BMJ 2002;325:74 ( 13 July )

Papers

Familial, psychiatric, and socioeconomic risk factors for suicide in young people: nested case-control study

Esben Agerbo, assistant professor, a Merete Nordentoft, associate professor, b Preben Bo Mortensen, professor. a

a National Centre for Register-based Research, University of Aarhus, DK-8000 Aarhus C, Denmark, b Psychiatric Department E, Bispebjerg Hospital, DK-2400 Copenhagen NV, Denmark

Correspondence to: E Agerbo ea{at}ncrr.dk

Objective: To estimate the risk of suicide in young people related to family and individual psychiatric and socioeconomic factors.
Design: Population based nested case-control study.
Setting: Data from longitudinal Danish registers.
Cases and controls: 496 young people aged 10-21 years who had committed suicide during 1981-97 in Denmark and 24 800 controls matched for sex, age, and time.
Main outcome measures: All suicides in Denmark compared with controls; parents and siblings identified from population based registers; inpatient information from discharge registers of national hospitals; and socioeconomic data from administrative registers.
Results: Parental factors associated with an increased risk of suicide in young people were suicide or early death, admission to hospital for a mental illness, unemployment, low income, poor schooling, and divorce, as well as mental illness in siblings and mental illness and short duration of schooling in the young people themselves. The strongest risk factor was mental illness in the young people. The effect of the parents' socioeconomic factors decreased after adjustment for a family history of mental illness and a family history of suicide.
Conclusions: Recognising mental illness in young people and dealing with it appropriately could help prevent suicides. The high relative risk associated with a low socioeconomic status of the parents may be confounded and overestimated if not adjusted for mental illness and suicide in the family.

What is already known on this topic
Young people who commit suicide have a history of mental illness or a family history of mental illness or suicidal behaviour

Dysfunctional family backgrounds and socioeconomic adversity also contribute to suicide in young people

Targets for preventive strategies are controversial, as few population based studies have been conducted and none have included all the risk factors

What this study adds
Suicide is more likely among young people if a parent commits suicide or there is a history of mental illness in the individual and their siblings

Socioeconomic risk factors seem to be less important

Preventive strategies should be aimed at the early recognition and optimal treatment of mental illnesses




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