Anxiety disorders and suicidality in the National Comorbidity Survey-Replication
ABSTRACT The current study sought to examine the unique associations between anxiety disorders and suicidality using a large nationally representative sample and controlling for a number of established risk factors for suicide.
Data from the National Comorbidity Survey-Replication were used for analyses. Lifetime diagnostic history and demographics were obtained in this survey through a structured interview. Lifetime suicidal ideation and attempts were also assessed.
Multivariate analyses covarying for psychiatric comorbidity and demographic variables found social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and panic disorder (PD) to be unique predictors of suicidal ideation, while only SAD, PTSD, and GAD were predictive of suicide attempts. Analyses by gender indicated that each of these four disorders were predictive of suicidal ideation or suicide attempts among women, while only PTSD and PD acted as risk factors among men.
Findings provide further evidence of the negative impact of anxiety disorders, suggest efforts should be made towards their early detection and treatment, and emphasize the importance of suicide risk assessment in treating individuals with anxiety disorders.
- SourceAvailable from: Charles B Nemeroff
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- "The majority of patients with PTSD also meet criteria for other psychiatric disorders and experience significant functional impairment . Many also attempt suicide . Despite its impact on society, there is only partial understanding of the etiology or pathophysiology of this disorder. "
ABSTRACT: Pharmacologic treatment options for posttraumatic stress disorder (PTSD) are limited in number and effectiveness. Medications currently in use to treat PTSD were originally approved based on their efficacy in other disorders, such as major depression. Substantial research in PTSD suggests that increased activity of corticotropin releasing hormone (CRH)-containing circuits are involved in the pathophysiology of the disease. This Phase II trial aims to evaluate the efficacy of a CRH type 1 receptor (CRHR1) antagonist in the treatment of PTSD. Currently untreated adult women, ages 18 to 65 years, with a primary psychiatric diagnosis of PTSD of at least 3 months’ duration, are being enrolled in a parallel-group, double-blind, placebo-controlled, randomized clinical trial evaluating the efficacy and safety of GSK561679, a novel CRHR1 receptor antagonist. GSK561679 (or matching placebo) is prescribed at a fixed dose of 350 mg nightly for six weeks. The primary trial hypothesis is that GSK561679 will reduce symptoms of PTSD, as measured by the Clinician-Administered PTSD Scale (CAPS), significantly more than placebo after six weeks of treatment. Putative biological markers of PTSD which may influence treatment response are measured prior to randomization and after five weeks’ exposure to the study medication, including: fear conditioning and extinction using psychophysiological measures; variants of stress-related genes and gene expression profiles; and indices of HPA axis reactivity. In addition, the impact of PTSD and treatment on neuropsychological performance and functional capacity are assessed at baseline and after the fifth week of study medication. After completion of the six-week double blind treatment period, subjects enter a one-month follow-up period to monitor for sustained response and resolution of any adverse effects. Considerable preclinical and human research supports the hypothesis that alterations in central nervous system CRH neuronal activity are a potential mediator of PTSD symptoms. This study is the first to assess the efficacy of a specific antagonist of a CRH receptor in the treatment of PTSD. Furthermore, the biological and neuropsychological measures included in this trial will substantially inform our understanding of the mechanisms of PTSD. Trial registration Clinicaltrials.gov Identifier: NCT01018992. Registered 6 November 2009. First patient randomized 14 January 2010.Trials 06/2014; 15(1):240. DOI:10.1186/1745-6215-15-240 · 2.12 Impact Factor
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- "an independent risk factor for suicide ideation and attempt for both sexes [ 45 , 46 ] . Cougle et al . ( 2009 ) report that for women all four anxiety disorders ( social anxiety disorder , posttraumatic stress disorder , generalized anxiety disorder , panic disorder ) were predictive of suicidality , while for men only posttraumatic stress disorder and panic disorder were identified as risk factors ."
ABSTRACT: Previous research has shown an association between certain personality characteristics and suicidality. Methodological differences including small sample sizes and missing adjustment for possible confounding factors could explain the varying results. The aim of this study was to assess the impact of the Big Five personality dimensions on suicidality in a representative population based sample of adults. Interviews were conducted in a representative German population-based sample (n=2555) in 2011. Personality characteristics were assessed using the Big Five Inventory-10 (BFI-10) and suicide risk was assessed with the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Multivariate logistic regression models were calculated adjusting for depression, anxiety, and various sociodemographic variables. Neuroticism and openness were significantly associated with suicide risk, while extraversion and conscientiousness were found to be protective. Significant sex differences were observed. For males, extraversion and conscientiousness were protective factors. Neuroticism and openness were found to be associated with suicide risk only in females. These associations remained significant after adjusting for covariates. The results highlight the role of personality dimensions as risk factors for suicide-related behaviors. Different personality dimensions are significantly associated with suicide-related behaviors even when adjusting for other known risk factors of suicidality.PLoS ONE 10/2013; 8(10):e76646. DOI:10.1371/journal.pone.0076646 · 3.23 Impact Factor
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- "In 2010 nearly 2 million adults experienced nonfatal injuries requiring hospitalization, while millions more with traumatic injuries were treated in emergency departments (ED).1 The potential development of posttraumatic stress disorder (PTSD), characterized by core symptoms of re-experiencing, avoidance/numbing, and hyperarousal, exacerbates trauma's aftermath. Approximately 6.8% of United States (U.S.) adults currently have PTSD, and 40% of them reported suicidal thoughts, while 19% attempted suicide.2,3 People with PTSD often experience significant health conditions, such as hypertension, asthma, peptic ulcers, gastrointestinal problems, and increased use of medical services.4 "
ABSTRACT: This study analyzed predictors of post-traumatic stress disorder (PTSD) in civilian trauma victims to assess how peritraumatic dissociation (PD) relates to PTSD symptom development. We examined PD and PTSD symptoms from a prior trauma simultaneously to better understand the extent to which past and current reactions to a trauma can predict the development of PTSD for a current trauma. Participants (N=48) were recruited from the emergency department (ED) of a large, southeastern hospital and assessed immediately after a trauma and again at 4 weeks and 12 weeks post-trauma. We used both self-report and interviewer-based questionnaires to assess PD and PTSD symptoms for prior and current trauma. A hierarchical linear regression revealed that at 4-week follow up, when controlling for several demographic variables and trauma type, a model including both PD and PTSD symptoms from a prior trauma significantly predicted PTSD outcome (F(47)= 3.70, p=0.00), with PD and prior PTSD symptoms significantly contributing 17% and 9% of variance respectively. At 12 weeks, PTSD symptoms from prior trauma (β=0.094, p=0.538) and PD (β=-0.017, p=0.909) did not account for a significant proportion of the variance in PTSD for the enrolling trauma. Prior and current reactions to trauma are both important factors in predicting the development of PTSD symptoms to a current trauma. The more immediate measurement of PD during presentation to the ED may explain the strength of its relationship to PTSD symptom development. Furthermore, our findings support the use of PTSD symptoms of a past trauma, as opposed to trauma frequency, as a predictor of PTSD from a subsequent trauma. Methodological limitations and future directions are discussed.The western journal of emergency medicine 08/2012; 13(3):220-4. DOI:10.5811/westjem.2012.3.11777