Children who Lost a Parent to Suicide at a Higher Risk for Suicide

It is estimated that 7,000–12,000 children lose a parent to suicide annually in the United States. According to a study led by Johns Hopkins Children’s Center, children of parents who have committed suicide have a significantly greater risk for hospitalization for suicide attempts and for developing depressive, psychotic, and personality disorders. In addition, child survivors of parental suicide are also at high risk for hospitalization for drug disorders and psychosis.
 

In a retrospective cohort study, researchers looked at the Swedish population for >30 years to analyze the effects of untimely and/or sudden death of a parent on childhood development. They compared data on suicides, psychiatric hospitalizations, and violent crime convictions during 30 years in >500,000 Swedish children, teens, and young adults <25 years of age who had lost a parent to suicide, illness, or an accident, to data on 4 million children, teens, and young adults with living parents.
 

The study revealed that children or teens who lost a parent to suicide were three times more likely to commit suicide than children and teens with living parents. Children <13 years of age who lost parents to a sudden accident were twice as likely to commit suicide than those whose parents were alive. The study also showed that those who lost parents to suicide were almost twice as likely to be hospitalized for depression than those with living parents, with a 30% to 40% higher risk for hospitalization in those who lost parents to a sudden accident.
 

Lead researcher Holly C. Wilcox, PhD, noted, “Forty-five percent of parents who died by suicide had a prior psychiatric hospitalization for depression or another psychiatric disorder. The link between parental suicide and adverse offspring outcomes remained after adjusting for parental psychiatric disorders severe enough to warrant psychiatric hospitalizations.”
 

The cause of a parent’s death and when it occurred during the child’s life strongly influenced the child’s risk. Researchers reported that environmental and developmental factors as well as genetics are likely to contribute to next-generation risk.
 

Dr. Wilcox said the most surprising finding was, “Parental mode of death and offspring’s age at the time of parental death both moderated risk for suicide among offspring.” Regardless of the cause, losing a parent increased a child’s risk for committing a violent crime.
 

“There are opportunities for children and adolescents who lose parents to suicide to be recognized in primary care,” Dr. Wilcox explained. “Pediatricians could carefully monitor children and adolescents who lose parents to suicide for signs and symptoms of depression, or other psychiatric conditions, and refer children for psychiatric evaluation, and, if needed, care. Early identification and treatment of depression and other psychiatric disorders could help prevent suicide and suicide attempts in survivors of parental suicide.”
 

Funding for this study was provided by the National Alliance for Research on Schizophrenia and Depression, the National Institute on Drug Abuse, and the Swedish Research Council. (J Am Acad Child Adolesc Psychiatry. 2010;49(5):514-523). – JV

 

SSRIs: Cardiovascular Benefits?

The cardiovascular morbidity and other mortality risks associated with untreated depression are well documented. The effects of antidepressants themselves, particularly the selective serotonin reuptake inhibitors (SSRIs), are still unclear. A new study, however, presented recently at the Experimental Biology 2010 meeting in Anaheim, California, suggests that SSRIs may have some benefit for cardiovascular health.
 

Preliminary research by a group at Loyola University Medical Center, led by Evangelos Litinas, MD, found evidence suggesting that SSRIs may slow platelet aggregation in patients being treated for depression.
 

The investigators drew multiple blood samples from 25 patients receiving SSRIs and 25 healthy non-SSRI patients. After adding a platelet aggregating substance and saline to blood samples at week 4, aggregometer results showed that healthy volunteers and the SSRI group had platelet aggregation rates of 95% and 37%, respectively. Aggregation rates increased by week 8 for the SSRI group.
 

For more information, please visit www.the-aps.org/press/releases/10/9.htm. (Litinas E. Poster presented at: the Experimental Biology 2010 meeting; April 24-28, 2010; Anaheim, California.) –LS

 

Deep Brain Stimulation Studied to Provide Insight into Treatment-Resistant Depression

It is estimated that 26.2% (~57.7 million) of Americans >18 years of age suffer from a diagnosable mental disorder every year, whereas ~6% suffer from a severe psychiatric illness and an estimated 340 million suffer from an episode of major depression every year worldwide. Psychotherapy and medication may provide some relief; however, ~20% of patients fail to respond.
 

Researchers at Massachusetts General Hospital/Harvard Medical School in Boston, studied the role of the ventral striatum in the brain to analyze processing rewards in people with severe treatment-resistant major depression. Six patients (five male, one female) 27–64 years of age with severe depression undergoing deep brain stimulation (DBS) were involved in a phase 3 clinical trial to analyze the human ventral striatum in reward processing.
 

DBS surgery involves the placement of tiny implantable electrodes into specific parts of the brain that function abnormally. Dysfunction of circuits involving the ventral striatum can lead to a variety of disorders, including depression and obsessive-compulsive disorder. With DBS, electrodes emit tiny pulses of stimulation to block abnormal activity in the brain that causes pain tremors and movement problems, as well as obsessions, moods, and anxieties associated with psychiatric disorders. DBS is reversible, nondestructive, and can be modified by adjustment of the stimulator settings after implantation.
 

The targeting electrode was placed in the ventral striatum. The patient was then asked to play a simplified version of the card game War while placing bets of $5 or $20. In 20% of the hands being dealt, the bet was increased to $50, unbeknownst to the patient until payout. The study revealed that at various parts of the game, neurons changed their firing. In some cases, neurons were very attuned to receiving an upcoming reward before the computer’s card was revealed.  In other cases, neurons were specifically activated after revealing the computer’s card when it was decided who the winner or loser was. Understanding how the brain processes expectations of positive results, modifies behavior to achieve these results, and responsiveness will provide a look into conditions characterized by pleasure-related circuitry dysfunction, such as depression and addiction. 
 

Funding for this research was provided by the American Association of Neurological Surgeons. For more information, please visit www.aans.org. –JV
 

Psychiatric dispatches is written by Lonnie Stoltzfoos and Jennifer Verlangieri.