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Brent et al. - JAMA Psychiatry

Familial Pathways to Early-Onset Suicide Attempt:  A 5.6-Year Prospective Study
Brent DA, Melhem NM, Oquendo M, Burke A, Birmaher B, Stanley B, Biernesser C, Keilp J, Kolko D, Ellis S, Porta G,  Zelazny J, Iyengar S and Mann JJ.
JAMA Psychiatry. Published online December 30, 2014

Suicide is a leading cause of adolescent mortality.  Although suicide attempts are strong predictors of suicide and are highly familial, the mechanisms of familial transmission are not clearly understood.  In arecent study published online in JAMA Psychiatry, Dr. David Brent and his colleagues examined the mechanisms and pathways by which suicidal behavior is transmitted from parent to child.  The investigators conducted a prospective study of 701 offspring (ages 10 to 50 years) of 334 clinically referred probands with mood disorders who were followed for a mean of 5.6 years. Of the probands, 191 (57.2%) had made a suicide attempt. 

Among the 701 offspring, 44 had made a suicide attempt before participating in the study, and 29 made an attempt during study follow-up. Multivariate logistic regression revealed that proband suicide attempt was a predictor of offspring suicide attempt, even after controlling for other salient offspring variables including baseline history of mood disorder, baseline history of suicide attempt, and mood disorder  before the suicide attempt. Path analyses were consistent with these findings, revealing a direct effect of proband suicide attempt on offspring suicide attempt, a strong effect of offspring mood disorder, and impulsive aggression as a precursor of mood disorder.

Dr. Brent and his colleagues concluded that parental history of a suicide attempt conveys a nearly 5-fold increased odds of suicide attempt in offspring at risk for mood disorder, even after adjusting for the familial transmission of mood disorder.  In terms of clinical implications, the investigators posited that interventions to target mood disorder and impulsive aggression in high-risk offspring may attenuate the familial transmission of suicidal behavior. 

Contributors:
David A. Brent, MD, Nadine M. Melhem, PhD, Boris Birmaher, MD, Candice Biernesser, LSW, MPH, David Kolko, PhD and Jamie Zelazny, MPH, RN (Department of Psychiatry, University of Pittsburgh)

Satish Iyengar, PhD (Department of Statistics, University of Pittsburgh)

Giovanna Porta, MS (Western Psychiatric Institute and Clinic of UPMC)

Maria Oquendo, MD, Ainsley Burke, PhD, John Keilp, PhD, Steve Ellis, PhD, Barbara Stanley, PhD and J. John Mann, MD (Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University and New York State Psychiatric Institute)

This article appeared in JAMA Psychiatry.  The abstract is available by clicking here.