Familial clustering of suicide risk: a total population study of 11.4 million individuals (original) (raw)
Related papers
Is it in the Family? A Reflection from the Field on Hereditary Factors influencing Suicide
Heredity as a factor influencing suicide is in the realm of the probable. The present paper is an attempt to probe the probability of considering heredity as a factor influencing suicide. Effort is made to juxtapose the two divergent views on heredity – one acknowledging the possibility and the other rejecting the possibility-as a cause for suicide. Authors who lay greater emphasis on the individual and who consider suicide as an individual act tend to hold the view that suicide can be hereditary. Durkheim who establishes suicide as a social fact negates the role of race and heredity in the suicidal act. The paper looks at these two views based on a review of literature. Without being naïve and dodgy on this issue the paper further attempts with two narratives from the field to nudge the point that in the search for the causes of suicide nothing should be left unconsidered. All causes (even if they are not proved beyond doubt), even the apparently paltry; need to be considered to arrive at a more encompassing understanding of the tantalizing phenomenon of suicide.
Journal of Epidemiology & Community Health, 2006
Study objective: Suicides cluster in both families and persons with psychiatric disorders and socioeconomic disadvantages. This study compares these factors between suicide cases, their siblings, and population based controls in an attempt to evaluate both the familial and the individual element of these factors. Design: Nested case-control study. Information on causes of death, psychiatric admission, marital status, children, and socioeconomic factors was obtained from routine registers. Setting: Denmark. Participants: 985 suicide cases, 1104 sex-age (¡3 years) matched siblings, and 16 619 controls. Main results: The suicide rate ratios obtained from the case-sibling and the case-control analysis, respectively, were of similar magnitude. For example, in the case-sibling analysis the adjusted suicide rate ratios associated with discharge from a psychiatric hospital within the previous 365 days, being unemployed the previous year, having a postgraduate degree and being single were 42.13 (95% CI 17.75 to 100.02), 1.78 (1.35 to 2.36), 0.51 (0.21 to 1.26), and 2.69 (1.91 to 3.79), respectively. The corresponding rate ratios obtained from the case-control analysis were 47.91 (35.41 to 64.83), 1.76 (1.49 to 2.08), 0.45 (0.26 to 0.76), and 2.39 (1.87 to 3.07). Moreover, the analogous ratios when comparing siblings and controls were 1.98 (1.08 to 3.63), 1.22 (1.06 to 1.41), 0.65 (0.44 to 0.95), and 0.89 (0.75 to 1.06). Conclusions: People who commit suicide deviate similarly from siblings and controls in exposure to hospitalised psychiatric disorders and socioeconomic disadvantages, although these factors contribute to the familial aggregation of suicides. 776 www.jech.com
American Journal of Psychiatry, 2009
Objective: There is substantial evidence suggesting that suicide aggregates in families. However, the extent of overlap between the liability to suicide and psychiatric disorders, particularly major depressive disorder, remains an important issue. Similarly, factors that account for the familial transmission of suicidal behavior remain unclear. Thus, through direct and blind assessment of first-degree relatives, the authors conducted a family study of suicide by examining three proband groups: probands who committed suicide in the context of major depressive disorder, living depressed probands with no history of suicidal behavior, and psychiatrically normal community comparison probands.
Psychiatry Research, 2004
The goals of the study were (1) to determine the association between parental and offspring suicidal ideation and suicide attempts among adult offspring in a general community sample, and (2) to examine the extent to which this association can be explained by mediating processes of mental disorders. Data were drawn from the National Comorbidity Survey (ns8098), a representative household sample of adults aged 15-54 in the United States. The relationships between suicidal ideation and suicide attempts among adult offspring and suicidal ideation and suicide attempt in their parents, compared with those in parents not characterized by suicidal ideation or suicide attempts, were calculated using multiple logistic regression analyses. Analyses were adjusted for differences in sociodemographic characteristics and for mental disorders. Results showed that parental suicidal ideation was associated with a significantly increased likelihood of suicidal ideation wORs1.7 (1.2, 2.5)x and suicide attempt wORs1.4 (0.9, 2.1)x among offspring. Parental suicide attempt was associated with increased odds of suicidal ideation wORs2.0 (1.4, 2.9)x and suicide attempt wORs2.2 (1.4, 3.4)x among offspring. Comorbid mental disorders contributed to the strength of these associations, but with the exception of the link between parental suicidal ideation and offspring suicide attempt, all remained statistically significant even after adjustment. These data provide initial evidence of familial linkages (parent-offspring) of suicidal ideation and behavior among a sample of adults representative of the US population. The data suggest that comorbid mental disorders contribute to these associations but do not completely account for them. The findings are consistent with and extend results from family, clinical, and high-risk studies suggesting that a familial risk of suicidal ideation and suicide behavior occurs in the general population. Implications for prevention and future research are discussed.
