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: Elmar Brähler
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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 · 3.53 Impact Factor
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- "Based on recent studies of PTSD and suicidality (Nepon et al., 2010; Cougle et al., 2009), MDD and PD diagnoses were added to the regression model to determine if the result was confounded by these factors. MDD diagnosis was included because of the significant comorbidity between PTSD and MDD (Cougle et al., 2009). PD diagnosis was added because of the high rate of suicide attempts among those diagnosed with a personality disorder (Nepon et al., 2010). "
ABSTRACT: Recent reports of increasing suicide rates among military personnel indicate a need for increased work in understanding processes relevant to suicide risk in the military. Anxiety, along with anxiety-related risk factors have been implicated in suicidality as well as posttraumatic stress disorder (PTSD). One such risk factor, anxiety sensitivity (AS), refers to fear of anxiety-related symptoms. Subfactors of AS, notably the physical and cognitive concerns factors, appear to be relevant to the construct of acquired capability for suicidal behavior, a risk factor for death by suicide postulated by the Interpersonal-Psychological Theory of Suicide (Joiner, 2005; Van Orden et al., 2010). Study 1 examined the interaction of AS-cognitive concerns and AS-physical concerns in an outpatient sample with PTSD symptomatology (N = 128). Analyses were consistent with our a priori model and indicated that the interaction of AS-cognitive concerns by AS-physical concerns predicted previous suicide attempt. Specifically, those with high AS-cognitive concerns and low AS-physical concerns were at increased risk for suicide attempt. Study 2 prospectively examined the associations between AS and suicidal ideation in a sample of military cadets undergoing basic training (N = 1081). A similar interaction emerged such that high AS-cognitive and low AS-physical scores at Time 1 significantly predicted suicidal ideation several months later, even after controlling for Time 1 suicidal ideation and psychopathology. These findings suggest that suicide potential may be related to interactions between cognitive risk factors for anxiety among individuals with PTSD symptomatology as well as individuals experiencing stressful life events.Journal of Psychiatric Research 11/2011; 46(2):174-80. DOI:10.1016/j.jpsychires.2011.10.009 · 4.09 Impact Factor
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- "Panic disorder has a negative impact on well-being and on health perception (Katerndahl & Realini, 1997 ; Klerman et al. 1991), and is associated with impaired functioning (Kessler et al. 2006 ; Wittchen et al. 1998) and absence from work (Alonso et al. 2004 ; Kouzis & Eaton, 1994, 1997). In addition, panic disorder may be associated with suicidal ideation and/or attempts (Cougle et al. 2009 ; Goodwin & Roy-Byrne, 2006 ; Lepine et al. 1993 ; Weissman et al. 1989), even if the impact of comorbid disorders on this association is a matter of debate (Hornig & McNally, 1995) and although the evidence that panic disorder causes suicidality remains unclear (Sareen et al. 2005a). Panic disorder is also associated with medical morbidity, including cardiovascular disease (Chen et al. 2009 ; Gomez-Caminero et al. 2005 ; Sareen et al. 2005b ; Smoller et al. 2007). "
ABSTRACT: The evidence-based pharmacotherapy of panic disorder continues to evolve. This paper reviews data on first-line pharmacotherapy, evidence for maintenance treatment, and management options for treatment-refractory patients. A Medline search of research on pharmacotherapy was undertaken, and a previous systematic review on the evidence-based pharmacotherapy of panic disorder was updated. Selective serotonin reuptake inhibitors remain a first-line pharmacotherapy of panic disorder, with the serotonin noradrenaline reuptake inhibitor venlafaxine also an acceptable early option. Temporary co-administration of benzodiazepines can be considered. Maintenance treatment reduces relapse rates, but further research to determine optimal duration is needed. For patients not responding to first-line agents several pharmacotherapy options are available, but there is a notable paucity of data on the optimal choice.The International Journal of Neuropsychopharmacology 06/2011; 15(3):1-13. DOI:10.1017/S1461145711000800 · 5.26 Impact Factor