Skip to main content
×
Home
    • Aa
    • Aa

Familial clustering of suicide risk: a total population study of 11.4 million individuals

  • D. Tidemalm (a1), B. Runeson (a1), M. Waern (a2), T. Frisell (a3) (a4), E. Carlström (a3), P. Lichtenstein (a3) and N. Långström (a3) (a4)...
Abstract
Background

Research suggests that suicidal behaviour is aggregated in families. However, due to methodological limitations, including small sample sizes, the strength and pattern of this aggregation remains uncertain.

Method

We examined the familial clustering of completed suicide in a Swedish total population sample. We linked the Cause of Death and Multi-Generation Registers and compared suicide rates among relatives of all 83 951 suicide decedents from 1952–2003 with those among relatives of population controls.

Results

Patterns of familial aggregation of suicide among relatives to suicide decedents suggested genetic influences on suicide risk; the risk among full siblings (odds ratio 3.1, 95% confidence interval 2.8–3.5, 50% genetic similarity) was higher than that for maternal half-siblings (1.7, 1.1–2.7, 25% genetic similarity), despite similar environmental exposure. Further, monozygotic twins (100% genetic similarity) had a higher risk than dizygotic twins (50% genetic similarity) and cousins (12.5% genetic similarity) had higher suicide risk than controls. Shared (familial) environmental influences were also indicated; siblings to suicide decedents had a higher risk than offspring (both 50% genetically identical but siblings having a more shared environment, 3.1, 2.8–3.5 v. 2.0, 1.9–2.2), and maternal half-siblings had a higher risk than paternal half-siblings (both 50% genetically identical but the former with a more shared environment). Although comparisons of twins and half-siblings had overlapping confidence intervals, they were supported by sensitivity analyses, also including suicide attempts.

