pension and death due to other reasons than suicide; Model III: like Model II and additionally adjusted for offspring’s inpatient care due to psychiatric diagnoses prior to the index suicide attempt; *significant age dependent effects; “early”: refers to exposure to parental markers of morbidity and mortality occurring before the 10th birthday of the offspring; “short”: Short term was defined as an offspring’s suicide attempt occurring less than 2 years after exposure to parental markers of morbidity and mortality; “long”: Long term was defined as an offspring’s suicide attempt occurring later than 2 years after exposure to parental markers of morbidity and mortality; “Psych.”: Inpatien care due to a psychiatric diagnosis; “Attempt”: Inpatient care due to suicide attempt; “Death”: Death due to reasones other than suicide.
Exposure | N | Crude | Model I | Model II | Model III | ||||||
Parental factors | OR (95% CI) | ||||||||||
Suicide early | 60 | 3.01 (2.25–4.03) | 1.64 (1.21–2.22) | 1.41 (1.04–1.92) | 1.06 (0.72–1.57) | ||||||
Suicide short | 15 | 2.29 (1.30–4.01) | 1.82 (1.03–3.23) | 1.21 (0.68–2.17) | 1.05 (0.51–2.18) | ||||||
Suicide long | 124 | 2.76 (2.26–3.37) | 1.79 (1.46–2.21) | 1.44 (1.16–1.78) | 1.21 (0.92–1.58) | ||||||
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Attempt early | 237 | 3.45 (2.97–4.01) | 2.44 (2.09–2.84) | 1.55 (1.31–1.82) | 1.34 (1.08–1.66) | ||||||
Attempt short | 149 | 4.13 (2.73–6.25) | 3.46 (2.26–5.29) | 2.07 (1.34–3.20) | 2.33 (1.35–4.02) | ||||||
Attempt long | 48 | 3.54 (2.93–4.27) | 2.78 (2.29–3.38) | 1.70 (1.39–2.08) | 1.57 (1.21–2.04) | ||||||
Psych. early | 555 | 2.97 (2.69–3.28)* | 2.23 (2.02–2.47)* | 1.62 (1.44–1.81)* | 1.12 (0.97–1.29) | ||||||
Psych. short | 51 | 2.00 (1.48–2.71) | 1.72 (1.27–2.34) | 1.38 (1.01–1.88) | 1.33 (0.91–1.94) | ||||||
Psych. long | 276 | 2.44 (2.13–2.79) | 2.01 (1.76–2.31) | 1.47 (1.28–1.70)* | 1.25 (1.04–1.49)* | ||||||
Death short | 44 | 1.90 (1.38–2.64) | 1.85 (1.33–2.57) | 1.53 (1.09–2.13) | 1.41 (0.93–2.15) | ||||||
Death long | 116 | 1.67 (1.37–2.04) | 1.29 (1.04–1.61) | 1.18 (0.95–1.47) | 1.19 (0.91–1.55) | ||||||
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Attempt early | 221 | 3.82 (3.26–4.47) | 2.66 (2.26–3.12) | 1.70 (1.44–2.03) | 1.21 (0.97–1.52)* | ||||||
Attempt short | 92 | 3.79 (2.23–6.45) | 2.92 (1.69–5.01) | 1.73 (1.00–3.00) | 1.35 (0.65–2.79) | ||||||
Attempt long | 19 | 2.56 (2.03–3.23) | 1.92 (1.52–2.43) | 1.15 (0.91–1.47) | 0.83 (0.61–1.13) | ||||||
Psych. early | 630 | 3.17 (2.88–3.48) | 2.25 (2.04–2.48) | 1.76 (1.58–1.96) | 1.54 (1.35–1.77) | ||||||
Psych. short | 50 | 1.93 (1.42–2.61) | 1.72 (1.26–2.35) | 1.58 (1.15–2.15) | 1.29 (0.88–1.90) | ||||||
Psych. long | 283 | 2.07 (1.82–2.36) | 1.69 (1.48–1.93) | 1.41 (1.23–1.61)* | 1.27 (1.07–1.51)* | ||||||
Death short | 71 | 1.59 (1.24–2.06) | 1.38 (1.07–1.79) | 1.13 (0.87–1.46) | 1.14 (0.83–1.56) | ||||||
Death long | 267 | 1.77 (1.55–2.02) | 1.25 (1.09–1.44) | 1.16 (1.01–1.33) | 1.12 (0.95–1.33) |
Model I: adjusted for parental socioeconomic and civil status; Model II: like Model I and additionally adjusted for parental suicidal behaviour, parental inpatient care due to psychiatric diagnoses, disability pension and death due to other reasons than suicide; Model III: like Model II and additionally adjusted for offspring’s inpatient care due to psychiatric diagnoses prior to the index suicide attempt; *significant age dependent effects; “early”: refers to exposure to parental markers of morbidity and mortality occurring before the 10th birthday of the offspring; “short”: Short term was defined as an offspring’s suicide attempt occurring less than 2 years after exposure to parental markers of morbidity and mortality; “long”: Long term was defined as an offspring’s suicide attempt occurring later than 2 years after exposure to parental markers of morbidity and mortality; “Psych.”: Inpatien care due to a psychiatric diagnosis; “Attempt”: Inpatient care due to suicide attempt; “Death”: Death due to reasones other than suicide.
