Youth suicide attempts and the dose–response relationship to parental risk factors: a population-based study

BackgroundThere is a lack of specific knowledge about the dose–response effect of multiple parental risk factors for suicide attempts among children and adolescents. The aim of this study was to determine the dose–response effect of multiple parental risk factors on an offspring's risk for suicide attempt.MethodWe designed a population-based two-generation nested case–control study and used Danish register data. A population of 403 431 individuals born between 1983 and 1989 was sampled. Among these, 3465 (0.8%) were registered as having had a suicide attempt. Twenty controls were matched to each case and a link to the offspring's biological parents was established.ResultsThere was a dose–response relationship between the number of exposures and the risk of suicide attempts, with the increased risk seeming to be a multiplicative effect. Parental suicide, suicide attempt, psychiatric illness and low level of income were all significant independent risk factors for offspring's suicide attempts.ConclusionsKnowledge of the effect of multiple risk factors on the likelihood of suicide attempts in children and adolescents is important for risk assessment. Dose–response effects of multiple parental risk factors are multiplicative, but it is rare for children and adolescents to be exposed to multiple parental risk factors simultaneously. Nevertheless, they should be considered along with the offspring's own multiple risk factors in determining the overall risk of a suicide attempt. Further research incorporating both parental and offspring's risk factors is indicated to determine the overall dose–response effect of multiple risk factors.

Download Full-text

Incidence and risk factors for suicide attempts in a general population of young people: A Danish register-based study

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867412463737 ◽

2012 ◽

Vol 47 (3) ◽

pp. 259-270 ◽

Cited By ~ 23

Author(s):

Erik Christiansen ◽

Kim Juul Larsen ◽

Esben Agerbo ◽

Niels Bilenberg ◽

Elsebeth Stenager

Keyword(s):

Risk Factors ◽

Mental Illness ◽

General Population ◽

Suicide Attempts ◽

Conditional Logistic Regression ◽

Incidence Rates ◽

Parental Mental Illness ◽

Multiple Risk Factors ◽

Multiple Risk ◽

The Impact

Objective: To estimate the Danish epidemiological long-term incidence rates for suicide attempts in the general population of children and adolescents, and to analyze the impact from single and multiple risk factors on the risk of suicide attempts. Method: We used longitudinal register data from a total cohort of all individuals born between 1983 and 1989 and living in Denmark to calculate incidence rates. From the cohort, we identified all who have attempted suicide, and matched 50 controls to each case. A nested case–control design was used to estimate the impact from risk factors on the risk for index suicide attempts. We established a link to the biological parents and identified risk factors for two generations. Risk factors were analyzed in a conditional logistic regression model. Results: We identified 3718 suicide attempters and 185,900 controls (189,618 individuals, aged 10–21 years). We found increasing incidence rates during the period 1994–2005, and higher incidence rates for girls and the oldest adolescents. Mental illness was the strongest independent risk factor (IRR = 4.77, CI = (4.35–5.23), p < 0.0001), but parental mental illness (psychopharmacological drugs: IRR = 1.27, CI = (1.18–1.37), p < 0.0001) and socio-demographic factors (parents not living together: IRR = 1.38, CI = (1.28–1.48), p < 0.0001) were also significant independent risk factors. Exposure to multiple risk factors increased the risk significantly. Conclusions: Suicide attempt is a multi-factorial problem, and a problem on the increase in the period studied. Individuals exposed to multiple risk factors are at the highest risk for suicide attempts, and when spotted or in contact with authorities they should be given proper care and treatment to prevent suicide attempts and death.

