MedicalResearch.com Interview with:
Dr. Brent David MD
Academic Chief, Child and Adolescent Psychiatry at Western Psychiatric Institute and Clinic Professor of Psychiatry, Pediatrics & Epidemiology
University of Pittsburgh School of Medicine
Medical Research: What is the background for this study?
Dr. David: There are now many studies that show that suicide and suicidal behavior run in families. A family history of suicide increases the risk for suicide attempt and vice versa, so that we believe that the trait that is being passed from parent to child is a tendency to act on suicidal thoughts, resulting in either an attempt or an actual suicide. However, what was not not known was the mechanism by which parents transmitted the risk of suicidal behavior to their children, and what the precursors of suicidal behavior looked like in individuals who were at risk for suicidal behavior, but had not yet engaged in a suicide attempt. Therefore, we conducted a high-risk family study, in which studied the children of parents with mood disorders, about half of whom also had a history of a suicide attempt.
Medical Research: What are the main findings?
Dr. David: We followed 701 offspring for an average of 5.6 years, and found that those offspring whose parents had made a suicide attempt were almost 5 times more likely to make a suicide attempt themselves, even after accounting for mood disorder in parent and child and past suicidal behavior in the offspring. We found three main pathways by which suicidal behavior was passed from parent to child:
- Parental mood disorder was transmitted to children, and that was a precursor of a suicide attempt.
- Parent attempt was related to offspring impulsive aggression, which in turn increased the risk for mood disorder, which then increased the likelihood of a suicide attempt. (We define impulsive aggression as a tendency to response with hostility or aggression to provocation or frustration.
- Finally, there is a direct path from parent attempt to child attempt, with no precursors or intervening variables.
Implications for clinicians and patients:
- First, these findings highlight that a parental history of a suicide attempt increases the risk of an attempt in the parent’s children. Clinicians who take care of adults who have attempted suicide should make sure that children are assessed as they are at increased risk and that parents know what to look for in the future in order to get their children into needed treatment.
- Second, the transmission of suicidal behavior from parent to child can be attenuated by preventing the transmission of mood disorder, and of impulsive aggression. There are now evidence based interventions that reduce the likelihood of a child of a depressed parent from developing depression; these treatment involve cognitive behavioral principles and may also involve family interventions. There are now good family-based interventions for impulsive aggression that can attenuate the risk that the child or adolescent will go on to develop a mood disorder, which in turn greatly increases the risk for suicidal behavior.
Medical Research: What should clinicians and patients take away from your report?
Dr. David: For patients, it is important to know that family history and genetics are not destiny. While the risk for suicidal behavior is elevated, because the behavior is relatively rare, it is still much more likely that the child of a parent with suicidal behavior will NOT engage in suicidal behavior him or herself. But the family history can be a sign to take notice and be vigilant, just as one should be vigilant if one has a family history of breast cancer or diabetes. This means that the person with a positive family history of suicidal behavior should be able to recognize signs of depression, suicidal thoughts, and other related psychiatric conditions, and know how to get help if needed.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. David: There are two main directions that are suggested by these findings.
- First, because the strongest pathway was between parent and child suicide attempt, with no intervening variables, this means that we have NOT explained all of the transmission of suicidal tendencies from parent to child. Future work should focus on looking at simpler traits related to suicidal behavior, like the way individuals process information, make decisions about risk and reward, and respond to stress, to see if these traits are related to suicidal risk and might explain mechanisms by which suicidal behavior runs in families.
- Second, these findings provide targets with which to frame future preventive interventions for youth with a strong family history of suicide. By targeting the transmission of mood disorder and of impulsive aggression, it should be possible to reduce the likelihood of suicidal behavior in the next generation.