Background

Suicidal behaviour runs in families, but the nature of transgenerational concordance needs elucidation. The aim of this study was to examine parent-to-child transmission by investigating whether presence and nature of parental suicidal behaviour was associated with suicidal behaviour in children.

Methods

We did a retrospective, nationwide, register-based cohort study in Demark using register data. We included all individuals born after 1953 who were 10 years or older and who were recorded as living in Denmark at some point between Jan 1, 1980, and Dec 31, 2016. Adults listed as living with their child at first registration in the Civil Registration System were considered as parents; later records of different legal parents allowed identification of potential step-parents. Self-reported ethnicity data were not available. Exposure to parental suicide attempt and suicide was identified using information from hospital contacts and causes of death from national registers. The examined outcomes were suicide attempt and death by suicide. We calculated incidence rate ratios (IRRs) and cumulative hazards for children's suicide attempt and suicide, taking into account type of parental suicidal behaviour, child's age of exposure, and sex.

Findings

In total, 4 419 642 individuals aged 10–63 years were observed during 1980–2016. Of these individuals, 150 222 (3·4%) were exposed to one or more parents with a suicide attempt, 31 564 (0·7%) to at least one parent who died by suicide, and 12 834 (0·3%) to both events. Individuals exposed to parental suicide attempt had higher rates of suicide attempt (IRR 2·72 [95% CI 2·33–3·17]) than individuals exposed to parental suicide (1·77 [1·50–2·09]) when compared with unexposed individuals. Higher rates of suicide were found for individuals exposed to parental suicide (IRR 3·18 [95% CI 2·84–3·58]) than for those exposed to parental suicide attempt (2·37 [2·19–2·57]). The cumulative hazard of suicide attempt was 0·07 for individuals exposed to parental suicide attempt, and the cumulative hazard of suicide was 0·009 for individuals exposed to parental suicide. Individuals exposed to parental suicide had higher odds of violent suicidal methods than those exposed to suicide attempt alone (odds ratio 2·0 [95% CI 1·7–2·3]).

Interpretation

A concordant pattern of higher rates of the same type of suicidal behaviour as the one of the parents was observed, including type of suicide method. Preventive, family-oriented interventions are warranted to mitigate familial transmission of risk, as are clinical considerations of familial exposure in risk assessment of patients.

Funding

Mental Health Services, Capital Region of Denmark.

中文翻译：

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自杀行为亲子传播的跨代一致性：丹麦 4 419 642 人的回顾性、全国性、基于登记的队列研究

背景

自杀行为在家庭中存在，但跨代和谐的本质需要阐明。本研究的目的是通过调查父母自杀行为的存在和性质是否与儿童的自杀行为相关，来检查父母对孩子的传播。

方法

我们使用登记数据在丹麦进行了一项回顾性、全国性、基于登记的队列研究。我们纳入了所有 1953 年之后出生、年满 10 岁且在 1980 年 1 月 1 日至 2016 年 12 月 31 日之间的某个时间点被记录为居住在丹麦的个人。在民事登记中首次登记时被列为与子女同住的成年人系统被视为父母；后来不同合法父母的记录允许识别潜在的继父母。无法获得自我报告的种族数据。使用来自医院联系人的信息和来自国家登记册的死因确定了父母自杀未遂和自杀的风险。检查的结果是自杀未遂和自杀死亡。我们计算了儿童自杀未遂和自杀的发生率比 (IRR) 和累积危害，

发现

在 1980-2016 年期间，总共观察到 4419642 名 10-63 岁的个体。在这些人中，150 222 (3·4%) 人曾与一位或多位自杀未遂的父母接触过，31 564 人 (0·7%) 曾与至少一位因自杀而死亡的父母接触过，12 834 人 (0·3%) ) 到这两个事件。暴露于父母自杀未遂的个体的自杀未遂率（IRR 2·72 [95% CI 2·33-3·17]）高于暴露于父母自杀的个体（1·77 [1·50-2·09]）与未暴露的个体相比。暴露于父母自杀的个体（IRR 3·18 [95% CI 2·84–3·58]）的自杀率高于暴露于父母自杀企图的个体（2·37 [2·19–2·57] ]）。对于暴露于父母自杀未遂的个体，自杀未遂的累积风险为 0·07，父母自杀者的累积自杀风险为0·009。暴露于父母自杀的个体使用暴力自杀方法的几率高于仅暴露于自杀未遂的个体（优势比 2·0 [95% CI 1·7-2·3]）。

解释

观察到与父母之一相同类型的自杀行为发生率较高的一致模式，包括自杀方法的类型。有必要采取预防性的、面向家庭的干预措施来减轻风险的家庭传播，在患者风险评估中对家庭接触的临床考虑也是如此。

资金

丹麦首都地区心理健康服务。