Skip to main content Accessibility help

The association of parental fatal and non-fatal suicidal behaviour with offspring suicidal behaviour and depression: a systematic review and meta-analysis

  • G. Geulayov (a1), D. Gunnell (a1), T. L. Holmen (a2) and C. Metcalfe (a1)



Children whose parents die by, or attempt, suicide are believed to be at greater risk of suicidal behaviours and affective disorders. We systematically reviewed the literature on these associations and, using meta-analysis, estimated the strength of associations as well as investigated potential effect modifiers (parental and offspring gender, offspring age).


We comprehensively searched the literature (Medline, PsycINFO, EMBASE, Web of Science), finding 28 articles that met our inclusion criteria, 14 of which contributed to the meta-analysis. Crude odds ratio and adjusted odds ratio (aOR) were pooled using fixed-effects models.


Controlling for relevant confounders, offspring whose parents died by suicide were more likely than offspring of two living parents to die by suicide [aOR 1.94, 95% confidence interval (CI) 1.54–2.45] but there were heterogeneous findings in the two studies investigating the impact on offspring suicide attempt (aOR 1.31, 95% CI 0.73–2.35). Children whose parents attempted suicide were at increased risk of attempted suicide (aOR 1.95, 95% CI 1.48–2.57). Limited evidence indicated that exposure to parental death by suicide is associated with subsequent risk of affective disorders. Maternal suicidal behaviour and younger age at exposure were associated with larger effect estimates but there was no evidence that the association differed in sons versus daughters.


Parental suicidal behaviour is associated with increased risk of offspring suicidal behaviour. Findings suggest that maternal suicidal behaviour is a more potent risk factor than paternal, and that children are more vulnerable than adolescents and adults. However, there is no evidence of a stronger association in either male or female offspring.


Corresponding author

*Address for correspondence: G. Geulayov, M.Sc., School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK. (Email:


