10 April 2019

Why suicide risk can run in families

Clinical Mental Health

If anything keeps GPs up at night, it’s the fear that one of their patients is at risk of suicide and they missed the warning signs.

Previous studies have indicated that suicide risk runs in families, but it has been hard for researchers to tell whether it’s nature or nurture that’s driving the relationship.

A recent study, published in JAMA Psychiatry, has gathered one of the largest data-sets yet to tease out these associations.

The study of more than 1,000 patients and more than 5,300 of their relatives in the US and Switzerland, has revealed the tendency for suicide to run is families is largely explained by the presence of inherited comorbid mental health disorders.

In the study, around 8% of patients and 4% of their relatives had a lifetime history of a suicide attempt. Having a relative attempt suicide roughly tripled a person’s lifetime risk of a suicide attempt themselves.

Suicide attempts ran in families with major depression, generalised anxiety disorder, social anxiety disorder or substance use disorder – but this association was only significant when family members had more than one mental health condition.

“The findings suggest that suicide attempt is moderately familial and largely explained by comorbidity with mood and other disorders, particularly bipolar disorder,” the authors said.

Familial studies were important because they showed that suicide attempts were not tied to fleeting personal crises, but were driven by severe underlying mental health conditions, said Professor Ian Hickie, the co-director of health and policy at The University of Sydney’s Brain and Mind Centre and a clinical psychiatry researcher.

“We have more and more people, particularly young people, coming to emergency departments around Australia with suicidal behaviour and self-harm and they are receiving very short-term and very inadequate care,” he said.

“And it’s often dismissed as, ‘they had a fight with the boyfriend’, ‘had trouble at school’, ‘minor problem with bullying’, ‘minor problem with texting and social media’. This study makes the case that if you want to really deal with suicidal behaviour, much of it is tied up with the risks around mental ill health.

“So, from a doctor’s point of view … just having short-term risk checklists about suicidal behaviour won’t cut it. You’ve got to treat the associated mental health problem long enough to actually reduce the risk of suicidal behaviour.”

GPs played a really important role in suicide prevention by having deeper knowledge of the family context, Professor Hickie said.

“It means identifying and discussing with young people and with their families that, just as propensity of other illnesses tends to run in families, suicidal behaviour does run in families and if you do see the early presentations of behaviour like that, it means early identification and more systematic management. Not dismissing, not putting aside.”

The study is one of the first to show that suicide attempt can also be linked to familial social anxiety disorder.

Social anxiety in teenagers was usually dismissed as a normal part of growing up, but this study showed it needed to be treated as a potential risk factor for self-harm, Professor Hickie said.

JAMA Psychiatry 2019, March 27