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Lawrence TI, Mcfield AA. Does Conduct, Oppositional Defiant, and Panic Disorder Symptoms Associate with Suicidal Ideations Among African American Adolescents? JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:1179-1189. [PMID: 36439662 PMCID: PMC9684375 DOI: 10.1007/s40653-022-00452-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 05/25/2023]
Abstract
Previous studies suggest that mental illness symptoms among adolescents, such as conduct disorder, oppositional defiant disorder, and panic disorder symptoms often associate with suicidal ideations. Despite this, few studies have examined whether these mental illness symptoms associate with suicidal ideations among African American adolescents. To address these limitations, the current study examined whether conduct disorder, oppositional defiant disorder, and panic disorder symptoms associated with suicidal ideations (N = 261). Using binominal logistic regression, results suggest that conduct disorder symptoms were associated with a higher likelihood of endorsing suicidal ideations than oppositional defiant disorder symptoms. Finally, panic disorder symptoms and gender differences were not associated with suicidal ideations. Preventive efforts and psychotherapy implications are discussed.
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Affiliation(s)
- Timothy I. Lawrence
- Prairie View, A&M University, P. O Box 519 MS, 100 University Dr, Prairie View, Texas 77446 USA
| | - Ariel A. Mcfield
- Psychology Department , University of Texas Permian Basin, 4901 E University Blvd, Odessa, TX 79762 USA
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2
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Scheer V, Blanco C, Olfson M, Lemogne C, Airagnes G, Peyre H, Limosin F, Hoertel N. A comprehensive model of predictors of suicide attempt in individuals with panic disorder: Results from a national 3-year prospective study. Gen Hosp Psychiatry 2020; 67:127-135. [PMID: 33129137 DOI: 10.1016/j.genhosppsych.2020.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE People with panic disorder are at increased risk of suicide. Multiple factors influence their risk suggesting a need to combine them into an integrative model to develop more effective suicide prevention strategies for this population. In this report, we sought to build a comprehensive model of the 3-year risk of suicide attempt in individuals with panic disorder using a longitudinal nationally representative study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; wave 1, 2001-2002; wave 2, 2004-2005). METHOD We used structural equation modeling to simultaneously examine effects of six broad groups of clinical factors previously identified as potential predictors of suicide attempt in adults with panic disorder: 1) severity of panic disorder, 2) severity of comorbidity, 3) prior history of suicide attempt, 4) family history of psychiatric disorders, 5) sociodemographic characteristics and 6) treatment-seeking behavior. RESULTS The 3-year prevalence rate of suicide attempt was 4.6%. A general psychopathology factor, lower physical health-related quality of life, prior suicide attempt and a greater number of stressful life events at baseline significantly and independently predicted suicide attempt between the two waves (p < .05). R-square of the models ranged from 0.47 to 0.50. CONCLUSION This model may help inform future research and identify high-risk individuals among adults with panic disorder.
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Affiliation(s)
- Valentin Scheer
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France.
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY 10032, USA
| | - Cédric Lemogne
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Guillaume Airagnes
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; UMS 011, Population-based Epidemiological Cohorts, Inserm, Villejuif, France
| | - Hugo Peyre
- Robert Debré Hospital, Child and Adolescent Psychiatry Department, Assistance Publique-Hôpitaux de Paris, Paris, France; Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France
| | - Frédéric Limosin
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Nicolas Hoertel
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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3
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Shen Y, Zhang Y, Chan BSM, Meng F, Yang T, Luo X, Huang C. Association of ADHD symptoms, depression and suicidal behaviors with anxiety in Chinese medical college students. BMC Psychiatry 2020; 20:180. [PMID: 32321462 PMCID: PMC7175542 DOI: 10.1186/s12888-020-02555-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 03/18/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Anxiety is one of the most common psychiatric disorder and imposes a great burden on both the individual and the society. Previous studies indicate a high comorbidity of anxiety disorders and Attention Deficit Hyperactivity Disorder (ADHD). However, few studies have examined the comorbidity of anxiety and ADHD among medical college students in mainland China. This study aimed to examine the prevalence of anxiety and the associated risk factor of anxiety disorder as well as to explore the association between ADHD symptoms, depression, suicidal behaviors and anxiety. METHODS A cross-sectional design was employed among 4882 medical college students who were recruited and enrolled with convenience sampling. Self-reported demographic information and clinical characteristics were collected online on a computer or through a social media app named Wechat. RESULTS The prevalence of anxiety in this study was 19.9%. Students with anxiety were more likely to have a poor relationship with parents, be of Han nationality, have smoking or drinking habits, have an extensive physical disorder history and have engaged in suicidal behaviors. The independent risk factors for anxiety were: smoking, physical disorder history, suicidal ideations, suicide attempts, inattention and hyperactivity. Significant associations were observed between anxiety and depression, inattention, hyperactivity, suicide plans and suicide attempts. CONCLUSIONS Nearly one in five medical students suffered from anxiety. The findings of this study indicate the importance of addressing both anxiety and ADHD symptoms in order to better promote mental health and the well-being of medical students as well as reduce suicidal behaviors.
