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Parental psychiatric disorders increase risk for attempted suicide, violence

Children whose parents have psychiatric disorders have higher risk for attempted suicide and violent offending, particularly if parents have antisocial personality disorder, cannabis misuse and attempted suicide.

“It has been well established that suicidal and violent behaviors aggregate within families, via possible interplay between genetics, epigenetics, and social and environmental influences. Elevated risks for the two behaviors in offspring have also been linked with a parental history of mental illnesses. However, to our knowledge, no studies have investigated the full spectrum of parental psychiatric disease and both offspring suicide attempts and violent offending jointly in the same population,” Pearl L. H. Mok, PhD, of University of Manchester, England, and colleagues wrote.

To determine associations between parental psychiatric disorders and risk for attempted suicide and violent offending among offspring, researchers followed a population-based cohort of all individuals born in Denmark from 1967 through 1997 from age 15 years until occurrence of adverse outcomes or through December 2012 (n = 1,743,525). Analysis included 27.2 million person-years.

Risk for attempted suicide and violent offending among offspring were increased across the full spectrum of parental psychiatric disorders. However, risk was highest among parental diagnoses of antisocial personality disorder (IRR = 3.96; 95% CI, 3.72-4.21 for attempted suicide; IRR = 3.62; 95% CI, 3.41-3.84 for violent offending), cannabis misuse (IRR = 3.57; 95% CI, 3.25-3.92; IRR = 4.05; 95% CI, 3.72-4.39) and parental suicide attempt (IRR = 3.42; 95% CI, 3.29-3.55; IRR = 3.31; 95% CI, 3.19-3.44).

Parental mood disorders, particularly bipolar disorder, were associated with more modest increases in risk.

Offspring of two parents with a history of mental illness or attempted suicide had double the risk for attempted suicide or violent offending, compared with offspring with one parent with such history.

Associations between parental psychiatric disorders and offspring violent offending were more pronounced among female offspring, while there was little sex difference in risk for attempted suicide in offspring.

“We owe a debt of gratitude to Mok and colleagues for an elegant study that identifies salient, common parental mental health risk factors for suicide attempts and violent offending in their children. To capitalize on these findings, we need further work that can more precisely define the liabilities that are being transmitted, and research to explain individual differences in trajectories of violent and suicidal behavior,” David A. Brent, MD, of University of Pittsburgh School of Medicine, Pennsylvania, and colleagues wrote in an accompanying editorial. “The effects of the best prevention programs often last decades, affect broad sets of outcomes that make for more productive citizens, and are highly cost-effective. What we do need is the scientific and political will to align clinical infrastructure and reimbursement strategies with the extant scientific evidence. Given the concerning, decade-long increase in the U.S. suicide rate, we need to put to use what we know now about how to prevent “common sources of family unhappiness” and thus prevent suicide and violence in the future.” – by Amanda Oldt

Disclosure: Mok and colleagues report no relevant financial disclosures. Brent reports receiving funding from the NIMH, royalties from Guilford Press, royalties from the electronic self-rated version of the Columbia Suicide Severity Rating Scale from ERT, Inc, royalties from performing duties as an UptoDate Psychiatry Section Editor, and consulting fees from Healthwise, and serves on the Neuroscience in Psychiatry Network Steering Committee and the Scientific Board of the Klingenstein Third Generation Foundation. Please see the full study for a list of all authors’ relevant financial disclosures.