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Original Investigation
May 22, 2019

Association Between Parental Medical Claims for Opioid Prescriptions and Risk of Suicide Attempt by Their Children

Author Affiliations
  • 1Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 2Center for Health Statistics, University of Chicago, Chicago, Illinois
  • 3Department of Medicine, University of Chicago, Chicago, Illinois
  • 4Department of Public Health Sciences, University of Chicago, Chicago, Illinois
JAMA Psychiatry. Published online May 22, 2019. doi:10.1001/jamapsychiatry.2019.0940
Key Points

Question  Is there an association between parental use of prescription opioids and suicide attempts by their children?

Findings  This pharmacoepidemiologic study compared rates of suicide attempts in children of parents who used opioids (>1 year of filled prescriptions) with a matched set of families in which parents did not fill opioid prescriptions. A statistically significant doubling of the risk of suicide attempts among the children of parents who used opioids was found.

Meaning  Children of parents who use opioids may be at increased risk for suicide attempts, which may be a contributing factor to the time trend in adolescent suicidality.

Abstract

Importance  The rate of youth suicide has increased over the past 15 years in the United States as has the rate of death due to opioid overdose in adults of parental age.

Objective  To explore the possible connection between parental use of prescription opioids and the increasing rate of youth suicide.

Design, Setting, and Participants  A pharmacoepidemiologic study was conducted from January 1, 2010, to December 31, 2016, linking medical claims for parental opioid prescriptions with medical claims for suicide attempts by their children. The study used MarketScan medical claims data covering more than 150 million privately insured people in the United States. The study included 121 306 propensity score–matched 30- to 50-year-old parents who used opioids and parents who did not use opioids and their 10- to 19-year-old children (148 395 children of parents who did not use opioids and 184 142 children of parents who used opioids). Propensity score matching was used to identify relevant control families based on demographic features and concomitant use of psychotropic medication.

Exposures  Opioid use in a parent was defined as having prescription fills covering more than 365 days of an opioid between 2010 and 2016.

Main Outcomes and Measures  Suicide attempt rate in the children of parents who used opioids and those who did not use opioids.

Results  A total of 148 395 children (75 575 sons and 72 820 daughters; mean [SD] age, 11.5 [1.6] years at the start of follow-up) had parents who did not use opioids and 184 142 children (94 502 sons and 89 640 daughters; mean [SD] age, 11.8 [1.8] years at the start of follow-up) with parents who did use opioids. There were 100 899 children aged 10 to 14 years and 47 496 children aged 15 to 19 years with parents who did not use opioids and 96 975 children aged 10 to 14 years and 87 163 children aged 15 to 19 years with parents who did use opioids. Of the children with parents who did not use opioids, 212 (0.14%) attempted suicide; of the children with parents who did use opioids, 678 (0.37%) attempted suicide. Parental use of opioids was associated with a doubling of the risk of a suicide attempt by their offspring (odds ratio [OR], 1.99; 95% CI, 1.71-2.33). The association remained significant after adjusting for child age and sex (OR, 1.85; 95% CI, 1.58-2.17), addition of child and parental depression and diagnoses of substance use disorder (OR, 1.46; 95% CI, 1.24-1.72), and addition of parental history of suicide attempt (OR, 1.45; 95% CI, 1.23-1.71). Geographical variation in opioid use did not change the association (OR, 2.00; 95% CI, 1.71-2.34).

Conclusions and Relevance  Children of parents who use prescription opioids are at increased risk for suicide attempts, which could be a contributing factor to the time trend in adolescent suicidality. The care of families with a parent who uses opioids should include mental health screening of their children.

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