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Affiliation(s)
- Yanmei Shen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, 410011, Hunan, China.,The Department of Educational and Counselling Psychology, and Special Education, The University of British Columbia, Vancouver, Canada
| | - Yaru Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, 410011, Hunan, China
| | - Bella Siu Man Chan
- The Department of Educational and Counselling Psychology, and Special Education, The University of British Columbia, Vancouver, Canada
| | - Fanchao Meng
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, 410011, Hunan, China
| | - Tingyu Yang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, 410011, Hunan, China
| | - Xuerong Luo
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. .,Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, 410011, Hunan, China.
| | - Chunxiang Huang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. .,Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, 410011, Hunan, China.
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Tietbohl-Santos B, Chiamenti P, Librenza-Garcia D, Cassidy R, Zimerman A, Manfro GG, Kapczinski F, Passos IC. Risk factors for suicidality in patients with panic disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2019; 105:34-38. [DOI: 10.1016/j.neubiorev.2019.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 12/22/2022]
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5
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Dong M, Zeng LN, Lu L, Li XH, Ungvari GS, Ng CH, Chow IHI, Zhang L, Zhou Y, Xiang YT. Prevalence of suicide attempt in individuals with major depressive disorder: a meta-analysis of observational surveys. Psychol Med 2019; 49:1691-1704. [PMID: 30178722 DOI: 10.1017/s0033291718002301] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Suicide attempt (SA), which is one of the strongest predictors of completed suicide, is common in major depressive disorder (MDD) but its prevalence across epidemiological studies has been mixed. The aim of this comprehensive meta-analysis was to examine the pooled prevalence of SA in individuals with MDD. METHODS A systematic literature search was conducted in PubMed, Embase, PsycINFO, Web of Science and Cochrane Library from their commencement date until 27 December 2017. Original studies containing data on prevalence of SA in individuals with MDD were analyzed. RESULTS In all, 65 studies with a total of 27 340 individuals with MDD were included. Using the random effects model, the pooled lifetime prevalence of SA was 31% [95% confidence interval (CI) 27-34%], 1-year prevalence was 8% (95% CI 3-14%) and 1-month prevalence was 24% (95% CI 15-34%). Subgroup analyses revealed that the lifetime prevalence of SA was significantly associated with the patient setting, study region and income level, while the 1-month prevalence of SA was associated with only the patient setting. CONCLUSION This meta-analysis confirmed that SA was common in individuals with MDD across the world. Careful screening and appropriate interventions should be implemented for SA in the MDD population.
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Affiliation(s)
- Min Dong
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Liang-Nan Zeng
- Department of Neurosurgery,The Affiliated Hospital of Southwest Medical University,Luzhou,China
| | - Li Lu
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Xiao-Hong Li
- The National Clinical Research Center for Mental Disorders, China & Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University,Beijing,China
| | - Gabor S Ungvari
- University of Notre Dame Australia/Marian Centre,Perth,Australia
| | - Chee H Ng
- Department of Psychiatry,University of Melbourne,Melbourne, Victoria,Australia
| | - Ines H I Chow
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics,School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology,Beijing,China
| | - Yuan Zhou
- CAS Key Laboratory of Behavioral Science & Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences,Beijing,China
| | - Yu-Tao Xiang
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
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6
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Beşirli A. The relationship between impulsivity and panic disorder-agoraphobia: The role of affective temperament. Psychiatry Res 2018; 264:169-174. [PMID: 29649673 DOI: 10.1016/j.psychres.2018.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 12/27/2017] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
There are opinions regarding that impulsivity may play a role in the pathogenesis of neuropsychiatric disorders. The aim of this study was to investigate the relationship between impulsivity and panic disorder (PD) in the patient group, to compare impulsivity and affective temperamental traits between patients and healthy controls and to investigate whether there is a relationship between impulsivity and affective temperamental traits. Participants comprised 70 patients with PD and 58 healthy volunteers. The Panic Agoraphobia Scale (PAS), the Barratt Impulsiveness Scale (BIS-11) and the Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire (TEMPS-A) were applied. Patients have significantly higher scores in affective temperament (except hyperthymic) and attentional impulsiveness subscales than the healthy controls. Positive and negative correlations were found between some PAS and BIS-11 scores as well as correlations between especially cyclothymic, hyperthymic, irritable and anxious subscale scores of the TEMPS-A and the BIS-11 scores in the patient group. The results of this study indicate a relationship between impulsivity and PD. The correlations found between affective temperament dimensions and impulsivity suggest how affective temperamental traits may influence different impulsivity dimensions.
