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Parental psychopathology and the risk of suicidal behavior in their offspring: results from the World Mental Health surveys

Molecular Psychiatry volume 16, pages 1221–1233 (2011)Cite this article

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Abstract

Previous research suggests that parental psychopathology predicts suicidal behavior among offspring; however, the more fine-grained associations between specific parental disorders and distinct stages of the pathway to suicide are not well understood. We set out to test the hypothesis that parental disorders associated with negative mood would predict offspring suicide ideation, whereas disorders characterized by impulsive aggression (for example, antisocial personality) and anxiety/agitation (for example, panic disorder) would predict which offspring act on their suicide ideation and make a suicide attempt. Data were collected during face-to-face interviews conducted on nationally representative samples (N=55 299; age 18+) from 21 countries around the world. We tested the associations between a range of parental disorders and the onset and persistence over time (that is, time since most recent episode controlling for age of onset and time since onset) of subsequent suicidal behavior (suicide ideation, plans and attempts) among offspring. Analyses tested bivariate and multivariate associations between each parental disorder and distinct forms of suicidal behavior. Results revealed that each parental disorder examined increased the risk of suicide ideation among offspring, parental generalized anxiety and depression emerged as the only predictors of the onset and persistence (respectively) of suicide plans among offspring with ideation, whereas parental antisocial personality and anxiety disorders emerged as the only predictors of the onset and persistence of suicide attempts among ideators. A dose-response relation between parental disorders and respondent risk of suicide ideation and attempt was also found. Parental death by suicide was a particularly strong predictor of persistence of suicide attempts among offspring. These associations remained significant after controlling for comorbidity of parental disorders and for the presence of mental disorders among offspring. These findings should inform future explorations of the mechanisms of intergenerational transmission of suicidal behavior.

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Acknowledgements

This report was carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. We thank the WMH staff for assistance with instrumentation, fieldwork and data analysis. These activities were supported by the United States National Institute of Mental Health (R01MH070884, R01MH077883), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864 and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, the Eli Lilly & Company Foundation, Ortho-McNeil Pharmaceutical, GlaxoSmithKline and Bristol-Myers Squibb. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/. The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204-3. The Bulgarian Epidemiological Study of common mental disorders EPIBUL is supported by the Ministry of Health and the National Center for Public Health Protection. The Chinese World Mental Health Survey Initiative is supported by the Pfizer Foundation. The Shenzhen Mental Health Survey is supported by the Shenzhen Bureau of Health and the Shenzhen Bureau of Science, Technology, and Information. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The WMHI was funded by WHO (India) and helped by Dr R Chandrasekaran, JIPMER. The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026 and H16-KOKORO-013) from the Japan Ministry of Health, Labour and Welfare. The Lebanese National Mental Health Survey (LEBANON) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), Fogarty International, Act for Lebanon, anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from Janssen Cilag, Eli Lilly, GlaxoSmithKline, Roche and Novartis. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544- H), with supplemental support from the PanAmerican Health Organization (PAHO). Te Rau Hinengaro: The New Zealand Mental Health Survey (NZMHS) is supported by the New Zealand Ministry of Health, Alcohol Advisory Council and the Health Research Council. The Nigerian Survey of Mental Health and Wellbeing (NSMHW) is supported by the WHO (Geneva), the WHO (Nigeria) and the Federal Ministry of Health, Abuja, Nigeria. The Romania WMH study projects ‘Policies in Mental Health Area’ and ‘National Study regarding Mental Health and Services Use’ were carried out by National School of Public Health & Health Services Management (former National Institute for Research & Development in Health), with technical support of Metro Media Transilvania, the National Institute of Statistics-National Centre for Training in Statistics, SC. Cheyenne Services SRL, Statistics Netherlands and were funded by Ministry of Public Health (former Ministry of Health) with supplemental support of Eli Lilly Romania SRL. The South Africa Stress and Health Study (SASH) is supported by the US National Institute of Mental Health (R01-MH059575) and National Institute of Drug Abuse with supplemental funding from the South African Department of Health and the University of Michigan. The Ukraine Comorbid Mental Disorders during Periods of Social Disruption (CMDPSD) study is funded by the US National Institute of Mental Health (RO1-MH61905). The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W. Alden Trust.

