Risk of Suicide Attempt Four Times Greater in Adoptees Compared with Nonadoptees

Pediatrics has published a new study comparing suicide attempts of adoptees to nonadoptees. The abstract can be read at this link. You can purchase the article for $12.

Keyes, MA, Malone SM, Sharma A, Iacono WG, McGue M. Risk of Suicide Attempt in Adopted and Nonadopted Offspring. Pediatrics. 2013; 132(4):1-7.

This study was conducted from 1998 to 2008 on adoptees placed from three agencies in Minnesota.  The children were between ages 11 and 21. Ninety-six percent of children were placed to the adoptive family before 1 year of age. All were placed to the adoptive family before two years of age. Seventy-four percent were internationally adopted with sixty percent female and ninety percent of the international adoptees were Korean. Because 23 subjects had attempted suicide prior to the study launch, they were excluded from the rest of the analysis (15 were adopted and 8 were not adopted). In other words 79 of the sample had actually attempted suicide. Unlike a previous study in Sweden, there was no difference in attempts between domestic and international adoptees.Nonwhite ethnicity did not predict suicide attempt.

There were small to moderate differences between adoptees and nonadoptees in the following categories: childhood disruptive disorder symptoms; teacher reports of externalizing behavior and negative mood (although 24% of participants had this data missing); family discord and academic disengagement(as reported solely by adoptive parent on grade point average and academic motivation).

“The study of more than 1,200 teens, all living in Minnesota, found that those who were adopted were almost four times more likely to attempt suicide. Out of all the participants, 47 out of 56 who attempted suicide were adopted, and girls faced a larger risk. Of the 47 adopted teens, 16 were boys and 31 were girls, and among those who weren’t adopted, four were boys and five were girls, Medscape reported.

“Adolescence, in general, is a period of higher risk [for suicide attempt],” Dr. Victor Fornari, director of child and adolescent psychiatry at North Shore-LIJ Health System, told HealthDay News. “And now there’s evidence that the risk may be relatively higher for adopted adolescents.”

All of the 692 adopted teens were placed into their families before the age of two. About 75 percent of them were foreign born — mostly from South Korea. The researchers compared them to 540 non-adopted teens — all teens were 15 at the time of enrollment. Three years later, they and their parents were interviewed, along with their teachers, to assess for risk factors. The researchers found that certain behavioral issues were associated with those who tried to commit suicide, including family discord (reported by parents), academic disengagement, externalizing behavior, and negative moods.

The authors of the study, however, wrote that they found “no significant difference in odds for suicide attempt between domestic and intercountry adoptees, and nonwhite ethnicity did not predict suicide attempt,” MedPage Today reported. The gender gap between boys and girls appeared because “boys are 10 times more likely to complete a suicide, because they use more lethal means,” Fornari told HealthDay. “But girls are about 10 times more likely than boys to attempt suicide.”

Suicide is the third leading cause of death among young people ages 10 to 24. Each year, about 157,000 young people receive medical care for self-inflicted wounds relating to attempted suicide, according to the Centers for Disease Control and Prevention. The most common methods used to commit suicide include firearm (45 percent), suffocation (40 percent), and poisoning (eight percent).

Why Adopted Teens May Resort To Suicide and What Clinicians Should Remember

The researchers noted that adopted children could have attempted suicide more often because of factors inherited from their biological parents, such as psychiatric disorders and substance abuse, or also from adjustmemnt and developmental problems, including loss of attachment and early placement in an institution.

“It doesn’t surprise me that children who’ve been adopted in great numbers have struggles, which, I guess, if you took to its natural consequences, would increase the suicide rate,” Chuck Johnson, president of the National Council for Adoption, told Medscape. “But the thing that really comes out at me is it appears a vast majority of children are doing really well.” [Typical downplay!]

Dr. Margaret Keyes, lead author of the study, told Medscape that the study is a stark reminder to clinicians that they should take adoptive parents’ concerns seriously. “Adoptive parents are sometimes viewed as overreporters and quick to refer to helping agencies, social services agencies, or their family doctor. I think their concerns should be taken seriously and not necessarily viewed as overreporting or overanxiousness. They may be looking at a real phenomenon in their family,” she said.”

Adopted Teens 4 Times More Likely To Attempt Suicide: A Stark Reminder That Clinicians Should Take Parental Concerns Seriously

[Medical Daily 9/9/13 by Anthony Rivas]

REFORM Puzzle Piece