Timing of Parental Suicide Influences Risk in Kids

Fran Lowry

March 11, 2013

Children with parents who have died by suicide have a greater risk for earlier hospitalization for suicidal attempts compared with their counterparts whose parents died unintentionally. Furthermore, the risk varies according to the timing of parental death, new research shows.

Investigators at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, found that the hospitalization risk for suicide attempts continued to rise for decades in offspring who experienced parental suicide in early childhood.

"The risk in offspring who lost a parent to suicide or an unintentional injury during childhood surpassed the other age groups' risk approximately 5 years after the origin and, for the youngest group, continued to rise over decades," the authors, led by S. Janet Kuramoto, PhD, currently of the American Psychiatric Institute for Research and Education, Arlington, Virginia, write.

Further, children who lost a parent during adolescence or young adulthood were at greatest risk within 1 to 2 years after parental death, but this risk declined over time. Those who lost a parent to suicide in childhood and young adulthood had earlier onset of hospitalization for suicide attempt compared with offspring who lost a parent to an unintentional injury, they add.

The study was published in the February issue of JAMA Psychiatry.

According to investigators,"suicide affects millions of individuals worldwide and leaves a devastating impact on family members left behind." Previous research suggests that children who experience parental suicide at earlier ages are at higher risk for future hospitalization for suicide attempt. However, the researchers point out that how these risk trajectories differ by age was unknown.

The population-based cohort study included 26,096 offspring who experienced parental suicide and 32,395 offspring who experienced the death of a parent through unintentional injury before age 25 years. The study period spanned 30 years, from 1973 to 2003.

The children were divided into 4 age groups that reflected the time they experienced their loss of a parent: early childhood (0 - 5 years old), later childhood (6 - 12 years old), adolescence (13 - 17 years old), and young adulthood (18 - 24 years old).

The researchers found that the chance of a child being hospitalized for a suicide attempt differed according to the child's age at the time of the parent's suicide.

Offspring who experienced parental suicide during early childhood had the greatest chance of being hospitalized for a suicide attempt approximately 5 years after the parental suicide, and this hazard continued to rise until it leveled off 2 decades later.

Similarly, children who lost a parent to suicide during later childhood (from the age of 6 to 12 years) had an increased chance of being hospitalized for a suicide attempt compared with those who lost a parent during young adulthood, although the hazard did not increase after approximately 5 years after the parent's death.

Children who lost a parent due to suicide when they were teenagers or young adults had the highest chance of being hospitalized for a suicide attempt in the first 2 years after the parental suicide, but this decreased over time.

The researchers also studied the trajectories of hospitalization for a suicide attempt among children who lost a parent through unintentional injury and compared them with those of children whose parents committed suicide.

They found that children who lost a parent to suicide in early childhood, later childhood, and young adulthood had significantly earlier onset of hospitalization for suicide attempt than offspring who lost a parent to an unintentional injury during the same ages (P = 0.001, P = 0.02, and P = 0.04, respectively).

The authors note that the study has several limitations. It focused on hospitalizations for suicide attempt, and in so doing captured only a subset of individuals who attempted suicide. Also, misclassification of suicides as unintentional injuries could be possible.

In addition, the study excluded those children who had been hospitalized for a suicide attempt before the parental suicide, as well as children who experienced the death of their other parent prior to parental suicide. This might have made the study results "more conservative because these subgroups may be at particularly high risk for subsequent suicide attempt," the authors write.

According to the authors, the findings have implications for clinicians and parents with regard to the monitoring of the risk for suicide attempt, which may vary depending on when the child experienced the parental death.

"Future studies should identify malleable factors that could protect and build resilience in young survivors of parental death such as the surviving parent's health and psychological well-being and support provided by grandparents and other extended family members," the authors conclude.

The authors report no relevant financial relationships.

JAMA Psychiatry. 2013;70:149-157. Abstract

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