Effects of Parental Severe Mental Disorders on All-Cause and Suicide Mortalities in Adolescents and Young Adults With Major Depressive Disorder

Shih-Jen Tsai, MD ; Chih-Ming Cheng, MD ; Wen-Han Chang, MS ; Ya-Mei Bai, MD, PhD ; Tung-Ping Su, MD ; Tzeng-Ji Chen, MD, PhD ; Mu-Hong Chen, MD, PhD

J Clin Psychiatry 2025;86(2):24m15476

Abstract

Background: Major depressive disorder (MDD) has been associated with both all cause and suicide mortality in young adults. However, the effects of parental severe mental disorders (SMDs), such as schizophrenia, bipolar disorder, MDD, alcohol use disorder (AUD), and substance use disorder, on the risks of all-cause and suicide mortality in adolescents and young adults with MDD remain unclear.

Methods: We retrospectively evaluated the incidence of all-cause and suicide mortality (2001–2011) in 196,000 adolescents (age: 10−17 years) and young adults (age: 18−29 years) with MDD. We investigated associations between parental SMDs and all-cause and suicide mortality among patients with MDD using Cox regression analyses. In addition, we assessed the additive effects of paternal and maternal SMDs on the mortality risk of depressed offspring.

Results: Our findings revealed that all cause mortality in offspring was associated with paternal AUD (hazard ratio [HR]: 1.66) as well as maternal schizophrenia (HR: 2.77), bipolar disorder (HR: 1.99), and MDD (HR: 1.25). Furthermore, suicide mortality in offspring was associated with maternal schizophrenia (HR: 4.36) and bipolar disorder (HR: 4.01). Notably, the risk of suicide mortality was the highest in offspring with paternal bipolar disorder and maternal MDD (HR: 7.31).

Conclusion: Parental SMDs such as schizophrenia, bipolar disorder, MDD, and AUD are associated with all-cause and suicide mortality in adolescents and young adults with MDD. Optimizing support systems and prioritizing early interventions for parental mental health problems may help reduce the risks of suicide and premature death in young patients with MDD.

J Clin Psychiatry 2025;86(2):24m15476

Author affiliations are listed at the end of this article.

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References (34)

