On the genetic and environmental relationship between suicide attempt and death by suicide
Open accessAbstract
OBJECTIVE: The authors examined the extent to which the genetic and environmental etiology of suicide attempt and suicide death is shared or unique. METHODS: The authors used Swedish national registry data for a large cohort of twins, full siblings, and half siblings (N=1,314,990) born between 1960 and 1990 and followed through 2015. They conducted twin-family modeling of suicide attempt and suicide death to estimate heritability for each outcome, along with genetic and environmental correlations between them. They further assessed the relationship between suicide attempt by young people compared with adults. RESULTS: In bivariate models, suicide attempt and death were moderately heritable among both women (attempt: additive genetic variance component [A]=0.52, 95% CI=0.44, 0.56; death: A=0.45, 95% CI=0.39, 0.59) and men (attempt: A=0.41, 95% CI=0.38, 0.49; death: A=0.44, 95% CI=0.43, 0.44). The outcomes were substantially, but incompletely, genetically correlated (women: rA=0.67, 95% CI=0.55, 0.67; men: rA=0.74, 95% CI=0.63, 0.87). Environmental correlations were weaker (women: rE=0.36, 95% CI=0.29, 0.45; men: rE=0.21, 95% CI=0.19, 0.27). Heritability of suicide attempt was stronger among people ages 10-24 (A=0.55-0.62) than among those age 25 and older (A=0.36-0.38), and the genetic correlation between attempt during youth and during adulthood was stronger for women (rA=0.79, 95% CI=0.72, 0.79) than for men (rA=0.39, 95% CI=0.26, 0.47). CONCLUSIONS: The genetic and environmental etiologies of suicide attempt and death are partially overlapping, exhibit modest sex differences, and shift across the life course. These differences must be considered when developing prevention efforts and risk prediction algorithms. Where feasible, suicide attempt and death should be considered separately rather than collapsed, including in the context of gene identification efforts.
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Environmental factors such as low socioeconomic status, firearm availability, and strained parental relationships elevate suicide risk.
“Several studies have explored the role of environmental factors, such as low socioeconomic status, firearm availability, and strained parental relationships in elevating suicide risk (5–7).”
From Exploring the neurobiological markers of suicidal behaviors in pediatric population: a narrative review (2026) · cites this paper as [6]
The data did not fit a model in which suicide attempt and death sit on a single continuum of severity, suggesting these outcomes are not simply mild and severe versions of the same biological process.
“Importantly, the data did not fit a model in which attempt and death sit on a single continuum of severity, suggesting that these outcomes are not simply mild and severe versions of the same biological process (6).”
From Exploring the neurobiological markers of suicidal behaviors in pediatric population: a narrative review (2026) · cites this paper as [6]
Using Swedish national registry data on more than a million individuals, Edwards et al. estimated that genetic risk for suicide attempt overlaps with genetic risk for death by suicide with a genetic correlation of 0.67 in women and 0.74 in men, but the overlap is incomplete with a substantial proportion of genetic risk unique to each phenotype.
“Using Swedish national registry data on more than a million individuals, Edwards et al. (6) estimated how much of the genetic risk for suicide attempt overlaps with the genetic risk for death by suicide. They found substantial overlap (genetic correlation of 0.67 in women and 0.74 in men) but the overlap was incomplete, with a substantial proportion of genetic risk is unique to each phenotype.”
From Exploring the neurobiological markers of suicidal behaviors in pediatric population: a narrative review (2026) · cites this paper as [6]
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“Using Swedish national registry data on more than a million individuals, Edwards et al. (6) estimated how much of the genetic risk for suicide attempt overlaps with the genetic risk for death by suicide.”
- Authors
- Edwards, A. C., Ohlsson, H., Mościcki, E., Crump, C., Sundquist, J., Lichtenstein, P., Kendler, K. S., & Sundquist, K.
- Affiliations
- Virginia Commonwealth University (US)
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2021-11
- Volume
- 178
- Issue
- 11
- Pages
- 1060-1069
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC8570976
- OpenAlex
- W3182733247
- Cited by
- 86
- References
- 71
- Citations by year
- 2026: 19 · 2025: 17 · 2024: 14 · 2023: 14 · 2022: 15 · 2021: 6 · 2020: 1
- FWCI
- 8.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (K01AA021399, R01AA023534, R01AA027522)
- National Institute on Drug Abuse (R01DA030005)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- suicide attempts, suicide mortality, heritability, genetic correlation, environmental correlation, sex differences, life course, youth suicide, genetic etiology, environmental etiology
- MeSH terms
- Adolescent, Adult, Age Factors, Cause of Death, Female, Humans, Male, Preventive Psychiatry, Registries, Sex Factors, Suicide, Attempted, Sweden, Twins, Self-Injurious Behavior, Risk Assessment, Genetic Predisposition to Disease, Siblings, Gene-Environment Interaction
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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