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

doi:10.1136/bmj.325.7355.74

BMJ 2002;325:74 ( 13 July )

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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 peoplerelated to family and individual psychiatric and socioeconomicfactors.
Design: Population based nested case-controlstudy.
Setting: Data from longitudinal Danishregisters.
Cases and controls: 496 young people aged 10-21 years who hadcommitted suicide during 1981-97 in Denmark and 24 800 controlsmatched for sex, age, andtime.
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 administrativeregisters.
Results: Parental factors associated with an increasedrisk of suicide in young people were suicide or early death, admissionto hospital for a mental illness, unemployment, low income, poorschooling, and divorce, as well as mental illness in siblingsand mental illness and short duration of schooling in the youngpeople themselves. The strongest risk factor was mental illnessin the young people. The effect of the parents' socioeconomicfactors decreased after adjustment for a family history of mentalillness and a family history ofsuicide.
Conclusions: Recognising mental illness in young peopleand dealing with it appropriately could help prevent suicides.The high relative risk associated with a low socioeconomic statusof the parents may be confounded and overestimated if not adjustedfor mental illness and suicide in thefamily.

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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