Children of Parents Prescribed Opioids Are at Increased Risk of Suicide Attempt

Youth suicide has increased in the US over the last 15 years and little is known about why. This pharmacoepidemiologic study linked medical claims for parental opioid prescriptions with medical claims for suicide attempts by their children. In a large privately insured sample, propensity matching was used to compare suicide attempt claims in 148,395 10–19 year old children of parents who were not prescribed opioids and 184,142 matched children of parents who were prescribed opioids covering at least one year between 2010 and 2016.

• Of the children with parents not prescribed opioids, 212 (0.014%) had claims related to a suicide attempt, while 678 (0.037%) children of parents prescribed opioids had a suicide attempt claim.
• Children of parents prescribed opioids had an increased rate of suicide attempts compared with children of matched controls (odds ratio [OR], 1.99) with rates of 11.68 versus 5.87 per 10,000 person-years. Similar differences were found when stratified by sex and age.
• After controlling for parental substance use disorder (SUD) and depression as well as child age, sex, depression, opioid use disorder, and SUD, the association between parental opioid prescription and child suicide attempt was still significant, though the odds ratio was reduced (OR, 1.46).
• Additional analyses accounting for the number of parents prescribed opioids, parental history of suicide attempt, method of suicide attempt (overdose versus other), and geographic region did not change the results. Controlling for sleep medication use reduced the adjusted odds ratio (OR, 1.26).

Comments: This study provides observational support for the association between parental opioid prescriptions and suicide attempts by their children. The association was seen after controlling for multiple potential confounders, although the magnitude of the effect was reduced, raising the possibility that unmeasured or incompletely measured factors might explain the association.  Whether this association explains the recent increase in youth suicide cannot be directly assessed by this study.

Joseph Merrill, MD, MPH

Reference: Brent DA, Hur K, Gibbons RD. Association between parental medical claims for opioid prescriptions and risk of suicide attempt by their children. JAMA Psychiatry. 2019 [Epub ahead of print]. doi: 10.1001/jamapsychiatry.2019.0940.