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Family Risk Factors for Suicidal Behavior: Opportunities for Early Identification and Intervention

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Understanding Suicide
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Abstract

In this chapter, the most common and potent familial risk and protective factors for suicidal behavior will be reviewed, namely, family history of psychiatric disorder and suicidal behavior and exposure to family adversity, such as bereavement, divorce, or maltreatment. We then will discuss strategies for identification of families and youth at risk and extant and proposed preventive interventions that could attenuate the risk for youth suicidal behavior.

The following schematic (Fig. 30.1) provides a developmental framework for understanding familial risk and protective factors as targets for screening, prevention, and early intervention. Individuals are at risk for suicide and suicide attempts due to family history of suicidal behavior, psychiatric disorders, and impulsive aggression that increase the likelihood that the child will inherit these conditions, which increased offspring’s risk of suicidal behavior. In addition, family history increases the likelihood of perinatal complications, and of family adversity, both of which also increase the likelihood of child risk factors and of suicidal behavior. We first review the relationship of each of these categories of risk to suicidal outcome and then, using this developmental framework, discuss evidence-based preventive and treatment interventions that target these risk factors to decrease the risk of suicidal behavior or one of its precursors.

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References

  • Afifi TO, Boman J, Fleisher W, Sareen J (2009) The relationship between child abuse, parental divorce, and lifetime mental disorders and suicidality in a nationally representative adult sample. Child Abuse Negl 33(3):139–147

    Article  PubMed  Google Scholar 

  • Agerbo E, Nordentoft M, Mortensen PB (2002) Familial, psychiatric, and socioeconomic risk factors for suicide in young people: nested case-control study. BMJ 325(7355):74

    Article  PubMed  PubMed Central  Google Scholar 

  • Ayers TS, Wolchik SA, Sandler IN, Twohey JL, Weyer JL, Padgett-Jones S, Weiss L, Cole E, Kriege G (2013) The Family Bereavement Program: description of a theory-based prevention program for parentally-bereaved children and adolescents. Omega (Westport) 68(4):293–314

    Article  Google Scholar 

  • Brent DA, Melhem N (2008) Familial transmission of suicidal behavior. Psychiatr Clin N Am 31(2):157–177

    Article  Google Scholar 

  • 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, Mann JJ (2014) Familial pathways to early-onset suicide attempt: a 5.6-year prospective study. JAMA Psychiatry 72(2):160–8

    Google Scholar 

  • Brent D, Melhem N, Donohoe MB, Walker M (2009) The incidence and course of depression in bereaved youth 21 months after the loss of a parent to suicide, accident, or sudden natural death. Am J Psychiatry 166(7):786–794

    Article  PubMed  PubMed Central  Google Scholar 

  • Brent DA, Kolko DJ, Birmaher B, Baugher M, Bridge J, Roth C, Holder D (1998) Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression. J Am Acad Child Adolesc Psychiatry 37(9):906–914

    Article  CAS  PubMed  Google Scholar 

  • Chaffin M, Funderburk B, Bard D, Valle LA, Gurwitch R (2011) A combined motivation and parent-child interaction therapy package reduces child welfare recidivism in a randomized dismantling field trial. J Consult Clin Psychol 79(1):84–95

    Article  PubMed  Google Scholar 

  • Compas BE, Forehand R, Thigpen JC, Keller G, Hardcastle EJ, Cole DA, Potts J, Watson KH, Rakow A, Colletti C, Reeslund K, Fear J, Garai E, McKee L, Merchant MJ, Roberts L (2011) Family group cognitive-behavioral preventive intervention for families of depressed parents: 18- and 24-month outcomes. J Consult Clin Psychol 79(4):488–499

    Article  PubMed  PubMed Central  Google Scholar 

  • Costello EJ, Compton SN, Keeler G, Angold A (2003) Relationships between poverty and psychopathology: a natural experiment. JAMA 290(15):2023–2029

    Article  CAS  PubMed  Google Scholar 

  • Costello EJ, Erkanli A, Copeland W, Angold A (2010) Association of family income supplements in adolescence with development of psychiatric and substance use disorders in adulthood among an American Indian population. JAMA 303(19):1954–1960

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cox LJ, Stanley BH, Melhem NM, Oquendo MA, Birmaher B, Burke A, Kolko DJ, Zelazny JM, Mann JJ, Porta G, Brent DA (2012) A longitudinal study of nonsuicidal self-injury in offspring at high risk for mood disorder. J Clin Psychiatry 73(6):821–828

