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Prospective study of risk factors for suicidal behavior in individuals with anxiety disorders

Published online by Cambridge University Press:  09 November 2012

L. A. Uebelacker ,
R. Weisberg ,
M. Millman ,
S. Yen  and
M. Keller
L. A. Uebelacker*
Affiliation:
Department of Psychiatry and Human Behavior Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, USA
R. Weisberg
Affiliation:
Department of Psychiatry and Human Behavior Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, USA
M. Millman
Affiliation:
Department of Psychiatry and Human Behavior Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, USA
S. Yen
Affiliation:
Department of Psychiatry and Human Behavior Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, USA
M. Keller
Affiliation:
Department of Psychiatry and Human Behavior Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, USA
*
*Address for correspondence: L. A. Uebelacker, Ph.D., Assistant Professor (Research), Psychosocial Research Program, Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, USA. (Email: luebelacker@butler.org)
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Abstract

Background

Anxiety disorders are very common and increase risk for suicide attempts. Little is known about predictors of increased risk specifically among individuals with anxiety disorders. The purpose of this study was to investigate whether specific anxiety disorders and other co-morbid psychiatric disorders, physical health, or work or social functioning increased the future likelihood of a suicide attempts among individuals with anxiety disorders.

Method

In this prospective study, 676 individuals with an anxiety disorder were followed for an average of 12 years.

Results

As hypothesized, we found that post-traumatic stress disorder, major depressive disorder (MDD), intermittent depressive disorder (IDD), epilepsy, pain, and poor work and social functioning all predicted a shorter time to a suicide attempt in univariate analyses. In multivariate analyses, baseline MDD and IDD were independent predictors of time to suicide attempt, even when controlling for a past history of suicide attempt. No specific anxiety disorder was an independent predictor of time to attempt in this anxiety-disordered sample. Adding baseline physical health variables and social functioning did not improve the ability of the model to predict time to suicide attempt.

Conclusions

Mood disorders and past history of suicide attempts are the most powerful predictors of a future suicide attempt in this sample of individuals, all of whom have an anxiety disorder.

Keywords

Anxiety disorderssuicidesuicide attempts
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 7 , July 2013 , pp. 1465 - 1474
Copyright
Copyright © Cambridge University Press 2012 

