Suicide and Anxiety Disorders: What Is the Risk?

– Posted in: Anxiety

Suicidal behavior has not been associated with the Anxiety Disorders alone until recently.

It has long been known that as many as 90 percent of suicides in the United States are associated with mental illness, especially substance abuse disorders, schizophrenia, and mood disorders such as depression. Up to 75 percent of all people with depression, schizophrenia or other mental illnesses who attempt or complete suicide also are diagnosed with one or more of the Anxiety Disorders.

As recently as 1999, the Surgeon General could only say that, ” it is likely that the rate of comorbid [simultaneous] anxiety in suicide is underestimated.” There had been no studies at the time of Anxiety Disorder alone being a risk factor for suicide.

However, since then there have been a number of studies of the risks of Anxiety Disorders alone for suicide. It has been universally found that the suicide risk in patients with Anxiety Disorders is much higher than previously thought. Bob Montgomery and Laurel Morris say,

Patients with anxiety problems, especially but not only panic problems, suffer an unexpectedly high rate of heart disease and suicide. Suicide has long been recognized as a risk associated with depression. But [when] researchers compared a group of anxious with a matched group of depressed patients and found that the suicide rates for anxious patients were equal to or slightly higher than for the depressed patients.

This post summarizes some landmark studies from the past three years that have proven Anxiety Disorders, both alone and in association with other mental illnesses, are a significant risk factor for suicidal ideation, attempts, and completions.

Anxiety Disorders alone can be a risk factor for suicidal behavior

First large-scale study of Anxiety Disorders alone as a suicide risk

A large research project was undertaken by Jitender Sareen and associates to determine whether the Anxiety Disorders, as a group, are associated with suicidal behavior. The data came from the Netherlands Mental Health Survey and Incidence Study, and involved a total of 7,076 people over a three-year period. This was the first study to consider Anxiety Disorders separated from other mental illnesses in suicidal behavior. The results were reported in the November, 2005 issue of the Archives of General Psychiatry.

The researchers found that the presence of any Anxiety Disorder was significantly associated with suicidal ideation and suicide attempts. The presence of any Anxiety Disorder in combination with a mood disorder such as depression was associated with a higher likelihood of suicide attempts in comparison with a mood disorder alone. Other findings were:

  • Among those with suicidal ideation, 52.4 percent had at least one Anxiety Disorder. 
  • Among those with suicidal attempts, 64.1 percent had at least one Anxiety Disorder. 
  • The presence of one or more Anxiety Disorders was significantly associated with lifetime suicidal ideation and suicide attempts. 
  • All of the Anxiety Disorders were strongly associated with lifetime suicidal ideation and suicide attempts. 
  • Panic Disorder, Agoraphobia without panic and simple phobia (not Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, or Social Phobia) were significantly associated with lifetime suicide attempts, even after adjusting for other mental disorders and sociodemographic variables.
  • Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, and Social Phobia were strongly linked with suicidal ideation, but not with suicide attempts.
  • Post Traumatic Stress Disorder (PTSD) was positively associated with suicidal behavior of all types. 

Sareen, the lead researcher in the study, states that,

Together with strong evidence that anxiety disorders are highly underrecognized and undertreated in the community and primary care, the current findings suggest that untreated anxiety disorders might be missed opportunities for preventing suicidal behavior.

Anxiety and nervousness a rising risk factor for suicidal behavior

Nervous, anxious, uneasy people up to 9 times as likely to attempt suicide

Swedish researchers reported in 2005 in the Journal of Epidemiology and Community Health that people who report feeling nervous, anxious, and uneasy are much more likely to attempt suicide than others who perceive themselves as relaxed. Men are nine times more likely to have suicidal behavior, and women almost four times as likely. The findings are based on results from the Swedish Survey of Living Conditions, a representative face-to-face survey of 34,500 16 to 74 year olds, carried out every year in Sweden.

Severe anxiety and nervousness was a greater risk factor for death from all causes other than smoking and longstanding illness over five to 10 years. And their risk of suicide increased over time, so that it was 15 times as high after 10 years. 

The researchers were puzzled by the rising rates of anxiety, nervousness and uneasiness over the past 20 years, and speculate that at least some of the rise is due to people’s being willing to admit it. It is also not certain why nervousness and anxiety were more closely linked to suicide attempts in men than in women. Are women more open about those feelings? Do such emotions effect men and women differently?

 The researchers say that the rising reports of anxiety were an “alarm signal that society should take seriously.” Besides calling for more studies, they urge health care workers to “pay attention to patient anxiety.” 

In summary

Many mental health professionals do not think Anxiety Disorders alone a suicide risk

There are many studies that connect Anxiety Disorders with other mental illnesses, such as depression and schizophrenia, in suicidal behavior. Some studies state that as many as 75 percent of all people with suicidal behavior have Anxiety Disorder along with another Axis I mental illness. This has led many mental health professionals to not regard Anxiety Disorders alone as a risk for suicidal behavior.

The studies mentioned in this post, as well as others, point to the Anxiety Disorders alone being a significant risk for suicidal ideation, suicide attempts, and suicide completion. As Sareen states in his study, mental health professionals need to be aware of the suicide risk that Anxiety Disorders present:

[P]ublic health treatment strategies aimed at reducing suicidal behavior in the community should target individuals with mood disorders alone, anxiety disorders alone, and especially those with both an anxiety and a mood disorder.

For anyone with one or more of the Anxiety Disorders, it will come as no surprise that thoughts of suicide can accompany the disorder. But thoughts of suicide — suicidal ideation — are a far cry from suicide attempts and what psychiatrists rather euphemistically call “suicide completion.” But the research outlined in this post suggests that we not let down our guard when we have Anxiety Disorders alone, because a significant number of people go beyond mere ideation to suicide attempts and completion with no other mental illnesses to blame. 

What do you think?

  • Have you ever thought about suicide? Do you have Anxiety Disorders alone?
  • Do you know of anyone that committed suicide? What were there diagnosed mental illnesses, if any?
  • Were you surprised to see that Anxiety Disorders alone are a risk for suicidal behavior?

As always, your comments are welcome!

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Resources used in this post:

Bio-Medicine. (2005, August 11). Anxiety Can Increase the Risk of Attempting Suicide in Men. Retrieved September 30, 2008 from Bio-Medicine Web site: http://www.bio-medicine.org/medicine-news/Anxiety-Can-Increase-The-Risk-Of-Attempting-Suicide-In-Men-4500-1/

Brain Explorer. (2008). Anxiety Disorders: Comorbidity. Retrieved September 30, 2008 from Brain Explorer Web site: http://www.brainexplorer.org/anxiety/Anxiety_Comorbidity.shtml

Hitti, Miranda. (2005, August 10). Study Links Anxiety, Nervousness to Suicide. Retrieved September 30, 2008 from WebMD Web site: http://www.webmd.com/anxiety-panic/news/20050810/study-links-anxiety-nervousness-to-suicide

Khan, A.; Leventhal, R.; Khan, S.; Brown, W. (2000, December 26). Suicide risk in patients with anxiety disorders: a meta-analysis of the FDA database. Retrieved September 30, 2008 from Journal of Affective Disorders Web site: http://www.jad-journal.com/article/S0165-0327(01)00354-8/abstract

Montgomery, Bob; Morris, Laurel. Living with Anxiety: A Clinically Tested Step-by-step Plan for Drug-free Management. Cambridge, MA: Da Capo Press. 2001. pp 253-254

North Carolina State University Counseling Center. (2008). Depression/Anxiety/Mood/Suicide Resources. Retrieved September 30, 2008 from North Carolina State University Counseling Center Web site: http://www.ncsu.edu/counseling_center/resources/personal/mood_issues/mood_issues.htm

Placidi, G.; Owuendo, M.; Malone, K.; Brodsky, B.; Ellis, S.; Mann, J. (2000, October). Anxiety in Major Depression: Relationship to Suicide Attempts. Retrieved September 30, 2008 from American Journal of Psychiatry Web site: http://ajp.psychiatryonline.org/cgi/content/full/157/10/1614

Satcher, David. (1999). Mental Health: A Report of the Surgeon General 1999: Chapter 4, Anxiety Disorders. Retrieved September 30, 2008 from US Department of Health and Human Services Web site: http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html

