Childhood parental death and lifetime suicide attempt of the opposite-gender offspring in a nationwide community sample of Korea

Youth Suicidality in the Context of Disasters

PURPOSE OF REVIEW

The purpose of this review is to summarize the current literature regarding youth suicidality (suicidal ideation, suicidal behavior, and completed suicide) in the context of disasters.

RECENT FINDINGS

There are fewer studies that examine the effect of disasters on suicidality specifically in children and youth than studies that focus on adults or general population. Numerous studies have reported on the effect of disasters on youth mental health in general without zeroing in on suicide risk. Some variables that have shown to increase suicide risk in children and youth after disasters include female gender, age at the time of disaster exposure, dependence on adults, attachments to places and caregivers, family functioning, and vulnerability to mistreatment. Several studies have demonstrated that youth suicidality fluctuates in response to disasters, at times increasing immediately post-disaster and at other times decreasing immediately post-disaster followed by an increase later. Exposure to natural disasters (e.g., earthquakes, typhoons, hurricanes, wildfires, and extremes of temperature and humidity), man-made disasters (e.g., armed conflict, global warming, and pollution), and unique disasters (e.g., the COVID-19 pandemic) have had significant impact on suicidality in children and adolescents. Although there are several promising interventions to mitigate the post-disaster suicide risk among youth, there is no consensus on a single intervention that is superior to others. More research is needed to study youth suicide risk in the context of disasters and develop culturally appropriate and evidence-based interventions.

Machine learning prediction of suicidal ideation, planning, and attempt among Korean adults: A population-based study

Background

Suicide remains the leading cause of premature death in South Korea. This study aims to develop machine learning algorithms for screening Korean adults at risk for suicidal ideation and suicide planning or attempt.

Methods

Two sets of balanced data for Korean adults aged 19–64 years were drawn from the 2012–2019 waves of the Korea Welfare Panel Study using the random down-sampling method (N = 3292 for the prediction of suicidal ideation, N = 488 for the prediction of suicide planning or attempt). Demographic, socioeconomic, and psychosocial characteristics were used to predict suicidal ideation and suicide planning or attempt. Four machine-learning classifiers (logistic regression, random forest, support vector machine, and extreme gradient boosting) were tuned and cross-validated.

Results

All four algorithms demonstrated satisfactory classification performance in predicting suicidal ideation (sensitivity 0.808–0.853, accuracy 0.843–0.863) and suicide planning or attempt (sensitivity 0.814–0.861, accuracy 0.864–0.884). Extreme gradient boosting was the best-performing algorithm for predicting both suicidal outcomes. The most important predictors were depressive symptoms, self-esteem, income, consumption, and life satisfaction. The algorithms trained with the top two predictors, depressive symptoms and self-esteem, showed comparable classification performance in predicting suicidal ideation (sensitivity 0.801–0.839, accuracy 0.841–0.846) and suicide planning or attempt (sensitivity 0.814–0.837, accuracy 0.874–0.884).

Limitations

Suicidal ideation and behaviors may be under-reported due to social desirability bias. Causality is not established.

Discussion

More than 80% of individuals at risk for suicidal ideation and suicide planning or attempt could be predicted by a number of mental and socioeconomic characteristics of respondents. This finding suggests the potential of developing a quick screening tool based on the known risk factors and applying it to primary care or community settings for early intervention.

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This study develops machine learning models to predict suicidal ideation and behaviors.

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Logistic regression, random forest, support vector machine, and extreme gradient boosting are used.

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The algorithms correctly identifyed 80–90% of suicidal cases.

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The algorithms with the top two predictors (depressive symptoms and self-esteem) could achieve comparable accuracy.

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Our findings can be used to design a quick screening tool for use in primary care or community settings.

