The familial aggregation of adolescent suicide attempts

The objective of this study was to determine whether the familial aggregation of suicidal behaviour is explained by the familial aggregation of personality disorder and aggression. The relatives of 62 clinically referred adolescent suicide attempters were compared with 70 never-suicidal psychiatric controls. The first-degree relatives of the suicide attempters had a higher rate of suicide attempts/completion than those of the psychiatric controls. This rate remained significantly higher after controlling for Axis I and II differences in the probands and the relatives, but familial personality disorder was significantly associated with suicidal risk in probands. Among the adolescent attempters, high scores on a measure of assaultiveness were associated with significantly higher familial rates of suicide attempts/completion. Our results support the hypothesis that suicidal behaviour may be transmitted as a trait independent of Axis I and II psychopathology but that, in addition, personality disorder has a role in the transmission of suicidal behaviour. An interrelationship between proband assaultiveness and the familial aggregation of suicidality was noted.     

Risk factors for suicide and attempted suicide among young people

OBJECTIVE: Suicide rates in young people have increased during the past three decades, particularly among young males, and there is increasing public and policy concern about the issue of youth suicide in Australia and New Zealand. This paper summarises current knowledge about risk factors for suicide and suicide attempts in young people. METHOD: Evidence about risk factors for suicidal behaviour in young people was gathered by review of relevant English language articles and other papers, published since the mid-1980s. RESULTS: The international literature yields a generally consistent account of the risk factors and life processes that lead to youth suicide and suicide attempts. Risk factor domains which may contribute to suicidal behaviour include: social and educational disadvantage; childhood and family adversity; psychopathology; individual and personal vulnerabilities; exposure to stressful life events and circumstances; and social, cultural and contextual factors. Frequently, suicidal behaviours in young people appear to be a consequence of adverse life sequences in which multiple risk factors from these domains combine to increase risk of suicidal behaviour. CONCLUSIONS: Current research evidence suggests that the strongest risk factors for youth suicide are mental disorders (in particular, affective disorders, substance use disorders and antisocial behaviours) and a history of psychopathology, indicating that priorities for intervening to reduce youth suicidal behaviours lie with interventions focused upon the improved recognition, treatment and management of young people with mental disorders.     

Peripubertal suicide attempts in offspring of suicide attempters with siblings concordant for suicidal behavior

OBJECTIVE: The authors sought to determine 1) whether the risk for familial transmission of suicidal behavior is greater with increased family loading for suicide attempts, and 2) whether the transmission of suicidal behavior is mediated by impulsive aggression. METHOD: A reanalysis of a high-risk study compared the offspring of three mood disorder proband groups: suicide attempters with a sibling who also attempted suicide (N=19), suicide attempters whose siblings never made a suicide attempt (N=73), and nonsuicidal probands whose siblings also never engaged in suicidal behavior (N=73). Probands and offspring were assessed with respect to psychopathology, suicide attempt history, impulsive aggression, and exposure to familial adversity. RESULTS: Offspring of suicide attempters with siblings concordant for suicidal behavior showed a higher risk of suicide attempt than did offspring of nonsuicidal probands and had an earlier age at onset of suicidal behavior than offspring of suicide attempters with siblings discordant for suicidal behavior. Probands from sibling pairs concordant for suicidal behavior and their offspring reported greater lifetime impulsive aggression compared with each of the other two proband/offspring groups. In the offspring, impulsive aggression was the most powerful predictor of early age at first suicide attempt. CONCLUSIONS: Familial loading for suicide attempts may affect rates of transmission as well as age at onset of suicidal behavior, and its effect may be mediated by the familial transmission of impulsive aggression.     

