Parental Psychiatric Disease and Risks of Attempted Suicide and Violent Criminal Offending in Offspring

Mok, Pearl L. H.; Pedersen, Carsten Bøcker; Springate, David A.; Astrup, Aske; Kapur, Navneet; Antonsen, Steen; Mors, Ole; Webb, Roger T.

doi:10.1001/jamapsychiatry.2016.1728

Cited by 56 publications

(54 citation statements)

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“…Finally, in this study we did not examine the potential influences of psychopathology among cohort members and also their parents' mental disorders. The latter could have important roles in the cause of trauma-related hospital admission during childhood 26 as well as self-harm and interpersonal violence during older adolescence and early adulthood 27 . A comprehensive investigation of these potential causal mechanisms would require a complex study design and a sophisticated analytical approach, ideally with linkage to both primary and secondary care data sources to enable capture of all diagnosed mental illnesses among cohort members and their parents.…”

Section: Discussionmentioning

confidence: 99%

Self-harm and violent criminality among young people who experienced trauma-related hospital admission during childhood: a Danish national cohort study

Webb

Antonsen

Carr

et al. 2017

The Lancet Public Health

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SummaryBackgroundDevelopment of a better understanding of subsequent pathways for individuals who experienced trauma during childhood might usefully inform clinicians and public health professionals regarding the causes of self-harm and interpersonal violence. We aimed to examine these risks during late adolescence and early adulthood among people admitted to hospital following injuries or poisonings during their childhood.MethodsThis national cohort study included Danish people born between Jan 1, 1977, and Dec 31, 1997, and was linked to the National Patient Register and Psychiatric Central Research Register to identify all people exposed to hospital admissions for injuries or poisonings due to self-harm, interpersonal violence, or accidents before their 15th birthday. Linkage to these two registers and to the National Crime Register enabled ascertainment of self-harm and violent offending, respectively, as adverse outcomes at ages 15–35 years. Sex-specific incidence rate ratios (IRRs; relative risks) and cumulative incidence percentage values (absolute risks) were estimated. The confounding influence of parental socioeconomic status was also explored.Findings1 087 672 Danish people were included in this study. The prevalence of any trauma-related hospital admission was 10% (105 753 per 1 087 672; males: 64 454 [11%]; females: 44 299 [8%]) and for both sexes, accident was by far the most prevalent of the categories assessed (males: 59 011 [11%]; females: 40 756 [8%]). Similar patterns of increased risk for self-harm and violent criminality were observed in both sexes, although the IRRs were consistently and significantly larger in women (self-harm: IRR 1·94 [95% CI 1·85–2·02]; violent criminality: 2·16 [1·97–2·36]) than in men (self-harm: 1·61 [1·53–1·69]; violent criminality: 1·58 [1·53–1·63]). Confounding by parental socioeconomic status explained little of the increased risks observed. For young adult men, the highest absolute risk observed was for violent offending among individuals admitted to hospital for interpersonal violence injury during childhood (cumulative incidence 25·0% [95% CI 21·2–28·9]). For young adult women, absolute risk was highest for repeat self-harm among those admitted to hospital following self-harm during childhood (cumulative incidence 21·4% [95% CI 19·8–23·1]). More frequent trauma-related hospital admissions in childhood, and being admitted multiple times for more than one reason, conferred substantial risk increases among young people, with especially steep gradients of this nature observed among women.InterpretationTrauma-related hospital admission early in life could be a useful marker for childhood distress that subsequently predicts internalised and externalised destructive behaviours among youths and young adults and might provide a timely opportunity for initiating family-oriented interventions.FundingEuropean Research Council.

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Section: Discussionmentioning

confidence: 99%

Self-harm and violent criminality among young people who experienced trauma-related hospital admission during childhood: a Danish national cohort study

Webb

Antonsen

Carr

et al. 2017

The Lancet Public Health

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“…After accidents, intentional self-harm and assault are the next two most common causes of death among people aged 20-24 years globally, 10 with many more affected individuals consequently experiencing non-fatal injuries and emotional trauma. Although internally and externally directed aggression might seem incongruent behaviours, they share common individual and familial risk factors, including emotional dysregulation, lack of impulse control, mental illness, and parental psychopathology, [11][12][13] prompting calls for more integrated approaches to research and prevention. 14 Of the three key socioeconomic indices-income, education, and occupation-income represents the most direct measure of affluence versus deprivation, and is the variable that can be tracked most sensitively over time.…”

Section: Introductionmentioning

confidence: 99%

Family income inequalities and trajectories through childhood and self-harm and violence in young adults: a population-based, nested case-control study