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Affiliation(s)
- Aslı Beşirli
- Department of Psychiatry, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Halaskargazi Street, 34371 Şişli, İstanbul, Turkey.
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7
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Association of comorbidity of mood and anxiety disorders with suicidal behaviors. J Affect Disord 2018; 227:810-816. [PMID: 29689695 DOI: 10.1016/j.jad.2017.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/09/2017] [Accepted: 11/04/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Suicidal behaviors are strong predictors of suicide death and are much more common than completed suicides. This study aimed to describe the prevalence and transitions of suicidal behaviors in an Inner Mongolian City of China and to explore the association of comorbidity of mood and anxiety disorders with suicidal behaviors. METHOD This study was a cross-sectional study. The Composite International Diagnostic Interview-3.0 (CIDI-3.0) was administered face-to-face to make diagnoses of mental disorders, measure suicidal behaviors and collect social demographic information. RESULTS A total of 4528 respondents were interviewed. The lifetime prevalence of suicidal ideation, suicide plan and suicide attempt were 1.52%, 0.70% and 0.54%, respectively. Among those respondents with suicidal ideation, 21.1% of them had planned suicide attempt, and 6.6% had unplanned suicide attempt. When comorbidity was not considered in the model, mood and anxiety disorders were the most important drivers of suicidal behaviors. However, when including the comorbidity, those respondents with mood and anxiety disorders, rather than those with a specific disorder only, had a significant positive association with suicidal behaviors. In the model, being unemployed, rural, female, no income and childhood adversities were also related to suicidal behaviors. LIMITATIONS There might be systematic recall bias as the data were based on retrospective self-reports. Suicide is a sensitive question, so the respondents were probably ashamed to talk about suicidal behaviors. CONCLUSIONS The comorbidity of mood and anxiety disorders was the most important risk factor of suicidal behaviors. Special attention should be paid to those patients with this comorbidity.
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8
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Kim SW, Putzke M, Uhl E, Krishnan KG. Self-Inflicted Hammer Blows to the Cranial Vault: An Interdisciplinary Challenge. Prim Care Companion CNS Disord 2016; 18:15br01927. [PMID: 27722022 DOI: 10.4088/pcc.15br01927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 01/26/2016] [Indexed: 10/21/2022] Open
Abstract
Depression is predicted to be the most common cause of disability in the coming decade. Self-inflicted hammer blow to the cranium is a rare phenomenon seen in patients with a history of attempted suicide. The resulting comminuted depressed skull fracture of the midline vertex is life threatening. Rapid interdisciplinary communication and intervention are essential to reduce morbidity and mortality. We present a case of self-inflicted hammer blows to the head, review the relevant literature on this topic, and discuss neurosurgical and psychiatric implications.
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Affiliation(s)
- Seong Woong Kim
- Department of Neurosurgery, Justus Liebig University Giessen, Germany
| | - Michael Putzke
- Department of Psychiatry and Psychotherapy, Friedberg Hospital, Friedberg, Germany
| | - Eberhard Uhl
- Department of Neurosurgery, Justus Liebig University Giessen, Germany
| | - Kartik G Krishnan
- Department of Neurosurgery, Justus Liebig University Giessen, Germany
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Umamaheswari V, Avasthi A, Grover S. Risk factors for suicidal ideations in patients with bipolar disorder. Bipolar Disord 2014; 16:642-51. [PMID: 24467510 DOI: 10.1111/bdi.12179] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 08/29/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify the risk factors for suicidal ideation in subjects with bipolar depression. METHODS One-hundred and thirty subjects diagnosed with bipolar depression were evaluated on the following scales: Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Patient Health Questionnaire-15 (PHQ-15), Barrat's Impulsivity Scale (BIS), Irritability, Anxiety, and Depression (IDA) Scale, Young Mania Rating Scale (YMRS), Buss-Durke Hostile Inventory (BDHI), and Brief Psychiatric Rating Scale (BPRS). RESULTS Based on the BDI suicidal thoughts and wishes item (score of ≥ 1), the study sample was divided into those with and those without suicidal ideation. Compared to those without suicidal ideations, patients with bipolar depression with suicidal ideation had significantly higher scores on the BDI, YMRS, BPRS total score, IDA total score, PHQ-15, BHS total score, and most of the hostility subscales of the BHI. [corrected]. On binary logistic regression analysis, the odds ratio (OR) for [corrected] presence of suicidal ideations was more than one and was significant for the BHS [OR = 1.53, [corrected] 95% confidence interval (CI): 1.24-1.99], the IDA-irritability directed inwards (OR = 1.48, 95% CI: 1.03-2.13), and the total hostility score (OR = 1.10, 95% CI: 1.02-1.20). Other factors for which the OR was more than one but the difference was not statistically significant were: Hindu religion (OR = 3.13, 95% CI: 0.76-12.99), lifetime mean duration of depressive episodes (OR = 1.08, 95% CI: 0.74-1.57), past history of hospitalization (OR = 1.10, 95% CI: 0.24-6.16), any preceding life events (OR = 1.45, 95% CI: 0.28-7.52), subsyndromal manic symptoms (OR = 1.01, 95% CI:0.53-1.92), presence of psychotic symptoms (OR = 1.06, 95% CI: 0.92-1.22), and irritability directed outwards (OR = 1.14, 95% CI: 0.92-1.41). [corrected]. CONCLUSION Among the various predictors of suicidal ideations, the severity of hopelessness, irritability directed inwards, and hostility are the most important risk factors for suicidal ideations in patients with bipolar disorder. [corrected]. Hence, patients with these risk factors should be closely monitored to prevent suicide attempts and completed suicides.