Familial aggregation of suicidal behavior: a family study of male suicide completers from the general population

OBJECTIVE: This study compared suicidality in families of adult male suicide completers and community comparison subjects. METHOD: Two hundred forty-seven relatives of 25 male suicide completers and 171 relatives of 25 matched comparison subjects were assessed for recurrent risk of suicidal and related behaviors. Analyses were performed on a subgroup of relatives of suicide completers with cluster B personality disorders. RESULTS: Relatives of suicide completers were over 10 times more likely than relatives of comparison subjects to attempt or complete suicide after the authors controlled for psychopathology. Relatives of suicide completers were not more likely to exhibit suicidal ideation but had more severe suicidal ideation than relatives of comparison subjects. These findings were stronger for the suicide completers diagnosed with cluster B personality disorders. CONCLUSIONS: Suicide has a familial component independent of psychopathology that may be mediated by a combination of factors, including more severe suicidal ideation and aggressive behavior.     

Family patterns of psychopathology in psychiatric disorders

ObjectiveFamilial loading and crucial outcomes of family history of psychopathology in psychiatric disorders have long been recognized. There has been ample literature providing convincing evidence for the importance of family psychopathology in development of emotional disturbances in children as well as worse outcomes in the course of psychiatric disorders. More often, maternal psychopathology seems to have been an issue of interest rather than paternal psychopathology while effects of second-degree familiality have received almost no attention. In this study, we addressed the relations between affected first- and second-degree relatives of probands and categories of psychiatric disorders.MethodSubjects were 350 hospitalized psychiatric inpatients, consecutively admitted to psychiatry clinics in Van, Turkey. Mean age was 34.16 (SD ± 12) and 51.4% of the sample consisted of male patients. Assessment of psychopathology in psychiatric probands was conducted based on DSM-IV TR. Familial loading of psychiatric disorders amongst first- and second-degree relatives of patients were initially noted primarily relying on patients' retrospective reports, and confirmed by both phone call and following official health records via the Medical Knowledge System. We analyzed the data using latent class analysis approach.ResultsWe found four patterns of familial psychopathology. Latent homogeneous subsets of patients due to familial characteristics were as paternal kinship psychopathology with schizophrenia, paternal kinship psychopathology with mood disorders, maternal kinship psychopathology and core family psychopathology.ConclusionFamily patterns were critical to exerting variation in psychiatric disorders of probands and affected relatives. Probands with a core family pattern of psychopathology exhibited the most colorful clinical presentations in terms of variation in psychopathology. We observed a specificity of intergenerational transmission of psychiatric disorders when family patterns of psychopathology were taken into consideration, even second-degree relatives of psychiatric probands.     

Familial transmission of suicidal ideation and suicide attempts: evidence from a general population sample

The goals of the study were (1) to determine the association between parental and offspring suicidal ideation and suicide attempts among adult offspring in a general community sample, and (2) to examine the extent to which this association can be explained by mediating processes of mental disorders. Data were drawn from the National Comorbidity Survey (n=8098), a representative household sample of adults aged 15-54 in the United States. The relationships between suicidal ideation and suicide attempts among adult offspring and suicidal ideation and suicide attempt in their parents, compared with those in parents not characterized by suicidal ideation or suicide attempts, were calculated using multiple logistic regression analyses. Analyses were adjusted for differences in sociodemographic characteristics and for mental disorders. Results showed that parental suicidal ideation was associated with a significantly increased likelihood of suicidal ideation [OR=1.7 (1.2, 2.5)] and suicide attempt [OR=1.4 (0.9, 2.1)] among offspring. Parental suicide attempt was associated with increased odds of suicidal ideation [OR=2.0 (1.4, 2.9)] and suicide attempt [OR=2.2 (1.4, 3.4)] among offspring. Comorbid mental disorders contributed to the strength of these associations, but with the exception of the link between parental suicidal ideation and offspring suicide attempt, all remained statistically significant even after adjustment. These data provide initial evidence of familial linkages (parent-offspring) of suicidal ideation and behavior among a sample of adults representative of the US population. The data suggest that comorbid mental disorders contribute to these associations but do not completely account for them. The findings are consistent with and extend results from family, clinical, and high-risk studies suggesting that a familial risk of suicidal ideation and suicide behavior occurs in the general population. Implications for prevention and future research are discussed.     

