Parental psychopathology and the risk of suicidal behavior in their offspring: results from the World Mental Health surveys.

Previous research suggests that parental psychopathology predicts suicidal behavior among offspring; however, the more fine-grained associations between specific parental disorders and distinct stages of the pathway to suicide are not well understood. We set out to test the hypothesis that parental disorders associated with negative mood would predict offspring suicide ideation, whereas disorders characterized by impulsive aggression (for example, antisocial personality) and anxiety/agitation (for example, panic disorder) would predict which offspring act on their suicide ideation and make a suicide attempt. Data were collected during face-to-face interviews conducted on nationally representative samples (N=55 299; age 18+) from 21 countries around the world. We tested the associations between a range of parental disorders and the onset and persistence over time (that is, time since most recent episode controlling for age of onset and time since onset) of subsequent suicidal behavior (suicide ideation, plans and attempts) among offspring. Analyses tested bivariate and multivariate associations between each parental disorder and distinct forms of suicidal behavior. Results revealed that each parental disorder examined increased the risk of suicide ideation among offspring, parental generalized anxiety and depression emerged as the only predictors of the onset and persistence (respectively) of suicide plans among offspring with ideation, whereas parental antisocial personality and anxiety disorders emerged as the only predictors of the onset and persistence of suicide attempts among ideators. A dose-response relation between parental disorders and respondent risk of suicide ideation and attempt was also found. Parental death by suicide was a particularly strong predictor of persistence of suicide attempts among offspring. These associations remained significant after controlling for comorbidity of parental disorders and for the presence of mental disorders among offspring. These findings should inform future explorations of the mechanisms of intergenerational transmission of suicidal behavior.

Is sexual orientation related to mental health problems and suicidality in young people?

BACKGROUND: This study examines the extent to which gay, lesbian, and bisexual young people are at increased risk of psychiatric disorder and suicidal behaviors using data gathered on a New Zealand birth cohort studied to age 21 years. METHODS: Data were gathered during the course of the Christchurch Health and Development Study, a 21-year longitudinal study of a birth cohort of 1265 children born in Christchurch, New Zealand. At 21 years of age, 1007 sample members were questioned about their sexual orientation and relationships with same-sex partners since the age of 16 years. Twenty-eight subjects (2.8%) were classified as being of gay, lesbian, or bisexual sexual orientation. Over the period from age 14 to 21 years, data were gathered on a range of psychiatric disorders that included major depression, generalized anxiety disorder, conduct disorder, and substance use disorders. Data were also gathered on suicidal ideation and suicide attempts. RESULTS: Gay, lesbian, and bisexual young people were at increased risks of major depression (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.8-9.3), generalized anxiety disorder (OR, 2.8; 95% CI, 1.2-6.5), conduct disorder (OR, 3.8; 95% CI, 1.7-8.7), nicotine dependence (OR, 5.0; 95%, CI, 2.3-10.9), other substance abuse and/or dependence (OR, 1.9; 95% CI, 0.9-4.2), multiple disorders (OR, 5.9; 95% CI, 2.4-14.8), suicidal ideation (OR, 5.4; 95% CI, 2.4-12.2), and suicide attempts (OR, 6.2; 95% CI, 2.7-14.3). CONCLUSIONS: Findings support recent evidence suggesting that gay, lesbian, and bisexual young people are at increased risk of mental health problems, with these associations being particularly evident for measures of suicidal behavior and multiple disorder.

Relationship between dissociation, childhood sexual abuse, childhood physical abuse, and mental illness in a general population sample.

OBJECTIVE: The aim of this study was to examine the relationship between childhood sexual abuse, childhood physical abuse, current psychiatric illness, and measures of dissociation in an adult population. METHOD: The authors used a randomly selected sample of 1,028 individuals. Each subject completed a semistructured face-to-face interview that included measures of childhood sexual abuse, childhood physical abuse, DSM-III-R psychiatric diagnoses, and selected items from the Dissociative Experiences Scale. RESULTS: Many individuals experienced occasional dissociative symptoms, and 6.3% of the population suffered from three or more frequently occurring dissociative symptoms. Among these individuals, the rate of childhood sexual abuse was two and one-half times as high, the rate of physical abuse was five times as high, and the rate of current psychiatric disorder was four times as high as the respective rates for the other subjects. Logistic regression modeling showed that physical abuse and current psychiatric illness were directly related to a high rate of dissociative symptoms but sexual abuse was not. The influence of sexual abuse was due to its associations with current psychiatric illness and with childhood physical abuse. Childhood physical abuse was not directly related to current psychiatric illness. Its association appeared to be mediated by its link to childhood sexual abuse. CONCLUSIONS: This study confirms that a small proportion (approximately 6%) of the general population suffer from high levels of dissociative symptoms. It calls into question the hypothesized direct relationship between childhood sexual abuse and adult dissociative symptoms.

Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-control study.

OBJECTIVE: The aim of this study was to compare the prevalence and comorbidity patterns of psychiatric disorders in subjects making medically serious suicide attempts and in comparison subjects. METHOD: The association between mental disorders and the risk of a suicide attempt was examined in 302 consecutive individuals who made serious suicide attempts and 1,028 randomly selected comparison subjects. Each subject completed a semistructured interview, and a significant other underwent a parallel interview; best-estimate DSM-III-R diagnoses were then generated. RESULTS: Of those who made serious suicide attempts, 90.1% had a mental disorder at the time of the attempt. Multiple logistic regression showed that those who made suicide attempts had high rates of mood disorders (odds ratio = 33.4, 95% confidence interval = 21.9-1.2); substance use disorders (odds ratio = 2.6, 95% confidence interval = 1.6-4.3); conduct disorder or antisocial personality disorder (odds ratio = 3.7, 95% confidence interval = 2.1-6.5); and nonaffective psychosis (odds ratio = 16.8, 95% confidence interval = 2.7-105.8). The relationship between psychiatric morbidity and suicide risk varied with age and gender. The incidence of comorbidity was high: 56.6% of those who made serious suicide attempts had two or more disorders. The risk of a suicide attempt increased with increasing psychiatric morbidity: subjects with two or more disorders had odds of serious suicide attempts that were 89.7 times the odds of those with no psychiatric disorder. CONCLUSIONS: Individuals who made serious suicide attempts had high rates of mental disorders and of comorbid disorders. Subjects with high levels of psychiatric comorbidity had markedly high risks of serious suicide attempts.

Life events and childhood morbidity: a prospective study.

The relationship between family life events and rates of childhood morbidity was studied prospectively in a birth cohort of New Zealand children during the period from ages 1 to 4 years. Family life events were associated with increased risk of medical consultation and hospital attendance for illness of the lower respiratory tract, gastroenteritis, accidents, burns, scalds, and accidental poisoning. In addition, children from families experiencing large numbers of life events had an increased risk of hospital admission for suspect or inadequate care. The correlation between life events and rates of child morbidity persisted when a series of measures of family social and economic background was taken into account statistically. Possible explanations of the role of family life events in the development of childhood morbidity are discussed.

Family life events and behavioral problems in preschool-aged children.

The relationship between family life events and rates of maternal reports of child behavior and child rearing problems was studied in a birth cohort of 1,265 New Zealand preschool-aged children. Mothers experiencing a large number of life events reported higher rates of child rearing problems. The correlation between family life events and child rearing problems persisted when a number of statistical measures of family and social background were taken into account. Possible explanations for the relationship between family life events and maternal reports of child rearing problems are discussed.

A controlled field trial of a poisoning prevention method.

A controlled field trial was conducted to determine the effectiveness of Mr Yuk labels as a poisoning prevention aid for children aged 2 to 3 years. Comparison of poisoning rates and levels of household hazard in a group of 583 families supplied with Mr Yuk labels and a control group of 543 families not given Mr Yuk labels failed to reveal any significant differences. Consumer reactions to the program were mixed: approximately 60% of users gave a favorable evaluation of the method and 40% either did not use the method or made adverse comments. Examination of the reasons for the failure of the experimental manipulation suggested that three factors were involved: parents failed to provide an adequate coverage of all poisons in the home; a significant number of poisonings occurred with substances that could not be labeled with Mr Yuk; and, in a minority of cases, clear failures of the method were observed. Results of the study do not support the view that simply supplying Mr Yuk stickers to families with young children reduces risks of accidental poisoning. However, the method may be effective with older children or as an adjunct to an integrated poisoning prevention campaign.

Risk factors for serious suicide attempts among youths aged 13 through 24 years.

OBJECTIVE: To examine associations between a series of sociodemographic factors, childhood experiences, and mental disorders and risk of serious suicide attempt in young people aged 13 through 24 years and to explore the joint relationship between these factors and vulnerability to serious suicide attempt. METHOD: The study used a case-control design in which a sample of 129 young people who had made serious suicide attempts was contrasted with 153 randomly selected community controls. Measures included sociodemographic factors (educational qualifications, annual income, residential mobility), childhood experiences (parental relationship, parental care, childhood sexual abuse), and psychiatric morbidity. RESULTS: On the basis of multiple logistic regression, those making serious suicide attempts reported elevated rates of sociodemographic disadvantage (p < .0001), higher rates of disadvantageous childhood experiences (p < .05), and elevated rates of psychiatric morbidity (p < .0001). CONCLUSIONS: Risks of serious suicide attempt among young people increased with extent of exposure to childhood adversity, social disadvantage, and psychiatric morbidity, with each of these factors making independent contributions to risk of serious suicide attempt.

