title: Familial pathways to early-onset suicidal behavior: familial and individual antecedents of suicidal behavior.
abstract: OBJECTIVE
  The authors sought to identify clinical predictors of new-onset suicidal behavior in children of parents with a history of mood disorder and suicidal behavior.
  
  
  METHODS
  In a prospective study of offspring of parents with mood disorders, 365 offspring (average age, 20 years) of 203 parents were followed for up to 6 years. Offspring with incident suicide attempts or emergency referrals for suicidal ideation or behavior ("incident events") were compared with offspring without such events on demographic and clinical characteristics. Multivariate analyses were conducted to examine predictors of incident events and predictors of time to incident event.
  
  
  RESULTS
  Offspring of probands who had made suicide attempts, compared with offspring of parents with mood disorders who had not made attempts, had a higher rate of incident suicide attempts (4.1% versus 0.6%, relative risk=6.5) as well as overall suicidal events (8.3% versus 1.9%, relative risk=4.4). Mood disorder and self-reported impulsive aggression in offspring and a history of sexual abuse and self-reported depression in parents predicted earlier time to, and greater hazard of, an incident suicidal event.
  
  
  CONCLUSIONS
  In offspring of parents with mood disorders, precursors of early-onset suicidal behavior include mood disorder and impulsive aggression as well as parental history of suicide attempt, sexual abuse, and self-reported depression. These results suggest that efforts to prevent the familial transmission of early-onset suicidal behavior by targeting these domains could reduce the morbidity of suicidal behavior in high-risk youths.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Nadine M
authors.initials: NM
authors.lastname: Melhem
authors.forename: David A
authors.initials: DA
authors.lastname: Brent
authors.forename: Melissa
authors.initials: M
authors.lastname: Ziegler
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
authors.forename: David
authors.initials: D
authors.lastname: Kolko
authors.forename: Maria
authors.initials: M
authors.lastname: Oquendo
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: Ainsley
authors.initials: A
authors.lastname: Burke
authors.forename: Jamie
authors.initials: J
authors.lastname: Zelazny
authors.forename: Barbara
authors.initials: B
authors.lastname: Stanley
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000374:Aggression / Q000523:psychology; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology / Q000706:statistics & numerical data; D016241:Child of Impaired Parents / Q000706:statistics & numerical data*; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005195:Family Relations; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000453:epidemiology / Q000523:psychology; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015999:Multivariate Analysis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D000297:Psychology, Adolescent; D012307:Risk Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data