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Affiliation(s)
- Vanamoorthy Umamaheswari
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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10
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Age-related differences in the influence of major mental disorders on suicidality: a Korean nationwide community sample. J Affect Disord 2014; 162:96-101. [PMID: 24767012 DOI: 10.1016/j.jad.2014.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 03/08/2014] [Accepted: 03/08/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND We compared the influence of major mental disorders on suicidality according to age, adjusting for suicide-related correlates. METHODS This study was based on the Korean national epidemiological survey of mental disorders including community-dwelling adults between 18 and 74 years of age (n=6022). Subjects were classified into three age groups; young (18-39), middle-aged (40-59), and late adulthood (60-74). Face-to-face interviews were conducted using the Korean version of the Composite International Diagnostic Interview. According to age groups, the influence of major depressive disorder (MDD), anxiety disorder, and alcohol use disorder on risk for suicidality were investigated by multiple logistic regression models adjusting for sex, years of education, marital status, income, employment, presence of chronic medical illness, and lifetime history of suicide attempt. RESULTS After including MDD as a covariate, anxiety disorder remained a risk factor only in the middle-aged group (adjusted OR: 2.83, 95% CI: 1.54-5.22), and alcohol use disorder was a risk factor for suicidality only in the young group (adjusted OR: 2.81, 95% CI: 1.06-7.43). Conversely, MDD was the only mental disorder that significantly increased suicidality in all age groups. LIMITATIONS This was a cross-sectional study and did not include subjects over 75 years of age. CONCLUSION This study showed that the contribution of psychiatric disorders to risk for suicidality varied according to age group. Therefore, strategies for suicide prevention should be specifically designed for different age groups.
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11
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Impulsivity in patients with panic disorder-agoraphobia: the role of cyclothymia. Compr Psychiatry 2013; 54:1090-7. [PMID: 23746711 DOI: 10.1016/j.comppsych.2013.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 04/25/2013] [Accepted: 05/01/2013] [Indexed: 12/12/2022] Open
Abstract
The relationship between Panic Disorder (PD) and impulsivity is not well explored. The present investigation aims to compare impulsivity, measured by different rating tools, in PD patients vs. healthy controls and to explore the influence of co-morbid Cyclothymic Disorder (CD) on the relationship between PD and impulsivity. Sixty-four subjects with PD and 44 matched controls underwent a diagnostic and symptomatological evaluations by the Mini Neuropsychiatric Interview (M.I.N.I) Plus 5.0; the Bech-Rafaelsen Depression and Mania Scale (BRDMS), the State-Trait Anxiety Inventory (STAI), the Hypomania Check List (HCL-32) and the Clinical Global Impression (CGI); the Questionnaire for the Affective and Anxious Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Modified (TEMPS-M), the Separation Anxiety Sensitivity Index (SASI), the Interpersonal Sensitivity Symptoms Inventory (ISSI). Finally, psychometric and neurocognitive evaluations of impulsivity was carried out using the Barratt Impulsiveness Scale (BIS-11) and the Immediate and Delayed Memory Task (IMT/DMT). Subjects with PD were more impulsive than the controls in all the explored measures, reporting higher scores in symptomatological and temperamental scales. The comparison between PD patients with (Cyclo+) and without (Cyclo-) comorbid CD and controls showed that Cyclo+ are the most impulsive subjects in all the investigated measures and are characterized by the greatest symptomatological impairment, the highest scores in temperamental scales, and the highest levels of interpersonal sensitivity and separation anxiety. In our patients with PD, without lifetime comorbidity with major mood episodes, trait and state impulsivity may be related to the presence of comorbid cyclothymic mood instability.