Familial pathways to early-onset suicide attempt: risk for suicidal behavior in offspring of mood-disordered suicide attempters

BACKGROUND: Although adoption, twin, and family studies have shown that suicidal behavior is familial, the risk factors for familial transmission from parent to child remain unclear. METHODS: A high-risk family study was conducted comparing the offspring of 2 mood-disordered groups: suicide attempters and nonattempters. Recruited from 2 sites, probands were 81 attempters and 55 nonattempters, with 183 and 116 offspring, respectively. Offspring were assessed by investigators masked to proband status. Probands and offspring were assessed with respect to psychopathologic findings, suicide attempt history, impulsive aggression, and exposure to familial environmental stressors. RESULTS: Offspring of attempters had a 6-fold increased risk of suicide attempts relative to offspring of nonattempters. Familial transmission of suicide attempt was more likely if (1) probands had a history of sexual abuse and (2) offspring were female and had a mood disorder, substance abuse disorder, increased impulsive aggression, and a history of sexual abuse. CONCLUSIONS: The offspring of mood-disordered suicide attempters are at markedly increased risk for suicide attempts themselves. Familial transmission of suicidal behavior in families with mood disorders almost always requires transmission of a mood disorder and is also related to the offspring's impulsive aggression and the familial transmission of sexual abuse. Early treatment of mood disorders and targeting impulsive aggression and sexual trauma may be helpful in the prevention and treatment of suicidal behavior in families with mood disorders.     

Suicide attempts in an adolescent female twin sample.

OBJECTIVE: To examine suicide attempts in an epidemiologically and genetically informative youth sample. METHOD: 3,416 Missouri female adolescent twins (85% participation rate) were interviewed from 1995 to 2000 with a telephone version of the Child Semi-Structured Assessment for the Genetics of Alcoholism, which includes a detailed suicidal behavior section. Mean age was 15.5 years at assessment. RESULTS: At least one suicide attempt was reported by 4.2% of the subjects. First suicide attempts were all made before age 18 (and at a mean age of 13.6). Major depressive disorder, alcohol dependence, childhood physical abuse, social phobia, conduct disorder, and African-American ethnicity were the factors most associated with a suicide attempt history. Suicide attempt liability was familial, with genetic and shared environmental influences together accounting for 35% to 75% of the variance in risk. The twin/cotwin suicide attempt odds ratio was 5.6 (95% confidence interval [CI] 1.75-17.8) for monozygotic twins and 4.0 (95% CI 1.1 -14.7) for dizygotic twins after controlling for other psychiatric risk factors. CONCLUSIONS: In women, the predisposition to attempt suicide seems usually to manifest itself first during adolescence. The data show that youth suicide attempts are familial and possibly influenced by genetic factors, even when controlling for other psychopathology.     

Comorbidity patterns in adolescents and young adults with suicide attempts

The role of comorbidity as a risk for suicide attempts is investigated in a random sample of 3021 young adults aged 14–24 years. The M-CIDI, a fully standardized and modified version of the Composite International Diagnostic Interview, was used for the assessment of various DSM-IV lifetime and 12-month diagnoses as well as suicidal ideation and suicide attempts. Of all suicide attempters, 91% had at least one mental disorder, 79% were comorbid or multimorbid respectively and 45% had four or more diagnoses (only 5% in the total sample reached such high levels of comorbidity). Suicide attempters with more than three diagnoses were 18 times more likely (OR = 18.4) to attempt suicide than subjects with no diagnosis. Regarding specific diagnoses, multivariate comorbidity analyses indicated the highest risk for suicide attempt in those suffering from anxiety disorder (OR = 4.3), particularly posttraumatic stress disorder followed by substance disorder (OR = 2.2) and depressive disorder (OR = 2.1). Comorbidity, especially when anxiety disorders are involved, increases the risk for suicide attempts considerably more than any other individual DSM-IV diagnoses. Received: 17 July 1997 / Accepted: 15 December 1997     