Shattered Voices: Daughters' Meaning Reconstruction in Loss of a Mother to Intimate Partner Homicide

Intimate partner homicide is a major public health concern around the world and the most lethal outcome of domestic violence. Its impact on the surviving bereaved offspring is immense, yet there is a significant gap in the literature regarding the long-term effects of this type of loss. The current qualitative study is aimed at filling this gap. The study used the constructivist paradigm of bereavement as a theoretical background to reveal the meanings constructed by bereaved Israeli daughters whose biological mothers were killed in acts of intimate partner homicide by their biological fathers. Three main themes of meaning emerged from 12 in-depth semi-structured interviews: "destruction of one's home"; "blast injury"; and "in doubt". An examination of the three themes in the current study reveals a deep shatter in participants' world of meaning to its very basic foundations. In light of intense psychological and social forces, the participants constructed and reconstructed such narratives of meaning in a continuous process of meaning making throughout their lives, years, and decades post loss. Derived from the findings are implications for practice. Mental healthcare professionals must attend to this basic shatter with an extreme level of caution, as they help homicide survivors reconstruct a world of meaning shattered by loss. Moreover, the long-lasting effects emphasize an appropriate legal and political involvement; specifically, policy regulations and rights should provide psychosocial care programs that are suited to the needs of offspring co-victims of intimate partner homicide in particular. In light of the strong social influence on participants' loss experience, further efforts are required to raise social awareness about this burning social concern and to fight the stigmatization of co-victims of homicide in general and co-victims of intimate partner homicide in particular.

Role of SES on the association between childhood parental death and adulthood suicidal ideation: a mediation analysis using longitudinal dataset in South Korea

BACKGROUND

We sought to examine the association between childhood experience of parental death (CEPD) and adulthood suicidal ideation, and the mediating role of adulthood SES in the association.

METHODS

We analyzed a nationally representative dataset of 8609 adults from the Korea Welfare Panel Study, which is a longitudinal cohort dataset in South Korea. CEPD was measured using a question: "During your childhood (0-17 years old), have you experienced the death of parents?" We classified responses of CEPD during 2006-2011 into 'yes,' and the others into 'no.' Suicidal ideation over the past year was assessed annually during 2012-2019. As a potential mediator, adulthood educational attainment and household income in 2011 were included in the analysis. Logistic regression was applied to examine the association of CEPD with adulthood suicidal ideation across age groups (early adulthood, 19-39 years old; middle adulthood, 40-59 years old; late adulthood, ≥60 years old), after excluding people who reported lifetime suicidal ideation in 2011. Causal mediation analysis using a parametric regression model was applied to examine the mediating role of adulthood SES in the association between CEPD and adulthood suicidal ideation.

RESULTS

After adjusting for potential confounders including childhood SES, CEPD was significantly associated with adulthood suicidal ideation among the late adulthood group (OR: 1.43; 95% CI: 1.13-1.81), while the association was not statistically significant among the early; and middle adulthood groups. In mediation analysis of adulthood household income, both indirect association (OR^NIE: 1.05; 95% CI: 1.02-1.09) and direct association (OR^NDE: 1.37; 95% CI: 1.09-1.73) were statistically significant among the late adulthood group. In the mediation analysis of adulthood education attainment among the late adulthood, only a direct association was statistically significant (OR^NDE: 1.43; 95% CI: 1.14-1.80).

CONCLUSIONS

These results suggest that CEPD could be a risk factor for adulthood suicidal ideation. Furthermore, the findings imply that income security policy might be necessary to reduce suicide among the late adulthood group.

Evaluation of risk factors for Suicide Attempts in Turkey's East: A Five-Year Study

Objectives:

Suicide attempt has different risk factors for each community. In the study we aimed to reveal the causes of suicide attempt in Turkey’s Eastern part and to make suggestions to prevent suicide.

Methods:

For this study, 130 patients who were admitted to the Emergency Department of the University Hospital due to suicide attempt between January 2013 and December 2017 were included. Our University Hospital is the largest hospital in the East of Turkey. The data were obtained from hospital records and files of judicial investigations. Clinical progress records were obtained from the hospital archive. Investigation files were received from local judicial units.