Download Full-text

Attachment Organization in Suicide Prevention Research

Crisis ◽

10.1027/0227-5910/a000231 ◽

2014 ◽

Vol 35 (1) ◽

pp. 60-66 ◽

Cited By ~ 10

Author(s):

Amanda Venta ◽

Carla Sharp

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

Suicide Attempt ◽

Interpersonal Relationships ◽

Suicide Ideation ◽

Suicide Attempts ◽

Critical Role ◽

Self Report ◽

Future Research ◽

Self Harm

Background: Identifying risk factors for suicide-related thoughts and behaviors (SRTB) is essential among adolescents in whom SRTB remain a leading cause of death. Although many risk factors have already been identified, influential theories now suggest that the domain of interpersonal relationships may play a critical role in the emergence of SRTB. Because attachment has long been seen as the foundation of interpersonal functioning, we suggest that attachment insecurity warrants attention as a risk factor for SRTB. Aims: This study sought to explore relations between attachment organization and suicidal ideation, suicide attempts, and self-harm in an inpatient adolescent sample, controlling for demographic and psychopathological covariates. Method: We recruited 194 adolescents from an inpatient unit and assigned them to one of four attachment groups (secure, preoccupied, dismissing, or disorganized attachment). Interview and self-report measures were used to create four variables reflecting the presence or absence of suicidal ideation in the last year, single lifetime suicide attempt, multiple lifetime suicide attempts, and lifetime self-harm. Results: Chi-square and regression analyses did not reveal significant relations between attachment organization and SRTB, although findings did confirm previously established relations between psychopathology and SRTB, such that internalizing disorder was associated with increased self-harm, suicide ideation, and suicide attempt and externalizing disorder was associated with increased self-harm. Conclusion: The severity of this sample and methodological differences from previous studies may explain the nonsignificant findings. Nonsignificant findings may indicate that the relation between attachment organization and SRTB is moderated by other factors that should be explored in future research.

Download Full-text

Suicide Attempts Among Depressed Inpatients with Depressive Disorder in a Malaysian Sample

Crisis ◽

10.1027/0227-5910/a000088 ◽

2011 ◽

Vol 32 (5) ◽

pp. 283-287 ◽

Cited By ~ 14

Author(s):

L. F. Chan ◽

T. Maniam ◽

A. S. Shamsul

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

Suicide Attempt ◽

Depressive Disorder ◽

Suicide Attempts ◽

Psychosocial Risk Factors ◽

Psychosocial Risk ◽

Life Event ◽

Axis I ◽

A Current

Background: Depressed inpatients constitute a high-risk population for suicide attempts. Aims: To describe the interactions of clinical and psychosocial risk factors influencing suicide attempts among a Malaysian sample of depressed inpatients. Methods: Seventy-five subjects were diagnosed with a depressive disorder according to the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinical Version (SCID-CV). Data on suicide attempts, suicidal ideation (Scale for Suicidal Ideation, SSI), depression severity (Beck’s Depression Inventory, BDI), recent life-event changes (Social Readjustment Rating Scale, SRRS), sociodemographic and other relevant clinical factors were collected. Results: A third of the subjects presented after a current suicide attempt. Significant factors for a current suicide attempt were race, religion, recent life-event changes, suicidal ideation, and alcohol use disorder. Independent predictive risk factors for a current suicide attempt were Chinese race, recent marital separation, major mortgage or loans, and being newly diagnosed with depression. Any recent change in personal habits was shown to be a protective factor against current suicide attempt. Age and gender were nonsignificant factors. Conclusions: The findings are generally consistent with existing studies and highlight the role of psychosocial risk factors.

Download Full-text

Managing Multiple Risk Factors

PsycEXTRA Dataset ◽

10.1037/e445602005-001 ◽

1998 ◽

Author(s):

Charlie M. Lolis ◽

Keyword(s):

Risk Factors ◽

Multiple Risk Factors ◽

Multiple Risk

Download Full-text

Data Watch: Racial/Ethnic Groups Reporting Multiple Risk Factors for Heart Disease, Stroke

Family Practice News ◽

10.1016/s0300-7073(05)71952-6 ◽

2005 ◽

Vol 35 (20) ◽

pp. 22

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Ethnic Groups ◽

Multiple Risk Factors ◽

Multiple Risk ◽

Racial Ethnic

Download Full-text

Is Speed of Onset of Anti-anxiety Efficacy with Pregabalin Influenced by Starting Dose?

