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Original Investigation |

Parental Psychiatric Disease and Risks of Attempted Suicide and Violent Criminal Offending in Offspring A Population-Based Cohort Study ONLINE FIRST

Pearl L. H. Mok, PhD1; Carsten Bøcker Pedersen, DrMedSc2,3,4; David Springate, PhD5; Aske Astrup, MSc2,3; Nav Kapur, MD1; Sussie Antonsen, MSc2,3; Ole Mors, MD, PhD4,6; Roger T. Webb, PhD1
[+] Author Affiliations
1Centre for Mental Health and Safety, University of Manchester, Manchester, England
2Centre for Integrated Register-Based Research, CIRRAU, Aarhus University, Aarhus, Denmark
3National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
4The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
5Institute of Population Health, University of Manchester, Manchester, England
6Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark
JAMA Psychiatry. Published online August 31, 2016. doi:10.1001/jamapsychiatry.2016.1728
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Importance  Self-directed and interpersonal violence share some common risk factors such as a parental history of mental illness. However, relationships between the full spectrum of parental psychiatric disease and these 2 related outcomes are unclear.

Objective  To examine associations between the full spectrum of parental psychiatric disease and risks of attempted suicide and violent offending among offspring.

Design, Setting, and Participants  Population-based cohort study of all persons born in Denmark 1967 through 1997, followed up from their 15th birthday until occurrence of adverse outcome or December 31, 2012, whichever came first.

Exposures  Array of parental psychiatric disorders and parental suicide attempt, delineated from records of secondary care treatments.

Main Outcomes and Measures  Using survival analyses techniques, incidence rate ratios were estimated for offspring suicide attempt and violent offending.

Results  We examined 1 743 525 cohort members (48.7% female; total follow-up, 27.2 million person-years). Risks for offspring suicide attempt and violent offending were elevated across virtually the full spectrum of parental psychiatric disease. Incidence rate ratios were the most elevated for parental diagnoses of antisocial personality disorder (suicide attempt, 3.96; 95% CI, 3.72-4.21; violent offending, 3.62; 95% CI, 3.41-3.84) and cannabis misuse (suicide attempt, 3.57; 95% CI, 3.25-3.92; violent offending, 4.05; 95% CI, 3.72-4.39), and for parental suicide attempt (suicide attempt, 3.42; 95% CI, 3.29-3.55; violent offending, 3.31; 95% CI, 3.19-3.44). Parental mood disorders (and bipolar disorder in particular) conferred more modest risk increases. A history of mental illness or suicide attempt in both parents was associated with double the risks compared with having just 1 affected parent. Associations between parental psychiatric disease and offspring violent offending were stronger for female than for male offspring, whereas little sex difference in risk was found for offspring suicide attempt.

Conclusions and Relevance  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.

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Figure.
Incidence Rate Ratios (IRRs) and 95% CIs for Offspring Suicide Attempt and Offspring Violent Offending, According to Whether the Mother Only, the Father Only, or Both Parents Were Affected by Any Psychiatric Disorder, Stratified by Offspring Sex

The reference group was individuals with neither parent having a psychiatric diagnosis or history of suicide attempt. Models adjusted for offspring sex and age, calendar year, and the interactions between these variables. Symbols indicate IRR, and error bars, 95% CI.

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