Adolescent/Adult Differences in Suicidal Behavior and Outcome

A comprehensive literature review compared the patterns of suicide and suicidal behavior for adolescents and adults to identify age-related similarities and differences. Particular attention was given to follow-up rates of suicide by psychiatrically treated persons in these age groups. The major findings were that (1) adults and adolescent suicide completers were similar with respect to their gender ratio, use of guns in the attempt, completion of the initial attempt, and serious psychopathology; (2) adolescents differed from adults in suicidal behavior in their greater attempt rate, higher attempt/completion ratio, and lower rates of short and intermediate completion following psychiatric treatment; (3) the suicide outcome following psychiatric hospitalization is eightfold greater in adults than in youths during the first 3.5 years post-discharge; and (4) the 5:1 male/female ratio is the same for both adolescent attempters who later suicide and for all U.S. 15–19-year-old suicide completers. The frequent practice of combining adult and adolescent suicide and suicide behavior findings can result in misleading conclusions.     

Repetition of attempted suicide among teenagers in Europe: frequency, timing and risk factors

Background. Adolescents in many countries show high rates of suicide attempts and repetitions of attempts as a common feature. Attempted suicide is the best predictor of future suicide. Repetition of attempts further increases the risk of suicide. The present study sought to identify patterns and risk factors for repetition of attempts in older teenagers. Methods. Data were collected by uniform procedures in a longitudinal follow-up study in seven European centres participating in the WHO/EURO Multicentre Study on Suicidal Behaviour. Information on attempted suicide in the 15–19-year age group during the period 1989–1995 was analysed. Results. A total of 1,720 attempts by 1,264 individuals over a mean follow-up period of 204 weeks (SD 108.9) were recorded. When life-table analysis was performed, 24 % of the individuals who had previously attempted suicide made another attempt within one year after the index attempt, compared with 6.8 % of the “first-evers”, with no major gender difference. Cox regression analysis revealed that previous attempted suicide (OR 3.3, 95 % CI 2.4–4.4) and use of “hard” methods (OR 1.5, 95 % CI 1.1–2.1) were both significantly associated with repetition of attempted suicide. Stepwise Cox regression analysis showed that a history of previous attempted suicide was the most important independent predictor of repetition (OR 3.2, 95 % CI 2.4–4.4). Conclusion. For young suicide attempters, follow-up and adequate aftercare are very important if repetition and risk of suicide are to be reduced. This applies particularly to those who have already made more than one attempt. Accepted: 19 February 2001     

Adolescent problem behaviours predicting DSM-IV diagnoses of multiple substance use disorder

Background Whether there is an independent association between problem behaviours and substance use disorders (SUD) needs further investigation. This study examined prospective associations of adolescent psychopathology and problem behaviours with SUD in early adulthood, and whether these associations are confounded by other factors. Method Data were from a prospective study of 2,429 young Australian adults from birth to the age of 21 when data on SUD were collected. Adolescent psychopathology and behaviour were assessed at 14 years via the Youth Self Report instrument on eight sub-scales of emotional and behavioural problems. Results In multivariate analyses, attention problems, delinquency, and aggression were associated with both single and multiple SUD in early adulthood, with delinquent behaviour being the strongest predictor (OR = 2.0, 95% CI 1.4–2.9 for one SUD and OR = 3.6, 95% CI 2.4–5.0 for multiple SUDs). Conclusions Problem behaviours, in particular delinquency and aggression in early adolescence predict long-term SUD. The results suggest that substance use prevention programs should target adolescents with early symptoms of psychopathology and problem behaviour.     

Mental disorders and risk of suicide attempt in prisoners

Background

Mental disorders are overrepresented in prisoners, placing them at an increased risk of suicide. Advancing our understanding of how different mental disorders relate to distinct stages of the suicidal process—the transition from ideation to action—would provide valuable information for clinical risk assessment in this high-risk population.

