Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-30T23:49:01.411Z Has data issue: false hasContentIssue false
  • English
  • Français

Parental schizophrenia and increased offspring suicide risk: exploring the causal hypothesis using cousin comparisons

Published online by Cambridge University Press:  18 June 2012

T. Ljung ,
P. Lichtenstein ,
S. Sandin ,
B. D'Onofrio ,
B. Runeson ,
N. Långström  and
H. Larsson
T. Ljung*
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
P. Lichtenstein
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
S. Sandin
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
B. D'Onofrio
Affiliation:
Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
B. Runeson
Affiliation:
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
N. Långström
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Center for Violence Prevention, Karolinska Institutet, Stockholm, Sweden
H. Larsson
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
*
*Address for correspondence: Ms. T. Ljung, Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, SE-17177 Stockholm, Sweden. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Little is known about suicide risk among offspring of parents hospitalized for schizophrenia and the mechanisms behind this association.

Method

We applied a nested case–control design based on linkage of Swedish population-based registers. Among 12- to 30-year-old offspring, we identified 68 318 offspring with suicidal behavior (attempted and completed suicide) and their parents. Five healthy control–parent pairs were matched to each suicidal case–parent pair and conditional logistic regression used to obtain odds ratios (ORs). Further, to disentangle familial confounding from causal environmental mechanisms, we compared the population-based suicide risk with the risk found within full-cousins and half-cousins differentially exposed to parental schizophrenia.

Results

Offspring of parents with schizophrenia had significantly increased suicide risk after accounting for socio-economic status, parental suicidal behavior and offspring mental illness [OR 1.68, 95% confidence interval (CI) 1.53–1.85]. Suicide risks in offspring of schizophrenic mothers and fathers were similar in magnitude; so were risks across different developmental periods. Importantly, offspring suicide risk remained essentially unchanged across genetically different relationships; offspring of siblings discordant for schizophrenia had equivalent risk increases within full-cousins (OR 1.96, 95% CI 1.66–2.31) and half-cousins (OR 1.69, 95% CI 1.17–2.44).

Conclusions

Parental schizophrenia was associated with increased risk of offspring suicidal behavior, independent of gender of the schizophrenic parent, and persisting into adulthood. The suicide risk in offspring remained at a similar level when comparing genetically different relationships, which suggests that at least part of the association is due to environmental mechanisms. These findings should inspire increased attention to suicidal ideation and prevention efforts in offspring of parents with schizophrenia.