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12
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Grunebaum MF, Keilp JG, Ellis SP, Sudol K, Bauer N, Burke AK, Oquendo MA, Mann JJ. SSRI versus bupropion effects on symptom clusters in suicidal depression: post hoc analysis of a randomized clinical trial. J Clin Psychiatry 2013; 74:872-9. [PMID: 24107760 PMCID: PMC4313534 DOI: 10.4088/jcp.12m08000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 12/19/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Identifying the depression symptoms most closely associated with suicidal thoughts and which medications provide the fastest depression relief may help suicide prevention. METHOD Post hoc analysis of data from a randomized, double-blind, 8-week clinical trial of the selective serotonin reuptake inhibitor paroxetine controlled release (n = 36) versus the norepinephrine-dopamine reuptake inhibitor bupropion extended release (n = 38) was conducted in patients with DSM-IV major depressive disorder and past suicide attempt or current suicidal thoughts. Treatment effects on Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory symptom clusters were compared. We hypothesized that paroxetine would demonstrate a superior effect on nonsuicidal, affective/cognitive depression symptom clusters that our prior work found to be associated with suicidal thoughts and attempts. Data were collected from February 2005 to January 2010. RESULTS There was a treatment main effect on HDRS psychic depression (depressed mood, guilt, retardation, helpless, hopeless, worthless) (estimate = -2.2; 95% CI, -3.2 to -1.1; t67.16 = -4.01; P < .001), one of the clusters most strongly correlated to suicidal ideation. The net drug effect demonstrated that mean psychic depression score was 2.2 points lower after 1 week of paroxetine compared to bupropion treatment. The significance level of this effect was P < .001 at weeks 1 and 2, P = .012 at week 3 and P = .051 at week 4. Results for other depression scale factors were nonsignificant (P > .05). CONCLUSIONS The results require replication but suggest a pathway by which selective serotonin reuptake inhibitor treatment may exert a stronger effect compared with norepinephrine-dopamine reuptake inhibitor treatment on reduction of suicidal thoughts during initial weeks of pharmacotherapy in these higher risk patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00429169.
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Affiliation(s)
- Michael F Grunebaum
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, 1051 Riverside Drive, Box 42, New York, NY 10032
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13
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Uebelacker LA, Weisberg R, Millman M, Yen S, Keller M. Prospective study of risk factors for suicidal behavior in individuals with anxiety disorders. Psychol Med 2013; 43:1465-1474. [PMID: 23137440 PMCID: PMC3686832 DOI: 10.1017/s0033291712002504] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Anxiety disorders are very common and increase risk for suicide attempts. Little is known about predictors of increased risk specifically among individuals with anxiety disorders. The purpose of this study was to investigate whether specific anxiety disorders and other co-morbid psychiatric disorders, physical health, or work or social functioning increased the future likelihood of a suicide attempts among individuals with anxiety disorders. Method In this prospective study, 676 individuals with an anxiety disorder were followed for an average of 12 years. RESULTS As hypothesized, we found that post-traumatic stress disorder, major depressive disorder (MDD), intermittent depressive disorder (IDD), epilepsy, pain, and poor work and social functioning all predicted a shorter time to a suicide attempt in univariate analyses. In multivariate analyses, baseline MDD and IDD were independent predictors of time to suicide attempt, even when controlling for a past history of suicide attempt. No specific anxiety disorder was an independent predictor of time to attempt in this anxiety-disordered sample. Adding baseline physical health variables and social functioning did not improve the ability of the model to predict time to suicide attempt. CONCLUSIONS Mood disorders and past history of suicide attempts are the most powerful predictors of a future suicide attempt in this sample of individuals, all of whom have an anxiety disorder.
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Affiliation(s)
- L A Uebelacker
- Department of Psychiatry and Human Behavior Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA.
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14
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Bagge CL, Lamis DA, Nadorff M, Osman A. Relations between hopelessness, depressive symptoms and suicidality: mediation by reasons for living. J Clin Psychol 2013; 70:18-31. [PMID: 23798005 DOI: 10.1002/jclp.22005] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The present study examined whether reasons for living (RFL) would partially account for the associations between traditional risk factors (depressive symptoms, hopelessness) and suicidal ideation and attempts. METHOD Data were collected from 1,075 undergraduate college students who completed a battery of online assessments. RESULTS Results from a series of simultaneous mediational models indicated that the relations between risk factors and current suicidal ideation were partially mediated by total RFL (and Coping Beliefs and Self-Evaluation subscales). Further, total RFL (and the Coping Beliefs subscale) fully mediated the relation between hopelessness and past-year suicide attempt, and partially mediated the depressive symptoms-suicide attempt relation. CONCLUSIONS This study demonstrates the importance of assessing for the presence of these suicide risk and protective factors. Implications for the improved identification and treatment of young adults at risk for suicide are discussed.
