Transmission Of Suicidal Behavior Research Articles

Transgenerational concordance in parent-to-child transmission of suicidal behaviour: a retrospective, nationwide, register-based cohort study of 4 419 642 individuals in Denmark

Suicidal behaviour runs in families, but the nature of transgenerational concordance needs elucidation. The aim of this study was to examine parent-to-child transmission by investigating whether presence and nature of parental suicidal behaviour was associated with suicidal behaviour in children. We did a retrospective, nationwide, register-based cohort study in Demark using register data. We included all individuals born after 1953 who were 10 years or older and who were recorded as living in Denmark at some point between Jan 1, 1980, and Dec 31, 2016. Adults listed as living with their child at first registration in the Civil Registration System were considered as parents; later records of different legal parents allowed identification of potential step-parents. Self-reported ethnicity data were not available. Exposure to parental suicide attempt and suicide was identified using information from hospital contacts and causes of death from national registers. The examined outcomes were suicide attempt and death by suicide. We calculated incidence rate ratios (IRRs) and cumulative hazards for children's suicide attempt and suicide, taking into account type of parental suicidal behaviour, child's age of exposure, and sex. In total, 4 419 642 individuals aged 10-63 years were observed during 1980-2016. Of these individuals, 150 222 (3·4%) were exposed to one or more parents with a suicide attempt, 31 564 (0·7%) to at least one parent who died by suicide, and 12 834 (0·3%) to both events. Individuals exposed to parental suicide attempt had higher rates of suicide attempt (IRR 2·72 [95% CI 2·33-3·17]) than individuals exposed to parental suicide (1·77 [1·50-2·09]) when compared with unexposed individuals. Higher rates of suicide were found for individuals exposed to parental suicide (IRR 3·18 [95% CI 2·84-3·58]) than for those exposed to parental suicide attempt (2·37 [2·19-2·57]). The cumulative hazard of suicide attempt was 0·07 for individuals exposed to parental suicide attempt, and the cumulative hazard of suicide was 0·009 for individuals exposed to parental suicide. Individuals exposed to parental suicide had higher odds of violent suicidal methods than those exposed to suicide attempt alone (odds ratio 2·0 [95% CI 1·7-2·3]). A concordant pattern of higher rates of the same type of suicidal behaviour as the one of the parents was observed, including type of suicide method. Preventive, family-oriented interventions are warranted to mitigate familial transmission of risk, as are clinical considerations of familial exposure in risk assessment of patients. Mental Health Services, Capital Region of Denmark.

Geographic proximity is associated with transmission of suicidal behaviour among siblings.

The aim of this study was to clarify the role of 'contagion', or social transmission, in risk of suicidal behaviour (SB) among siblings. We followed Swedish sibling pairs until one of them (S1; N=111,848) was registered for a suicide attempt or completion. We tested the effect of geographic proximity between siblings on risk of a first SB registration of S1's sibling (S2). To control for familial confounding, we conducted complementary analyses of sibling trios (N=701), comparing risk in different siblings as a function of their respective proximity to S1. The best-fitting model across sibling pairs included an effect of distance between siblings (HR=0.96, 95% CI=0.93-0.99). Hazard ratios declined quickly up to 25km and largely stabilized beyond 150km. Across all pairs, a larger age difference between siblings was associated with reduced SB risk (HR=0.96 95% CI=0.93-0.98). Findings were consistent within the sibling trios. Consistent with the concept of suicide contagion, risk of suicidal behaviour subsequent to a sibling's suicide completion or attempt is higher as a function of sibling closeness. These findings are robust to potentially confounding familial factors.

