title: Youth suicide attempts and the dose-response relationship to parental risk factors: a population-based study.
abstract: BACKGROUND
  There is a lack of specific knowledge about the dose-response effect of multiple parental risk factors for suicide attempts among children and adolescents. The aim of this study was to determine the dose-response effect of multiple parental risk factors on an offspring's risk for suicide attempt.
  
  
  METHODS
  We designed a population-based two-generation nested case-control study and used Danish register data. A population of 403 431 individuals born between 1983 and 1989 was sampled. Among these, 3465 (0.8%) were registered as having had a suicide attempt. Twenty controls were matched to each case and a link to the offspring's biological parents was established.
  
  
  RESULTS
  There was a dose-response relationship between the number of exposures and the risk of suicide attempts, with the increased risk seeming to be a multiplicative effect. Parental suicide, suicide attempt, psychiatric illness and low level of income were all significant independent risk factors for offspring's suicide attempts.
  
  
  CONCLUSIONS
  Knowledge of the effect of multiple risk factors on the likelihood of suicide attempts in children and adolescents is important for risk assessment. Dose-response effects of multiple parental risk factors are multiplicative, but it is rare for children and adolescents to be exposed to multiple parental risk factors simultaneously. Nevertheless, they should be considered along with the offspring's own multiple risk factors in determining the overall risk of a suicide attempt. Further research incorporating both parental and offspring's risk factors is indicated to determine the overall dose-response effect of multiple risk factors.
authors.affiliation: Clinic of Suicide Prevention, Department of Child and Adolescent Psychiatry, Odense University Hospital, Denmark. erik.christiansen@ouh.fyns-amt.dk
authors.forename: E
authors.initials: E
authors.lastname: Christiansen
authors.forename: R D
authors.initials: RD
authors.lastname: Goldney
authors.forename: A L
authors.initials: AL
authors.lastname: Beautrai
authors.forename: E
authors.initials: E
authors.lastname: Agerbo
mesh_terms: D000293:Adolescent; D002648:Child; D003863:Depression / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D005192:Family Health; D005260:Female; D006801:Humans; D007360:Intelligence; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D010290:Parents; D016012:Poisson Distribution; D011627:Puberty / Q000523:psychology; D012044:Regression Analysis; D012307:Risk Factors; D013406:Suicide, Attempted / Q000523:psychology*