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15
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Smitherman TA, Kolivas ED, Bailey JR. Panic disorder and migraine: comorbidity, mechanisms, and clinical implications. Headache 2012; 53:23-45. [PMID: 23278473 DOI: 10.1111/head.12004] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 12/17/2022]
Abstract
A growing body of literature suggests that comorbid anxiety disorders are more common and more prognostically relevant among migraine sufferers than comorbid depression. Panic disorder (PD) appears to be more strongly associated with migraine than most other anxiety disorders. PD and migraine are both chronic diseases with episodic manifestations, involving significant functional impairment and shared symptoms during attacks, interictal anxiety concerning future attacks, and an absence of identifiable secondary pathology. A meta-analysis of high-quality epidemiologic study data from 1990 to 2012 indicates that the odds of PD are 3.76 times greater among individuals with migraine than those without. This association remains significant even after controlling for demographic variables and comorbid depression. Other less-rigorous community and clinical studies confirm these findings. The highest rates of PD are found among migraine with aura patients and those presenting to specialty clinics. Presence of PD is associated with greater negative impact of migraine, including more frequent attacks, increased disability, and risk for chronification and medication overuse. The mechanisms underlying this common comorbidity are poorly understood, but both pathophysiological (eg, serotonergic dysfunction, hormonal influences, dysregulation of the hypothalamic-pituitary-adrenal axis) and psychological (eg, interoceptive conditioning, fear of pain, anxiety sensitivity, avoidance behavior) factors are implicated. Means of assessing comorbid PD among treatment-seeking migraineurs are reviewed, including verbal screening for core PD symptoms, ruling out medical conditions with panic-like features, and administering validated self-report measures. Finally, evidence-based strategies for both pharmacologic and behavioral management are outlined. The first-line migraine prophylactics are not indicated for PD, and the selective serotonin re-uptake inhibitors used to treat PD are not efficacious for migraine; thus, separate agents are often required to address each condition. Core components of behavioral treatments for PD are reviewed, and their integration into clinical headache practice is discussed.
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Affiliation(s)
- Todd A Smitherman
- Department of Psychology, University of Mississippi, Oxford, MS, USA
| | | | - Jennifer R Bailey
- Department of Psychology, University of Mississippi, Oxford, MS, USA
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16
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Chartrand H, Sareen J, Toews M, Bolton JM. Suicide attempts versus nonsuicidal self-injury among individuals with anxiety disorders in a nationally representative sample. Depress Anxiety 2012; 29:172-9. [PMID: 21948315 DOI: 10.1002/da.20882] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 06/26/2011] [Accepted: 07/08/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study is aimed to determine whether anxiety disorders are associated with suicide attempts with intent to die and to further investigate the characteristics of deliberate self-harm (DSH) among anxiety disorders. METHOD Data came from the Collaborative Psychiatric Epidemiological Surveys (N = 20,130; age 18 years and older; response rate = 72.3%). DSM-IV anxiety disorders were assessed using the World Mental Health Composite International Diagnostic Interview. People with an anxiety disorder endorsing a history of DSH were subcategorized as those who made suicide attempts (n = 159; individuals who intended to die), versus those who made nonsuicidal self-injuries (n = 85; individuals who did not intend to die). RESULTS Anxiety disorders were associated with both suicide attempts and nonsuicidal self-injury (NSSI). People with generalized anxiety disorder and social phobia who engaged in DSH were more likely to have made a suicide attempt than a NSSI, independent of the effects of mood and substance use disorders. In addition, individuals with generalized anxiety disorder and social phobia who engaged in DSH were more likely to engage in this behavior multiple times, and at least one of those times was a suicide attempt. CONCLUSION This study suggests that anxiety disorders are associated with suicide attempts with intent to die. Social phobia and generalized anxiety disorder appear to be associated with the more worrisome patterns of DSH including multiple suicide attempts.
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Affiliation(s)
- Hayley Chartrand
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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17
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Affiliation(s)
- Jitender Sareen
- Department of Psychiatry, University of Manitoba, PZ-430 771 Bannatyne Ave, Winnipeg, Manitoba, Canada R3E 3N4.