Genetic risk of suicidal behavior in bipolar spectrum disorder: analysis of 737 pedigrees

Suicide is a significant cause of mortality in patients with major affective disorders (MAD), and suicidal behavior and MAD co-aggregate in families. However, the transmission of suicidal behavior is partially independent from that of MAD. We analyzed the lifetime prevalence of completed and attempted suicides in a large sample of families with bipolar disorder (BD), its relation to family history of MAD and BD, and the contribution of clinical and treatment factors to the risk of suicidal behavior. We studied 737 families of probands with MAD with 4919 first-degree relatives (818 affected, 3948 unaffected, and 153 subjects with no information available). Lifetime psychiatric diagnoses and suicidal behavior in first-degree relatives were assessed using semi-structured interviews, family history methods, and reviews of clinical records. Cox proportional hazard and logistic regression models were used to investigate the role of clinical covariates in the risk of suicidal behavior, and in the prevalence of MAD and BD. The estimated lifetime prevalence of suicidal behavior (attempted and completed suicides) in 737 probands was 38.4 ± 3.0%. Lithium treatment decreased suicide risk in probands (p = 0.007). In first-degree relatives, a family history of suicidal behavior contributed significantly to the joint risk of MAD and suicidal behavior (p = 0.0006). The liability to suicidal behavior is influenced by genetic factors (particularly family history of suicidal behavior and MAD). Even in the presence of high genetic risk for suicidal behavior, lithium treatment decreases suicide rates significantly.

AS18-02 - Genetics and epigenetic effects on suicidal behaviour

The most prevalent mental disorders among suicide victims are depressive syndromes. Beside depression, research relates a wide range of psychosocial characteristics and stressors to suicide behaviour. Increasing amount of data about suicidal behaviour indicates that suicide is familial and that familial transmission of suicidal behaviour cannot be explained by the transmission of psychiatric disorder alone. Genetic and epigenetic effects are involved on suicidal behaviour beside environmental factors. Aberrant genes regulating serotoninergic, dopaminergic and noradrenergic systems could increase suicidal risk. Associations between catechol-O-methyltransferase (COMT) and tryptophan hydroxylase 2 (TPH2) polymorphisms, the rate-limiting enzyme for brain serotonin, and completed suicide were observed in suicide victims in populations with high suicide risk. On the other hand, it is also known that brain-derived neurotrophic factor (BDNF) influences a variety of neural processes during the development like neurogenesis, neuronal survival, and maturation of neural development pathways and it seems that BDNF plays a central role in neurobiology of suicidal behaviour and depression. The Met-carrying genotypes and Met allele seems to be connected with increased risk for suicide. The dynamic nature of the epigenetic mechanisms could be involved in the predominant episodic clinical picture of depression. The potential reversibility of epigenetic modifications could be important for management of patients with bipolar disorder offering the opportunity to influence aberrant gene expression by modifying environmental factors with the methods such as psychotherapy.

Parental Mental Disorders and Suicidal Behavior in the Nigerian Survey of Mental Health and Well-Being

The objective of this study was to determine which parental mental disorders predict offspring suicidal behavior in a general adult population sample of a sub-Saharan African country. The World Health Organization Composite International Diagnostic Interview, version 3 was used to assess respondents' suicidal behaviors as well as psychopathology in their parents. The effects of parental disorders in predicting offspring suicide ideation and attempts were examined in a series of bivariate and multivariate models. Sections on suicidality were administered to the entire sample (n = 6752), but associations with parental psychopathology were examined in a subsample of respondents (n = 2143). Lifetime prevalence (95% confidence interval) of suicide ideation, plans, and attempts was 3.2% (1.4–6.5), 1.0% (0.4–7.5), and 0.7% (0.5–1.0) respectively. Parental panic disorder and substance abuse were associated with suicide ideation in offspring, but only parental panic disorder was linked to suicide attempts. Parental panic disorder predicted the onset and persistence of suicide ideation and attempts and also which persons with suicide ideation go on to make a suicide attempt. This study further affirms findings from previous studies of the role of disorders characterized by anxiety and impulse control in suicide attempts and as being a probable link in the transmission of suicidal behavior to offspring.

Psychiatric contribution to the debate on films of the silent movie era in Germany

Literary writers and scientists of various disciplines have contributed to debates about the silent movie in the 10s and 20s in Germany, leading to basic insights into the structure and effects of the new film medium. Psychiatric authors of the documented period have elaborated propositions towards a theory of film perception and analyses of different possibly nocuous film effects. The hypothesis of a causal effect of the film medium on violence and the notion of a transmission of suicidal behaviour by fictitious film models are still controversially discussed.