Sareen, J.; Cox, B; Afifi, T.; de Graaf, R.; Asmundson, G.; ten Have, M.; Stein, M. (2005). Anxiety Disorders and Risk for Suicidal Ideation and Suicide Attempts. Retrieved September 30, 2008 from Archives of General Psychiatry Web site: http://archpsyc.ama-assn.org/cgi/content/full/62/11/1249

Silverman, Morton. (2008). Suicide Assessment, Intervention and Prevention. Retrieved September 30, 2008 from The Doctor Will See You Now Web site: http://www.thedoctorwillseeyounow.com/articles/behavior/suicide_13/

Simon, N.; Zalta, A.; Otto, M.; Ostacher, M.; Fischmann, D.; Chow, C.; Thompson, E.; Stevens, J.; Demopulos, C.; Nierenberg, A.; Pollack, M. (2006, August). The association of comorbid anxiety disorders with suicide attempts and suicidal ideation in outpatients with bipolar disorder. Retrieved September 30, 2008 from ScienceDirect Web site: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T8T-4M4TP2T-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=43e6cf0f2f815e468f18760f2f638a3e

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96 Comments… add one
Cheryl August 18, 2013, 10:47 pm

Hi Patti,
The book I ordered is Charles Linden author, Stress Free in 30 Days. He has a whole program to beat anxiety but it was expensive do i thought I would try the book with the cd first.
I am a little better with the meds but I dont know why I feel
less comfortable now about the job.
Thanks for writing.
Cheryl

Cheryl August 26, 2013, 11:33 pm

Patti,
The fever was low grade. I actually think it is hormonal, possibly estrogen related from like a hot flush to my head.
It stopped now. It is perimenopause and posdibly thyroid to.
Top it with anxiety and it is one big nightmare. Oh well.
I may need to do a regular beta blocker until this passes.
I wish I could tolerate the ssri meds they are supposed to be a help with this stuff due to serotonin.
I hope I can get some control over this hormonal imbalances.
If not it could ruin my career.
Let me know if you know of any remedies.
thanks………cheryl

Patti
Twitter:
August 27, 2013, 8:21 am

Geeeeezzzzz – I have no suggestions on the hormone issue. I had a total hyst in 2001. Did a year of Estrace and then stopped due to the link of HRT to breast cancer which runs in my family. You might grab one of Suzanne Sommers books – she’s really into the hormone thing and you might learn something there. Glad no high fever or apparent infx. Let me know how your week finishes out. :)

Cheryl September 5, 2013, 10:38 pm

Been moving ahead……..only 1 klonopin in 2 weeks!
Still having physical symptoms and anxiety but pushing through.
I can only take one day at a time.
Not a great way to live though, having to plan around anxiety and physical symptoms. I guess it could be worse though.
I pray that I will get along better in the future.
Cheryl

Patti
Twitter:
September 5, 2013, 11:16 pm

Good NewsCheryl! Way to go – any movement ahead is awesome. Very glad for you and yes, it could be a lot worse so I think you’re doing Great!! My prayers are with you – hope you continue to improve and get along without the Klonopin. Hope the job is going well also now and not so stressful – :)
Patti

Cheryl September 6, 2013, 8:43 pm

Thanks Patti!
I appreciate your support. Still need the meds prn.
I try to think so what instead of what if.
I push myself and figure that I am human if I pass out or
get ill its not something I plan or want. so I do my best.

Hope all is well with you and that your music is going good!
Cheryl

Patti
Twitter:
September 7, 2013, 12:10 am

Sounds like you are coping better and that is good! Im doing ok this week and music is going well. Thanks for keeping me posted and have a very nice weekend! :)

cheryl October 2, 2013, 11:39 pm

Hi Patti,
How are you? I have been going through physical stuff along with my anxiety. Just cant seem to get a break at all.
My hashimoto thyroid turned to hyperthyroid, heart iissues like tachycardia, high bp, headache, more anxiety and even some afib. Now on beta blockers which are not controlling the anxiety or chest pain.
Never any relief. I guess if the thyroid keeps hyper it will damage my heart.
Scary and no where to turn. I pray I can keep performing at
work. If not I am done.