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18
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Nepon J, Belik SL, Bolton J, Sareen J. The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Depress Anxiety 2010; 27:791-8. [PMID: 20217852 PMCID: PMC2940247 DOI: 10.1002/da.20674] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Previous work has suggested that anxiety disorders are associated with suicide attempts. However, many studies have been limited by lack of accounting for factors that could influence this relationship, notably personality disorders. This study aims to examine the relationship between anxiety disorders and suicide attempts, accounting for important comorbidities, in a large nationally representative sample. METHODS Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2. Face-to-face interviews were conducted with 34,653 adults between 2004 and 2005 in the United States. The relationship between suicide attempts and anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, posttraumatic stress disorder (PTSD)) was explored using multivariate regression models controlling for sociodemographics, Axis I and Axis II disorders. RESULTS Among individuals reporting a lifetime history of suicide attempt, over 70% had an anxiety disorder. Even after adjusting for sociodemographic factors, Axis I and Axis II disorders, the presence of an anxiety disorder was significantly associated with having made a suicide attempt (AOR=1.70, 95% confidence interval (CI): 1.40-2.08). Panic disorder (AOR=1.31, 95% CI: 1.06-1.61) and PTSD (AOR=1.81, 95% CI: 1.45-2.26) were independently associated with suicide attempts in multivariate models. Comorbidity of personality disorders with panic disorder (AOR=5.76, 95% CI: 4.58-7.25) and with PTSD (AOR=6.90, 95% CI: 5.41-8.79) demonstrated much stronger associations with suicide attempts over either disorder alone. CONCLUSION Anxiety disorders, especially panic disorder and PTSD, are independently associated with suicide attempts. Clinicians need to assess suicidal behavior among patients presenting with anxiety problems.
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Affiliation(s)
- Josh Nepon
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shay-Lee Belik
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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19
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Abstract
Mental disorders are among the strongest predictors of suicide attempts. However, little is known regarding which disorders that are uniquely associated with suicidal behavior because of high levels of psychiatric comorbidity. We examined the unique associations between individual disorders and subsequent suicidal behavior (suicide ideation, plans and attempts) using data from the National Comorbidity Survey Replication, a nationally representative household survey of 9282 US adults. Results revealed that approximately 80% of suicide attempters in the United States have a temporally prior mental disorder. Anxiety, mood, impulse-control and substance use disorders all significantly predict subsequent suicide attempts in bivariate analyses (odds ratios (OR)=2.7-6.7); however, these associations decrease substantially in multivariate analyses controlling for comorbidity (OR=1.5-2.3) but remain statistically significant in most cases. Disaggregation of the observed effects reveals that depression predicts suicide ideation, but not suicide plans or attempts among those with ideation. Instead, disorders characterized by severe anxiety/agitation (for example, post-traumatic stress disorder) and poor impulse control (for example, conduct disorder, substance use disorders) predict which suicide ideators who go on to make a plan or attempt. These results advance understanding of the unique associations between mental disorders and different forms of suicidal behavior. Future research must further delineate the mechanisms through which people come to think about suicide and progress from suicidal thoughts to attempts.
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20
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Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, Beautrais A, Borges G, Bromet E, Bruffaerts R, de Girolamo G, de Graaf R, Florescu S, Gureje O, Haro JM, Hu C, Huang Y, Karam EG, Kawakami N, Kovess V, Levinson D, Posada-Villa J, Sagar R, Tomov T, Viana MC, Williams DR. Cross-national analysis of the associations among mental disorders and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS Med 2009; 6:e1000123. [PMID: 19668361 PMCID: PMC2717212 DOI: 10.1371/journal.pmed.1000123] [Citation(s) in RCA: 508] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 06/25/2009] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide is a leading cause of death worldwide. Mental disorders are among the strongest predictors of suicide; however, little is known about which disorders are uniquely predictive of suicidal behavior, the extent to which disorders predict suicide attempts beyond their association with suicidal thoughts, and whether these associations are similar across developed and developing countries. This study was designed to test each of these questions with a focus on nonfatal suicide attempts. METHODS AND FINDINGS Data on the lifetime presence and age-of-onset of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) mental disorders and nonfatal suicidal behaviors were collected via structured face-to-face interviews with 108,664 respondents from 21 countries participating in the WHO World Mental Health Surveys. The results show that each lifetime disorder examined significantly predicts the subsequent first onset of suicide attempt (odds ratios [ORs] = 2.9-8.9). After controlling for comorbidity, these associations decreased substantially (ORs = 1.5-5.6) but remained significant in most cases. Overall, mental disorders were equally predictive in developed and developing countries, with a key difference being that the strongest predictors of suicide attempts in developed countries were mood disorders, whereas in developing countries impulse-control, substance use, and post-traumatic stress disorders were most predictive. Disaggregation of the associations between mental disorders and nonfatal suicide attempts showed that these associations are largely due to disorders predicting the onset of suicidal thoughts rather than predicting progression from thoughts to attempts. In the few instances where mental disorders predicted the transition from suicidal thoughts to attempts, the significant disorders are characterized by anxiety and poor impulse-control. The limitations of this study include the use of retrospective self-reports of lifetime occurrence and age-of-onset of mental disorders and suicidal behaviors, as well as the narrow focus on mental disorders as predictors of nonfatal suicidal behaviors, each of which must be addressed in future studies. CONCLUSIONS This study found that a wide range of mental disorders increased the odds of experiencing suicide ideation. However, after controlling for psychiatric comorbidity, only disorders characterized by anxiety and poor impulse-control predict which people with suicide ideation act on such thoughts. These findings provide a more fine-grained understanding of the associations between mental disorders and subsequent suicidal behavior than previously available and indicate that mental disorders predict suicidal behaviors similarly in both developed and developing countries. Future research is needed to delineate the mechanisms through which people come to think about suicide and subsequently progress from ideation to attempts.