Methods

Data were drawn from a representative sample of 1212 adults (1093 men) incarcerated across 13 New Zealand prisons, accounting for 14% of the national prison population. Guided by an ideation-to-action framework, three mutually exclusive groups of participants were compared on the presence of mental disorders assessed by validated DSM-IV diagnostic criteria: prisoners without any suicidal history (controls; n = 778), prisoners who thought about suicide but never made a suicide attempt (ideators; n = 187), and prisoners who experienced suicidal ideation and acted on such thoughts (attempters; n = 247).

Results

One-third (34.6%) of participants reported a lifetime history of suicidal ideation, of whom 55.6% attempted suicide at some point (19.2% of all prisoners). Suicidal outcomes in the absence of mental disorders were rare. Whilst each disorder increased the odds of suicidal ideation (OR range 1.73–4.13) and suicide attempt (OR range 1.82–4.05) in the total sample (n = 1212), only a select subset of disorders was associated with suicide attempt among those with suicidal ideation (n = 434). Drug dependence (OR 1.65, 95% CI 1.10–2.48), alcohol dependence (OR 1.89, 95% CI 1.26–2.85), and posttraumatic stress disorder (OR 2.09, 95% CI 1.37–3.17) distinguished attempters from ideators.

Conclusion

Consistent with many epidemiological studies in the general population, our data suggest that most mental disorders are best conceptualized as risk factors for suicidal ideation rather than for suicide attempt. Once prisoners consider suicide, other biopsychosocial factors beyond the mere presence of mental disorders may account for the progression from thoughts to acts of suicide.

     

Suicidal behaviour in national and international adult adoptees

Background Previous studies have shown an elevated risk for suicidal behaviour in adolescent and young adult international adoptees. Comparisons between national and international adoptees in this respect have been inconclusive. Methods A total of 6,065 international adoptees were compared to 7,340 national adoptees and 1,274,312 non-adopted study subjects, all born between 1963 and 1973 and followed up until 2002 using the National Swedish Registers. Cox regression of person years was used in multivariate analyses to compare risks for suicide death and suicide attempt. Results International adoptees had clearly increased risks for suicide attempt (risk ratio 4.5 [95% confidence interval 3.7–5.5]) and suicide death (3.6 [2.6–5.2]) after adjustments for sex, age and socio-economic factors. National adoptees had lower risks than international adoptees, but had increased risks compared to non-adoptees (suicide attempt, 2.8 [2.2–3.5]; suicide death, 2.5 [1.8–3.3]). Biological parents' morbidity explained approximately one third of the increased risk for national adoptees. Female international adoptees' risk for suicide attempt was elevated to an even greater extent than in male international adoptees, when compared to the general population. Conclusions Clinicians should be aware that an increased risk for suicide and suicide attempts in international adoptees is a topic that is equally relevant to child and adult psychiatry.     

Substance use disorders and suicide attempts in bipolar subtypes

Bipolar disorder (BD) is associated with high rates of suicide attempt and completion. Substance use disorders (SUD) have been identified as potent risk factors for suicidal behavior in BD. However, little is known concerning differences between BD subtypes with regard to SUD as a risk factor for suicidal behavior. We studied previous suicidal behavior in adults with a major depressive episode in context of BD type I (BD-I; N = 96) or BD type II (BD-II; N = 42), with and without history of SUD. Logistic regressions assessed the association between SUD and suicide attempt history by BD type, and exploratory analyses examined the effects of other clinical characteristics on these relationships. SUD were associated with suicide attempt in BD-I but not BD-II, an effect not attributable to sample size differences. The higher suicide attempt rate associated with alcoholism in BD-I was mostly explained by higher aggression scores, and earlier age of BD onset increased the likelihood that alcohol use disorder would be associated with suicide attempt(s). The higher suicide attempt rate associated with other drug use disorders in BD-I was collectively explained by higher impulsivity, hostility, and aggression scores. The presence of both alcohol and drug use disorders increased odds of a history of suicide attempt in a multiplicative fashion: 97% of BD-I who had both co-morbid drug and alcohol use disorders had made a suicide attempt. A critical next question is how to target SUD and aggressive traits for prevention of suicidal behavior in BD-I.     

