Department of Epidemiology,University of Toronto,Dalla Lana School of Public Health,Toronto,Ontario,Canada.
Epidemiol Psychiatr Sci. 2019 Apr;28(2):179-190. doi: 10.1017/S2045796017000397. Epub 2017 Jul 27.
The primary objective of this systematic review was to identify and synthesise analytic studies examining the association between exposure to parental psychopathology in childhood and the nature of subsequent suicide-related thoughts (SRT) and suicide-related behaviour (SRB) (severity of ideation, planned/unplanned attempts/lethality) and to describe the direction, and magnitude of associations. The secondary objective was to determine if the associations from the primary objective differ by the type(s) and timing of parental psychopathology, sex/gender of the parent and child and is mediated by child psychiatric symptoms and family functioning.
A systematic review was conducted using guidelines from the PRISMA statement. MEDLINE, CINAHL, EMBASE, psycINFO, Web of Science and grey literature sources were searched by two reviewers to March, 2017. Studies were included if they examined any parental psychopathology (Diagnostic and Statistical Manual of Mental Disorders criteria or equivalent) or SRT or SRB and offspring SRT or SRB occurring from birth <25 years of age.
Out of 10 231 studies identified, 54 were included for review. Studies were clinically and methodologically heterogeneous with none at low risk of bias (ROB). Nine studies with moderate ROB indicated a significantly increased risk of offspring SRT, suicide attempts (SA) and suicide among those exposed to maternal SA and suicide in childhood or adolescence. In the remaining 45 studies with higher ROB this association persisted. Several studies (67%) did not confirm that the exposure occurred in the offspring's childhood or adolescence. Findings were suggestive of a mediating effect of offspring psychiatric symptoms, however, few studies examined mediation and effect modification of contextual variables.
Offspring exposed to maternal SA are at an increased risk of these same behaviours early in life. Prospective attention to the types and timing of maternal and paternal psychopathology and the intermediate pathways to offspring SRT and SRB onset is needed and could have implications for informing modifiable targets for early intervention and prevention.
本系统评价的主要目的是确定和综合分析研究，以探讨儿童时期父母精神病理学的暴露与随后自杀相关思维（SRT）和自杀相关行为（SRB）（意念严重程度、计划/非计划尝试/致命性）的性质之间的关系，并描述关联的方向和程度。次要目的是确定主要目的的关联是否因父母精神病理学的类型和时间、父母和孩子的性别、儿童精神病理症状和家庭功能的中介作用而不同。
按照 PRISMA 声明的指南进行系统评价。两位审查员通过 MEDLINE、CINAHL、EMBASE、psycINFO、Web of Science 和灰色文献来源进行搜索，检索时间截至 2017 年 3 月。如果研究检查了任何父母精神病理学（《精神障碍诊断与统计手册》标准或同等标准）或 SRT 或 SRB 以及后代 SRT 或 SRB 从出生到 <25 岁发生，就将其纳入研究。
在确定的 10231 项研究中，有 54 项符合纳入标准进行综述。这些研究在临床和方法学上存在异质性，没有研究的偏倚风险（ROB）较低。9 项 ROB 中等的研究表明，与未暴露于母亲自杀和童年或青少年时期自杀的后代相比，暴露于母亲自杀和自杀的后代发生 SRT、自杀尝试（SA）和自杀的风险显著增加。在其余 45 项 ROB 较高的研究中，这种关联仍然存在。有几项研究（67%）并未证实暴露发生在后代的儿童或青少年时期。研究结果表明，后代精神病理症状具有中介作用，但是很少有研究检验了中间路径对后代 SRT 和 SRB 发病的调节作用和修饰作用。
暴露于母亲自杀的后代在生命早期就有更高的风险出现这些相同的行为。需要前瞻性关注父母的精神病理学的类型和时间以及后代 SRT 和 SRB 发病的中间路径，这可能对确定可改变的早期干预和预防目标具有重要意义。