Mok

Antonsen

Pedersen

et al. 2018

The Lancet Public Health

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Background Childhood poverty is associated with elevated later risks for self-directed and externalised violence, but how risks are modified by parental socioeconomic mobility remains unclear. We investigated parental income trajectories during childhood and subsequent risks of self-harm and violent criminality in young adulthood.Methods Using Danish national registers, we delineated a nested case-control study of Danish citizens born from Jan 1, 1982, to Dec 31, 2000, with first hospital-treated self-harm episodes and first violent crime convictions at ages 15-33 years. Each case was matched on age and gender to 25 randomly selected controls. Parental income was assessed in birth-year and at ages 5 years, 10 years, and 15 years. We considered parental age, the child's number of siblings, parental mental health, and parental education to be covariates. We estimated incidence rate ratios (IRRs) by conditional logistic regression inherently adjusted for age, gender, and calendar year; we then made additional adjustments for the covariates considered.Findings We identified 21 267 first episodes of hospital-treated self-harm, to which we matched 531 675 controls, and 23 724 first violent crime convictions, to which we matched 593 100 controls. We observed inverse relationships between parental income and risks for the two outcomes for each of the ages parental income was measured. The longer a child lived in poorer circumstances, the higher their subsequent risks for self-harm and violent criminality, and vice versa for time spent living in affluent conditions. Associations were stronger for violent criminality than for self-harm. Compared with individuals who were born and remained in the most affluent families, all other income trajectories were associated with elevated risks for both outcomes. Those who remained in the least affluent quintile showed the highest risks for self-harm (IRR 7·2, 95% CI 6·6-7·9; 1174 [6%] cases) and for violent criminality (IRR 13·0; 95% CI 11·9-14·1; 1640 [7%] cases). The risk patterns were attenuated, but essentially persisted, after covariate adjustment. For any parental income level at birth, being upwardly mobile was associated with lower risk compared with downward mobility.Interpretation Parental income represents a multitude of unmeasured familial sociodemographic indices. Tackling the causes of inequality and associated psychosocial and sociocultural challenges to enable upwards socioeconomic mobility could potentially reduce risks for self-directed and externalised violence.

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“…Similarly, parental psychiatric disorder is strongly associated with both attempted and completed suicide in the offspring. 15,16 It has therefore been hypothesized that incomplete adjustment for important factors, such as prior suicidality and parental history of psychiatric disorder, may introduce bias or even possibly explain the observed association between antiepileptic drug use and subsequent suicide risk. 12,17 In the present study, we examine this hypothesis by investigating whether prior suicidal behavior and familial predisposition to psychiatric disorder could explain the association between use of antiepileptic drugs and suicide in a Danish nationwide study of antiepileptic drug users.…”

Section: Manymentioning

confidence: 99%

“…Many of the existing studies have no or only short‐term data on prior suicidality. Similarly, parental psychiatric disorder is strongly associated with both attempted and completed suicide in the offspring . It has therefore been hypothesized that incomplete adjustment for important factors, such as prior suicidality and parental history of psychiatric disorder, may introduce bias or even possibly explain the observed association between antiepileptic drug use and subsequent suicide risk …”

mentioning

confidence: 99%

Antiepileptic Drugs and Suicide: Role of Prior Suicidal Behavior and Parental Psychiatric Disorder

Dreier

Pedersen

Gasse

et al. 2019

Annals of Neurology

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Objective To examine whether prior suicidal behavior and familial predisposition to psychiatric disorders modify the association between antiepileptic drug use and completed suicide. Methods Using the Danish National Prescription Register, we identified all incident users of antiepileptic drugs aged 15 years or older in Denmark between July 1997 and December 2015. We carried out a nested case–control study and defined exposure to antiepileptic drugs at the index date (ie, time of suicide). Conditional logistic regressions were used to estimate mortality rate ratios (MRRs) of suicide in current versus previous users of antiepileptic drugs. We also analyzed suicide risk associated with the 9 most commonly used antiepileptic drugs. Results We identified 1,759 individuals completing suicide. Current versus previous use of any antiepileptic drug was associated with an increased risk of suicide (MRR = 1.26, 95% confidence interval [CI] = 1.13–1.40). This excess risk was observed in individuals with a history of suicidal behavior (MRR = 1.28, 95% CI = 1.07–1.54) and in those without (MRR = 1.26, 95% CI = 1.11–1.43), and in individuals with a familial predisposition to psychiatric disorders (MRR = 1.48, 95% CI = 1.18–1.87) and in those without (MRR = 1.21, 95% CI = 1.07–1.35). Interpretation Use of antiepileptic drugs was associated with an increased risk of suicide. The findings do not support that the risk of suicide following treatment with antiepileptic drugs identified in randomized trials is explained by prior suicidality or familial predisposition to psychiatric disorders. The additional risk of suicide associated with use of antiepileptic drugs was generally low and should be balanced against benefits of treatment. ANN NEUROL 2019;86:951–961

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Parental Psychiatric Disease and Risks of Attempted Suicide and Violent Criminal Offending in Offspring

Abstract: The similarities in risk patterns observed between the 2 outcomes may evidence a shared etiology. Early interventions to tackle parental mental disorders may be beneficial to both parents and children.

Cited by 56 publications

References 36 publications

Self-harm and violent criminality among young people who experienced trauma-related hospital admission during childhood: a Danish national cohort study

Self-harm and violent criminality among young people who experienced trauma-related hospital admission during childhood: a Danish national cohort study

Family income inequalities and trajectories through childhood and self-harm and violence in young adults: a population-based, nested case-control study

Antiepileptic Drugs and Suicide: Role of Prior Suicidal Behavior and Parental Psychiatric Disorder

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