    Article  PubMed  PubMed Central  Google Scholar 

  • Dietz LJ, Stoyak S, Melhem N, Porta G, Matthews KA, Walker Payne M, Brent DA (2013) Cortisol response to social stress in parentally bereaved youth. Biol Psychiatry 73(4):379–387

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Dupere V, Leventhal T, Lacourse E (2009) Neighborhood poverty and suicidal thoughts and attempts in late adolescence. Psychol Med 39(8):1295–1306

    Article  CAS  PubMed  Google Scholar 

  • Embry DD (2002) The Good Behavior Game: a best practice candidate as a universal behavioral vaccine. Clin Child Fam Psychol Rev 5(4):273–297

    Article  PubMed  Google Scholar 

  • Enns MW, Cox BJ, Afifi TO, De Graaf R, Ten Have M, Sareen J (2006) Childhood adversities and risk for suicidal ideation and attempts: a longitudinal population-based study. Psychol Med 36(12):1769–1778

    Article  PubMed  Google Scholar 

  • Fergusson DM, Woodward LJ, Horwood LJ (2000) Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychol Med 30(1):23–39

    Article  CAS  PubMed  Google Scholar 

  • Garber J, Clarke GN, Weersing VR, Beardslee WR, Brent DA, Gladstone TR, DeBar LL, Lynch FL, D’Angelo E, Hollon SD, Shamseddeen W, Iyengar S (2009) Prevention of depression in at-risk adolescents: a randomized controlled trial. JAMA 301(21):2215–2224

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Geulayov G, Gunnell D, Holmen TL, Metcalfe C (2012) The association of parental fatal and non-fatal suicidal behaviour with offspring suicidal behaviour and depression: a systematic review and meta-analysis. Psychol Med 42(8):1567–1580

    Article  CAS  PubMed  Google Scholar 

  • Geulayov G, Metcalfe C, Heron J, Kidger J, Gunnell D (2014) Parental suicide attempt and offspring self-harm and suicidal thoughts: results from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. J Am Acad Child Adolesc Psychiatry 53(5):509–517.e502

    Article  PubMed  Google Scholar 

  • Gureje O, Oladeji B, Hwang I, Chiu WT, Kessler RC, Sampson NA, Alonso J, Andrade LH, Beautrais A, Borges G, Bromet E, Bruffaerts R, de Girolamo G, de Graaf R, Gal G, He Y, Hu C, Iwata N, Karam EG, Kovess-Masfety V, Matschinger H, Moldovan MV, Posada-Villa J, Sagar R, Scocco P, Seedat S, Tomov T, Nock MK (2011) Parental psychopathology and the risk of suicidal behavior in their offspring: results from the World Mental Health surveys. Mol Psychiatry 16(12):1221–1233

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hamdan S, Melhem NM, Porta G, Song MS, Brent DA (2013) Alcohol and substance abuse in parentally bereaved youth. J Clin Psychiatry 74(8):828–833

    Article  PubMed  PubMed Central  Google Scholar 

  • Hawkins JD, Oesterle S, Brown EC, Abbott RD, Catalano RF (2014) Youth problem behaviors 8 years after implementing the communities that care prevention system: a community-randomized trial. JAMA Pediatr 168(2):122–129

    Article  PubMed  PubMed Central  Google Scholar 

  • Jakobsen IS, Christiansen E, Larsen KJ, Waaktaar T (2011) Differences between youth with a single suicide attempt and repeaters regarding their and their parents history of psychiatric illness. Arch Suicide Res 15(3):265–276

    Article  PubMed  Google Scholar 

  • Kitzman HJ, Olds DL, Cole RE, Hanks CA, Anson EA, Arcoleo KJ, Luckey DW, Knudtson MD, Henderson CR Jr, Holmberg JR (2010) Enduring effects of prenatal and infancy home visiting by nurses on children: follow-up of a randomized trial among children at age 12 years. Arch Pediatr Adolesc Med 164(5):412–418

    Article  PubMed  PubMed Central  Google Scholar 

  • Kosterman R, Hawkins JD, Mason WA, Herrenkohl TI, Lengua LJ, McCauley E (2009) Assessment of behavior problems in childhood and adolescence as predictors of early adult depression. J Psychopathol Behav Assess 32(1):118–127

    Article  PubMed  PubMed Central  Google Scholar 

  • Kuramoto SJ, Runeson B, Stuart EA, Lichtenstein P, Wilcox HC (2013) Time to hospitalization for suicide attempt by the timing of parental suicide during offspring early development. JAMA Psychiatry 70(2):149–157

