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Familial clustering of suicidal behaviour and psychopathology in young suicide attempters

A register-based nested case control study

Abstract

Introduction

Familial clustering of suicidal behaviour and psychopathology has been reported in young suicide attempters. Most of these studies were predominantly carried out in clinical treatment settings and lacked statistical power to assess the independent and modifying influences of own and familial psychopathology and suicidal behaviour.

Methods

We carried out a population-based record-linkage study with a nested case control design. The 14,440 individuals hospitalised due to suicide attempt (cases) and 144,400 matched controls were born in Sweden between 1968 and 1980 and followed up till December 31, 1999.

Results

Among the strongest independent familial risk factors for youth suicide attempt were siblings’ (OR 3.4; 2.8–4.1), maternal (OR 2.7; 2.5–3.1) and paternal (OR 1.9; 1.7–2.1) suicide attempt. Other important risk factors were familial personality and substance abuse disorders, maternal schizophrenia, non-affective psychoses and organic disorders and parental neurotic, stress-related and somatoform disorders (1.9–3.2 fold increase), and paternal (OR 1.9; 1.6–2.3) and maternal (OR 1.8; 1.3–2.4) suicide completion. Mental illnesses in index subjects, particularly substance abuse, affective and personality disorders, were the dominant determinants of suicide attempt. Strong interactions were observed between psychopathology in index subjects and familial suicidality. Familial suicide completion had a stronger effect on suicide attempt of earlier onset and on boys. Nearly half (47%) of all suicide attempts could be attributed to familial psychopathology (13%), family suicide attempt (7%) and suicide completion (1%) and own psychopathology (25%).

Conclusion

Early recognition and adequate treatment of individual mental illness contribute to prevent youth suicide attempts. Children of parents with psychopathology and suicidal behaviour should receive early support and attention. Evaluation of familial suicidal behaviour seems to be vital for suicide risk assessment in young psychiatric inpatients. There appears to be an independent effect of familial suicidal behaviour as well as familial psychopathology on youth suicide attempt beyond the transmission of mental illness.

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References

  1. 1.

    Agerbo E, Nordentoft M, Mortensen PB (2002) Familial psychiatric, and socioeconomic risk factors for suicide in young people: nested case-control study. BMJ 323:74–79

    Article  Google Scholar 

  2. 2.

    Allebeck P, Allgulander C, Henningsohn L, Jakobsson SW (1991) Causes of death in a cohort of 50465 young men—validity of recorded suicide as underlying cause of death. Scand J Soc Med 19:242–247

    PubMed  CAS  Google Scholar 

  3. 3.

    Andrews JA, Lewinsohn PM (1992) Suicidal attempts among older adolescents: prevalence and co-occurrence with psychiatric disorders. J Am Acad Child Adolesc Psychiatry 31:655–662

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Brent DA, Mann JJ (2005) Family genetic studies, suicide, and suicidal behavior. Am J Med Genet C Semin Med Genet 133:13–24

    PubMed  Google Scholar 

  5. 5.

    Brent DA, Perper JA, Moritz G, Liotus L, Schweers J, Balach L, Roth C (1994) Familial risk factors for adolescent suicide: a case-control study. Acta Psychiatr Scand 89:52–58

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Brent DA, Bridge J, Johnson BA, Connolly J (1996) Suicidal behaviour runs in families. A controlled family study of adolescent suicide victims. Arch Gen Psychiatry 53:1143–1152

    Google Scholar 

  7. 7.

    Brent DA, Oquendo M, Birmaher B, et al. (2002) Familial pathways to early-onset suicide attempt: risk for suicidal behavior in offspring of mood-disordered suicide attempters. Arch Gen Psychiatry 59:801–807

    PubMed  Article  Google Scholar 

  8. 8.

    Christoffersen MN, Soothill K (2003) The long-term consequences of parental alcohol abuse: a cohort study of children in Denmark. J Subst Abuse Treat 25:107–116

    PubMed  Article  Google Scholar 

  9. 9.

    Christoffersen MN, Poulsen HD, Nielsen A (2003) Attempted suicide among young people: risk factors in a prospective register based study of Danish children born in 1966. Acta Psychiatr Scand 108:350–358

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Cnattingius S, Ericson A, Gunnarskog J, Kallen B (1990) A quality study of a medical birth register. Scand J Soc Med 18:143–148

    PubMed  CAS  Google Scholar 

  11. 11.

    Dalman Ch, Broms J, Cullberg J, Allebeck P (2002) Young cases of schizophrenia identified in a national inpatient register—are the diagnoses valid? Soc Psychiatry Psychiatr Epidemiol 37:527–531

    PubMed  Article  Google Scholar 

  12. 12.

    Fergusson DM, Lynskey MT (1995) Suicide attempts and suicidal ideation in a birth cohort of 16-year-old New Zealanders. J Am Acad Child Adolesc Psychiatry 34:1308–1317

    PubMed  CAS  Google Scholar 

  13. 13.