PATTI October 3, 2013, 1:20 am

Cheryl -glad to hear from you – have been wondering how you’ve been. So – your hypothyroid has turned into hyperthyroid? How in the heck did that happen? I totally understand the problems related to that as I started this trek with anxiety when I was diagnosed with Graves in 1977 so I’ve dealt with all those symptoms you’re now having. I’m also on a beta blocker for tachycardia, a med for high BP, a antidepresent and a benzo and have been on these for years even after my Graves was treated by obliterating my whole thyroid gland and I became Hypothyroid. It has been a major battle for me as my eyes were also affected and I have permanent exophthalmus and double vision from it. Have been through 5 surgeries for that and its still bad. I worked the whole time but it was rough. What does your doctor say? Are you seeing an Endocrinologist?

cheryl October 5, 2013, 12:02 am

Hi Patti,

I see an endo PA they ordered labs but never followed up.
I have a nee young female internist, she has been following me and working with me. She had md stop the synthroid but I have to start back up low dose. My tsh moving upward. She wants me to see cardiologist due to the cardiac issues. I will be on beta blocker until i get balanced. It is hell.
I hope you are doing good’ How is the music?
Cheryl

Patti
Twitter:
October 5, 2013, 9:16 am

Geeeezzzz!! So sorry you are having this trouble! I’m still trying to find the right meds and dosage for my anxiety/dep. Just got off Lexapro and am now on Tofranil. I think it’s helping the panic but my stress has been high. My husband has prostate cancer (age 57) and is starting radiation treatment in Tulsa, OK which is about 150 miles from us. Prognosis looks good but he’s stressed so that makes me even more stressed. Thanks for asking about my music – it’s going well on the Internet but not making any $. I just released a piano CD by myself of 8 pieces I’ve been working on the past 2 years. Have sold 40 so far. Goal is 100. Trying to help recover some of the $ we’re spending on my husband’s ins copay for treatments. The band is expanding – we’ve added a permanent drummer and are still looking for a bass guitarist and female singer. We’re writing more songs – mostly Alternative Rock – it’s some good stuff. Our 3rd Instrumental CD should be released to iTunes by Dec. It’s our best work yet. Still can’t believe I’m doing all of that at age 60. I’m an old rocker – ha!! Have already won placements in some composition contests for several songs. :) That and being a first time Grandma to a 4 month old girl are about the only things that keep me going. I hope you can soon find some relief for your issues. Keep in touch when you can.
Patti

Cheryl October 6, 2013, 2:13 am

Hi Patti,

Wow! So sorry your husband has to go through this. It sounds like he will be okay once the treatment is complete. How stressful. You are very talented, that is a great thing and a wonderful creative outlet. I want to get back to music, I played violin and guitar and sing some. I feel so good after singing or doing something creative.
I really think thyroid causes some people to suffer depression and anxiety. The scientists just havent discovered it yet as fact.
I will pray for your husband and I really think you, him and your family will come through all this stronger.
Cheryl

Patti
Twitter:
October 6, 2013, 3:36 am

Thanks for your encouragement. I will keep you posted on OUR progress and you keep me posted on YOURS! :) Take care and good luck!
Patti

julie November 4, 2013, 2:32 pm

I have had social anxiety, since I was 11 with panic attacks. Depression has been mild but has come and gone with my ability to cope with my anxiety. I have been bullied all my life because of my problems with eye contact. I have had thoughts of suicide but because of my beliefs in Christ and raising 3 kids alone. They only are thoughts due to my wanting to escape my very own scary thoughts. So if I hadn’t had my beliefs and kids . I would have killed myself many times. But since I believe you go to Hell for suicide. I really don’t want to be in a worse place and I couldn’t do it to my kids because I am all they have.

Patti
Twitter:
November 4, 2013, 2:45 pm

Hi Julie – Thanks for sharing your thoughts and feelings. I too have suffered as you since childhood with anxiety, depression and panic attacks. The symptoms are sooooo horrible to tolerate. I always feel like I’m in a torture chamber. I’m 60 now but know I couldn’t have survived this long without medication regardless of my beliefs or my family. You didn’t say if you’re taking meds but I hope you are. Please feel free to correspond with me anytime. I really think it helps to relate to others who suffer and feel the same thing. God Bless.

ishara madushani January 16, 2014, 8:43 pm

Thank u vry much. This is more clear and helpfull for my assignmnt about suicide.

ishara madushani January 16, 2014, 8:45 pm

Thank u vry much. It was more helpful my assignmnt about suicide and mental disorders.