    Article  PubMed  PubMed Central  Google Scholar 

  • Luecken LJ, Hagan MJ, Sandler IN, Tein JY, Ayers TS, Wolchik SA (2014) Longitudinal mediators of a randomized prevention program effect on cortisol for youth from parentally bereaved families. Prev Sci 15(2):224–232

    Article  PubMed  PubMed Central  Google Scholar 

  • Mann JJ, Bortinger J, Oquendo MA, Currier D, Li S, Brent DA (2005) Family history of suicidal behavior and mood disorders in probands with mood disorders. Am J Psychiatry 162(9):1672–1679

    Article  PubMed  Google Scholar 

  • Mason WA, Kosterman R, Hawkins JD, Haggerty KP, Spoth RL (2003) Reducing adolescents’ growth in substance use and delinquency: randomized trial effects of a parent-training prevention intervention. Prev Sci 4(3):203–212

    Article  PubMed  Google Scholar 

  • Melhem NM, Walker M, Moritz G, Brent DA (2008) Antecedents and sequelae of sudden parental death in offspring and surviving caregivers. Arch Pediatr Adolesc Med 162(5):403–410

    Article  PubMed  PubMed Central  Google Scholar 

  • Melhem NM, Brent DA, Ziegler M, Iyengar S, Kolko D, Oquendo M, Birmaher B, Burke A, Zelazny J, Stanley B, Mann JJ (2007) Familial pathways to early-onset suicidal behavior: familial and individual antecedents of suicidal behavior. Am J Psychiatry 164(9):1364–1370

    Article  PubMed  PubMed Central  Google Scholar 

  • Mittendorfer-Rutz E, Rasmussen F, Lange T (2012) A life-course study on effects of parental markers of morbidity and mortality on offspring’s suicide attempt. PLoS One 7(12):e51585

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Molnar BE, Berkman LF, Buka SL (2001) Psychopathology, childhood sexual abuse and other childhood adversities: relative links to subsequent suicidal behaviour in the US. Psychol Med 31(6):965–977

    Article  CAS  PubMed  Google Scholar 

  • Niederkrotenthaler T, Rasmussen F, Mittendorfer-Rutz E (2012) Perinatal conditions and parental age at birth as risk markers for subsequent suicide attempt and suicide: a population based case-control study. Eur J Epidemiol 27(9):729–738

    Article  PubMed  Google Scholar 

  • Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, Beautrais A, Borges G, Bromet E, Bruffaerts R, de Girolamo G, de Graaf R, Florescu S, Gureje O, Haro JM, Hu C, Huang Y, Karam EG, Kawakami N, Kovess V, Levinson D, Posada-Villa J, Sagar R, Tomov T, Viana MC, Williams DR (2009) Cross-national analysis of the associations among mental disorders and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS Med 6(8):e1000123

    Article  PubMed  PubMed Central  Google Scholar 

  • Olds DL, Kitzman H, Knudtson MD, Anson E, Smith JA, Cole R (2014) Effect of home visiting by nurses on maternal and child mortality: results of a 2-decade follow-up of a randomized clinical trial. JAMA Pediatr 168(9):800–806

    Article  PubMed  PubMed Central  Google Scholar 

  • Perrino T, Pantin H, Prado G, Huang S, Brincks A, Howe G, Beardslee W, Sandler I, Brown CH (2014) Preventing internalizing symptoms among Hispanic adolescents: a synthesis across Familias Unidas trials. Prev Sci 15(6):917–928

    Article  PubMed  PubMed Central  Google Scholar 

  • Pilowsky DJ, Wickramaratne P, Talati A, Tang M, Hughes CW, Garber J, Malloy E, King C, Cerda G, Sood AB, Alpert JE, Trivedi MH, Fava M, Rush AJ, Wisniewski S, Weissman MM (2008) Children of depressed mothers 1 year after the initiation of maternal treatment: findings from the STAR*D-Child Study. Am J Psychiatry 165(9):1136–1147

    Article  PubMed  Google Scholar 

  • Prinz RJ, Sanders MR, Shapiro CJ, Whitaker DJ, Lutzker JR (2009) Population-based prevention of child maltreatment: the U.S. Triple P system population trial. Prev Sci 10(1):1–12

    Article  PubMed  PubMed Central  Google Scholar 

  • Qin P, Agerbo E, Mortensen PB (2002) Suicide risk in relation to family history of completed suicide and psychiatric disorders: a nested case-control study based on longitudinal registers. Lancet 360(9340):1126–1130

