Title:
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The impact of parental self-harm on offspring's self-harm, mental health and educational performance
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Studies have reported that offspring exposed to parental suicidal behaviours are at
risk of a variety of problems, most notably, suicidal behaviours and affective
disorders. Research to date has largely focussed on the impact of parental suicide
and has been bas,ed on populations in contact with psychiatric services. Most studies
have addressed offspring suicidal behaviour as an outcome; little is known about the
impact of parental suicidal behaviours on other aspects of their children's wellbeing.
This thesis aims to investigate the association of parental self-harm with selfharm,
suicidal thoughts, depression, and academic performance in their offspring in
a community-based prospective birth cohort - the Avon Longitudinal Study of
Parents and Children (ALSPAC).
Parental suicide attempt was self-reported on 10 occasions from pregnancy until the
children were 11 years old. Children self-reported lifetime self-harm and suicidal
thoughts at age 16-17 years. Symptoms of depression we're self-reported at age 10,
13, and 16-17 years. Academic performance was based on results from two national
assessment exercises conducted at age 11-16 years. The analytic sample varies
according to the exposure and outcomes being assessed but as an example: 4,396
mother-child and 2,541 father-child pairs were included in the analysis of the
association of parental suicide attempt and offspring self-harm.
Controlling for relevant confounders, maternal suicide attempt was associated with
a 3-fold increased odds of self-harm with suicidal intent in their offspring [Adjusted
odds ratio (aOR) 2.94, 95% confidence interval (CI) 1.43-6.07] but not with self-harm
without suicidal intent (aOR 0.83, 95% CI 0.35-1.99). Offspring whose mother had
attempted suicide were at an increased risk of suicidal thoughts and plans (aOR 5.04,
95% ,CI 2.24-11.36; aOR 2.17,95% CI 1.07-4.38, respectively). Findings in relation to
paternal suicide attempt were similar to those of maternal suicide attempt, but were
somewhat weaker and consistent with chance. Offspring whose mother had
attempted suicide had also 26% higher mean score of symptoms of depression in
adolescence relative to unexposed offspring (P=1.26, 95% CI 1.05 to 1.51, p=O.01).
Paternal suicide attempt was associated with somewhat elevated mean score of
depression but the evidence was weak and mostly consistent with chance.
Adolescents whose mother had attempted suicide were less likely than their peers to
achieve level five or above in English, Maths and Science combined at age 14 years
(aOR 0.65,95% CI 0.43-0.97) and less likely to obtain five or more qualifications (i.e.
GCSEs/GNVQs) at a top grade by age 16 years (aOR 0.41,95% CIO.17-0.96). Paternal
suicide attempt was inversely associated with their offspring's likelihood of
obtaining at least five qualifications by age 16 years (aOR 0.16, 95% CI 0.06-0.46).
This thesis demonstrates that non-fatal suicidal behaviours in parents represent a
major risk of psychiatric morbidity and poorer academic performance in their
offspring. It suggests that interventions aimed at individuals with suicidal
behaviours should identify individuals with parenting responsibilities and assess the
needs of their children as well.
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