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.”
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