Sudden parental death from external causes and risk of suicide in the bereaved offspring: A national study

Previous research has revealed an association between parental bereavement from external causes and risk of suicide in offspring. Few studies have however provided insights into specific influences of cause of death, gender of the deceased and bereaved, age at bereavement and suicide, and time since bereavement. The present nested case-control study was based on data from three longitudinal registers. Subjects comprised 19 015 persons who died from suicide at an age of 11-64 years during 1969-2012 (cases), and 332 046 live comparison individuals matched for gender and date of birth. Information about deceased parents' cause and date of death, and sociodemographic data was retrieved and merged. Data were analysed with conditional logistic regression. Losing a parent to suicide, transport accidents and other external causes of death was associated with an increased suicide risk in offspring. Parental suicide was associated with a substantially higher suicide risk than transport accidents and other external causes. These effects were equally strong for daughters and sons, and for the loss of a mother, father or both parents. Suicide risk was highest in younger bereaved offspring, and bereavement had both short and long-term impacts on suicide risk. In conclusion, all offspring exposed to parental death by external causes have an increased suicide risk, independent of factors related to the exposure. The consequences are long lasting, and offspring should be offered follow-up in primary healthcare. Younger offspring bereaved by parental suicide have the highest risk and may be targeted for prevention and intervention programs in specialist healthcare.