Results:

Fifty six percent of the patients (n = 73) were female. 48% of female cases (n = 35) were married. There was major depressive disorder in 34% (n = 44) of the cases. Medicine taking was the most frequent suicide method with 63% (n = 82). The main reason for suicide was parental conflicts for female cases; and psychiatric and financial problems for males.

Conclusion:

Family therapy for married individuals would reduce suicide attempts in females. Psychiatric history is an important risk factor and it should be ensured that these patients are followed up regularly by the health institutions and their relatives. To prevent drug abuse, there should not be too much medicine in homes. If medicine is available at home, it should be kept in a safer environment.

Childhood adversity predicted suicidal ideation in older age: Results from a National Survey in Korea

Objectives: Suicide is a major mental health concern in South Korea, where a rapid increase in suicide rates among older adults is evident. This study aims to understand the association of childhood adversity with suicidal ideation in later life, and whether gender differences in the effects of childhood adversity exist.Method: The sample consisted of older adults aged 60 years and more in six waves of the Korea Welfare Panel Study from 2012 to 2017 (N = 4,105). A mixed effect logistic regression with random intercept was used to test the effects of childhood adversity on the risk of 12-month suicidal ideation.Results: After controlling for socioeconomic status, psychosocial resources, and health conditions, the mixed effect models using longitudinal data indicated that parental death predicted an increased risk of suicidal ideation and that a greater number of childhood adversities predicted a higher likelihood of suicidal ideation. No gender differences were found in the effects of childhood adversity on suicidal thoughts.Conclusion: These findings support a life course perspective, highlighting the importance of assessing early life disadvantages to understand suicidal ideation among older adults. The findings suggest that interventions targeting older adults who experienced parental death in childhood or multiple adversities may be effective in preventing suicidal ideation.

Theoretical frameworks informing the relationship between parental death and suicidal behaviour: A scoping review

Background

Exposure to parental death in childhood has been strongly associated with offspring suicide although few studies have applied theoretical models to conceptualise this relationship.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Scoping Reviews guidelines, we conducted a scoping review of primary studies that identified a theory/framework explaining the aetiology of suicidal behaviour in adulthood, following childhood exposure to external-cause parental death, including suicide.

Results

The search yielded 1598 articles. Following full-text screening, 23 studies were identified as meeting inclusion criteria. Data extraction was then completed and found that the studies collectively referenced nine theories. The specific theories identified covered a range of biopsychosocial frameworks and included attachment theory, familial transmission of suicide, conservation of resources framework, diathesis-stress model, social integration theory, socio-ecological model, social learning theory, critical period hypothesis or life course approach and the developmental model of antisocial behaviour.

Limitations

It was beyond the scope of this review to conduct rigorous testing and evaluation of the theories identified. Future research could extend on this study by developing criteria to assess the range of theories and frameworks on suicide exposure, as well as the studies providing evidence for these theories, in order to guide more advanced theory development as well as policies, programs and interventions.

Conclusions

Based on these theories, the authors proposed that using an integrated biopsychosocial model will provide a more comprehensive understanding of the diverse risk and protective factors for suicidal behaviour following parental death.

The Effect of Sudden Death Bereavement on the Risk for Suicide

Background: Bereavement after a sudden death is associated with psychiatric sequelae including suicidal ideation and behavior. However, there is still uncertainty about whether bereavement due to suicide increases the risk for suicidal behavior more than bereavement due to other causes of death does. Aims: This study aimed to evaluate suicidal risk among sudden death-bereaved participants and to identify risk factors for suicidality that may be over-represented in those who are suicide-bereaved. Method: In total, 180 adult participants, half of whom had experienced the sudden death of a first-degree relative within the previous 5 years, completed self-report questionnaires assessing suicidal risk, symptoms of depression, somatization, posttraumatic stress disorder (PTSD), complicated grief, perceived social support, and demographic information. Results: Sudden death bereavement was associated with increased suicide risk even after adjusting for psychiatric symptomatology. Within the bereaved groups, the highest risk for suicide was among those bereaved by suicide, with additional contributions from depressive symptomatology, PTSD, somatization, lower perceived social support, and secular religious orientation. Limitations: The study was cross-sectional and bereaved participants had lost their loved one an average of 5 years before the assessment. Conclusion: These results are consistent with the conclusion that suicide bereavement is a risk factor for suicidal behavior.