Keywords

Environmental riskfamilial confoundingnationwide registersparental schizophreniasuicidal behaviour
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 3 , March 2013 , pp. 581 - 590
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abel, KM, Webb, RT, Salmon, MP, Wan, MW, Appleby, L (2005). Prevalence and predictors of parenting outcomes in a cohort of mothers with schizophrenia admitted for joint mother and baby psychiatric care in England. Journal of Clinical Psychiatry 66, 781–789; quiz 808–809.CrossRefGoogle Scholar
Beautrais, AL (2004). Further suicidal behavior among medically serious suicide attempters. Suicide and Life-Threatening Behavior 34, 1–11.CrossRefGoogle ScholarPubMed
Brennan, PA, Mednick, SA, Hodgins, S (2000). Major mental disorders and criminal violence in a Danish birth cohort. Archives of General Psychiatry 57, 494–500.CrossRefGoogle Scholar
Brent, D (2010). What family studies teach us about suicidal behavior: implications for research, treatment, and prevention. European Psychiatry 25, 260–263.CrossRefGoogle ScholarPubMed
Brent, DA, Mann, JJ (2005). Family genetic studies, suicide, and suicidal behavior. American Journal of Medical Genetics Part C: Seminars in Medical Genetics 133C, 13–24.CrossRefGoogle ScholarPubMed
Bridge, JA, Goldstein, TR, Brent, DA (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry 47, 372–394.CrossRefGoogle ScholarPubMed
Chen, YH, Chiou, HY, Tang, CH, Lin, HC (2010). Risk of death by unnatural causes during early childhood in offspring of parents with mental illness. American Journal of Psychiatry 167, 198–205.CrossRefGoogle ScholarPubMed
Ekholm, B, Ekholm, A, Adolfsson, R, Vares, M, Osby, U, Sedvall, GC, Jonsson, EG (2005). Evaluation of diagnostic procedures in Swedish patients with schizophrenia and related psychoses. Nordic Journal of Psychiatry 59, 457–464.CrossRefGoogle ScholarPubMed
Gottesman, II, Bertelsen, A (1989). Confirming unexpressed genotypes for schizophrenia. Risks in the offspring of Fischer's Danish identical and fraternal discordant twins. Archives of General Psychiatry 46, 867–872.CrossRefGoogle ScholarPubMed
Gould, MS, Fisher, P, Parides, M, Flory, M, Shaffer, D (1996). Psychosocial risk factors of child and adolescent completed suicide. Archives of General Psychiatry 53, 1155–1162.CrossRefGoogle ScholarPubMed
Hakko, H, Wahlberg, KE, Tienari, P, Rasanen, S (2011). Genetic vulnerability and premature death in schizophrenia spectrum disorders: a 28-year follow-up of adoptees in the Finnish Adoptive Family Study of Schizophrenia. Nordic Journal of Psychiatry 65, 259–265.CrossRefGoogle ScholarPubMed
Henriksson, KM, McNeil, TF (2004). Health and development in the first 4 years of life in offspring of women with schizophrenia and affective psychoses: Well-Baby Clinic information. Schizophrenia Research 70, 39–48.CrossRefGoogle ScholarPubMed
Hiroeh, U, Appleby, L, Mortensen, PB, Dunn, G (2001). Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. Lancet 358, 2110–2112.CrossRefGoogle ScholarPubMed
Ilgen, MA, Bohnert, AS, Ignacio, RV, McCarthy, JF, Valenstein, MM, Kim, HM, Blow, FC (2010). Psychiatric diagnoses and risk of suicide in veterans. Archives of General Psychiatry 67, 1152–1158.CrossRefGoogle ScholarPubMed
Johnson, JG, Cohen, P, Gould, MS, Kasen, S, Brown, J, Brook, JS (2002). Childhood adversities, interpersonal difficulties, and risk for suicide attempts during late adolescence and early adulthood. Archives of General Psychiatry 59, 741–749.CrossRefGoogle ScholarPubMed
Kendler, KS, Prescott, CA, Myers, J, Neale, MC (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry 60, 929–937.CrossRefGoogle ScholarPubMed
Lichtenstein, P, Yip, BH, Bjork, C, Pawitan, Y, Cannon, TD, Sullivan, PF, Hultman, CM (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet 373, 234–239.CrossRefGoogle ScholarPubMed
Lieb, R, Bronisch, T, Hofler, M, Schreier, A, Wittchen, HU (2005). Maternal suicidality and risk of suicidality in offspring: findings from a community study. American Journal of Psychiatry 162, 1665–1671.CrossRefGoogle ScholarPubMed
Mittendorfer-Rutz, E, Rasmussen, F, Wasserman, D (2008). Familial clustering of suicidal behaviour and psychopathology in young suicide attempters. A register-based nested case control study. Social Psychiatry and Psychiatric Epidemiology 43, 28–36.CrossRefGoogle ScholarPubMed
Nock, MK, Borges, G, Bromet, EJ, Cha, CB, Kessler, RC, Lee, S (2008). Suicide and suicidal behavior. Epidemiologic Reviews 30, 133–154.CrossRefGoogle ScholarPubMed
Nock, MK, Hwang, I, Sampson, NA, Kessler, RC (2010). Mental disorders, co-morbidity and suicidal behavior: results from the National Co-morbidity Survey Replication. Molecular Psychiatry 15, 868–876.CrossRefGoogle Scholar
Palmer, BA, Pankratz, VS, Bostwick, JM (2005). The lifetime risk of suicide in schizophrenia: a reexamination. Archives of General Psychiatry 62, 247–253.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Qin, P, Agerbo, E, 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. American Journal of Psychiatry 160, 765–772.CrossRefGoogle ScholarPubMed
Qin, P, Nordentoft, M (2005). Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Archives of General Psychiatry 62, 427–432.CrossRefGoogle ScholarPubMed
Ramchandani, P, Psychogiou, L (2009). Paternal psychiatric disorders and children's psychosocial development. Lancet 374, 646–653.CrossRefGoogle ScholarPubMed
Rothbaum, F, Weisz, JR (1994). Parental caregiving and child externalizing behavior in nonclinical samples: a meta-analysis. Psychological Bulletin 116, 55–74.CrossRefGoogle ScholarPubMed
Schulsinger, F, Kety, SS, Rosenthal, D, Wender, PH (1979). A family study of suicide. In Origins, Prevention, and Treatment of Affective Disorders (ed. Schou, S. E.), pp. 277–287. Academic Press: New York.Google Scholar
Statistics Sweden (2006). Multi-generation register 2005 – a description of contents and quality. Örebro 2006:08 (http://www.scb.se/statistik/_publikationer/BE9999_2005A01_BR_BE96ST0606.pdf). Accessed 5 June 2012.Google Scholar
Stenager, K, Qin, P (2008). Individual and parental psychiatric history and risk for suicide among adolescents and young adults in Denmark: a population-based study. Social Psychiatry and Psychiatric Epidemiology 43, 920–926.CrossRefGoogle Scholar
Tidemalm, D, Langstrom, N, Lichtenstein, P, Runeson, B (2008). Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long-term follow-up. BMJ 337, a2205.CrossRefGoogle ScholarPubMed
Tidemalm, D, Runeson, B, Waern, M, Frisell, T, Carlstrom, E, Lichtenstein, P, Langstrom, N (2011). Familial clustering of suicide risk: a total population study of 11.4 million individuals. Psychological Medicine 41, 2527–2534.CrossRefGoogle Scholar
Von Borczyskowski, A, Lindblad, F, Vinnerljung, B, Reintjes, R, Hjern, A (2011). Familial factors and suicide: an adoption study in a Swedish National Cohort. Psychological Medicine 41, 749–758.CrossRefGoogle Scholar
Webb, R, Abel, K, Pickles, A, Appleby, L (2005). Mortality in offspring of parents with psychotic disorders: a critical review and meta-analysis. American Journal of Psychiatry 162, 1045–1056.CrossRefGoogle ScholarPubMed
Webb, RT, Abel, KM, Pickles, AR, Appleby, L, King-Hele, SA, Mortensen, PB (2006). Mortality risk among offspring of psychiatric inpatients: a population-based follow-up to early adulthood. American Journal of Psychiatry 163, 2170–2177.CrossRefGoogle ScholarPubMed
Webb, RT, Pickles, AR, Appleby, L, Mortensen, PB, Abel, KM (2007). Death by unnatural causes during childhood and early adulthood in offspring of psychiatric inpatients. Archives of General Psychiatry 64, 345–352.CrossRefGoogle ScholarPubMed
Wilcox, HC, Kuramoto, SJ, Lichtenstein, P, Langstrom, N, Brent, DA, Runeson, B (2010). Psychiatric morbidity, violent crime, and suicide among children and adolescents exposed to parental death. Journal of American Academy of Child and Adolescent Psychiatry 49, 514– 523.; quiz 530.Google ScholarPubMed