Hide All
Agerbo, E, Nordentoft, M, Mortensen, PB (2002). Familial, psychiatric, and socioeconomic risk factors for suicide in young people: nested case–control study. British Medical Journal 325, 7477.
Brent, D, Melhem, N, Donohoe, MB, Walker, M (2009). The incidence and course of depression in bereaved youth 21 months after the loss of a parent to suicide, accident, or sudden natural death. American Journal of Psychiatry 166, 786794.
Brent, DA, Mann, JJ (2005). Family genetic studies, suicide, and suicidal behavior. American Journal of Medical Genetics. Part C Seminars in Medical Genetics 133C, 1324.
Brent, DA, Oquendo, M, Birmaher, B, Greenhill, L, Kolko, D, Stanley, B, Zelazny, J, Brodsky, B, Bridge, J, Ellis, S, Salazar, JO, Mann, JJ (2002). Familial pathways to early-onset suicide attempt: risk for suicidal behavior in offspring of mood-disordered suicide attempters. Archives of General Psychiatry 59, 801807.
Brent, DA, Oquendo, M, Birmaher, B, Greenhill, L, Kolko, D, Stanley, B, Zelazny, J, Brodsky, B, Firinciogullari, S, Ellis, SP, Mann, JJ (2003). Peripubertal suicide attempts in offspring of suicide attempters with siblings concordant for suicidal behavior. American Journal of Psychiatry 160, 14861493.
Bronisch, T, Lieb, R (2008). Maternal suicidality and suicide risk in offspring. Psychiatric Clinics of North America 31, 213221.
Brown, AC, Sandler, IN, Tein, JY, Liu, X, Haine, RA (2007). Implications of parental suicide and violent death for promotion of resilience of parentally-bereaved children. Death Studies 31, 301335.
Burke, AK, Galfalvy, H, Everett, B, Currier, D, Zelazny, J, Oquendo, MA, Melhem, NM, Kolko, D, Harkavy-Friedman, JM, Birmaher, B, Stanley, B, Mann, JJ, Brent, DA (2010). Effect of exposure to suicidal behavior on suicide attempt in a high-risk sample of offspring of depressed parents. Journal of the American Academy of Child and Adolescent Psychiatry 49, 114121.
Cain, AC, Fast, I (1966). Children's disturbed reactions to parent suicide. American Journal of Orthopsychiatry 36, 873880.
Cerel, J, Fristad, MA, Weller, EB, Weller, RA (1999). Suicide-bereaved children and adolescents: a controlled longitudinal examination. Journal of the American Academy of Child and Adolescent Psychiatry 38, 672679.
Cerel, J, Fristad, MA, Weller, EB, Weller, RA (2000). Suicide-bereaved children and adolescents: II. Parental and family functioning. Journal of the American Academy of Child and Adolescent Psychiatry 39, 437444.
Christiansen, E, Goldney, RD, Beautrai, AL, Agerbo, E (2011). Youth suicide attempts and the dose–response relationship to parental risk factors: a population-based study. Psychological Medicine 41, 313319.
Christoffersen, MN, Poulsen, HD, Nielsen, A (2003). Attempted suicide among young people: risk factors in a prospective register based study of Danish children born in 1966. Acta Psychiatrica Scandinavica 108, 350358.
Clark, SE, Goldney, RD (2000). The impact of suicide on relatives and friends. In The International Handbook of Suicide and Attempted Suicide (ed. Hawton, K. and van Heeringen, K.), pp. 467484. John Wiley and Sons Ltd: Chichester.
Egeland, JA, Sussex, JN (1985). Suicide and family loading for affective disorders. JAMA 254, 915918.
Fu, Q, Heath, AC, Bucholz, KK, Nelson, EC, Glowinski, AL, Goldberg, J, Lyons, MJ, Tsuang, MT, Jacob, T, True, MR, Eisen, SA (2002). A twin study of genetic and environmental influences on suicidality in men. Psychological Medicine 32, 1124.
Goodwin, RD, Beautrais, AL, Fergusson, DM (2004). Familial transmission of suicidal ideation and suicide attempts: evidence from a general population sample. Psychiatry Research 126, 159165.
Gravseth, HM, Mehlum, L, Bjerkedal, T, Kristensen, P (2010). Suicide in young Norwegians in a life course perspective: population-based cohort study. Journal of Epidemiology and Community Health 64, 407412.
Grossman, JA, Clark, DC, Gross, D, Halstead, L, Pennington, J (1995). Child bereavement after paternal suicide. Journal of Child and Adolescent Psychiatric Nursing 8, 517.
Hernan, MA, Hernandez-Diaz, S, Werler, MM, Mitchell, AA (2002). Causal knowledge as a prerequisite for confounding evaluation: an application to birth defects epidemiology. American Journal of Epidemiology 155, 176184.
Higgins, JPT, Green, S (2008). Cochrane Handbook for Systematic Reviews of Interventions, version 5.0.2 (updated September 2009). The Cochrane Collaboration, 2009 ( Accessed 15 March 2011.
Hung, NC, Rabin, LA (2009). Comprehending childhood bereavement by parental suicide: a critical review of research on outcomes, grief processes, and interventions. Death Studies 33, 781814.
Kessing, LV, Agerbo, E, Mortenssen, PB (2004). Major stressful life events and other risk factors for first admission with mania. Bipolar Disorders 6, 122129.
Kjoeller, M, Helweg-Larsen, M (2000). Suicidal ideation and suicide attempts among adult Danes. Scandinavian Journal of Public Health 28, 5461.
Kuramoto, SJ, Brent, DA, Wilcox, HC (2009). The impact of parental suicide on child and adolescent offspring. Suicide and Life-Threatening Behavior 39, 137151.
Kuramoto, SJ, Stuart, EA, Runeson, B, Lichtenstein, P, Langstrom, N, Wilcox, HC (2010). Maternal or paternal suicide and offspring's psychiatric and suicide-attempt hospitalization risk. Pediatrics 126, e1026e1032.
Lieb, R, Bronisch, T, Hofler, M, Schreier, A, Wittchen, H-U (2005). Maternal suicidality and risk of suicidality in offspring: findings from a community study. American Journal of Psychiatry 162, 16651671.
McLeod, JD (1991). Childhood parental loss and adult depression. Journal of Health and Social Behavior 32, 205220.
Melhem, NM, Brent, DA, Ziegler, M, Iyengar, S, Kolko, D, Oquendo, M, Birmaher, B, Burke, A, Zelazny, J, Stanley, B, Mann, JJ (2007). Familial pathways to early-onset suicidal behavior: familial and individual antecedents of suicidal behavior. American Journal of Psychiatry 164, 13641370.
Melhem, NM, Walker, M, Moritz, G, Brent, DA (2008). Antecedents and sequelae of sudden parental death in offspring and surviving caregivers. Archives of Pediatrics and Adolescent Medicine 162, 403410.
Mitchell, AM, Wesner, S, Garand, L, Gale, DD, Havill, A, Brownson, L (2007). A support group intervention for children bereaved by parental suicide. Journal of Child and Adolescent Psychiatric Nursing 20, 313.
Mittendorfer-Rutz, E, Rasmussen, F, Wasserman, D (2008). Familial clustering of suicidal behaviour and psychopathology in young suicide attempters. Social Psychiatry and Psychiatric Epidemiology 43, 2836.
Niederkrotenthaler, T, Floderus, B, Alexanderson, K, Rasmussen, F, Mittendorfer-Rutz, E (2010). Exposure to parental mortality and markers of morbidity, and the risks of attempted and completed suicide in offspring: an analysis of sensitive life periods. Journal of Epidemiology and Community Health. Published online: 5 October 2010. doi:10.1136/jech.2010.109595.
Nordentoft, M, Sogaard, M (2005). Registration, psychiatric evaluation and adherence to psychiatric treatment after suicide attempt. Nordic Journal of Psychiatry 59, 213216.
Papadimitriou, GN, Linkowski, P, Delarbre, C, Mendlewicz, J (1991). Suicide on the paternal and maternal sides of depressed patients with a lifetime history of attempted suicide. Acta Psychiatrica Scandinavica 83, 417419.
Pfeffer, CR (1981). Parental suicide: an organising event in the development of latency age children. Suicide and Life-Threatening Behavior 11, 4350.
Pfeffer, CR (2000). Children bereaved after suicide: the need for a clinical and research agenda. In Lifesavers, vol. 12, no. 3 (ed. Anonymous), pp. 1, 67, 13. Canadian Mental Health Association: Ottawa.
Pfeffer, CR, Karus, D, Siegel, K, Jiang, H (2000). Child survivors of parental death from cancer or suicide: depressive and behavioral outcomes. Psycho-oncology 9, 110.
Pfeffer, CR, Klerman, GL, Hurt, SW, Lesser, M, Peskin, JR, Siefker, CA (1991). Suicidal children grow up: demographic and clinical risk factors for adolescent suicide attempts. Journal of the American Academy of Child and Adolescent Psychiatry 30, 609616.
Pfeffer, CR, Normandin, L, Kakuma, T (1994). Suicidal children grow up: suicidal behavior and psychiatric disorders among relatives. Journal of the American Academy of Child and Adolescent Psychiatry 33, 10871097.
Pfeffer, CR, Normandin, L, Kakuma, T (1998). Suicidal children grow up: relations between family psychopathology and adolescents' lifetime suicidal behavior. Journal of Nervous and Mental Disease 186, 269275.
Qin, P, Agerbo, E, Mortensen, PB (2002). Suicide risk in relation to family history of completed suicide and psychiatric disorders: a nested case–control study based on longitudinal registers. Lancet 360, 11261130.
Roy, A (1983). Family history of suicide. Archives of General Psychiatry 40, 971974.
Roy, A, Nielsen, D, Rylander, G, Sarchiapone, M (2000). The genetics of suicidal behaviour. In The International Handbook of Suicide and Attempted Suicide (ed. Hawton, K. and van Heeringen, K.), pp. 209221. John Wiley and Sons Ltd: Chichester.
Schulsinger, F, Kety, SS, Rosenthal, D, Wender, PH (1979). A family study of suicide. In Origin, Prevention and Treatment of Affective Disorders (ed. Schou, M. and Tromgren, E.), pp. 277287. Academic Press: London.
Shepherd, DM, Barraclough, BM (1976). The aftermath of parental suicide for children. British Journal of Psychiatry 129, 267276.
Sorensen, HJ, Mortensen, EL, Wang, AG, Juel, K, Silverton, L, Mednick, SA (2009). Suicide and mental illness in parents and risk of suicide in offspring. Social Psychiatry and Psychiatric Epidemiology 44, 748751.
Sorenson, SB, Rutter, CM (1991). Transgenerational patterns of suicide attempt. Journal of Consulting and Clinical Psychology 59, 861866.
Statham, DJ, Heath, AC, Madden, PAF, Bucholz, KK, Bierut, L, Dinwiddie, SH, Slutske, WS, Dunne, MP, Martin, NG (1998). Suicidal behaviour: an epidemiological and genetic study. Psychological Medicine 28, 839855.
Stenager, K, Qin, P (2008). Individual and parental psychiatric history and risk for suicide among adolescents and young adults in Denmark: a population-based study. Social Psychiatry and Psychiatric Epidemiology 43, 920926.
Suvisaari, J, Hakkinen, L, Haukka, J, Lonnqvist, J (2008). Mortality in offspring of mothers with psychotic disorder. Psychological Medicine 38, 12031210.
Tsuchiya, KJ, Agerbo, E, Mortensen, PB (2005). Parental death and bipolar disorder: a robust association was found in early maternal suicide. Journal of Affective Disorders 86, 151159.
Weller, RA, Weller, EB, Fristad, MA, Bawa, PK (2001). Suicidal behavior and parental psychopathology in hospitalized depressed children. Depression and Anxiety 14, 183185.
Wender, PH, Kety, SS, Rosenthal, D, Schulsinger, F, Ortmann, J, Lunde, I (1986). Psychiatric disorders in the biological and adoptive families of adopted individuals with affective disorders. Archives of General Psychiatry 43, 923929.
Wilcox, HC, Kuramoto, SJ, Lichtenstein, P, Langstrom, N, Brent, DA, Runeson, B (2010). Psychiatric morbidity, violent crime, and suicide among children and adolescents exposed to parental death. Journal of the American Academy of Child and Adolescent Psychiatry 49, 514523.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed