Santana Geilson Lima, Coelho Bruno Mendonca, Borges Guilherme, Viana Maria Carmen, Wang Yuan Pang, Andrade Laura Helena
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil.
National Institute of Psychiatry and Metropolitan Autonomous University, Mexico City, Mexico.
PLoS One. 2015 Jul 31;10(7):e0134970. doi: 10.1371/journal.pone.0134970. eCollection 2015.
Suicide tends to occur in families, and parental psychopathology has been linked to offspring suicidal behaviors. This study explores the influence of parental mental disorders across the lifespan. Data are from the Sao Paulo Megacity Mental Health Survey, a cross-sectional household study with a representative sample of the adult population living in the Sao Paulo Metropolitan Area, Brazil (N=2,942). Survival models examined bivariate and multivariate associations between a range of parental disorders and offspring suicidality. After controlling for comorbidity, number of mental disorders and offspring psychopathology, we found that parental psychopathology influences suicidal behaviors throughout most part of the life cycle, from childhood until young adult years. Generalized anxiety disorder (GAD) and antisocial personality were associated with offspring suicidal ideation (OR 1.8 and 1.9, respectively), panic and GAD predicted suicidal attempts (OR 2.3 and 2.7, respectively), and panic was related to the transition from ideation to attempts (OR 2.7). Although noticed in many different stages of the lifespan, this influence is most evident during adolescence. In this period, depression and antisocial personality increased the odds of suicidal ideation (OR 5.1 and 3.2, respectively), and depression, panic disorder, GAD and substance abuse predicted suicidal attempts (OR varying from 1.7 to 3.8). In short, parental disorders characterized by impulsive-aggression and anxiety-agitation were the main predictors of offspring suicidality across the lifespan. This clinically relevant intergenerational transmission of suicide risk was independent of offspring mental disorders, and this underscores the need for a family approach to psychopathology.
自杀往往在家庭中发生，父母的精神病理学与子女的自杀行为有关。本研究探讨了父母精神障碍在整个生命周期中的影响。数据来自圣保罗大城市心理健康调查，这是一项横断面家庭研究，对居住在巴西圣保罗大都市区的成年人口进行了代表性抽样（N = 2942）。生存模型检验了一系列父母精神障碍与子女自杀倾向之间的双变量和多变量关联。在控制了共病、精神障碍数量和子女精神病理学之后，我们发现父母的精神病理学在从童年到青年时期的大部分生命周期中都会影响自杀行为。广泛性焦虑症（GAD）和反社会人格与子女自杀意念相关（分别为OR 1.8和1.9），惊恐障碍和GAD预测自杀未遂（分别为OR 2.3和2.7），惊恐障碍与从意念到未遂的转变有关（OR 2.7）。尽管在生命周期的许多不同阶段都有发现，但这种影响在青春期最为明显。在此期间，抑郁症和反社会人格增加了自杀意念的几率（分别为OR 5.1和3.2），抑郁症、惊恐障碍、GAD和药物滥用预测自杀未遂（OR范围为1.7至3.8）。简而言之，以冲动攻击和焦虑激动为特征的父母精神障碍是整个生命周期中子女自杀倾向的主要预测因素。这种具有临床相关性的自杀风险代际传递独立于子女的精神障碍，这突出了采用家庭方法治疗精神病理学的必要性。