A systematic review on the relationship between childhood exposure to external cause parental death, including suicide, on subsequent suicidal behaviour

BACKGROUND

Exposure to parental death in childhood has been associated with offspring suicide risk, although the strength of this association is unclear. The primary aim of this systematic review was to synthesise primary studies on the relationship between childhood exposure to external cause parental death, including suicide, and subsequent suicidal behaviour in adulthood. The secondary objective was to compare suicide-related outcomes of exposure to parental suicide with the outcomes of exposure to other external cause parental deaths.

METHODS

A systematic review was conducted using guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Ovid MEDLINE, Cochrane Library, Ovid PsycINFO, Web of Science, CINAHL and EMBASE were searched from January 2008 until November 2018. Two researchers independently screened the articles, performed data extraction and assessed quality of evidence using the Newcastle-Ottawa Scale.

RESULTS

Of the 618 studies identified, 26 were included for review. Only one study found no significant association between childhood exposure to suicide and increased suicide risk in adulthood. Four studies suggested the risk of suicidality in adulthood was greater for those exposed to parental suicide compared to other external cause deaths.

LIMITATIONS

The use of national registers in many studies did not allow for all variables of interest to be examined. Selective samples also limited the generalizability of findings.

CONCLUSIONS

A strong association between parental suicide and suicidal behaviour in adult offspring exists. Interventions for bereaved youth should consider the long-term effects of parental suicide and target individual and environmental-level risk factors for subsequent suicidality.

Sudden parental death from external causes and risk of suicide in the bereaved offspring: A national study

Previous research has revealed an association between parental bereavement from external causes and risk of suicide in offspring. Few studies have however provided insights into specific influences of cause of death, gender of the deceased and bereaved, age at bereavement and suicide, and time since bereavement. The present nested case-control study was based on data from three longitudinal registers. Subjects comprised 19 015 persons who died from suicide at an age of 11-64 years during 1969-2012 (cases), and 332 046 live comparison individuals matched for gender and date of birth. Information about deceased parents' cause and date of death, and sociodemographic data was retrieved and merged. Data were analysed with conditional logistic regression. Losing a parent to suicide, transport accidents and other external causes of death was associated with an increased suicide risk in offspring. Parental suicide was associated with a substantially higher suicide risk than transport accidents and other external causes. These effects were equally strong for daughters and sons, and for the loss of a mother, father or both parents. Suicide risk was highest in younger bereaved offspring, and bereavement had both short and long-term impacts on suicide risk. In conclusion, all offspring exposed to parental death by external causes have an increased suicide risk, independent of factors related to the exposure. The consequences are long lasting, and offspring should be offered follow-up in primary healthcare. Younger offspring bereaved by parental suicide have the highest risk and may be targeted for prevention and intervention programs in specialist healthcare.

Gender differences among medically serious suicide attempters aged 15-54 years in rural China

China is one of few countries which reported higher female suicide rates in the worldwide. However, little is known about the gender differences among Chinese rural suicide attempters. This study aims to analyze the gender differences among medically serious suicide attempters aged 15-54 years in rural China. Subjects were 791 medically serious suicide attempters and 791 controls aged 15-54 years in rural China. Socio-demographic, psychological and some critical variables were assessed in the interview. The results showed that all of the factors (education years, family suicide history, negative life events, social support, impulsivity and mental disorder) associated with male suicide attempters also could be found for females. Physical disease, mental disorder and pesticide ingestion played more roles on male suicide attempters. Ever married, peasant, religious belief, and less social support played more roles on female suicide attempters. Compared with male suicide attempters, female ones are mainly influenced by social factors. A gender-specific approach should be emphasized in suicide prevention.

Gender Differences in Somatic Symptoms and Current Suicidal Risk in Outpatients with Major Depressive Disorder

OBJECTIVE

Although somatic symptoms are common complaints of patients with major depressive disorder (MDD), their associations with suicide are still unclear.

