Time to Hospitalization for Suicide Attempt by the Timing of Parental Suicide During Offspring Early Development

Context: Previous studies have suggested that children who experience parental suicide at earlier ages are at higher risk of future hospitalization for suicide attempt. However, how the trajectories of risk differ by offspring age at the time of parental suicide is currently unknown. Objective: To study time at risk to suicide attempt hospitalization among offspring of suicide decedents as compared with offspring of unintentional injury decedents by their developmental period at the time of parental death. Design: Population-based retrospective cohort study. Setting: Sweden. Participants: Twenty-six thousand ninety-six offspring who experienced parental suicide and 32 395 offspring of unintentional injury decedents prior to age 25 years between the years 1973 and 2003. Main Outcome Measure: Parametric survival analysis was used to model the time to hospitalization for suicide attempt among offspring who lost a parent during early childhood (0-5 years old), later childhood (6-12 years old), adolescence (13-17 years old), and young adulthood (18-24 years old). Results: 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. Offspring who lost a parent during adolescence or young adulthood were at greatest risk within 1 to 2 years after parental death, and risk declined over time. Offspring 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. Conclusions: The hospitalization risk for suicide attempt in offspring who lost a parent during their childhood is different from those who lost a parent later in development. The results suggest critical windows for careful monitoring and intervention for suicide attempt risk, especially 1 to 2 years after parental death for the older age groups and over decades for childhood survivors of parental death. JAMA Psychiatry. 2013;70(2):149-157. Published online December 10, 2012. doi:10.1001/jamapsychiatry.2013.274