title: Incidence of Suicide Among Persons Who Had a Parent Who Died During Their Childhood: A Population-Based Cohort Study.
abstract: OBJECTIVE
  Parental death from suicide is associated with increased risk of suicide in the bereaved child, but little is known about the long-term risks of suicide after parental death from other causes. A better understanding of this association may improve suicide prevention efforts.
  
  
  OBJECTIVE
  To examine the long-term risks of suicide after parental death and how the risk trajectories differed by cause of parental death while accounting for major potential confounding variables.
  
  
  METHODS
  A population-based matched cohort study was performed using information from nationwide registers (data from 1968 to 2008) in 3 Scandinavian countries (for a total of 7,302,033 persons). We identified 189,094 children (2.6%) who had a parent who died before the child reached 18 years of age (ie, the bereaved cohort). Each bereaved child was matched by sex and age to 10 children who did not have a parent who died before they reached 18 years of age (for a total of 1,890,940 children) (ie, the reference cohort). Both cohorts were followed for up to 40 years. Poisson regression was used to calculate the incidence rate ratio (IRR), while accounting for age at parental death, sex, time since bereavement, maternal/paternal death, birth order, family history of psychiatric illness, and socioeconomic status. Data analyses were finalized June 24, 2015.
  
  
  METHODS
  The main exposure was death of a parent within the first 18 years of life.
  
  
  METHODS
  Incidence of suicide among persons who had a parent who died during their childhood.
  
  
  RESULTS
  During follow-up, 265 bereaved persons (0.14%) and 1342 nonbereaved persons (0.07%) died of suicide (IRR = 2.02 [95% CI, 1.75-2.34]); IRR = 3.44 (95% CI, 2.61-4.52) for children who had a parent who died of suicide, and IRR = 1.76 (95% CI, 1.49-2.09) for children who had a parent who died of other causes. The IRR tended to be higher for children who had a parent who died before they reached 6 years of age, and the IRR remained high for at least 25 years. During 25 years of follow-up, the absolute risk of suicide was 4 in 1000 persons for boys who experienced parental death and 2 in 1000 persons for girls who experienced parental death.
  
  
  CONCLUSIONS
  Parental death in childhood is, irrespective of cause, associated with an increased long-term risk of suicide. The consequences of parental death in childhood are far-reaching, and suicide risk trajectories may be influenced by early-life conditions. Future public health efforts should consider helping highly distressed children to cope with bereavement.
authors.affiliation: Research Unit for General Practice, Aarhus University, Aarhus, Denmark.
authors.forename: Mai-Britt
authors.initials: MB
authors.lastname: Guldin
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Jiong
authors.initials: J
authors.lastname: Li
authors.affiliation: Research Unit for General Practice, Aarhus University, Aarhus, Denmark3Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Henrik Søndergaard
authors.initials: HS
authors.lastname: Pedersen
authors.affiliation: Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark4Research Programme for Mental Child Health, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Carsten
authors.initials: C
authors.lastname: Obel
authors.affiliation: Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark.
authors.forename: Esben
authors.initials: E
authors.lastname: Agerbo
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland7Nordic School of Public Health, Gothenburg, Sweden.
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden.
authors.forename: Sven
authors.initials: S
authors.lastname: Cnattingius
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Jørn
authors.initials: J
authors.lastname: Olsen
authors.affiliation: Research Unit for General Practice, Aarhus University, Aarhus, Denmark3Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Mogens
authors.initials: M
authors.lastname: Vestergaard
mesh_terms: D000328:Adult; D000367:Age Factors; D001722:Birth Order; D002423:Cause of Death; D016241:Child of Impaired Parents / Q000523:psychology / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005192:Family Health; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D063129:Parental Death / Q000523:psychology / Q000706:statistics & numerical data*; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D012737:Sex Factors; D012923:Social Class; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult