title: Pathways to suicide-related behavior in offspring of mothers with depression: the role of offspring psychopathology.
abstract: OBJECTIVE
  Offspring of mothers with depression are a high-risk group for the development of suicide-related behavior. These offspring are therefore a priority for preventive interventions; however, pathways contributing to risk, including specific aspects of offspring psychopathology, remain unclear. The aim of this study was to examine whether offspring symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), disruptive behavior disorder (DBD), attention-deficit/hyperactivity disorder (ADHD), and alcohol abuse independently mediate the association between maternal depression and offspring suicide-related behavior.
  
  
  METHODS
  Data were used from a population-based birth cohort, the Avon Longitudinal Study of Parents and Children (ALSPAC). Three distinct classes of depression symptoms across the mothers' first 11 years of their child's life were identified (minimal, moderate, chronic-severe). Offspring psychopathology was assessed at age 15 years and suicide-related behavior at age 16 years. Data were analyzed using structural equation modeling.
  
  
  RESULTS
  There was evidence for increased risk of suicidal ideation in offspring of mothers with chronic-severe depression symptoms in comparison to offspring of mothers with minimal symptoms (odds ratio = 3.04, 95% CI = 2.19, 4.21). This association was independently mediated by offspring MDD, GAD, and DBD symptoms. The same mechanisms were found for offspring of mothers with moderate depression symptoms over time. Results were similar for offspring suicide attempt except for additional evidence of an indirect effect through offspring ADHD symptoms.
  
  
  CONCLUSIONS
  Findings highlight that suicide prevention efforts in offspring of mothers with depression should not only be targeted at offspring with MDD; it is also important to consider offspring with other forms of psychopathology.
authors.affiliation: Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK. Electronic address: hammertongl@cf.ac.uk.
authors.forename: Gemma
authors.initials: G
authors.lastname: Hammerton
authors.affiliation: Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Centre for Academic Mental Health, University of Bristol, Bristol, UK.
authors.forename: Stanley
authors.initials: S
authors.lastname: Zammit
authors.affiliation: Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Liam
authors.initials: L
authors.lastname: Mahedy
authors.affiliation: Centre for Academic Mental Health, University of Bristol, Bristol, UK.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Pearson
authors.affiliation: Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Sellers
authors.affiliation: Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Anita
authors.initials: A
authors.lastname: Thapar
authors.affiliation: Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Stephan
authors.initials: S
authors.lastname: Collishaw
mesh_terms: D000293:Adolescent; D000437:Alcoholism / Q000175:diagnosis; D001008:Anxiety Disorders / Q000175:diagnosis; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis; D016241:Child of Impaired Parents / Q000523:psychology*; D003863:Depression / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000175:diagnosis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009035:Mothers / Q000523:psychology*; D016017:Odds Ratio; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment; D012720:Severity of Illness Index; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000517:prevention & control*
keywords: ALSPAC; maternal depression; psychopathology; suicide-related behavior