Flores MW, Sharp A, Carson NJ, et al. Estimates of major depressive disorder and treatment among adolescents by race and ethnicity. JAMA Pediatr. 2023;177(11):1215–1223. CrossRef
Carrellas NW, Biederman J, Uchida M. How prevalent and morbid are subthreshold manifestations of major depression in adolescents? A literature review. J Affect Disord. 2017;210:166–173. PubMed CrossRef
Grossberg A, Rice T. Depression and suicidal behavior in adolescents. Med Clin North Am. 2023;107(1):169–182. CrossRef
Leone M, Kuja-Halkola R, Leval A, et al. Association of youth depression with subsequent somatic diseases and premature death. JAMA Psychiatry. 2021;78(3):302–310. CrossRef
GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):2133–2161.
Chang YH, Lin CY, Liao SC, et al. Societal factors and psychological distress indicators associated with the recent rise in youth suicide in Taiwan: a time trend analysis. Aust N Z J Psychiatry. 2023;57(4):537–549. CrossRef
Hung YA, Liao SC, Chang CM, et al. Population-attributable risk of psychiatric disorders for suicide among adolescents and young adults in Taiwan. Psychol Med. 2023;53(13):6161–6170. CrossRef
Jami ES, Hammerschlag AR, Bartels M, et al. Parental characteristics and offspring mental health and related outcomes: a systematic review of genetically informative literature. Transl Psychiatry. 2021;11(1):197. CrossRef
van Dijk MT, Murphy E, Posner JE, et al. Association of multigenerational family history of depression with lifetime depressive and other psychiatric disorders in children: results from the adolescent brain cognitive development (ABCD) study. JAMA Psychiatry. 2021;78(7):778–787.
Sandstrom A, Sahiti Q, Pavlova B, et al. Offspring of parents with schizophrenia, bipolar disorder, and depression: a review of familial high-risk and molecular genetics studies. Psychiatr Genet. 2019;29(5):160–169. PubMed CrossRef
Rasic D, Hajek T, Alda M, et al. Risk of mental illness in offspring of parents with schizophrenia, bipolar disorder, and major depressive disorder: a meta-analysis of family high-risk studies. Schizophr Bull. 2014;40(1):28–38. PubMed CrossRef
Maher BS, Marazita ML, Zubenko WN, et al. Genetic segregation analysis of alcohol and other substance-use disorders in families with recurrent, early-onset major depression. Am J Drug Alcohol Abuse. 2002;28(4):711–731. PubMed CrossRef
Kendler KS, Ohlsson H, Mościcki EK, et al. Genetic liability to suicide attempt, suicide death, and psychiatric and substance use disorders on the risk for suicide attempt and suicide death: a Swedish national study. Psychol Med. 2023;53(4):1639–1648. CrossRef
Ballard ED, Cui L, Vandeleur C, et al. Familial aggregation and coaggregation of suicide attempts and comorbid mental disorders in adults. JAMA Psychiatry. 2019;76(8):826–833. CrossRef
Stenager K, Qin P. Individual and parental psychiatric history and risk for suicide among adolescents and young adults in Denmark: a population-based study. Soc Psychiatry Psychiatr Epidemiol. 2008;43(11):920–926. PubMed CrossRef
Zhou M, Lageborn CT, Sjolander A, et al. Psychiatric diagnoses in parents and psychiatric, behavioral, and psychosocial outcomes in their offspring: a Swedish population-based register study. Am J Psychiatry. 2024;181(8):761–773. CrossRef
Trespalacios F, Boyle A, Serravalle L, et al. The perceived social support of parents having bipolar disorder impacts their children’s mental health: a 10-year longitudinal study. Int J Bipolar Disord. 2024;12(1):27. CrossRef
Chen MH, Hsu JW, Huang KL, et al. Risk and coaggregation of major psychiatric disorders among first-degree relatives of patients with bipolar disorder: a nationwide population-based study. Psychol Med. 2019;49(14):2397–2404. PubMed CrossRef
Cheng CM, Chang WH, Chen MH, et al. Co-aggregation of major psychiatric disorders in individuals with first-degree relatives with schizophrenia: a nationwide population-based study. Mol Psychiatry. 2018;23(8):1756–1763. PubMed CrossRef
Chen MH, Hsu JW, Huang KL, et al. Sexually transmitted infection among adolescents and young adults with attention-deficit/hyperactivity disorder: a nationwide longitudinal study. J Am Acad Child Adolesc Psychiatry. 2018;57(1):48–53. CrossRef
Chen MH, Hsu JW, Huang KL, et al. Risk and coaggregation of major psychiatric disorders among first-degree relatives of patients with bipolar disorder: a nationwide population-based study. Psychol Med. 2019;49(14):2397–2404. PubMed CrossRef
Chen MH, Lan WH, Hsu JW, et al. Risk of developing type 2 diabetes in adolescents and young adults with autism spectrum disorder: a nationwide longitudinal study. Diabetes Care. 2016;39(5):788–793. CrossRef
Zhang B, Wang HE, Bai YM, et al. Inflammatory bowel disease is associated with higher dementia risk: a nationwide longitudinal study. Gut. 2021;70(1):85–91. PubMed CrossRef
Liu CY, Hung YT, Chuang YL, et al. Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Management (Chin). 2006;4:1–22.
Burenkova OV, Podturkin AA, Naumova OY, et al. Neuroendocrine and autonomic stress systems activity in young adults raised by mothers with mental health and substance abuse problems: a prospective cohort study. Dev Psychobiol. 2021;63(8):e22213.
Steen JT. Children of substance-abusing parents: dynamics and treatment. Subst Use Misuse. 2014;49(1–2):202–203.
Stapelberg NJC, Branjerdporn G, Adhikary S, et al. Environmental stressors and the PINE network: can physical environmental stressors drive long-term physical and mental health risks? Int J Environ Res Public Health. 2022;19(20):13226. CrossRef
Sander JB, McCarty CA. Youth depression in the family context: familial risk factors and models of treatment. Clin Child Fam Psychol Rev. 2005;8(3):203–219. PubMed CrossRef
Oquendo MA, Ellis SP, Chesin MS, et al. Familial transmission of parental mood disorders: unipolar and bipolar disorders in offspring. Bipolar Disord. 2013;15(7):764–773. PubMed CrossRef
Sandstrom A, MacKenzie L, Pizzo A, et al. Observed psychopathology in offspring of parents with major depressive disorder, bipolar disorder and schizophrenia. Psychol Med. 2020;50(6):1050–1056. PubMed CrossRef
Tsai SJ, Hsu JW, Huang KL, et al. Risk of parental psychiatric disorders among adolescents with major depressive disorder according to response to antidepressant treatment: does the type of antidepressant matter? CNS Spectr. 2023;28(5):614–619. CrossRef
Thompson MP, Kingree JB, Lamis D. Associations of adverse childhood experiences and suicidal behaviors in adulthood in a U.S. nationally representative sample. Child Care Health Dev. 2019;45(1):121–128. PubMed CrossRef
Seeman MV. Grappling with issues of motherhood for women with schizophrenia. Healthcare (Basel). 2023;11(21):2882. CrossRef
Giannakopoulou O, Lin K, Meng X, et al. The genetic architecture of depression in individuals of east asian ancestry: a genome-wide association study. JAMA Psychiatry. 2021;78(11):1258–1269.