METHODS

A total of 811 MDD outpatients of aged between 18 to 64 years were enrolled nationwide in Korea with the suicidality module of the Mini-International Neuropsychiatric Interview (MINI) and the Depression and Somatic Symptom Scale (DSSS).

RESULTS

On stepwise regression analysis, current suicidality scores were most strongly associated with chest pain in men, and neck or shoulder pain in women. Severe chest pain was associated with higher current suicidality scores in men than in women, whereas severe neck or shoulder pain showed no significant differences between the genders. In conclusion, MDD patients of both sexes with suicidal ideation showed significantly more frequent and severe somatic symptoms than those without. Current suicidal risk was associated with chest pain in men, and neck or shoulder pain in women.

CONCLUSION

We suggest that clinicians pay attention to patients' somatic symptoms in real world practice.

Suicidal Behavior and Psychological Distress in University Students: A 12-nation Study

This study investigated the prevalence of suicidal behavior and psychological distress in university students across 12 nations. A total of 5,572 university students from 12 countries were surveyed about suicide ideation, suicide attempts, and psychological distress by means of a self-administered questionnaire. Almost 29% of the samples reported having contemplated suicide and 7% reported attempting suicide. Of the total sample, 51.1% scored above the General Health Questionnaire-12 ≥ 3 cut-off points, 41.6% above the GHQ-12 ≥ 4 cut-off points, and 33.8% scored above the GHQ-12 ≥ 5 cut-off points. While odds of suicide ideation were elevated in Austria and the UK, reduced ORs were detected for China, Italy, Saudi Arabia, Tunisia, and Turkey. Similarly, while odds of suicide attempt were high in Jordan, Palestine, Saudi Arabia, and to some extent in Turkey, reduced ORs were observed for Austria, China, Italy, Japan and the United States. Elevated ORs for psychological distress were seen in Japan, Jordan, Palestine, Saudi Arabia, Tunisia, and Turkey but reduced ORs were noted in Austria, China, Iran, Italy, and the United States. Psychological distress was strongly associated with reports of suicide ideation and attempts. Suicide ideation, suicide attempt, and psychological distress are common in university students but their rates vary depending on the sociocultural context. Due attention should be devoted to the mental health needs of young adults enrolled in higher educational institutions and more cross-cultural research is warranted to better understand the etiology of the observed intersocietal variations in suicidal behavior and psychological distress.

Reduced frontal-subcortical white matter connectivity in association with suicidal ideation in major depressive disorder

Major depressive disorder (MDD) and suicidal behavior have been associated with structural and functional changes in the brain. However, little is known regarding alterations of brain networks in MDD patients with suicidal ideation. We investigated whether or not MDD patients with suicidal ideation have different topological organizations of white matter networks compared with MDD patients without suicidal ideation. Participants consisted of 24 patients with MDD and suicidal ideation, 25 age- and gender-matched MDD patients without suicidal ideation and 31 healthy subjects. A network-based statistics (NBS) and a graph theoretical analysis were performed to assess differences in the inter-regional connectivity. Diffusion tensor imaging (DTI) was performed to assess topological changes according to suicidal ideation in MDD patients. The Scale for Suicide Ideation (SSI) and the Korean version of the Barrett Impulsiveness Scale (BIS) were used to assess the severity of suicidal ideation and impulsivity, respectively. Reduced structural connectivity in a characterized subnetwork was found in patients with MDD and suicidal ideation by utilizing NBS analysis. The subnetwork included the regions of the frontosubcortical circuits and the regions involved in executive function in the left hemisphere (rostral middle frontal, pallidum, superior parietal, frontal pole, caudate, putamen and thalamus). The graph theoretical analysis demonstrated that network measures of the left rostral middle frontal had a significant positive correlation with severity of SSI (r=0.59, P=0.02) and BIS (r=0.59, P=0.01). The total edge strength that was significantly associated with suicidal ideation did not differ between MDD patients without suicidal ideation and healthy subjects. Our findings suggest that the reduced frontosubcortical circuit of structural connectivity, which includes regions associated with executive function and impulsivity, appears to have a role in the emergence of suicidal ideation in MDD patients.

