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

Negative and positive urgency as pathways in the intergenerational transmission of suicide risk in childhood

Introduction

Parental suicide attempts and suicide death increase suicide risk in their offspring. High levels of impulsivity have been observed in families at high risk for suicide. Impulsivity, a highly heritable trait that is especially elevated in childhood, is frequently measured with the UPPS-P Impulsive Behavior Scale, which includes negative urgency, positive urgency, sensation seeking, premeditation, and perseverance. Our study examined the association between the UPPS-P facets and suicide ideation (without suicide attempts) and suicide attempts at baseline and first-time endorsement within the next two years in childhood. We also examined how the UPPS-P facets mediated the association between parental suicide attempts and suicide death and offspring first-time suicide ideation and attempts at follow-up.

Methods

The sample was 9,194 children (48.4% female; 9-10 years old) from the Adolescent Brain Cognitive Development (ABCD) study, assessed yearly three times. At Time 1 (T1), caregivers reported on suicide attempts and suicide deaths (combined) of the biological parents. Caregivers and children reported on suicide ideation and attempts in the KSADS-PL DSM-5 at each time point, T1 and follow-up (T2 and/or T3). The Short UPPS-P Scale (child-report) assessed the impulsivity facets at T1, which were computed as latent variables.

Results

At T1, 6.7% of children had a parent who had attempted or died by suicide. Most UPPS-P facets were associated with suicide ideation and attempts at T1 and T2/T3. In adjusted models, parental suicide attempts and suicide death were associated with offspring negative and positive urgency. In mediation models, parental suicide attempts and suicide death had an indirect effect on offspring first-time suicide ideation at T2/T3 through negative urgency (OR = 1.04; 95% CI, 1.01-1.08) and positive urgency (OR = 1.03, 95% CI, 1.01-1.05). Similar results were found for first-time suicide attempts at T2/T3.

Discussion

Our findings support an impulsive pathway in the familial transmission of suicide risk. For all youth, interventions that target multiple UPPS-P facets may help prevent or reduce suicide risk. For offspring whose parents have attempted or died by suicide, clinicians should pay particular attention to children who impulsively act on extreme emotions, as they may be at higher suicide risk.

The familial transmission of suicide and non-suicidal self-injury in different income levels in town

BACKGROUND

Prior researches have established that suicide and non-suicidal self-injury (NSSI) exhibit familial transmission patterns. However, the extent to which these patterns vary across different income levels remains unclear, as well as the specific factors that influence them. This study aimed to explore these questions.

METHODS

We analyzed data from 13,988 parent-child pairs in Chongqing, China, where the children were aged from 7 to 12 years old. Six income levels were considered, and the children's depression and anxiety symptoms were assessed using standardized scales (the Center for Epidemiological Studies Depression Scale for Children, [CES-DC], and the Screen for Child Anxiety Related Emotional Disorders [SCARED], respectively). Binary logistic regression analysis was employed to examine the transmission of suicide and NSSI across different income levels.

RESULTS

Familial transmission of suicide was significant difference in all income levels except the highest, while familial transmission of NSSI was significant difference in all income levels except the lowest. Notably, in both low- and high-income levels, suicide and NSSI transmissions primarily occurred among male children, mothers with higher education, and children who spent long time with their mothers. Additionally, the transmissions were mediated partially or entirely by children's depression and anxiety symptoms.

LIMITATIONS

Future studies should investigate the separate effects of fathers' and mothers' suicide and NSSI histories on familial transmission patterns.

CONCLUSION

The familial transmissions of suicide and NSSI exhibited distinct patterns across different income levels.

The joint effect of mental illness and parental suicide attempt on offspring suicide attempt and death: A Danish nationwide, registry-based study using multistate modeling

AIM

The aim of this study was to analyse the joint impact of moderate-to-severe mental illness and parental suicidal attempts on suicidal attempt and premature death.

METHODS

Using the Danish, nationwide health registries, a cohort study was conducted including the birth cohorts 1983-1989. Cox regression and multistate models were used to estimate relative and absolute risks of suicide attempt and premature death.

OUTCOME

We included 384,569 individuals and 7,218 individuals experienced their first suicide attempt during follow-up, while 2,762 individuals died of all causes. Joined exposure to parental suicide attempt and own mental illness increased the relative risk of suicide attempt (HR 22.57) and premature death all causes (HR 3.17). The absolute risk of suicide attempt before the age of 35 years was 20 % for offspring exposed to both parental suicide attempts and own mental illness (23 % for women vs. 15 % for men), while the risk of death was 4 % (0.6 % for women vs. 7 % for men).

CONCLUSION

Exposure to both parental suicide attempt and own mental illness increases the relative and absolute risks of suicide attempt and premature death with considerable differences across sex. These findings are important in the clinical assessment of individuals with suicidal behavior.

Beyond abuse and neglect: validation of the childhood interpersonal trauma inventory in a community sample of adults

Introduction

Childhood trauma is not restricted to abuse or neglect and other potentially traumatic experiences need to be pondered in practice and research. The study aimed to collect validity evidence of a new measure of exposure to a broad range of potentially traumatic experiences, the Childhood Interpersonal Trauma Inventory (CITI), by evaluating whether the CITI provides important additional information compared to a gold standard measure of childhood trauma.