Proximal psychiatric risk factors for suicidality in youth: the Great Smoky Mountains Study

CONTEXT: Psychiatric disorder is a major risk factor for suicidality but has poor positive predictive value. OBJECTIVES: To characterize proximal risks for suicidality associated with anxiety, depressive, disruptive behavior, and substance use disorders, and to test whether there are critical combinations of disorders that discriminate at-risk youth independent of severity of psychopathology. DESIGN: The Great Smoky Mountains Study, a representative sample of children and adolescents aged 9 to 16 years from the southeastern United States. Subjects and their parents were interviewed on multiple occasions from 1993 to 2000 about the subjects' recent psychiatric and suicidal history. SETTING: An epidemiological sample of youth. PARTICIPANTS: The sample included 1420 individual subjects with 6676 records across 8 waves of data collection. MAIN OUTCOME MEASURES: Wanting to die, suicidal ideation, suicide plans, or suicide attempt during the past 3 months. RESULTS: Eleven broad psychiatric profiles discriminated suicidal youth. Risk was greatest in association with current depression plus anxiety (specifically GAD [generalized anxiety disorder]) (odds ratio, 468.53) or depression plus a disruptive disorder (primarily ODD [oppositional-defiant disorder]) (odds ratio, 222.94). Unless comorbid, anxiety and substance use disorders were not proximally associated with suicidality. The severity of symptom-related impairment and, in some cases, total symptom load explained risk associated with all psychiatric profiles except depression plus anxiety, specifically GAD (adjusted odds ratio, 50.16). Severity of impairment and poverty defined by federal guidelines for families were both independent risk factors, irrespective of psychiatric profile. Suicidal youth without diagnosable disorders had subthreshold (mostly disruptive) disorders, disabling relationship difficulties, or psychiatric symptoms without associated impairment. CONCLUSIONS: Severity of symptom-related impairment and total symptom load explained most of the risk for suicidality associated with current psychiatric disorders. Only depression plus GAD discriminated at-risk youth independent of severity of psychopathology.     

Parent of origin effect and allelic expression imbalance of the serotonin transporter in bipolar disorder and suicidal behaviour

Suicide and suicidal behaviour are a major health concern worldwide particularly in patients with mood disorders. Family, adoption and twin studies show that genetics influences suicidal behaviour. The serotonin transporter (5HTT) plays an important role in the pathophysiology of mood disorders and may also be involved in suicidal behaviour since 5HTT binding is decreased in the brain of suicide completers. Because the effect of genomic imprinting in the 5HTT gene on suicidal behaviour has not been investigated, we analysed the parent-of-origin effect (POE) of four 5HTT markers and the differential expression of the 5HTT G2651T (rs1042173) alleles in suicide attempters affected by bipolar disorder. We performed a family based association study and ETDT/QTDT analyses of the rs25531, HTTLPR, VNTR-2 and G2651T polymorphisms in 312 nuclear families with at least one subject affected by bipolar disorder. The main outcomes investigated in this study are bipolar disorder diagnosis, suicide attempts, suicidal behaviour severity and age at onset of bipolar disorder. We also compared the allele-specific mRNA levels in lymphoblastoid cells from 13 bipolar suicide attempters and 8 bipolar non-suicide attempters. Allele 2651T was transmitted significantly more often to bipolar patients (P = 0.042). There was no significant difference between maternal and paternal transmission ratios. Furthermore, there was no significant difference in the ratio of T/G-specific mRNA expression between bipolar attempters and non-attempters. These data do not support a role for differential allelic expression of 5HTT for suicidal behaviour in bipolar disorder. Small sample size and the fact that RNA was obtained from lymphoblastoid cell lines were some of the limitations of this study.     

