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Anxiety Disorders and Risk for Suicidal Ideation and Suicide Attempts
A Population-Based Longitudinal Study of Adults
Jitender Sareen, MD, FRCPC;
Brian J. Cox, PhD;
Tracie O. Afifi, MSc;
Ron de Graaf, PhD;
Gordon J. G. Asmundson, PhD;
Margreet ten Have, PhD;
Murray B. Stein, MD, MPH
Arch Gen Psychiatry. 2005;62:1249-1257.
Context Controversy exists whether anxiety disorders are independently associated (ie, after adjusting for comorbid mental disorders) with suicidal ideation and suicide attempts.
Objective To examine whether anxiety disorders are risk factors for suicidal ideation and suicide attempts in a large population-based longitudinal study.
Methods Data come from the Netherlands Mental Health Survey and Incidence Study, a prospective population-based survey with a baseline and 2 follow-up assessments over a 3-year period. The Composite International Diagnostic Interview was used to assess DSM-III-R mental disorders. Lifetime diagnoses of anxiety disorders (social phobia, simple phobia, generalized anxiety disorder, panic disorder, agoraphobia, obsessive-compulsive disorder) were assessed at baseline. Multiple logistic regression analyses were used to examine whether anxiety disorders were associated with suicidal ideation and attempts at baseline (n = 7076) and whether anxiety disorders were risk factors for subsequent onset of suicidal ideation and attempts (n = 4796).
Results After adjusting for sociodemographic factors and all other mental disorders assessed in the survey, baseline presence of any anxiety disorder was significantly associated with suicidal ideation and suicide attempts in both the cross-sectional analysis (adjusted odds ratio for suicidal ideation, 2.29; 95% confidence interval, 1.85-2.82; adjusted odds ratio for suicidal attempts, 2.48; 95% confidence interval, 1.70-3.62) and longitudinal analysis (adjusted odds ratio for suicidal ideation, 2.32; 95% confidence interval, 1.31-4.11; adjusted odds ratio for suicide attempts, 3.64; 95% confidence interval, 1.70-7.83). Further analyses demonstrated that the presence of any anxiety disorder in combination with a mood disorder was associated with a higher likelihood of suicide attempts in comparison with a mood disorder alone.
Conclusions This is the first study to demonstrate that a preexisting anxiety disorder is an independent risk factor for subsequent onset of suicidal ideation and attempts. Moreover, the data clearly demonstrate that comorbid anxiety disorders amplify the risk of suicide attempts in persons with mood disorders. Clinicians and policymakers need to be aware of these findings, and further research is required to delineate whether treatment of anxiety disorders reduces the risk of subsequent suicidal behavior.
Author Affiliations: Department of Psychiatry, University of Manitoba, Winnipeg (Drs Sareen and Cox and Ms Afifi); Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Drs de Graaf and ten Have), Anxiety and Illness Behaviours Laboratory, University of Regina, Regina, Saskatchewan (Dr Asmundson); and Departments of Psychiatry and Family and Preventive Medicine, University of California, San Diego (Dr Stein).
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