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The Prevalence and Psychosocial Correlates of Suicide Attempts Among Inpatient Adolescent Offspring of Croatian PTSD Male War Veterans

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Abstract

Despite evidence that children of male war veterans with combat-related posttraumatic stress disorder (PTSD) are at particularly high risk for behavior problems, very little is currently known about suicidal behaviors in this population of youth. This study aimed to examine the prevalence and psychosocial correlates of suicide attempts among psychiatrically hospitalized adolescent offspring of Croatian male PTSD veterans. Participants were psychiatric inpatients, ages 12–18 years. Self-report questionnaires assessed demographics, suicide attempts, psychopathology, parenting style, and family functioning. The prevalence of suicide attempts was 61.5 % (65.2 % for girls and 58.0 % for boys). Internalizing symptoms, family dysfunction, lower levels of maternal and paternal care, and paternal overcontrol were significantly associated with suicide attempts. Our findings suggest that suicide attempts are common among inpatient adolescent offspring of male PTSD veterans and that interventions targeting both adolescent psychopathology and family relationships are needed for adolescents who have attempted suicide.

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Boričević Maršanić, V., Margetić, B.A., Zečević, I. et al. The Prevalence and Psychosocial Correlates of Suicide Attempts Among Inpatient Adolescent Offspring of Croatian PTSD Male War Veterans. Child Psychiatry Hum Dev 45, 577–587 (2014). https://doi.org/10.1007/s10578-013-0426-2

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