American Journal of Psychiatry, 2007
Objective-The authors sought to identify clinical predictors of new-onset suicidal behavior in children of parents with a history of mood disorder and suicidal behavior. Method-In a prospective study of offspring of parents with mood disorders, 365 offspring (average age, 20 years) of 203 parents were followed for up to 6 years. Offspring with incident suicide attempts or emergency referrals for suicidal ideation or behavior ("incident events") were compared with offspring without such events on demographic and clinical characteristics. Multivariate analyses were conducted to examine predictors of incident events and predictors of time to incident event. Results-Offspring of probands who had made suicide attempts, compared with offspring of parents with mood disorders who had not made attempts, had a higher rate of incident suicide attempts (4.1% versus 0.6%, relative risk=6.5) as well as overall suicidal events (8.3% versus 1.9%, relative risk=4.4). Mood disorder and self-reported impulsive aggression in offspring and a history of sexual abuse and self-reported depression in parents predicted earlier time to, and greater hazard of, an incident suicidal event. Conclusions-In offspring of parents with mood disorders, precursors of early-onset suicidal behavior include mood disorder and impulsive aggression as well as parental history of suicide attempt, sexual abuse, and self-reported depression. These results suggest that efforts to prevent the familial transmission of early-onset suicidal behavior by targeting these domains could reduce the morbidity of suicidal behavior in high-risk youths. The literature on suicide demonstrates, on the basis of adoption, twin, and family studies, that suicidal behavior aggregates in families and that the familial transmission of suicidal behavior cannot be explained by the transmission of major psychiatric disorders alone (1). However, nearly all of these family genetic studies are cross-sectional, which means that little is known about the precursors of suicidal behavior that place offspring of suicidal individuals at increased risk of suicidal behavior and the causal models to explain how suicidal behavior is transmitted from parent to child. Nevertheless, the literature provides clues as to the mechanisms and precursors of familial transmission of suicidal behavior. Longitudinal community studies show that precursors of youthful suicidal behavior include depression, suicidal ideation, behavioral symptoms, child
Variables associated with familial suicide attempts in a sample of suicide attempters
Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2007
Attempted suicide appears to be a familial behavior. This study aims to determine the variables associated with family history of attempted suicide in a large sample of suicide attempters. The sample included 539 suicide attempters 18 years or older recruited in an emergency room. The two dichotomous dependent variables were family history of suicide attempt (10%, 51/539) and of completed suicide (4%, 23/539). Independent variables were 101 clinical variables studied with two data mining techniques: Random Forest and Forward Selection. A model for family history of completed suicide could not be developed. A classificatory model for family history of attempted suicide included the use of alcohol in the intent and family history of completed suicide (sensitivity, specificity, 98.7%; and accuracy, 96.6%). This is the first study that uses a powerful new statistical methodology, data mining, in the field of familial suicidal behaviors and suggests that it may be important to study familial variables associated with alcohol use to better understand the familiality of suicide attempts.
Familial pathways to early-onset suicide attempt: a 5.6-year prospective study
JAMA Psychiatry, 2015
IMPORTANCE Suicide attempts are strong predictors of suicide, a leading cause of adolescent mortality. Suicide attempts are highly familial, although the mechanisms of familial transmission are not understood. Better delineation of these mechanisms could help frame potential targets for prevention. OBJECTIVE To examine the mechanisms and pathways by which suicidal behavior is transmitted from parent to child. DESIGN, SETTING, AND PARTICIPANTS In this prospective study conducted from July 15, 1997, through June 21, 2012, a total of 701 offspring aged 10 to 50 years (mean age, 17.7 years) of 334 clinically referred probands with mood disorders, 191 (57.2%) of whom had also made a suicide attempt, were followed up for a mean of 5.6 years. MAIN OUTCOMES AND MEASURES The primary outcome was a suicide attempt. Variables were examined at baseline, intermediate time points, and the time point proximal to the attempt. Participants were assessed by structured psychiatric assessments and self-report and by interview measures of domains hypothesized to be related to familial transmission (eg, mood disorder and impulsive aggression). RESULTS Among the 701 offspring, 44 (6.3%) had made a suicide attempt before participating in the study, and 29 (4.1%) made an attempt during study follow-up. Multivariate logistic regression revealed that proband suicide attempt was a predictor of offspring suicide attempt (odds ratio [OR], 4.79; 95% CI, 1.75-13.07), even controlling for other salient offspring variables: baseline history of mood disorder (OR, 4.20; 95% CI, 1.37-12.86), baseline history of suicide attempt (OR, 5.69; 95% CI, 1.94-16.74), and mood disorder at the time point before the attempt (OR, 11.32; 95% CI, 2.29-56.00). Path analyses were consistent with these findings, revealing a direct effect of proband attempt on offspring suicide attempt, a strong effect of offspring mood disorder at each time point, and impulsive aggression as a precursor of mood disorder. CONCLUSIONS AND RELEVANCE Parental history of a suicide attempt conveys a nearly 5-fold increased odds of suicide attempt in offspring at risk for mood disorder, even after adjusting for the familial transmission of mood disorder. Interventions that target mood disorder and impulsive aggression in high-risk offspring may attenuate the familial transmission of suicidal behavior.
American Journal of Psychiatry, 2003
Objective: Suicide risk was addressed in relation to the joint effect of factors regarding family structure, socioeconomics, demographics, mental illness, and family history of suicide and mental illness, as well as gender differences in risk factors.