Conclusions

Familial clustering of suicide is primarily influenced by genetic and also shared environmental factors. The family history of suicide should be considered when assessing suicide risk in clinical settings or designing and administering preventive interventions.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Familial clustering of suicide risk: a total population study of 11.4 million individuals
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Familial clustering of suicide risk: a total population study of 11.4 million individuals
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Familial clustering of suicide risk: a total population study of 11.4 million individuals
      Available formats
      ×
Copyright
The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence . The written permission of Cambridge University Press must be obtained for commercial re-use.
Corresponding author
*Address for correspondence: Dr D. Tidemalm, Department of Clinical Neuroscience, Karolinska Institutet, Division of Psychiatry, St Göran, SE-112 81 Stockholm, Sweden. (Email: dag.tidemalm@ki.se)
References
Hide All
Agerbo E (2005). Midlife suicide risk, partner's psychiatric illness, spouse and child bereavement by suicide or other modes of death: a gender specific study. British Medical Journal 59, 407.
Agerbo E, Nordentoft M, Mortensen PB (2002). Familial, psychiatric, and socioeconomic risk factors for suicide in young people: nested case-control study. British Medical Journal 325, 74.
Baldessarini RJ, Hennen J (2004). Genetics of suicide: an overview. Harvard Review of Psychiatry 12, 113.
Baud P (2005). Personality traits as intermediary phenotypes in suicidal behavior: genetic issues. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics 133C, 3442.
Bertolote JM, Fleischmann A (2005). Suicidal behavior prevention: WHO perspectives on research. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics 133C, 8–12.
Bondy B, Buettner A, Zill P (2006). Genetics of suicide. Molecular Psychiatry 11, 336351.
Brent D (2010). What family studies teach us about suicidal behavior: implications for research, treatment, and prevention. European Psychiatry 25, 260263.
Brent DA, Bridge J, Johnson BA, Connolly J (1996). Suicidal behavior runs in families. A controlled family study of adolescent suicide victims. Archives of General Psychiatry 53, 11451152.
Brent DA, Mann JJ (2005). Family genetic studies, suicide, and suicidal behavior. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics 133C, 1324.
Brent DA, Mann JJ (2006). Familial pathways to suicidal behavior – understanding and preventing suicide among adolescents. New England Journal of Medicine 355, 27192721.
Brent DA, Melhem N (2008). Familial transmission of suicidal behavior. Psychiatric Clinics of North America 31, 157177.
Brezo J, Bureau A, Merette C, Jomphe V, Barker ED, Vitaro F, Hebert M, Carbonneau R, Tremblay RE, Turecki G (2010). Differences and similarities in the serotonergic diathesis for suicide attempts and mood disorders: a 22-year longitudinal gene-environment study. Molecular Psychiatry 15, 831843.
Brezo J, Klempan T, Turecki G (2008). The genetics of suicide: a critical review of molecular studies. Psychiatric Clinics of North America 31, 179203.
Burke AK, Galfalvy H, Everett B, Currier D, Zelazny J, Oquendo MA, Melhem NM, Kolko D, Harkavy-Friedman JM, Birmaher B, Stanley B, Mann JJ, Brent DA (2010). Effect of exposure to suicidal behavior on suicide attempt in a high-risk sample of offspring of depressed parents. Journal of the American Academy of Child and Adolescent Psychiatry 49, 114121.
Currier D, Mann JJ (2008). Stress, genes and the biology of suicidal behavior. Psychiatric Clinics of North America 31, 247269.
Dinwiddie S, Heath AC, Dunne MP, Bucholz KK, Madden PA, Slutske WS, Bierut LJ, Statham DB, Martin NG (2000). Early sexual abuse and lifetime psychopathology: a co-twin-control study. Psychological Medicine 30, 4152.
Ernst C, Mechawar N, Turecki G (2009). Suicide neurobiology. Progress in Neurobiology 89, 315333.
Fergusson DM, Horwood LJ, Miller AL, Kennedy MA (2011). Life stress, 5-HTTLPR and mental disorder: findings from a 30-year longitudinal study. British Journal of Psychiatry 198, 129135.
Frisell T, Lichtenstein P, Långström N (2011). Violent crime runs in families: a total population study of 12.5 million individuals. Psychological Medicine 41, 97–105.
Frisell T, Pawitan Y, Långström N, Lichtenstein P (in press). Heritability, assortative mating and gender differences in violent crime: results from a total population sample using twin, adoption, and sibling models. Behavior Genetics.
Fu Q, Heath AC, Bucholz KK, Nelson EC, Glowinski AL, Goldberg J, Lyons MJ, Tsuang MT, Jacob T, True MR, Eisen SA (2002). A twin study of genetic and environmental influences on suicidality in men. Psychological Medicine 32, 1124.
Glowinski AL, Bucholz KK, Nelson EC, Fu Q, Madden PA, Reich W, Heath AC (2001). Suicide attempts in an adolescent female twin sample. Journal of the American Academy of Child and Adolescent Psychiatry 40, 13001307.
Hawton K, van Heeringen K (2009). Suicide. Lancet 373, 13721381.
Kendler KS (2010). Genetic and environmental pathways to suicidal behavior: reflections of a genetic epidemiologist. European Psychiatry 25, 300303.
Kety SS, Rosenthal D, Wender PH, Schulsinger F (1968). The types and prevalence of mental illness in the biological and adoptive families of adopted schizophrenics. Journal of Psychiatric Research 6, 345362.
Kim CD, Seguin M, Therrien N, Riopel G, Chawky N, Lesage AD, Turecki G (2005). Familial aggregation of suicidal behavior: a family study of male suicide completers from the general population. American Journal of Psychiatry 162, 10171019.
Lichtenstein P, Yip BH, Björk C, Pawitan Y, Cannon TD, Sullivan PF, Hultman CM (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet 373, 234239.
Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A (2009). The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. European Journal of Epidemiology 24, 659667.
McGirr A, Alda M, Seguin M, Cabot S, Lesage A, Turecki G (2009). Familial aggregation of suicide explained by cluster B traits: a three-group family study of suicide controlling for major depressive disorder. American Journal of Psychiatry 166, 11241134.
McGirr A, Turecki G (2007). The relationship of impulsive aggressiveness to suicidality and other depression-linked behaviors. Current Psychiatry Reports 9, 460466.
Magnusson PK, Gunnell D, Tynelius P, Davey Smith G, Rasmussen F (2005). Strong inverse association between height and suicide in a large cohort of Swedish men: evidence of early life origins of suicidal behavior? American Journal of Psychiatry 162, 13731375.
Mann JJ, Arango VA, Avenevoli S, Brent DA, Champagne FA, Clayton P, Currier D, Dougherty DM, Haghighi F, Hodge SE, Kleinman J, Lehner T, McMahon F, Moscicki EK, Oquendo MA, Pandey GN, Pearson J, Stanley B, Terwilliger J, Wenzel A (2009). Candidate endophenotypes for genetic studies of suicidal behavior. Biological Psychiatry 65, 556563.
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. American Journal of Psychiatry 162, 1672–9.
Mittendorfer-Rutz E, Rasmussen F, Wasserman D (2004). Restricted fetal growth and adverse maternal psychosocial and socioeconomic conditions as risk factors for suicidal behaviour of offspring: a cohort study. Lancet 364, 11351140.
Mittendorfer-Rutz E, Rasmussen F, Wasserman D (2008). Familial clustering of suicidal behaviour and psychopathology in young suicide attempters. A register-based nested case control study. Social Psychiatry and Psychiatric Epidemiology 43, 2836.
National Board of Health and Welfare (2010). Causes of death 2008. National Board of Health and Welfare: Stockholm, Sweden.
Neeleman J, Wessely S (1997). Changes in classification of suicide in England and Wales: time trends and associations with coroners' professional backgrounds. Psychological Medicine 27, 467472.
Pedersen NL, Fiske A (2010). Genetic influences on suicide and nonfatal suicidal behavior: twin study findings. European Psychiatry 25, 264267.
Purcell SM, Wray NR, Stone JL, Visscher PM, O'Donovan MC, Sullivan PF, Sklar P (2009). Common polygenic variation contributes to risk of schizophrenia and bipolar disorder. Nature 460, 748752.
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, 11261130.
Qin P, Agerbo E, Mortensen PB (2003). Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. American Journal of Psychiatry 160, 765772.
Riordan DV, Selvaraj S, Stark C, Gilbert JS (2006). Perinatal circumstances and risk of offspring suicide. Birth cohort study. British Journal of Psychiatry 189, 502507.
Roy A (2002). Childhood trauma and neuroticism as an adult: possible implication for the development of the common psychiatric disorders and suicidal behaviour. Psychological Medicine 32, 14711474.
Roy A, Rylander G, Sarchiapone M (1997). Genetics of suicides. Family studies and molecular genetics. Annals of the New York Academy of Sciences 836, 135157.
Roy A, Sarchiopone M, Carli V (2009). Gene-environment interaction and suicidal behavior. Journal of Psychiatric Practice 15, 282288.
Rujescu D, Thalmeier A, Moller HJ, Bronisch T, Giegling I (2007). Molecular genetic findings in suicidal behavior: what is beyond the serotonergic system? Archives of Suicide Research 11, 1740.
Runeson B, Åsberg M (2003). Family history of suicide among suicide victims. American Journal of Psychiatry 160, 15251526.
Runeson BS (1998). History of suicidal behaviour in the families of young suicides. Acta Psychiatrica Scandinavica 98, 497501.
Schulsinger F, Kety SS, Rosenthal D, Wender PH (1979). A family study of suicide. In Origins, Prevention, and Treatment of Affective Disorders (ed. Schou S. E.), pp. 277–87. Academic: New York.
Segal NL (2009). Suicidal behaviors in surviving monozygotic and dizygotic co-twins: is the nature of the co-twin's cause of death a factor? Suicide and Life-Threatening Behavior 39, 569575.
Statham DJ, Heath AC, Madden PA, Bucholz KK, Bierut L, Dinwiddie SH, Slutske WS, Dunne MP, Martin NG (1998). Suicidal behaviour: an epidemiological and genetic study. Psychological Medicine 28, 839855.
Turecki G (2001). Suicidal behavior: is there a genetic predisposition? Bipolar Disorders 3, 335349.
Wasserman D, Geijer T, Sokolowski M, Rozanov V, Wasserman J (2007). Nature and nurture in suicidal behavior, the role of genetics: some novel findings concerning personality traits and neural conduction. Physiology & Behavior 92, 245249.
Wasserman D, Terenius L, Wasserman J, Sokolowski M (2010). The 2009 Nobel conference on the role of genetics in promoting suicide prevention and the mental health of the population. Molecular Psychiatry 15, 1217.
Wender PH, Kety SS, Rosenthal D, Schulsinger F, Ortmann J, Lunde I (1986). Psychiatric disorders in the biological and adoptive families of adopted individuals with affective disorders. Archives of General Psychiatry 43, 923929.
von Borczyskowski A, Lindblad F, Vinnerljung B, Reintjes R, Hjern A (2010). Familial factors and suicide: an adoption study in a Swedish National Cohort. Psychological Medicine, 110.
Voracek M, Loibl LM (2007). Genetics of suicide: a systematic review of twin studies. Wiener Klinische Wochenschrift 119, 463475.
Voracek M, Loibl LM (2008). Consistency of immigrant and country-of-birth suicide rates: a meta-analysis. Acta Psychiatrica Scandinavica 118, 259271.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 14
Total number of PDF views: 178 *
Loading metrics...

Abstract views

Total abstract views: 7250 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th October 2017. This data will be updated every 24 hours.