There were 9 748 attempted suicides (64.2%) in girls/women and 5 445 (35.8%) in boys/men in the given sample. Mean age at suicide attempt was 20.8 years (SD: 3.8) for girls/women and 22.2 years (SD: 3.8) for boys/men. The main method for suicide attempt with certain intent (N = 12,563) was poisoning (61.6%) followed by cutting (2.2%). Even in uncertain suicide attempts (N = 2,630), the main method was poisoning (77.1%).
The dotted line represents the ORs after controlling for offspring’s own inpatient care due to psychiatric diagnoses; *adjusted for parental socioeconomic status, civil status, suicidal behaviour, inpatient care due to psychiatric diagnoses, death due to other reasons than suicide and parental disability pension; “long”: Long-term was defined as an offspring’s suicide attempt occurring later than 2 years after exposure to parental markers of morbidity and mortality; “Parent psychiatric”: At least one parent in inpatient care due to a psychiatric diagnosis.
With regard to parental suicide, short term effects were associated with the highest odds ratios (OR 2.9) among girls, whereas exposure during childhood had the greatest impact on suicide attempt risk among boys (OR 3.0) in the crude analyses (
In the univariate analyses, short-term exposure to maternal suicide attempt was associated with the highest risk of suicide attempt among all exposures studied (OR 4.1 for both girls and boys) (
Short-term effects of exposure to maternal inpatient care due to psychiatric diagnoses were much more detrimental with regard to the risks of carrying out a suicide attempt among young women compared to young men (multivariate adjusted ORs reached 2.6 and 1.4, respectively; p = 0.001 for gender difference) (
Gender differences were also seen with respect to age modification of the short- and long-term effects of parental inpatient care due to psychiatric diagnoses on offspring risk of suicide attempt (
Both exposure to maternal and paternal disability pension due to psychiatric diagnoses showed strongest effect sizes for short-term exposure in the analyses adjusting for all other parental risk factors among both young women and men (ORs ranging from 1.3 to 1.5). None of these associations remained statistically significant after considering the mediating effect of offspring’s inpatient care due to psychiatric diagnoses, with exception of the long-term exposure to parental disability pension due to psychiatric diagnoses in young women. With regard to maternal and paternal disability pension due to somatic diagnoses, long-term effects and effects of exposure during childhood on offspring’s suicide attempt risk were stronger than short-term effects for girls and boys (data not shown). Short term effects of maternal disability pension due to somatic diagnoses decreased significantly with age at suicide attempt in young women, leading to no risk after the age of 27 (p = 0.006 for variation with age) (
With regard to maternal and paternal death due to other causes than suicide, significantly increased ORs could be found only for young men for short-term effects of exposure to maternal death (OR 1.5) and long-term effects of exposure to paternal death (OR 1.2), adjusted for all parental risk factors. Particularly adjustment due to socio-economic and civil status decreased the effect on the estimates related to parental death due to other cases than suicide. Mediation through own psychiatric morbidity had only a marginal effect.