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Authors and Affiliations

  1. Department of Psychiatry, University College Hospital, Ibadan, Nigeria

    O Gureje & B Oladeji

  2. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    I Hwang, W T Chiu, R C Kessler & N A Sampson

  3. Health Services Research Unit, Institut Municipal d′Investigació Mèdica (IMIM-Hospital del Mar),

    J Alonso

  4. CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain

    J Alonso

  5. Department & Institute of Psychiatry, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil

    L H Andrade

  6. University of Otago, Christchurch, Public Health and General Practice, Christchurch, New Zealand

    A Beautrais

  7. Instituto Nacional de Psiquiatria Ramon de la Fuente, Mexico City, Mexico

    G Borges

  8. Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA

    E Bromet

  9. Katholieke Universiteit Leuven, Leuven, Belgium

    R Bruffaerts

  10. IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Bologna, Italy

    G de Girolamo

  11. Netherlands Institute of Mental, Health and Addiction, Utrecht, The Netherlands

    R de Graaf

  12. Mental Health Epidemiology and Psychosocial Aspects of Illness, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel

    G Gal

  13. Shanghai Mental Health Center, Shanghai, China

    Y He

  14. Shenzhen Institute of Mental Health, Shenzhen, Guangdong, China

    C Hu

  15. Hiroshima International University, Higashi-Hiroshima, Japan

    N Iwata

  16. Department of Psychiatry and Clinical Psychology Institute for Development, Research, Advocacy, and Applied Care (IDRAAC), St. George Hospital University Medical Center, Beirut, Lebanon

    E G Karam

  17. EA4069 Université Paris Descartes, Paris, France

    V Kovess-Masféty

  18. Clinic of Psychiatry, University of Leipzig, Leipzig, Germany

    H Matschinger

  19. National School of Public Health and Health Services Management, Bucharest, Romania

    M V Moldovan

  20. Saldarriaga Concha Foundation, Bogota, Colombia

    J Posada-Villa

  21. All India Institute of Medical Sciences (AIIMS), New Delhi, India

    R Sagar

  22. Department of Mental Health, Padua, Italy

    P Scocco

  23. MRC Research Unit on Anxiety and Stress Disorder, Cape Town, South Africa

    S Seedat

  24. New Bulgarian University, Sofia, Bulgaria

    T Tomov

  25. Harvard University, Cambridge, MA, USA

    M K Nock

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  1. O Gureje
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  2. B Oladeji
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  3. I Hwang
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  4. W T Chiu
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  5. R C Kessler
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  6. N A Sampson
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  7. J Alonso
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  8. L H Andrade
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  9. A Beautrais
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  10. G Borges
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  11. E Bromet
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  12. R Bruffaerts
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  13. G de Girolamo
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  14. R de Graaf
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  15. G Gal
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  16. Y He
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  17. C Hu
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  18. N Iwata
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  19. E G Karam
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  20. V Kovess-Masféty
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  21. H Matschinger
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  22. M V Moldovan
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  23. J Posada-Villa
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  24. R Sagar
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  25. P Scocco
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  26. S Seedat
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  27. T Tomov
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  28. M K Nock
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Correspondence to O Gureje.

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Competing interests

Dr Kessler has been a consultant for GlaxoSmith Kline, Kaiser Permanente, Pfizer, Sanofi-Aventis, Shire Pharmaceuticals and Wyeth-Ayerst; has served on advisory boards for Eli Lilly & Company and Wyeth-Ayerst; and has had research support for his epidemiological studies from Bristol-Myers Squibb, Eli Lilly & Company, GlaxoSmithKline, Johnson & Johnson Pharmaceuticals, Ortho-McNeil Pharmaceuticals, Pfizer, and Sanofi-Aventis. The remaining authors declare no conflict of interest.

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Gureje, O., Oladeji, B., Hwang, I. et al. Parental psychopathology and the risk of suicidal behavior in their offspring: results from the World Mental Health surveys. Mol Psychiatry 16, 1221–1233 (2011). https://doi.org/10.1038/mp.2010.111

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