Violent offending and suicidal behavior have common familial risk factors a rejoinder to tolstoy

Tolstoy’s novel Anna Karenina begins, “All happy families are alike; each unhappy family is unhappy in its own way.”1(p3) Mok et al,2 in this issue of JAMA Psychiatry, provide evidence to the contrary: in fact, many unhappy families share common risk factors. These authors report on a Danish record linkage study to elucidate the relationships between parental disorders and offspring suicide attempt and violent offending.2 The study encompassed 1 743 525 individuals born in Denmark between 1967 and 1997, followed up from their 15th birthday to the occurrence of adverse outcomes (suicide attempt or violent offending) or through 2012, whichever came first. Survival analyses were used to link parental mental disorders to the outcomes of suicide attempt and violent offending in offspring. Even controlling for the occurrence of other mental disorders and socioeconomic status (SES), parental history of cannabis misuse was related to offspring violent offending, and parental history of suicide attempt and antisocial personality disorder were associated with both offspring violent offending and offspring suicide attempt. Parental disorder conveyed a greater risk for both adverse outcomes in those of lower SES, and a greater risk of violent offending in females than in males. There is much to commend in this study, including the assessment and control for a broad range of parental psychiatric disorders, as well as the sheer size and representativeness of this sample. As in every study, there are limitations, some of which are noted by the authors. Although the authors controlled for SES, the impact of parental psychiatric disorder on suicide attempt and violent offending may still be overestimated, as there are likely to be other shared environmental factors correlated with parental disorder that could contribute to suicidal behavior and violent offending, such as maltreatment, separation from parents, and intrauterine drug and alcohol exposure... Language: en