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References

Boden, JM, Fergusson, DM, Horwood, LJ (2007). Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study. Psychological Medicine 374, 431–440.CrossRefGoogle Scholar
Bolton, JM, Cow, BJ, Clara, I, Sareen, J (2006). Use of alcohol and drugs to self-medicate anxiety disorders in a nationally representative sample. Journal of Nervous and Mental Disease 194, 818–825.CrossRefGoogle Scholar
Bolton, JM, Cox, BJ, Afifi, TO, Enns, MW, Bienvenue, OJ, Sareen, J (2008). Anxiety disorders and risk for suicide attempts: Findings from the Baltimore epidemiologic catchment area follow-up. Depression and Anxiety 25, 477–481.CrossRefGoogle ScholarPubMed
Bolton, JM, Pagura, J, Enns, MW, Grant, B, Sareen, J (2010). A population-based longitudinal study of risk factors for suicide attempts in major depressive disorder. Journal of Psychiatric Research 44, 817–826.CrossRefGoogle ScholarPubMed
Borges, G, Angst, J, Nock, MK, Ruscio, AM, Kessler, RC (2008). Risk factors for the incidence and persistence of suicide-related outcomes: A 10-year follow-up study using the National Comorbidity Surveys. Journal of Affective Disorders 105, 25–33.CrossRefGoogle ScholarPubMed
Braden, JB, Sullivan, MD (2008). Suicidal thoughts and behavior among adults with self-reported pain conditions in the National Comorbidity Survey Replication. Journal of Pain 9, 1106–1115.CrossRefGoogle ScholarPubMed
Brown, GK, Beck, AT, Steer, RA, Grisham, JR (2001). Risk factors for suicide in psychiatric outpatients: a 20 year longitudinal study. Journal of Consulting and Clinical Psychology 68, 371–377.CrossRefGoogle Scholar
Brown, LA, Gaudiano, BA, Miller, IW (2010). The impact of panic-agoraphobic comorbidity on suicidality in hospitalized patients with major depression. Depression and Anxiety 27, 310–315.CrossRefGoogle ScholarPubMed
Chartrand, H, Cox, B, El-Gabalawy, R, Clara, I (2011). Social anxiety disorder subtypes and their mental health correlates in a nationally representative sample. Canadian Journal of Behavioural Science 43, 89–98.CrossRefGoogle Scholar
Chartrand, H, Sareen, J, Toews, M, Bolton, J (2012). Suicide attempts versus nonsuicidal self injury among individuals with anxiety disorders in a nationally representative sample. Depression and Anxiety 29, 172–179.CrossRefGoogle Scholar
Christensen, J, Vestergaard, M, Morensen, PB, Sidenius, P, Agerbo, E (2007). Epilepsy and risk of suicide: a population-based case-control study. Lancet Neurology 6, 693–698.CrossRefGoogle ScholarPubMed
Coryell, W, Haley, J, Endicott, J, Solomon, Leon AC, Keller, M, Turvey, C, Maser, JD, Mueller, T (2002). The prospectively observed course of illness among depressed patients who commit suicide. Acta Psychiatrica Scandinavica 105, 218–223.CrossRefGoogle ScholarPubMed
Coryell, W, Young, EA (2005). Clinical predictors of suicide in primary major depressive disorder. Journal of Clinical Psychiatry 66, 412–417.CrossRefGoogle ScholarPubMed
Cougle, JR, Keough, ME, Riccardi, CJ, Sachs-Ericsson, N (2009). Anxiety disorders and suicidality in the National Comorbidity Survey – Replication. Journal of Psychiatric Research 43, 825–829.CrossRefGoogle ScholarPubMed
Diaconu, G, Turecki, G (2007). Panic disorder and suicidality: is comorbidity with depression the key? Journal of Affective Disorders 104, 203–209.CrossRefGoogle ScholarPubMed
Goldstein, TR, Ha, W, Axelson, DA, Goldstein, BI, Liao, F, Gill, M, Ryan, ND, Yen, S, Hunt, J, Hower, H, Keller, M, Strober, M, Birmaher, B (2012). Predictors of prospectively examined suicide attempts among youth with bipolar disorder. Archives of General Psychiatry. Published online 2 July 2012. doi:10.1001/archgenpsychiatry.2012.650.CrossRefGoogle ScholarPubMed
Grant, BF, Goldstein, RB, Chou, P, Huang, B, Stinson, FS, Dawson, DA, Saha, TW, Ruan, WJ, Compton, WM (2009). Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood, and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Molecular Psychiatry 14, 1051–1066.CrossRefGoogle ScholarPubMed
Holma, KM, Melartin, TK, Haukka, J, Holma, IAK, Sokero, TP, Isometsa, ET (2010). Incidence and predictors of suicide attempts in DSM-IV major depressive disorder: a five year prospective study. American Journal of Psychiatry 167, 801–808.CrossRefGoogle ScholarPubMed
Jones, JE, Hermann, BP, Barry, JJ, Gilliam, FG, Kanner, AM, Meador, KJ (2003). Rates and risk factors for suicide, suicidal ideations, and suicide attempts in chronic epilepsy. Epilepsy Behavior 4, 31–38.CrossRefGoogle ScholarPubMed
Keller, MB, Lavori, PW, Friedman, B, Nielsen, E, Endicott, J, McDonald-Scott, P, Andreansen, NC (1987). The Longitudinal Interview Follow-up Evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540–548.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.CrossRefGoogle ScholarPubMed
Krug, EG, Dahlberg, LL, Mercy, JA, Zwi, AB, Lozano, R (eds) (2002). World Report on Violence and Health. World Health Organization: Geneva.CrossRefGoogle ScholarPubMed
Kuo, W, Gallo, JJ, Tien, AY (2001). Incidence of suicidal ideation and attempts in adults: the 13-year follow-up of a community sample in Baltimore, Maryland. Psychological Medicine 31, 1181–1191.CrossRefGoogle ScholarPubMed
Links, P, Nisenbaum, R, Ambreen, M, Balderson, K, Bergmans, Y, Eynan, R, Harder, H, Cutcliffe, J (2012). Prospective study of risk factors for increased suicide ideation and behavior following recent discharge. General Hospital Psychiatry 34, 88–97.CrossRefGoogle ScholarPubMed