    Article  PubMed  Google Scholar 

  • Qin P, Mortensen PB, Pedersen CB (2009) Frequent change of residence and risk of attempted and completed suicide among children and adolescents. Arch Gen Psychiatry 66(6):628–632

    Article  PubMed  Google Scholar 

  • Samm A, Tooding LM, Sisask M, Kolves K, Aasvee K, Varnik A (2010) Suicidal thoughts and depressive feelings amongst Estonian schoolchildren: effect of family relationship and family structure. Eur Child Adolesc Psychiatry 19(5):457–468

    Article  PubMed  Google Scholar 

  • Sandler IN, Schoenfelder EN, Wolchik SA, MacKinnon DP (2011) Long-term impact of prevention programs to promote effective parenting: lasting effects but uncertain processes. Annu Rev Psychol 62:299–329

    Article  PubMed  PubMed Central  Google Scholar 

  • Selph SS, Bougatsos C, Blazina I, Nelson HD (2013) Behavioral interventions and counseling to prevent child abuse and neglect: a systematic review to update the US preventive services task force recommendation. Ann Intern Med 158(3):179–190

    Article  PubMed  Google Scholar 

  • Shaffer D, Gould MS, Fisher P, Trautman P, Moreau D, Kleinman M, Flory M (1996) Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry 53(4):339–348

    Article  CAS  PubMed  Google Scholar 

  • Southam-Gerow MA, Kendall PC, Weersing VR (2001) Examining outcome variability: correlates of treatment response in a child and adolescent anxiety clinic. J Clin Child Psychol 30(3):422–436

    Article  CAS  PubMed  Google Scholar 

  • Stenager K, Qin P (2008) Individual and parental psychiatric history and risk for suicide among adolescents and young adults in Denmark: a population-based study. Soc Psychiatry Psychiatr Epidemiol 43(11):920–926

    Article  PubMed  Google Scholar 

  • Swartz HA, Frank E, Zuckoff A, Cyranowski JM, Houck PR, Cheng Y, Fleming MA, Grote NK, Brent DA, Shear MK (2008) Brief interpersonal psychotherapy for depressed mothers whose children are receiving psychiatric treatment. Am J Psychiatry 165(9):1155–1162

    Article  PubMed  PubMed Central  Google Scholar 

  • Van Ryzin MJ, Stormshak EA, Dishion TJ (2012) Engaging parents in the family check-up in middle school: longitudinal effects on family conflict and problem behavior through the high school transition. J Adolesc Health 50(6):627–633

    Article  PubMed  PubMed Central  Google Scholar 

  • von Borczyskowski A, Hjern A, Lindblad F, Vinnerljung B (2006) Suicidal behaviour in national and international adult adoptees: a Swedish cohort study. Soc Psychiatry Psychiatr Epidemiol 41(2):95–102

    Article  Google Scholar 

  • Wilcox HC, Kellam SG, Brown CH, Poduska JM, Ialongo NS, Wang W, Anthony JC (2008) The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug Alcohol Depend 95(Suppl 1):S60–S73

    Article  PubMed  PubMed Central  Google Scholar 

  • Wilcox HC, Kuramoto SJ, Brent D, Runeson B (2012) The interaction of parental history of suicidal behavior and exposure to adoptive parents’ psychiatric disorders on adoptee suicide attempt hospitalizations. Am J Psychiatry 169(3):309–315

    Article  PubMed  Google Scholar 

  • Wilcox HC, Kuramoto SJ, Lichtenstein P, Langstrom N, Brent DA, Runeson B (2010) Psychiatric morbidity, violent crime, and suicide among children and adolescents exposed to parental death. J Am Acad Child Adolesc Psychiatry 49(5):514–523; quiz 530

    PubMed  Google Scholar 

  • Wolchik SA, Sandler IN, Tein JY, Mahrer NE, Millsap RE, Winslow E, Velez C, Porter MM, Luecken LJ, Reed A (2013) Fifteen-year follow-up of a randomized trial of a preventive intervention for divorced families: effects on mental health and substance use outcomes in young adulthood. J Consult Clin Psychol 81(4):660–673

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to David A. Brent MD .

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Brent, D.A. (2016). Family Risk Factors for Suicidal Behavior: Opportunities for Early Identification and Intervention. In: Courtet, P. (eds) Understanding Suicide. Springer, Cham. https://doi.org/10.1007/978-3-319-26282-6_30

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  • DOI: https://doi.org/10.1007/978-3-319-26282-6_30

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