Citation

Mann JJ. Am. J. Psychiatry 2021; 178(11): 994-997.

Copyright

(Copyright © 2021, American Psychiatric Association)

DOI

10.1176/appi.ajp.2021.21090913

PMID

34734746

Abstract

In this issue, Edwards and colleagues (1) report on a study that examines twins, siblings, and half siblings in the large Swedish national registry database to estimate the heritability of fatal and nonfatal suicidal behavior. The size of this database offers the advantage that they could examine genetic and environmental contributions to nonfatal suicide attempt and suicide death separately, and also in women and men as well as in youths and the older population. The authors found moderate heritability of both suicide attempt and suicide death, and in both men and women. The genetic load appears to be greater in women, both in youth and adulthood. By examining fatal and nonfatal suicidal behavior, Edwards et al. were able to show that there is substantial genetic overlap. From the opposite perspective, there is incomplete genetic overlap. The lack of total genetic overlap means that there may be important differences between the two types of suicidal behavior.

Edwards et al. propose that potential genetically determined differences between nonfatal and fatal suicidal behavior may make a difference in terms of risk prediction and new prevention approaches. One pressing clinical challenge has been that as many as 79% of all deaths by suicide appear to occur on the first attempt (2). Thus, even though a previous suicide attempt is the best predictor of risk of a future suicide, detecting such a nonfatal suicide attempt history would not help prevent most suicide deaths. Because suicide is transmitted in families (3, 4), another approach is to ask patients not only about a personal history of suicide attempt but also about a family history of suicide attempt or suicide death. Such a family history in a first- or second-degree relative can increase the risk of suicide in the proband by about sixfold. Moreover, the greater the family loading, the earlier the age at which the suicide attempt is manifested...

Language: en

Keywords

Suicide and Self-Harm; Genetics/Genomics