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Original Investigation |

Incidence of Suicide Among Persons Who Had a Parent Who Died During Their Childhood A Population-Based Cohort Study

Mai-Britt Guldin, PhD1; Jiong Li, PhD2; Henrik Søndergaard Pedersen, MSc1,3; Carsten Obel, PhD3,4; Esben Agerbo, PhD5; Mika Gissler, PhD6,7; Sven Cnattingius, PhD8; Jørn Olsen, PhD2; Mogens Vestergaard, PhD1,3
[+] Author Affiliations
1Research Unit for General Practice, Aarhus University, Aarhus, Denmark
2Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
3Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
4Research Programme for Mental Child Health, Department of Public Health, Aarhus University, Aarhus, Denmark
5Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
6National Institute for Health and Welfare, Helsinki, Finland
7Nordic School of Public Health, Gothenburg, Sweden
8Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
JAMA Psychiatry. 2015;72(12):1227-1234. doi:10.1001/jamapsychiatry.2015.2094.
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Importance  Parental death from suicide is associated with increased risk of suicide in the bereaved child, but little is known about the long-term risks of suicide after parental death from other causes. A better understanding of this association may improve suicide prevention efforts.

Objective  To examine the long-term risks of suicide after parental death and how the risk trajectories differed by cause of parental death while accounting for major potential confounding variables.

Design, Setting, and Participants  A population-based matched cohort study was performed using information from nationwide registers (data from 1968 to 2008) in 3 Scandinavian countries (for a total of 7 302 033 persons). We identified 189 094 children (2.6%) who had a parent who died before the child reached 18 years of age (ie, the bereaved cohort). Each bereaved child was matched by sex and age to 10 children who did not have a parent who died before they reached 18 years of age (for a total of 1 890 940 children) (ie, the reference cohort). Both cohorts were followed for up to 40 years. Poisson regression was used to calculate the incidence rate ratio (IRR), while accounting for age at parental death, sex, time since bereavement, maternal/paternal death, birth order, family history of psychiatric illness, and socioeconomic status. Data analyses were finalized June 24, 2015.

Exposure  The main exposure was death of a parent within the first 18 years of life.

Main Outcomes and Measures  Incidence of suicide among persons who had a parent who died during their childhood.

Results  During follow-up, 265 bereaved persons (0.14%) and 1342 nonbereaved persons (0.07%) died of suicide (IRR = 2.02 [95% CI, 1.75-2.34]); IRR = 3.44 (95% CI, 2.61-4.52) for children who had a parent who died of suicide, and IRR = 1.76 (95% CI, 1.49-2.09) for children who had a parent who died of other causes. The IRR tended to be higher for children who had a parent who died before they reached 6 years of age, and the IRR remained high for at least 25 years. During 25 years of follow-up, the absolute risk of suicide was 4 in 1000 persons for boys who experienced parental death and 2 in 1000 persons for girls who experienced parental death.

Conclusions and Relevance  Parental death in childhood is, irrespective of cause, associated with an increased long-term risk of suicide. The consequences of parental death in childhood are far-reaching, and suicide risk trajectories may be influenced by early-life conditions. Future public health efforts should consider helping highly distressed children to cope with bereavement.

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Figure 1.
Forest Plot of the Association Between Suicide and Specific Characteristics of the Study Population

IRR indicates incidence rate ratio, adjusted for sex of offspring, calendar time at parental death, age at time of parental death, and country.

aData from Denmark, Sweden, and Finland.

bData from Denmark and Sweden.

cData from Denmark.

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Figure 2.
Cumulative Incidence Proportion of Suicide Among Boys and Girls in the Bereaved Cohort and the Reference Cohort

Owing to data restrictions, the time points have been collapsed so that the underlying number of suicides exceeds 5 in each of the plotted time points.

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Figure 3.
Incidence Rate Ratio (IRR) of Suicides Based on Time Since Bereavement
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Incidence of suicide among persons who had a parent who died during their childhood - A population-based cohort study.
Posted on December 15, 2015
Thomas Verberne
Retired
Conflict of Interest: None Declared

In Guldin et al.‘s cohort study (1), the age of the parent at the time of the parent’s death was apparently not controlled for, although this is a relevant variable. It is relevant, because it will tend to be inversely correlated with indices of the parent’s physical and mental health. 

 

Neeleman et al. (2), and Neeleman (3), found an aetiological continuity between suicide and other causes of premature death. It is thus possible that some parents, without a history of mental illness, might yet have carried a predisposition to suicide, and passed this on to their children. Controlling for parental age at death is expected to reduce the disparity in the number of suicides between people who lost a parent in childhood and those who did not; possibly to non-significance.



References

1.  Mai-Britt Guldin,  Jiong Li, Henrik Sondergaard Pedersen, Carsten Obel, Esben Agerbo, Mika Gissler, Sven Cnattingius, Jørn Olsen, Mogens Vestergaard JAMA Psychiatry. Published online November 11, 2015. doi: 10.1001/jamapsychiatry.2015.2094 Incidence of suicide among persons who had a parent who died during their childhood - A population-based cohort study.



2.  Neeleman J, Wessely S, Wadsworth M. Predictors of suicide, accidental death, and premature natural death in a general-population birth cohort.  Lancet 1998; 351: 93-97.



3.  Neeleman J. A continuum of premature death. Meta-analysis of competing mortality in the psychosocially vulnerable. Internat J Epidemiology 2001; 30: 154-162.

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