Risk factors for suicidal ideation in psychiatric patients

Sociodemographic and clinical risk factors for suicidal ideation have been less studied than risk factors for parasuicide and suicide. No reports on associations between therapy satisfaction and suicidal ideation among psychiatric patients have been published. In this study we compared a group of patients with suicidal ideation (n= 84) with a randomly selected group of nonsuicidal patients (n = 166) in community-based psychiatric services. Patients with suicidal ideation felt a need for psychiatric treatment more often than nonsuicidal patients. They were also more likely to receive antidepressive medication, and weekly therapy sessions were more common among them. A wish to change therapist (OR 15.6, 95% CI 3.6–67.8), hopeless future orientation (OR 14.8, 95% CI 4.5–48.9), severe depression as evaluated by the Beck Depression Inventory (OR 14.0, 95% CI 4.3–45.2) and dysthymia (OR 12.8, 95% CI 1.7–97.3) were the factors most strongly associated with suicidal ideation in multivariate analysis. A wish to change therapist is an expression of therapy dissatisfaction, which may therefore be among the factors most strongly associated with suicidal ideation in psychiatric patients. To help prevent suicidality among psychiatric patients special attention to therapy factors is needed. Accepted: 15 September 1997     

Relationship between parental psychopathology,parenting strategies and child mental health

Background Parental and child psychiatric disorders have been found to be associated, and this association can be mediated by other psychosocial variables, including parenting attitudes and strategies. As most previous studies included clinical samples, the purpose of this study was to establish the relationship between parental psychopathology and parenting strategies with child psychiatric disorders in a national survey population. Methods The sample included 10,438 children of 5–15 years and their parents, from representative UK households. Families were assessed on child psychiatric diagnosis, parental psychopathology, family functioning, and socioeconomic status. Parenting strategies included using rewards, physical and non-physical punishments towards their child. Findings Parental psychopathology scores (OR 3.99, 95% CI 3.13–5.09) and non-physical punishment (OR 1.50, 95% CI 1.27–1.76) were associated with child psychiatric disorders. This association was particularly prominent among children with conduct disorders: parental psychopathology scores (OR 3.13, 95% CI 2.28–4.30) and non-physical punishment (OR 3.19, 95% CI 2.55–3.97). Absence of child psychopathology was associated with a combination of rewarding and non-punitive parenting strategies. Conclusions Although parents in the general population may be using less physical strategies than in the past, non-physical punishment is strongly related to mental health problems in children. Enhancement of positive parenting through universal and targeted interventions is an important preventive strategy.     

Parent–youth conflict as a predictor of depression in adulthood: a 15-year follow-up of a community-based cohort

Experiencing conflictual relations with one’s parents while growing up has been linked to onset, recurrence, and worse treatment outcome of adolescent depression. While this suggests that significant problems in the parent–youth relationship make depressive disorders more relentless, it is not clear whether this effect lasts into adulthood. Our aim was to examine if major and minor conflict with parents while growing up predicts depression in adulthood in youth with and without a history of depression. We utilized data from the Uppsala Longitudinal Adolescent Depression Study. This community-based cohort was assessed with structured diagnostic interviews both at age 16–17 and at follow-up 15 years later. The analyses included 382 individuals (227 with a history of child or adolescent depression; 155 peers without such a history). Binary logistic regression was used, adjusting for sex, disruptive behavior disorders, and additional family-related adversities. Among individuals with adolescent depression, major conflict with parents was strongly associated with adult depression (adjusted OR 2.28, 95% CI 1.07–4.87). While major conflict with parents was rare among non-depressed controls, a non-significant association of similar magnitude was still observed. Minor conflict, on the other hand, was not significantly associated with adult depression. Overall, conflict with parents did not predict adult anxiety disorders, substance use, suicidal behavior, somatoform disorders, or psychotic disorders. In conclusion, major parent–youth conflict during upbringing seems to be linked with an increased risk of depression in adulthood. These findings underscore the need to consider contextual/familial factors in the prevention and clinical management of early-life depression.