European Psychiatry ◽

10.1016/s0924-9338(09)70762-x ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

B. Herman ◽

F. Mandel

Keyword(s):

Dose Response ◽

Change Score ◽

Early Improvement ◽

Response Effect ◽

Starting Dose ◽

Dsm Iv ◽

The Mean ◽

Dose Response Effect ◽

Titration Schedule ◽

Speed Of Onset

Objective:There appears to be no dose-response effect for pregabalin at doses of 300-600 mg, and a modest dose-response effect in the range of 150-300 mg. The goal of the current investigation was to determine the effect of the starting dose on the speed of onset of anxiolytic efficacy.Methods:Data were analyzed from 7 trials of outpatients with DSM-IV GAD and a HAM-A total score ≥18. Starting doses of pregabalin ranged from 100 mg (N=301) or 150 mg (N=104), to 200 mg (N=167) and 300 mg (N=388). Assessment of early improvement included the HAM-A total score and CGI-Severity and Improvement scores.Results:The mean Week 1 HAM-A change score was similar for a starting dose of 200 mg/d with no titration (-8.24) when compared to patients who started on 200 mg/d and then titrated up to 400 mg/d on Day 4 (-8.64). The mean Week 1 HAM-A change score was somewhat higher for patients started on 300 mg/d, and then titrated to 450 mg/d on Day 4/5 (-8.84) when compared to patients started on a lower (100/150 mg/d) dose and titrated on Day 5 to 400/450 mg/d (-7.32). Starting on a dose of 300 mg/d with no titration resulted in an intermediate Week 1 change score (-7.87). The interaction of starting dose and titration schedule with baseline anxiety severity will be summarized in detail.Conclusion:The initial dose of pregabalin appears to have only a weak effect on the speed of onset of anxiolytic improvement.

Download Full-text

The relative and interactive impact of multiple risk factors in schizophrenia spectrum disorders: a combined register-based and clinical twin study

Psychological Medicine ◽

10.1017/s0033291721002749 ◽

2021 ◽

pp. 1-11

Author(s):

C. Lemvigh ◽

R. Brouwer ◽

R. Hilker ◽

S. Anhøj ◽

L. Baandrup ◽

...

Keyword(s):

Risk Factors ◽

Environmental Factors ◽

Childhood Trauma ◽

Cannabis Use ◽

Paternal Age ◽

Interactive Effects ◽

Polygenic Risk Score ◽

Multiple Risk Factors ◽

Schizophrenia Spectrum ◽

Multiple Risk

Abstract Background Research has yielded evidence for genetic and environmental factors influencing the risk of schizophrenia. Numerous environmental factors have been identified; however, the individual effects are small. The additive and interactive effects of multiple risk factors are not well elucidated. Twin pairs discordant for schizophrenia offer a unique opportunity to identify factors that differ between patients and unaffected co-twins, who are perfectly matched for age, sex and genetic background. Methods Register data were combined with clinical data for 216 twins including monozygotic (MZ) and dizygotic (DZ) proband pairs (one or both twins having a schizophrenia spectrum diagnosis) and MZ/DZ healthy control (HC) pairs. Logistic regression models were applied to predict (1) illness vulnerability (being a proband v. HC pair) and (2) illness status (being the patient v. unaffected co-twin). Risk factors included: A polygenic risk score (PRS) for schizophrenia, birth complications, birth weight, Apgar scores, paternal age, maternal smoking, season of birth, parental socioeconomic status, urbanicity, childhood trauma, estimated premorbid intelligence and cannabis. Results The PRS [odds ratio (OR) 1.6 (1.1–2.3)], childhood trauma [OR 4.5 (2.3–8.8)], and regular cannabis use [OR 8.3 (2.1–32.7)] independently predicted illness vulnerability as did an interaction between childhood trauma and cannabis use [OR 0.17 (0.03–0.9)]. Only regular cannabis use predicted having a schizophrenia spectrum diagnosis between patients and unaffected co-twins [OR 3.3 (1.1–10.4)]. Conclusion The findings suggest that several risk factors contribute to increasing schizophrenia spectrum vulnerability. Moreover, cannabis, a potentially completely avoidable environmental risk factor, seems to play a substantial role in schizophrenia pathology.

Download Full-text