Rudy March 8, 2014, 9:35 pm

I’m always trying to understand why I feel the way I do. The day to day lows outweigh the Highs. Anxiety and depressin is a constant battle , some times I don’t know if it is worth it.

Patti
Twitter:
March 8, 2014, 10:23 pm

Hi Rudy – I just want you to know that I totally understand what you’re feeling right now as I have been there many times with my anxiety / depression disorder. You are not alone. Thousands of us are in your shoes daily. If it wasn’t for medications, I would have ended the misery years ago. But I’m still here and doing ok. I still struggle on a daily basis but I’ve learned how to push through it and go on. I do that for the others in my life that depend on me to be there for them. I do it for myself too so that I can hopefully help others like yourself make sense of it all. I am 60 and have been plagued with these problems since a young girl. I started meds in 1980 and have been dependant on them ever since. I’ve been through every type of counseling there is. It did give me a lot of insight into the realms of psychology but the meds are the only thing that have truly helped control the symptoms. Chronic anxiety and depression are both permenant disorders. There is no cure for either – only coping skills and the correct meds can help us get through this daily life. So, if you have things to live for it’s totally worth it. If you don’t, find some things or someones to make you want to stay around!! We’re all going to die soon enough as it is because life on this earth is very short. You may as well stick it out as long as you can while you can! If it takes meds to do that then so be it. The days when the sun shines inwardly as well as outwardly do make it worth it – I promise. :)

cheryl March 9, 2014, 3:53 am

Hi Patti and Rudy,

It is sure hard at times to keep going. But for the occasional good day or hour worth sticking around.
I battle anxiety daily. I started new job in aug boss from hell.
Resigned after 6 months of successful work but a boss that just cut me down daily made me anxious 24/7.
So, now have to find a decent job and try again. Yes it seems easier to end it.

Patti
Twitter:
March 10, 2014, 8:20 am

Hi Cheryl – glad to hear from you again but so sorry about your continued job struggles! I was sure hoping that had settled down for you :( I know hunting for a new one is bringing you stress but you were right to leave a situation where you have an abusive boss.
I’ve been in that picture before myself and it’s not worth it!
At least you got in some good work that you can show on your resume. Don’t give up! How are the other things going in your life? Any new friends? Any support structures? Are you currently on any meds? Keep in touch when you can :)

Cheryl March 10, 2014, 12:43 pm

Hi Patti,

Thanks for writing back to me. I am trying to move ahead and
it is a battle.
I have a potential position locally and doing a few fill in work here and there.
I am feeling a bit defeated at times and extremely insecure about starting over again. IT is rough to keep going.
I have played in my head with the idea of working for myself but that is a huge challenge but a different kind of anxiety not as strong as I would not have a boss. But I also would have no steady income.

I am very scared now. I do not have a support system. I was always the strong independent person. Always took care of myself.
If I can manage to work another 12-16 years I should be okay.
I have also considered doing travel therapy although that is anxiety to but at least I am not commited to the position, it is 3 months.
I can keep my condo and come home between each placement and if I like an assignment thay can extend me or bring me on permanent.
I am so confused. A local rehab hopsitla that I backed out of a job 2 years ago is trying to reopen the job for me to start 32 hours part time but with benefits. I would have to build the program but it is 10 minutes from home. I am considering that to.
I feel like pulling a blanket back over my head and staying in bed but I keep pushing myself to get up as able during the week and doing a little work here and there .
Sometimes I think I should pack it all in and just move to some small town and maybe work and life will be easier and less anxiety provoking.
Cheryl

Patti
Twitter:
March 10, 2014, 1:12 pm

Cheryl – it sounds like you are doing pretty good – at least giving yourself some new work options. I know its a constant struggle trying to make it totally on your own but something positive will come of it. I’ll be sending good thought your way and hope something falls in place for you soon! Thanks for sharing the update – keep me posted! :)

smule download December 26, 2016, 12:04 am

Thank you very much. It was more helpful my assignmnt about suicide and mental disorders.I will keep you posted on OUR progress and you keep me posted on YOURS! :) Take care and good luck!
smule download recently posted… SNOW – MEMBAWA PEMINAT SELFIE KE SATU FASA YANG BARUMy Profile

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