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Suicidal Behavior Spreads From Parent to Child
Medscape Medical News
December 30, 2014

Children with a parent who has attempted suicide have nearly a fivefold increased risk of attempting suicide themselves, new research shows.

Results from a longitudinal, prospective study showed a direct effect of a parent's suicide attempt on a suicide attempt by their child, even after taking into account a history of previous suicide attempt by the offspring and familial transmission of a mood disorder.

"In this high-risk longitudinal study, we found that parental suicide attempt conveyed a nearly 5-fold increased risk of offspring attempt, even controlling for the familial transmission of mood disorder," the authors, led by David A. Brent, MD, University of Pittsburgh Medical Center, in Pennsylvania, write.

The study was published online December 30 in JAMA Psychiatry.

Family Transmission
Suicide attempts are strong predictors of suicide, a leading cause of adolescent mortality, the investigators note. They also point out that suicide attempts are "highly familial" but that the mechanisms of family transmission are unclear.

"Better delineation of these mechanisms could help frame potential targets for prevention," they write.

To examine the mechanisms and pathways by which suicide is transmitted from parent to child, the investigators examined children of parents with mood disorders during a period of nearly 6 years.

The prospective study was conducted from July 1997 to June 2012 and included 701 children aged 10 to 50 years (mean age, 17.7 years) of 334 parents with mood disorders, of whom 191 (57.2 %) had also made a suicide attempt.

Offspring were followed up for a mean of 5.6 years, and parents were also followed up prospectively.

Parents and offspring were assessed by separate, masked clinical interviewers. Baseline interviews covered lifetime occurrence of suicidal ideation and behavior, aggression, and psychiatric disorders. Subsequent annual interviews covered these domains from the time of the last assessment.

These interviews, along with self-report questionnaires, targeted factors known to contribute to suicidal risk, including previous attempt and suicidal ideation; mood, anxiety, and behavioral disorders; impulsive aggression personality disorders; family discord; history of head trauma; and history of abuse.

Clinical Implications
Of the 701 offspring 44 (6.3%) had made a suicide attempt before participating in the study; 29 (4.1%) attempted suicide during the study follow-up period.

Multivariate logistic regression revealed that proband suicide attempt was a predictor of offspring suicide attempt (odds ratio [OR], 4.79; 95% confidence interval [CI], 1.75 - 13.07), even after controlling for other salient offspring variables, including a baseline history of mood disorder (OR, 4.20; 95% CI,1.37 - 12.86), a 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).

The researchers report that path analyses were consistent with these findings and revealed a direct effect of a parental suicide attempt on offspring suicide attempt.

Results also revealed "a strong effect of offspring mood disorder at each time point and impulsive aggression as a precursor of mood disorder."

According to investigators, the findings underline the "importance of assessment and early intervention in the families of parents with mood disorders and history of a suicide attempt."

In addition, they suggest that preventing the onset of depression may attenuate the familial transmission of suicidal behavior, which could be tested with efficacious preventive interventions to reduce the risk for onset of depression in high-risk youth.

Furthermore, the investigators note that the fact that many of the parents who attempted suicide also had personality disorders suggests that effective interventions may benefit the parent- child relationships and subsequently improve functional outcomes in offspring.

Finally, they add that "because impulsive aggression can be a precursor to mood disorder, which in turn elevates suicidal risk, helping youth with prominent irritability and impulsive aggression to achieve better emotion regulation may reduce suicidal risk by diminishing the risk for mood disorder and the likelihood of acting on suicidal impulses."

The authors report no relevant financial relationships.

JAMA Psychiatry. Published online December 30, 2014
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