Are There Spillover Effects from the GI Bill? The Mental Health of Wives of Korean War Veterans

Background

The Korean War GI Bill provided economic benefits for veterans, thereby potentially improving their health outcomes. However potential spillover effects on veteran wives have not been evaluated.

Methods

Data from wives of veterans eligible for the Korean War GI Bill (N = 128) and wives of non-veterans (N = 224) from the Health and Retirement Study were matched on race and coarsened birth year and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78) were assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale. Regression analyses were stratified into low (mother < 8 years schooling / missing data, N = 95) or high (mother ≥ 8 years schooling, N = 257) childhood socio-economic status (cSES) groups, and were adjusted for birth year and childhood health, as well as respondent’s educational attainment in a subset of analyses.

Results

Husband’s Korean War GI Bill eligibility did not predict depressive symptoms among veteran wives in pooled analysis or cSES stratified analyses; analyses in the low cSES subgroup were underpowered (N = 95, β = -0.50, 95% Confidence Interval: (-1.35, 0.35), p = 0.248, power = 0.28).

Conclusions

We found no evidence of a relationship between husband’s Korean War GI Bill eligibility and wives’ mental health in these data, however there may be a true effect that our analysis was underpowered to detect.

Associations between the timing of childhood adversity and adulthood suicidal behavior: A nationally-representative cohort

BACKGROUND

Although childhood adversities (CAs) are known to be associated with later suicidal behavior, it is uncertain whether the timing of specific CAs may influence this association.

METHODS

We analyzed nationally representative data for 9205 participants from the Korean Welfare Panel Study. Four different CAs (parental death, parental divorce, suspension of school education and being raised in a relative's house due to financial strain) were assessed and were categorized as early childhood and adolescent onset. Lifetime experiences of suicidal behaviors along with the age of the first time experience were recorded. Cox regression was used.

RESULTS

After adjusting for age, sex, and childhood socioeconomic status, parental death before the age of 12 was associated with adulthood suicidal behavior (ideation HR 1.35, 95% CI 1.13, 1.61; attempt HR 1.60, 95% CI 1.02, 2.52), while suspension of school due to financial strain was associated with suicidal behavior when it occurred at adolescence (ideation HR 1.48, 95% CI 1.22, 1.79; plan HR 1.69, 95% CI 1.16, 2.48). When we also adjusted for adulthood SES, which is a potential mediator, there was no significant change except that the association between early parental death and suicidal attempt became non-significant (HR: 1.43, 95% CI: 0.92, 2.26).

LIMITATIONS

Experience of CA was assessed retrospectively, and the assessment of suicidal attempt was not specifically defined. There could be selection bias due to loss to the follow-up.

CONCLUSIONS

There may be a critical period for the effect of CA on later suicidal behavior depending on the characteristics of CA.

Childhood trauma, parental death, and their co-occurrence in relation to current suicidality risk in adults: a nationwide community sample of Korea

Although previous studies have suggested that childhood trauma and parental death are strongly associated with suicidality in adulthood, it is still unclear how these factors interact within the same population. A total of 1396 adults were recruited through nationwide multistage probability sampling in South Korea. Subjects were evaluated through face-to-face interviews using the Suicidality Module of the Mini-International Neuropsychiatric Interview and the Early Trauma Inventory Self Report-Short Form. Among the 1396 adults, the group that experienced both childhood trauma and parental death had the highest current suicidality risks (F = 12.16, p < 0.0001) and lifetime suicide attempt (χ2 = 35.81, p < 0.0001) compared with the other groups, which were only childhood trauma, only parental death, and neither. Multivariate logistic regression analyses revealed that middle-to-high current suicidality risk and lifetime suicide attempt were significantly associated with concurrent childhood trauma and parental death (odds ratio, 3.64; 95% confidence interval, 1.99-6.65) as well as with only childhood trauma (odds ratio, 1.95; 95% confidence interval, 1.33-2.87), after adjusting for age, sex, education, marital status, household monthly income, and living area. Emotional abuse was the only type of childhood trauma significantly associated with higher current suicidality scores in those who experienced childhood parental death than in those who did not (F = 3.26, p = 0.041). Current suicidality risk and lifetime suicide attempt are associated with experiencing both parental death and trauma, especially emotional abuse, in childhood, whereas experiencing only childhood parental death is associated with neither.

