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Background The psychological toll on parents of a child receiving a cancer diagnosis is known to be high, but there is a knowledge gap regarding suicidal behavior among these parents. The aim of this study was to investigate the risk of suicide attempt and death by suicide in relation to having a child with cancer. Methods and findings We performed a binational population-based and sibling-controlled cohort study, including all parents with a child diagnosed with cancer in Denmark (1978 to 2016) or Sweden (1973 to 2014), 10 matched unexposed parents per exposed parent (population comparison), and unaffected full siblings of the exposed parents (sibling comparison). Suicide attempt was identified through the Patient Register and the Psychiatric Central Register in Denmark and the Patient Register in Sweden, whereas death by suicide was identified through the Danish Causes of Death Register and the Swedish Causes of Death Register. In population comparison, we used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of suicide attempt and death by suicide associated with cancer diagnosis of a child, adjusting for sex, age, country of residence, calendar year, marital status, highest attained educational level, household income, history of cancer, history of psychiatric disorder, and family history of psychiatric disorder. The sibling comparison was performed to assess the role of familial confounding in the studied associations. The population comparison consisted of 106,005 exposed parents and 1,060,050 matched unexposed parents, with a median age of 56 at cohort entry and 46.9% male. During the median follow-up of 7.3 and 7.2 years, we observed 613 (incidence rate [IR], 58.8 per 100,000 person-years) and 5,888 (IR, 57.1 per 100,000 person-years) cases of first-onset suicide attempt among the exposed and unexposed parents, respectively. There was an increased risk of parental suicide attempt during the first years after a child's cancer diagnosis (HR, 1.15; 95% CI, [1.03, 1.28]; p = 0.01), particularly when the child was 18 or younger at diagnosis (HR, 1.25; 95% CI, [1.08, 1.46]; p = 0.004), when the child was diagnosed with a highly aggressive cancer (HR, 1.60; 95% CI, [1.05, 2.43]; p = 0.03), or when the child died due to cancer (HR, 1.63; 95% CI, [1.29, 2.06]; p < 0.001). The increased risk did not, however, maintain thereafter (HR, 0.86; 95% CI: [0.75, 0.98]; p = 0.03), and there was no altered risk of parental death by suicide any time after the child's cancer diagnosis. Sibling comparison corroborated these findings. The main limitation of the study is the potential residual confounding by factors not shared between full siblings. Conclusions In this study, we observed an increased risk of parental suicide attempt during the first years after a child's cancer diagnosis, especially when the child was diagnosed during childhood, or with an aggressive or fatal form of cancer. There was, however, no altered risk of parental death by suicide at any time after a child's cancer diagnosis. Our findings suggest extended clinical awareness of suicide attempt among parents of children with cancer, especially during the first few years after cancer diagnosis., Author(s): Qianwei Liu 1,2,*, Krisztina D. László 3,4, Dang Wei 2, Fen Yang 3, Katja Fall 2,5, Unnur Valdimarsdóttir 2,6,7, Maria Feychting 2, Jiong Li 8, Fang Fang 2 Introduction [...]

Background: High academic aspirations relate to higher achievement and better mental health, but less is known about how these aspirations are formed in relation to the educational context. Objective: This study aims to investigate the relationship between overall school climate, with particular concern for the dimensions of school level expectations and support as rated by both teachers and students and adolescent academic aspirations. Methods: Multilevel logistic models for repeated measures were used in order to investigate the relationship between measures of school climate and adolescents' academic aspirations. Three annual waves of questionnaire data were used to obtain aggregated teacher- and student-rating of school climate, including specific dimensions of teacher expectations and support. Results: Positive teacher-rated overall school climate was associated with an increased odds of adolescents aiming at a university education rather than at a lower one (adjusted OR 1.36, 95% CI 1.14-1.63 for the intermediate tertile; OR 1.39, 95% CI 1.14-1.70 for the highest tertile). A similar trend was found for the teacher-rated measures of expectations and student focus, but not for any of the student-rated school climate measures. Conclusion: A positive school climate rated by teachers appears to predict adolescents' university aspirations. Future research should clarify which aspects of the school climate may influence adolescent academic aspirations from the students' perspective.

Background and Aims Increasing evidence suggests that some reproductive factors/hazards are associated with a future risk of cardiovascular disease (CVD) in women. While major (non-perinatal) depression has consistently been associated with CVD, the long-term risk of CVD after perinatal depression (PND) is largely unknown. Methods A nationwide population-based matched cohort study involving 55 539 women diagnosed with PND during 2001–14 in Sweden and 545 567 unaffected women individually matched on age and year of conception/delivery was conducted. All women were followed up to 2020. Perinatal depression and CVD were identified from Swedish national health registers. Using multivariable Cox models, hazard ratios (HR) of any and type-specific CVD according to PND were estimated. Results The mean age at the PND diagnosis was 30.8 [standard deviation (SD) 5.6] years. During the follow-up of up to 20 years (mean 10.4, SD 3.6), 3533 (6.4%) women with PND (expected number 2077) and 20 202 (3.7%) unaffected women developed CVD. Compared with matched unaffected women, women with PND had a 36% higher risk of developing CVD [adjusted HR = 1.36, 95% confidence interval (CI): 1.31–1.42], while compared with their sisters, women with PND had a 20% higher risk of CVD (adjusted HR = 1.20, 95% CI 1.07–1.34). The results were most pronounced in women without a history of psychiatric disorder (P for interaction <.001). The association was observed for all CVD subtypes, with the highest HR in the case of hypertensive disease (HR = 1.50, 95% CI: 1.41–1.60), ischaemic heart disease (HR = 1.37, 95% CI: 1.13–1.65), and heart failure (HR 1.36, 95% CI: 1.06–1.74). Conclusions Women with PND are at higher risk of CVD in middle adulthood. Reproductive history, including PND, should be considered in CVD risk assessments of women. [ABSTRACT FROM AUTHOR]