Methods

The sample consisted of 2,518 adults who completed the CITI and self-reported measures of trauma (Childhood Trauma Questionnaire; CTQ) and psychiatric symptoms (PTSD Checklist for DSM-5; Kessler Psychological Distress Scale; Dissociative Experiences Scale).

Results

First, the sensitivity to properly detect participants having been exposed to childhood maltreatment, as measured by the CTQ (here used as the gold standard), ranged between 64.81% and 88.71%, and the specificity ranged between 68.55% and 89.54%. Second, hierarchical regressions showed that the CITI predicted between 5.6 and 14.0% of the variance in psychiatric symptoms while the CTQ only captured a very small additional part of variance (0.3 to 0.7%). Finally, 25% (n = 407) of CTQ-negative participants screened positive at the CITI. The latter reported higher severity of psychiatric symptoms than participants without trauma, suggesting that the CITI permits the identification of adults exposed to significant traumas that remain undetected using other well-validated measures.

Discussion

The findings underscore the utility of the CITI for research purposes and the latter's equivalence to a gold standard self-reported questionnaire to predict negative outcomes.

Brain structural and functional signatures of multi-generational family history of suicidal behaviors in preadolescent children

Parent-child transmission of suicidal behaviors has been extensively studied, but the investigation of a three-generation family suicide risk paradigm remains limited. In this study, we aimed to explore the behavioral and brain signatures of multi-generational family history of suicidal behaviors (FHoS) in preadolescents, utilizing a longitudinal design and the dataset from Adolescent Brain and Cognitive DevelopmentSM Study (ABCD Study®), which comprised 4 years of data and includes a total of 9,653 preadolescents. Our findings revealed that multi-generational FHoS was significantly associated with an increased risk of problematic behaviors and suicidal behaviors (suicide ideation and suicide attempt) in offspring. Interestingly, the problematic behaviors were further identified as a mediator in the multi-generational transmission of suicidal behaviors. Additionally, we observed alterations in brain structure within superior temporal gyrus (STG), precentral/postcentral cortex, posterior parietal cortex (PPC), cingulate cortex (CC), and planum temporale (PT), as well as disrupted functional connectivity of default mode network (DMN), ventral attention network (VAN), dorsal attention network (DAN), fronto-parietal network (FPN), and cingulo-opercular network (CON) among preadolescents with FHoS. These results provide compelling longitudinal evidence at the population level, highlighting the associations between multi-generational FHoS and maladaptive behavioral and neurodevelopmental outcomes in offspring. These findings underscore the need for early preventive measures aimed at mitigating the familial transmission of suicide risk and reducing the global burden of deaths among children and adolescents.

Physical injuries as triggers for self-harm: a within-individual study of nearly 250 000 injured people with a major psychiatric disorder

BACKGROUND

Although there is robust evidence for several factors which may precipitate self-harm, the contributions of different physical injuries are largely unknown.

OBJECTIVE

To examine whether specific physical injuries are associated with risks of self-harm in people with psychiatric disorders.

METHODS

By using population and secondary care registers, we identified all people born in Finland (1955-2000) and Sweden (1948-1993) with schizophrenia-spectrum disorder (n=136 182), bipolar disorder (n=68 437) or depression (n=461 071). Falls, transport-related injury, traumatic brain injury and injury from interpersonal assault were identified within these subsamples. We used conditional logistic regression models adjusted for age and calendar month to compare self-harm risk in the week after each injury to earlier weekly control periods, which allowed us to account for unmeasured confounders, including genetics and early environments.

FINDINGS

A total of 249 210 individuals had been diagnosed with a psychiatric disorder and a physical injury during the follow-up. The absolute risk of self-harm after a physical injury ranged between transport-related injury and injury from interpersonal assault (averaging 17.4-37.0 events per 10 000 person-weeks). Risk of self-harm increased by a factor of two to three (adjusted OR: 2.0-2.9) in the week following a physical injury, as compared with earlier, unexposed periods for the same individuals.

CONCLUSIONS

Physical injuries are important proximal risk factors for self-harm in people with psychiatric disorders.

CLINICAL IMPLICATIONS

Mechanisms underlying the associations could provide treatment targets. When treating patients with psychiatric illnesses, emergency and trauma medical services should actively work in liaison with psychiatric services to implement self-harm prevention strategies.

Use of Health Services and Support Resources by Immediate Family Members Bereaved by Suicide: A Scoping Review

The knowledge on health service use, systematic follow-up, and support for families bereaved by suicide remains scarce. This scoping review includes studies from 2010 to March 2022 that investigate the follow-up and support offered by health services, peer support services, and other resources available (e.g., internet-based resources) for families bereaved by suicide. We followed the scoping review framework provided by the Johanna Briggs Institute and performed a double-blinded screening process using Covidence. Data were extracted by four researchers and a thematic analysis was performed to summarize the results. The PRISMA Extension for Scoping reviews was used for reporting results. Of 2385 studies screened by title, 190 by abstract, and 93 by full-text reading, we included 63 original articles of which 24, 29 and 10 were quantitative, qualitative, or mixed-methods studies, respectively. The review shows that we have some knowledge about the need for, and experiences with, health services and support resources for immediate family members bereaved by suicide, but a lack of knowledge about their help-seeking behaviour, patient pathways, systematic follow-up, coordination between services, and long-term outcomes. We need more longitudinal observational studies of health service use and patient trajectories for people bereaved by suicide.