Feelings of worthlessness, traumatic experience, and their comorbidity in relation to lifetime suicide attempt in community adults with major depressive disorder

BACKGROUND

Major depressive disorder (MDD) and traumatic experience are independent risk factors for lifetime suicide attempt (LSA). However, the relationships between trauma history and depressive symptomatology as they relate to LSA are not fully understood.

METHODS

A total of 12,532 adults, randomly selected through one-person-per-household method, completed a face-to-face interview using the Korean version of Composite International Diagnostic Interview (K-CIDI) and a questionnaire for LSA (response rate 80.2%).

RESULTS

Among 825 subjects with MDD, 141 subjects reported an LSA (17.1%). LSAs were significantly greater in those who had experienced any trauma than in those who had not (χ(2)=34.66, p<0.0001). Multivariate logistic regression showed that only feelings of worthlessness were significantly associated with LSA among 20 depression symptoms in individuals with MDD (AOR=3.08, 95% CI 1.70-5.60). Feelings of worthlessness was associated with LSA in those who had experienced serious trauma (AOR=5.02, 95% CI 3.35-7.52), but not in those who had not. Serious traumas associated with LSA included military combat, witnessing a violent crime, rape or sexual assault, a bad beating, being threatened by others, and learning about traumas to others. Serious trauma showed no significant association with LSA in those who did not have feelings of worthlessness. PTSD was a comorbidity that showed the highest odds ratio with LSA in individuals with MDD.

CONCLUSIONS

Feelings of worthlessness are more strongly associated with LSA than other depression symptoms in individuals with MDD, and it is significantly associated with LSA in those who experienced serious trauma but not in those who did not.

Association between parental psychopathology and suicidal behavior among adult offspring: results from the cross-sectional South African Stress and Health survey

BACKGROUND

Prior studies have demonstrated a link between parental psychopathology and offspring suicidal behavior. However, it remains unclear what aspects of suicidal behavior among adult offspring are predicted by specific parental mental disorders, especially in Africa. This study set out to investigate the association between parental psychopathology and suicidal behavior among their adult offspring in a South African general population sample.

METHOD

Parental psychopathology and suicidal behavior in offspring were assessed using structured interviews among 4,315 respondents from across South Africa. The WHO CIDI was used to collect data on suicidal behavior, while the Family History Research Diagnostic Criteria Interview was used to assess prior parental psychopathology. Bivariate and multivariate survival models tested the associations between the type and number parental mental disorders (including suicide) and lifetime suicidal behavior in the offspring. Associations between a range of parental disorders and the onset of subsequent suicidal behavior (suicidal ideation, plans, and attempts) among adult offspring were tested.

RESULTS

The presence of parental psychopathology significantly increased the odds of suicidal behavior among their adult offspring. More specifically, parental panic disorder was associated with offspring suicidal ideation, while parental panic disorder, generalized anxiety disorder and suicide were significantly associated with offspring suicide attempts. Among those with suicidal ideation, none of the tested forms of parental psychopathology was associated with having suicide plans or attempts. There was a dose-response relationship between the number of parental disorders and odds of suicidal ideation.

CONCLUSIONS

Parental psychopathology increases the odds of suicidal behavior among their adult offspring in the South African context, replicating results found in other regions. Specific parental disorders predicted the onset and persistence of suicidal ideation or attempts in their offspring. Further research into these associations is recommended in order to determine the mechanisms through which parent psychopathology increases the odds of suicidal behavior among offspring.