The familial aggregation of adolescent suicide attempts.

The objective of this study was to determine whether the familial aggregation of suicidal behaviour is explained by the familial aggregation of personality disorder and aggression. The relatives of 62 clinically referred adolescent suicide attempters were compared with 70 never-suicidal psychiatric controls. The first-degree relatives of the suicide attempters had a higher rate of suicide attempts/completion than those of the psychiatric controls. This rate remained significantly higher after controlling for Axis I and II differences in the probands and the relatives, but familial personality disorder was significantly associated with suicidal risk in probands. Among the adolescent attempters, high scores on a measure of assaultiveness were associated with significantly higher familial rates of suicide attempts/completion. Our results support the hypothesis that suicidal behaviour may be transmitted as a trait independent of Axis I and II psychopathology but that, in addition, personality disorder has a role in the transmission of suicidal behaviour. An interrelationship between proband assaultiveness and the familial aggregation of suicidality was noted.

Suicidal Behavior Runs in Families

While previous studies have shown an increased rate of suicidal behavior in the relatives of suicide victims, it is unclear if this is attributable merely to increased familial rates of psychiatric disorders. Therefore, we conducted a family study of adolescent suicide victims (suicide probands) and community control probands (controls) to determine if the rates of suicidal behavior were higher in the relatives of adolescent suicide probands even after adjusting for differences in the familial rates of psychiatric disorders. The relatives of 58 adolescent suicide probands and 55 demographically similar controls underwent assessment for Axis I and II psychiatric disorders, lifetime history of aggression, and history of suicidal behavior (attempts and completions) using a combination of family study and family history approaches. The rate of suicide attempts was increased in the first-degree relatives of suicide probands compared with the relatives of controls, even after adjusting for differences in rates of proband and familial Axis I and II disorders (odds ratio, 4.3; 95% confidence intervals, 1.1-16.6). On the other hand, the excess rate of suicidal ideation found in the relatives of suicide probands was explained by increased familial rates of psychiatric disorders. Among suicide probands, higher ratings of aggression were associated with higher familial loading for suicide attempts. Liability to suicidal behavior might be familially transmitted as a trait independent of Axis I and II disorders. The transmitted spectrum of suicidal behavior includes attempts and completions, but not ideation, and the transmission of suicidal behavior and aggression are related.

Suicide on the paternal and maternal sides of depressed patients with a lifetime history of attempted suicide

The computational model of Slater, based on the analysis of ancestral secondary cases on the paternal and maternal sides of the subjects, was applied to depressed patients with a lifetime history of attempted suicide, either violent or nonviolent, in order to investigate possible modes of transmission of suicidal behavior. Among 549 patients, 15 had 2 or more ascendant first- and second-degree relatives who committed suicide. The results of the distribution of these cases were compatible with polygenic inheritance of suicidal behavior in depressed patients with a history of attempted suicide. In patients using violent methods, a significantly greater loading of ancestral secondary cases of suicide was observed on the maternal side and, in the nonviolent attempter group, on the paternal side.

A contribution to the discussion of the role of the genetic factor in suicide, based on five studies in an epidemiologically defined area (Province of Salzburg, Austria)

The question of what role genetic factors have in the transmission of suicidal behavior, in particular suicide itself, is discussed on the basis of five studies of an epidemiologically clearly defined region (the Province of Salzburg, Austria). The high percentage of suicide-positive family histories as compared with the literature is due to exceptionally good sources of information. It could be shown that in suicide cases also suffering from endogenous depression, both endogenous psychoses and suicides appeared to a greater extent in their families. However, in contrast to current assumptions, the suicide disposition is not just found in those with endogenous psychoses, but shows a separate genetic determination. The author concludes that the genetic factor in suicide research and in the evaluation of suicidality should be considered equally along with psychodynamic and sociodynamic factors.