Investigating the Impact of Adolescent Suicide Attempt and Death on Parents and Siblings

Youth suicidal behavior is a significant global public health problem. As rates of suicide death (SD) and non-fatal suicide attempt (SA) in young people have risen over the past two decades, the population of individuals exposed to and bereaved by adolescent suicide has increased exponentially. A number of studies have documented increased risk for psychiatric disorders and suicidal behavior in suicide-bereaved individuals. However, the psychological impact of exposure to non-fatal SA has been understudied relative to SD, and few studies have evaluated the effect of adolescent SA and SD on immediate family members. Further, the relationship between adolescent suicidal behavior and suicide risk in family members may be due to a number of factors, such as shared genetic and familial environmental factors, effects of any bereavement, and specific effects of suicide bereavement. Well-controlled studies are essential to distinguish between these mechanisms. The current proposal will leverage a rich data resource – Swedish population-based registries with national coverage – to address these critical knowledge gaps. We will estimate the short- and long-term effects of adolescent SA and SD on parents’ and siblings’ risk for psychiatric disorders, substance use disorders, and suicidal behavior. Analyses will account for key confounders, distinguish suicide-specific effects from the effects of exposure to a sudden, traumatic event, and maximize our ability to draw causal conclusions from observational data. In addition, we will evaluate whether the relationship of adolescent SA and SD with parents’ and siblings’ risk for suicidal behavior varies based on (1) characteristics of the adolescent, (2) characteristics of the family member, (3) pair-level characteristics (e.g., age difference between siblings), and (4) family-level characteristics (e.g., total number of children in the household). These analyses will provide key insights into when and under what conditions family members are most at-risk for psychopathology and suicidal behavior following adolescent SA and SD, informing the development of more effective postvention efforts in this population.