Abstract
IMPORTANCE: Suicide and suicidal behavior among US adolescents has increased dramatically over the past 2 decades, without a clear explanation. Deaths of despair in midlife adults, due to suicide, alcohol-related disease, or drug overdose, have doubled in the past decade, with parallel increases in corresponding diseases of despair (DoD), indicating that there could be an association between these 2 epidemics. OBJECTIVE: To assess associations of parental DoD with suicidal events (SE) in their offspring. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used the MarketScan commercial claims and encounter database, encompassing 164 million individuals, with claims data from 2010 to 2020. Prelinked parents aged 30 to 50 years and their children aged 8 to 15 years were included. Data were analyzed from November 2023 to May 2025. EXPOSURE: Parent with or without a DoD, defined as a suicide attempt, alcohol-related disease, or substance use disorder according to diagnostic codes. MAIN OUTCOMES AND MEASURES: The primary outcome was child SE, either a suicide attempt or self-harm, adjusted for age and sex. Children were followed until their SE, disenrollment from commercial health insurance, or 730 days after the parental DoD index diagnosis. Data were analyzed using a Cox proportional hazards model, with families with and without DoD balanced in terms of potential confounders through inverse probability weighting. RESULTS: The study included 561 837 families with at least 1 parent diagnosed with a DoD (291 463 male [51.9%]; 244 943 [43.6%] aged 30-39 years) and 1 180 546 control families (591 976 male [50.1%]; 498 778 [42.2%] aged 30-39 years), from which 817 133 children from families with DoD (417 770 male [51.1%]; 383 810 [47.0%] aged 8 to 11 years) and 1 744 182 children from control families (889 308 male [51.0%]; 884 749 [50.7%] aged 8-11 years) were identified. Exposure to parental DoD was associated with an increased hazard for an SE (hazard ratio [HR], 1.67; 95% CI, 1.54-1.82). Youths with 2 parents with DoD had a larger hazard for an SE than those with 1 affected parent (interaction HR, 1.95, 95% CI, 1.58-2.39). There was a significant age by sex interaction in girls aged 8 to 11 years (HR, 3.12; 95% CI, 2.05-4.74) but not boys (HR, 0.99; 95% CI, 0.63-1.54). Maternal DoD was associated with a higher risk for a child SE than paternal DoD (interaction HR, 1.44; 95% CI, 1.13-1.84). CONCLUSIONS AND RELEVANCE: This cohort study found an association of parental DoD with youth SE; this finding may be underlying the increase in adolescent suicidal behavior observed in the US over the past 2 decades. Improved access to care for parents with DoD and systematic screening and referral of their offspring could help to reduce the adolescent suicide rate.