    Fu Q, Heath AC, Bucholz KK, Nelson EC, Glowinski AL, Goldberg J, Lyons MJ, Tsuang MT, Jacob T, True MR, Eisen SA (2002) A twin study of genetic and environmental influences on suicidality in men. Psychol Med 32:11–24

    PubMed  CAS  Article  Google Scholar 

  14. 14.

    Garfinkel BD, Froese A, Hood J (1982) Suicide attempts in children and adolescents. Am J Psychiatry 139:1257–1261

    PubMed  CAS  Google Scholar 

  15. 15.

    Glowinski AL, Bucholz KK, Nelson EC, Fu Q, Madden PA, Reich W, Heath AC (2001) Suicide attempts in an adolescent female twin sample. J Am Acad Child Adolesc Psychiatry 40:1300–1307

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Goodman M, New A, Siever L (2004) Trauma, genes, and the neurobiology of personality disorders. Ann N Y Acad Sci 1032:104–116

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Goodwin RD, Beautrais AL, Fergusson DM (2004) Familial transmission of suicidal ideation and suicide attempts: evidence from a general population sample. Psychiatry Res 126:159–165

    PubMed  Article  Google Scholar 

  18. 18.

    Haw C, Hawton K, Houston K, Townsend E (2001) Psychiatric and personality disorders in deliberate self-harm patients. Br J Psychiatry 178:48–54

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Hawton K, Haw C, Houston K, Townsend E (2002) Family history of suicidal behaviour: prevalence and significance in deliberate self-harm patients. Acta Psychiatr Scand 106:387–393

    PubMed  Article  Google Scholar 

  20. 20.

    Johnson BA, Brent DA, Bridge J, Connolly J (1998) The familial aggregation of adolescent suicide attempts. Acta Psychiatr Scand 97:18–24

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Lieb R, Bronisch T, Höfler T, Schreier A, Wittchen HU (2005) Maternal suicidality and risk of suicidality in offspring: findings from a community study. Am J Psychiatry 162:1165–1671

    Article  Google Scholar 

  22. 22.

    Mittendorfer-Rutz E, Rasmussen F, Wasserman D (2004) Restricted fetal growth and adverse maternal psychosocial and socioeconomic conditions as risk factors for suicidal behaviour of offspring: a cohort study. Lancet 364:1135–1140

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Pfeffer CR, Normandin L, Kakuma T (1994) Suicidal children grow up: suicidal behavior and psychiatric disorders among relatives. J Am Acad Child Adolesc Psychiatry 33: 1087–1097

    PubMed  CAS  Article  Google Scholar 

  24. 24.

    Qin P, Agerbo E, Mortensen PB (2002) Suicide risk in relation to family history of completed suicide and psychiatric disorders: a nested case-control study based on longitudinal registers. Lancet 360:1126–1130

    PubMed  Article  Google Scholar 

  25. 25.

    Qin P, Agerbo E, Bo Mortensen PB (2003) Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. Am J Psychiatry 160:765–772

    PubMed  Article  Google Scholar 

  26. 26.

    Ramchandani P, Stein A, Evens J, O’Connor TG (2005) Paternal depression in the postnatal period and child development: a prospective population study. Lancet 365:2201–2205

    PubMed  Article  Google Scholar 

  27. 27.

    Roy A (2004) Family history of suicidal behavior and earlier onset of suicidal behavior. Psychiatry Res 129:217–219

    PubMed  Article  Google Scholar 

  28. 28.

    Runeson BS (1998) History of suicidal behaviour in the families of young suicides. Acta Psychiatr Scand 98:497–501

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Schulsinger F, Kety SS, Rosenthal D, Wender PH (1979) A family study of suicide. In: Schou M, Stromgren E (eds) Academic Press, New York, pp 277–287

  30. 30.

    Sørenson SB, Rutter CM (1991) Transgenerational patterns of suicide attempt. J Consult Clin Psychol 59:861–866

    PubMed  Article  Google Scholar 

  31. 31.

    Wender PH, Kety SS, Rosenthal D, Schulsinger F, Ortman J, Lunde I (1986) Psychiatric diagnoses in the biological and adoptive families of adopted individuals with affective disorders. Arch Gen Psychiatry 43:923–929

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We wish to thank the American Foundation for Suicide Prevention for funding this project and Per Tynelius, statistician, for preparation and quality control of the present data set and statistical advice. Ethics committee approval: The study has been approved by the Ethics committee of the Karolinska Institutet, Stockholm, Sweden. Conflict of interest: The authors declare that they have no conflict of interest.

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Correspondence to Ellenor Mittendorfer-Rutz.

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Mittendorfer-Rutz, E., Rasmussen, F. & Wasserman, D. Familial clustering of suicidal behaviour and psychopathology in young suicide attempters. Soc Psychiat Epidemiol 43, 28–36 (2008). https://doi.org/10.1007/s00127-007-0266-0

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Keywords

  • family
  • suicide
  • attempt
  • psychopathology
  • epidemiology