Precipitating factors and life events in serious suicide attempts among youths aged 13 through 24 years.

OBJECTIVE: Precipitating factors and life events associated with medically serious suicide attempts were examined in young people making serious suicide attempts and control subjects. METHOD: Using a case-control design, the authors contrasted 129 young people making serious suicide attempts with 153 randomly selected community controls on a series of life event occurrences within the preceding year. Precipitating factors for serious suicide attempts were also examined. RESULTS: The most common precipitants of serious suicide attempts were relationship breakdowns, other interpersonal problems, and financial difficulties. However, one third of those attempting suicide were unable to describe any precipitating factor. Individuals who made serious suicide attempts had elevated rates of life events which were associated principally with interpersonal difficulties, work issues, financial difficulties, and legal problems. When due allowance was made for intercorrelations between life event measures and antecedent social, family, and personality factors, interpersonal losses and conflicts and legal problems remained significant risk factors for serious suicide attempts. CONCLUSIONS: Important proximal occurrences for serious suicide attempts among young people include a series of life events associated principally with interpersonal conflicts, relationship difficulties, and legal problems.

Psychiatric contacts among youths aged 13 through 24 years who have made serious suicide attempts.

OBJECTIVE: To compare the history of psychiatric contacts among young people who have made medically serious suicide attempts and control subjects. METHOD: Using a case-control design, the authors contrasted 129 young people who made serious suicide attempts with 153 randomly selected community controls on a series of measures of lifetime, prior year, and prior month contacts with psychiatric services. RESULTS: Of those who made serious suicide attempts, 78.3% had a lifetime history of contact with health services for psychiatric reasons, 72.1% reported contact within the year preceding the suicide attempt 58.9% reported contact within the month preceding the suicide attempt, and 29.5% had a lifetime history of psychiatric hospital admission. Within the year preceding the suicide attempt, 21.7% had been admitted to a psychiatric hospital and 67.4% had outpatient consultations for psychiatric problems. Multiple logistic regression suggested that the best psychiatric service predictors of risk of serious suicide attempt were admission within the preceding year (p < .005) and outpatient consultation within the preceding month (p < .0001). CONCLUSIONS: Young people making serious suicide attempts had vastly elevated rates of a range of psychiatric contacts including hospital admissions and outpatient consultations. These findings imply that the development of improved treatment and management strategies for young people with psychiatric morbidity may be a very effective approach to reducing youthful suicidal behaviors.

Cannabis abuse and serious suicide attempts.

AIMS: To compare the relationship between cannabis abuse/dependence and risk of medically serious suicide attempts in individuals making serious suicide attempts and randomly selected comparison subjects. DESIGN: Case-control comparison. SETTING: Cases, a general hospital; controls, the local community. PARTICIPANTS: Cases were 302 consecutive individuals making medically serious suicide attempts; 1028 randomly selected control subjects. MEASUREMENTS: DSM-III-R mental disorder diagnoses; measures of socio-demographic characteristics and childhood and family experiences. FINDINGS: Of those making serious suicide attempts, 16.2% met DSM-III-R criteria for cannabis abuse/dependence at the time of the attempt, compared with 1.9% of comparison subjects (OR = 10.3; 95%CI, 5.95-17.8, p < 0.0001). Risks of serious suicide attempt were significantly related to a series of socio-demographic and childhood characteristics, and to mental disorders that were co-morbid with cannabis abuse/dependence. When the association between cannabis abuse/dependence and suicide attempt risk was controlled for socio-demographic factors, childhood factors and concurrent psychiatric morbidity, there was a marginally significant association (OR = 2.0; 95%CI, 0.97-5.3, p < 0.06) between cannabis abuse/dependence and serious suicide attempt risk. CONCLUSIONS: These results suggested that much of the association between cannabis abuse/dependence and suicide attempt risk arose because: (a) individuals who develop cannabis abuse/dependency tend to come from disadvantaged socio-demographic and childhood backgrounds which, independently of cannabis abuse, are associated with higher risk of suicide attempt, or (b) because cannabis abuse/dependence is co-morbid with other mental disorders which are independently associated with suicidal behaviour. Nevertheless, the possibility remains that cannabis abuse/dependence may make an independent contribution to risk of serious suicide attempt, both directly and through the possible effects of cannabis abuse on risk of other mental disorders.

Breast-feeding and cognitive development in the first seven years of life.

The relationship between breast-feeding practices and childhood intelligence and language development at ages 3, 5 and 7 years was examined in a birth cohort of New Zealand children. The results showed that even when a number of control factors including maternal intelligence, maternal education, maternal training in child rearing, childhood experiences, family socio-economic status, birth weight and gestational age were taken into account, there was a tendency for breast-fed children to have slightly higher test scores than bottle-fed infants. On average, breast-fed children scored approximately two points higher on scales with a standard deviation of 10 than bottle-fed infants when all control factors were taken into account. It was concluded that breast-feeding may be associated with very small improvements in intelligence and language development or, alternatively, that the differences may have been due to the effects of other confounding factors not entered into the analysis.