Maser, JD, Akiskal, HS, Shcettler, P, Scheftner, W, Mueller, T, Endicott, J, Solomon, D, Clayton, P (2002). Can temperament identify affectively ill patients who engage in lethal or near lethal suicidal behavior? A 14 year prospective study. Suicide and Life-Threatening Behavior 32, 10–32.CrossRefGoogle ScholarPubMed
Neeleman, J, de Graaf, R, Vollebergh, W (2004). The suicidal process: prospective comparison between early and later stages. Journal of Affective Disorders 82, 43–52.CrossRefGoogle ScholarPubMed
Nepon, J, Belik, SL, Bolton, J, Sareen, J (2010). The relationships between anxiety disorders and suicide attempts: findings from the national epidemiologic survey on alcohol and related conditions. Depression and Anxiety 0, 1–8.Google Scholar
Nock, MK, Hwang, I, Sampson, NA, Kessler, RC (2010). Mental disorders, comorbidity, and suicidal behavior: results from the National Comorbidity Survey Replication. Molecular Psychology 15, 868–876.CrossRefGoogle ScholarPubMed
Nock, MK, Kessler, RC (2006). Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Study. Journal of Abnormal Psychology 115, 616–623.CrossRefGoogle Scholar
Nrugham, L, Larsson, B, Sund, AM (2008). Specific depressive symptoms and disorders as associates and predictors or suicidal acts across adolescence. Journal of Affective Disorders 111, 83–93.CrossRefGoogle ScholarPubMed
Oquendo, MA, Currier, D, Mann, JJ (2006). Prospective studies of suicidal behavior in major depressive disorder and bipolar disorders: what is the evidence for predictive risk factors? Acta Psychiatrica Scandinavica 114, 151–158.CrossRefGoogle ScholarPubMed
Pirkola, SP, Isometsa, E, Suvisaari, J, Aro, H, Joukamaa, M, Poikolainen, K, Koskinen, S, Aromaa, A, Lonnqvist, JK (2005). DSM-IV mood-, anxiety- and alcohol use disorders and their comorbidity in the Finnish general population: results from the Health 2000 survey. Social Psychiatry and Psychiatric Epidemiology 40, 1–10.CrossRefGoogle Scholar
Posner, K, Brent, D, Lucas, C, Gould, M, Stanley, B, Brown, G, Fisher, P, Zelazny, J, Burke, A, Oquendo, M, Manne, J (2009). Columbia – Suicide Severity Rating Scale (C-SSRS), Baseline Version 1/14/09. New York: The Research Foundation for Mental Hygiene, Inc.Google Scholar
Ratcliffe, GE, Enns, MW, Belik, S, Sareen, J (2008). Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective. Clinical Journal of Pain 24, 204–210.CrossRefGoogle ScholarPubMed
Robinson, J, Cotton, S, Conus, P, Schimmelmann, BG, McGorry, P, Lambert, M (2009). Prevalence and predictors or suicide attempt in an incidence cohort of 661 young people with first-episode psychosis. Australian and New Zealand Journal of Psychiatry 43, 149–157.CrossRefGoogle ScholarPubMed
Sareen, J, Cox, BJ, Afifi, TO, de Graaf, R, Asmundson, GJG, ten Have, M, Stein, MB (2005). Anxiety disorders and risk for suicidal ideation and suicide attempts. Archives of General Psychiatry 62, 1249–1257.CrossRefGoogle ScholarPubMed
Silverman, MM, Berman, AL, Sanddal, ND, O'Carroll, PW, Joiner, TE (2007 a). Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale, and methodology. Suicide and Life Threatening Behavior 37, 248–263.CrossRefGoogle Scholar
Silverman, MM, Berman, AL, Sanddal, ND, O'Carroll, PW, Joiner, TE (2007 b). Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: Suicide-related ideations, communications, and behaviors. Suicide and Life Threatening Behavior 37, 264–277.CrossRefGoogle Scholar
Sokero, TP, Melartin, TK, Rytsala, HJ, Leskela, US, Lestela-Mielonen, PS, Isometsa, ET (2005). Prospective study of risk factors for attempted suicide among patients with DSM-IV major depressive disorder. British Journal of Psychiatry 186, 314–318.CrossRefGoogle ScholarPubMed
Spitzer, RL, Williams, JBW, Gibbon, M, First, MB (1990). Structured Clinical Interview for DSM-III-R – Patient Version. Biometrics Research Department, New York State Psychiatric Instititue: New York.Google Scholar
Stewart, AL, Hays, RD, Ware, JE Jr. (1998). The MOS General Health Form Short Survey: reliability and validity in patient population. Medical Care 25, 724–735.Google Scholar
Tidelmalm, D, Langstrom, N, Lichtenstein, P, Runeson, B (2008). Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. British Medical Journal 337, a2205.CrossRefGoogle Scholar
Vickers, K, McNally, RJ (2004). Panic disorder and suicide attempt in the National Comorbidity Study. Journal of Abnormal Psychology 113, 582–591.CrossRefGoogle Scholar
Warshaw, MG, Dolan, RT, Keller, MB (2000). Suicidal behavior in patient with current or past panic disorder: five years of prospective data from the Harvard/Brown Anxiety Research Program. American Journal of Psychiatry 157, 1876–1878.CrossRefGoogle ScholarPubMed
Warshaw, MG, Keller, MB (1996). The relationship between fluoxetine use and suicide in 654 subjects with anxiety disorders. Journal of Clinical Psychiatry 57, 158–166.Google ScholarPubMed
Warshaw, MG, Keller, MB, Stout, RL (1994) Reliability and validity of the longitudinal interval follow-up evaluation for assessing outcome of anxiety disorders. Journal of Psychiatric Research 28, 531–545.CrossRefGoogle ScholarPubMed
Warshaw, MG, Massion, AO, Peterson, LG, Pratt, LA, Keller, MB (1995). Suicidal behavior in patients with panic disorder: retrospective and prospective data. Journal of Affective Disorders 34, 235–247.CrossRefGoogle ScholarPubMed
Yen, S, Shea, MT, Sanislow, CA, Skodol, AE, Grilo, CM, Edelen, MO, Stout, RL, Morey, LC, Zanarini, MC, Markowitz, JC, McGlashan, TH, Daversa, MT, Gunderson, JG (2009). Personality traits as prospective predictors of suicide attempts. Acta Psychiatrica Scandinavica 120, 222–229.CrossRefGoogle ScholarPubMed