Different patterns for short- and long-term effects and effects of exposure during childhood for suicide attempt in offspring were found with regard to various markers of maternal and paternal morbidity and mortality among young women and men. Short-term effects were generally associated with higher ORs than long term effects, particularly among girls. Short -term effects of exposure to maternal suicide attempt were among the strongest risk factors, associated with two-fold increased ORs for suicide attempt in young women and men after multivariate adjustment. Exposure to maternal markers of morbidity and mortality was mainly associated with higher risk estimates than exposure to paternal markers. Some gender differences were found particularly with regard to short-term effects of exposure to maternal inpatient care due to psychiatric diagnoses, being more detrimental for young women. With regard to exposure to parental inpatient care due to psychiatric diagnoses, short-term effects decreased significantly with age for young women. For young men, long-term effects of exposure to parental inpatient care due to psychiatric diagnoses decreased significantly with age.
One of the main strengths of this study include the use of register data with good validity
Studies from Europe and the US indicate that up to two thirds of individuals with diagnosable mental disorders do not receive treatment
Maternal markers of morbidity and mortality showed the strongest effect sizes if exposure was short-term among girls. Maternal suicide attempt showed the strongest effect if exposure was short-term for both girls and boys. This finding stresses the importance of maternal suicide attempt for offspring’s suicide attempt as a triggering factor as well as the possibility for an imitation effect. Studies to date have tried to disentangle the underlying mechanisms of familial transmission of suicidal behavior. Potential mechanisms include genetic predisposition, psychosocial environment and imitation
We found a significant sex difference related to the short-term exposure to maternal inpatient care due to psychiatric diagnoses on the risk of suicide attempt in offspring: the OR adjusted for other parental risk factors reached 2.6 and 1.4 in young women and men, respectively. Similar but not that considerable sex differences were reported earlier with regard to the risk of offspring’s suicide
Some parental risk markers exerted the most detrimental effect if exposure occurred during early childhood as compared to short-term exposure to these risk markers, namely: for young women maternal and paternal disability pension due to somatic diagnoses and for young men paternal inpatient care due to psychiatric diagnoses. These analyses are expanding earlier reports of higher risk estimates of exposure to parental inpatient care due to psychiatric diagnoses and disability pension due to somatic diagnoses if exposure occurred in early childhood as opposed to later in life
This is to our best knowledge the first study analyzing if the effect of exposure to parental markers of morbidity and mortality, namely short- and long-term effects as well as effects of exposure during childhood, are modified by age. We found that short-term effects of exposure to parental inpatient care due to psychiatric diagnoses and maternal disability pension due to somatic diagnoses decreased significantly with age for young women, being associated with the highest risk in adolescence. Adolescence is associated with a higher degree of impulsive behavior and emotional turmoil than adulthood
The effect of exposure to a further parental marker decreased with age at offspring’s suicide attempt, namely the long-term effects of parental inpatient care due to psychiatric diagnoses for young men. These associations were independent from the offspring’s own psychopathology, measured by previous inpatient care due to psychiatric diagnoses. These risk factors might here resemble a stronger, maybe genetic, vulnerability for suicide attempt and their occurrence might be associated with an earlier age at suicidal behavior. Different familial risk factors, like a stronger familial loading for suicidal behavior and higher levels of impulsive aggression, have been reported to be associated with an earlier age at suicidal behavior
In general, parental morbidity and mortality were associated with an increase in suicide attempt risk in the offspring. The strongest risk for attempting suicide was within the two-year period following a mother’s inpatient care due to suicide attempt for both daughters and sons and mother’s inpatient care due to psychiatric diagnoses particularly for daughters. Adolescence represented the most critical period for attempting suicide when exposed to parental psychopathology. Preventive clinical and public health measures are strongly needed for adolescents shortly after they have been exposed to their parents’ inpatient care due to psychiatric diagnoses and suicidal behaviour. Effective prevention requires a tight intersectioral collaboration particularly collaboration between adult- and child-psychiatry. Examples of effective intervention for children of parents suffering from mental disorders have been published