Use of preschool dental services in a New Zealand birth cohort.

The utilisation of preschool dental services was examined prospectively in a birth cohort of New Zealand 4-year-old children. There were highly significant associations between non-utilisation of dental care services and a series of measures of family social background and the quality of care provided to the child. Factors associated with increased risks of non-utilisation of dental services included: mother of non-European ethnic origin; low gross family income; single parent family; non-attendance at preschool education facilities; failure to attend community nurse services and a lower utilisation of routine child health care services including immunisations and routine postnatal checks. The implications of the non-utilisation of preschool dental care are discussed in the context of the more general problem of providing an adequate and equitable standard of health care for children.

Personality traits and cognitive styles as risk factors for serious suicide attempts among young people.

The contribution of a series of measures of personality and/or cognitive style to serious suicide attempt risk in young people was examined in a case-control study. Individuals making suicide attempts had elevated odds of hopelessness, neuroticism, introversion, low self-esteem, impulsiveness, and external locus of control. When allowance was made for intercorrelations between these measures, hopelessness, neuroticism, and external locus of control remained significant risk factors for serious suicide attempt; self-esteem, extraversion, and impulsiveness were not significantly associated with suicide attempt risk. Nonsignificant findings were explained by the presence of substantial correlations between these measures and measures of hopelessness, neuroticism, and external locus of control.

Patient evaluation of otolaryngology department service at Christchurch Hospital.

One hundred and four consecutive patients seen in the ENT department for consultation and inpatient treatment completed a structured questionnaire at their first postoperative (or posttreatment) outpatient clinic appointment. The aims of the survey were to ascertain the patients opinions and perceptions regarding the ENT department service in a variety of areas. Satisfaction was high in areas of medical and nursing care and with the information given regarding treatment. The major area of dissatisfaction was with waiting times, particularly waiting times at appointments during ENT outpatient clinics.

Maternal satisfaction with primary health care.

Maternal reactions to child health care services were examined for 1143 Christchurch children during the period birth to three years. The majority of mothers were well satisfied with the service provided by their family doctor. Over half the mothers who reported problems with their family doctor did so because of perceived inadequacies in the doctor's management and treatment. Dissatisfaction with the doctor did not vary with maternal social background. Mothers were less satisfied with the Plunket nurse, with 25 percent feeling neutral or dissatisfied. Major areas of conflict between mothers and Plunket nurses concerned feeding regimes and weight gains. Dissatisfaction with the Plunket nurse was most common amongst young mothers and single mothers. While 24 percent of mothers would have liked some reduction in medical consultation fees for children, by a small majority mothers were opposed to or neutral about free medical consultations for children. A large majority of mothers favoured some form of compulsory system of routine child health care.

Psychiatric illness in a New Zealand sample of young people making serious suicide attempts.

AIM: To examine the extent of psychiatric illness amongst young people making medically serious suicide attempts and control subjects. METHOD: Using a case control design, 129 young people making serious suicide attempts were contrasted with 153 randomly selected community controls on a series of measures of current and lifetime DSM-III-R diagnoses of mental disorders. RESULTS: Individuals making suicide attempts were characterised by high rates of current mental disorder (89.5%), current comorbidity (54.3%), lifetime histories of psychiatric disorder (90.7%) and previous suicide attempts (52.7%). At the time of the suicide attempt, those making serious attempts had elevated rates of the following disorders: affective disorders (70.5%), substance use disorders (38.8%), anxiety disorders (14.7%), eating disorders (8.5%) and antisocial disorders (34.9%). CONCLUSIONS: Young people who made medically serious suicide attempts had high rates of a range of mental disorders, and of comorbid disorders, at the time of the suicide attempt. They had high rates of lifetime histories of mental disorders and previous suicide attempts. The implications of these findings for the development of strategies to manage, treat and prevent suicidal behaviours in young people are discussed.

The prevalence of illness in a birth cohort.

The prevalence of illness was studied in a birth cohort of Christchurch three-year-olds. By three-years sample members had made an average of 15.9 consultations to general practitioners; 29 percent had been admitted to hospital and 47 percent had made hospital outpatient attendances. The majority of general practitioner consultations involved: respiratory illness; skin rash; gastro-intestinal illness and accidents. Six categories of illness accounted for the majority of hospital admissions: respiratory illness, accidents, feeding and management problems, suspect or inadequate home environment, minor surgical procedures and gastro-intestinal illness. Major reasons for outpatient attendance were: accidents, musculoskeletal problems, respiratory illness, congenital heart murmur and vision problems.