Department of General Practice and Family Medicine & Institute for Medical Psychology, Center for Public Health, Medical University of Vienna, Severingasse 9, 1090 Vienna, Austria. firstname.lastname@example.org
J Epidemiol Community Health. 2012 Mar;66(3):233-9
There is evidence of parental risk factors for suicidal behaviour in offspring, but research on variations in their effects with offspring's age at first exposure is sparse.
To explore the effects of age at exposure to parental mortality and markers of morbidity on the risks of suicide and attempted suicide in offspring.
This was a case-control study effected through record linkage between Swedish registers. Individuals born 1973-83 who committed suicide (n=1407) or were hospitalised due to an attempted suicide (n=17?159) were matched to =10 controls by sex, month and county of birth. ORs were measured in time windows representing age at first exposure.
A general pattern of increasing risks of suicide and attempted suicide in offspring with decreasing age at exposure to parental risk factors emerged. Adjusted suicide risk (OR (95% CI)) was most pronounced in the youngest exposure window for parental psychiatric disability pension (3.1 (1.6 to 5.8)), somatic disability pension (1.9 (1.0 to 3.4)), psychiatric inpatient care (2.5 (2.0 to 3.1)), parental attempted suicide (2.9 (2.0 to 4.1)) and suicide (2.9 (1.7 to 5.2)). For parental non-suicidal deaths, the general pattern was the opposite. Patterns in offspring attempted suicide were similar to completed suicide for parental disability pension, psychiatric inpatient care and non-suicidal death. Attempted suicide risk after parental suicide showed an increasing trend with increasing age at exposure.
Parental morbidity and parental suicidal behaviour show the most detrimental effects on completed suicide among offspring when they appear early in life. Early interventions in families at risk are necessary to prevent suicide in offspring.
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.