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Affiliation(s)
- Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.
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21
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Kilbane EJ, Gokbayrak NS, Galynker I, Cohen L, Tross S. A review of panic and suicide in bipolar disorder: does comorbidity increase risk? J Affect Disord 2009; 115:1-10. [PMID: 19000640 DOI: 10.1016/j.jad.2008.09.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 09/13/2008] [Accepted: 09/14/2008] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Bipolar mood disorder carries a serious suicide risk. Panic disorder, which also confers an independent risk of suicide and psychiatric comorbidity, in general has been found to amplify suicidality in mood-disordered patients. This article assesses the available literature on how panic and suicide relate to each other in bipolar mood-disordered patients. METHODS We conducted a search on Medline and PsycINFO using the keywords "anxiety", "attempted suicide", "completed suicide", "mortality", "self-harm" in combination with "bipolar", "manic depression" and "panic". Twenty-four articles were included in the evaluation. RESULTS 14 papers support increased risk, 9 papers do not support increased risk, and 3 papers are inconclusive. CONCLUSIONS The presence of comorbid panic disorder in individuals with bipolar disorder may confer an increased risk of suicide risk. Some papers' reviewed have conflicting conclusions but the majority of papers support an increased risk. This is consistent with a recent (2008) literature review supporting increased risk of suicide in bipolar patients with comorbid anxiety disorders. Future research should study specific bipolar subgroups, focus on anxiety and panic symptoms rather than diagnosis, and look at the role of specific pharmacological treatment in patients with comorbid mood and anxiety disorders.
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Affiliation(s)
- Edward J Kilbane
- Beth Israel Medical Center, Department of Psychiatry, NYC, NY, United States.
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22
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Abstract
This cross-sectional study assessed the association between self-reported anxiety symptoms and self-reported suicidality among a mixed diagnostic sample of psychiatric outpatients. Data were obtained from chart review of 2,778 outpatients who completed a routine diagnostic clinical interview and a standardized self-report of psychiatric symptoms on admission. Bivariate analyses indicated that those with >or= moderate anxiety symptoms were over three times as likely to report >or= moderate difficulty with suicidality. Self-reported anxiety symptoms were associated with a 2-fold increased likelihood of reporting suicidality after controlling for confounding (demographics, depressive symptoms, and diagnoses). These data are consistent with a growing literature demonstrating an association between anxiety symptoms and suicidality, and suggest that this association is not accounted for by coexisting mood symptoms or diagnoses. A single item, self-report may be a useful screening tool for symptoms that are pertinent to assessment of suicide risk.
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Wojnar M, Ilgen MA, Wojnar J, McCammon RJ, Valenstein M, Brower KJ. Sleep problems and suicidality in the National Comorbidity Survey Replication. J Psychiatr Res 2009; 43:526-31. [PMID: 18778837 PMCID: PMC2728888 DOI: 10.1016/j.jpsychires.2008.07.006] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 07/17/2008] [Accepted: 07/25/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Links between sleep problems and suicidality have been frequently described in clinical samples; however, this issue has not been well-studied in the general population. Using data from a nationally representative survey, we examined the association between self-reported sleep difficulties and suicidality in the United States. METHODS The WHO Composite International Diagnostic Interview was used to assess sleep problems and suicidality in the National Comorbidity Survey Replication (NCS-R). Relationships between three measures of sleep (difficulty initiating sleep, maintaining sleep, early morning awaking), and suicidal thoughts, plans, and attempts were assessed in logistic regression analyses, while controlling for demographic characteristics, 12-month diagnoses of mood, anxiety and substance use disorders, and chronic health conditions. RESULTS In multivariate models, the presence of any of these sleep problems was significantly related to each measure of suicidality, including suicidal ideation (OR=2.1), planning (OR=2.6), and suicide attempt (OR=2.5). Early morning awakening was associated with suicidal ideation (OR=2.0), suicide planning (OR=2.1), and suicide attempt (OR=2.7). Difficulty initiating sleep was a significant predictor of suicidal ideation and planning (ORs: 1.9 for ideation; 2.2 for planning), while difficulty maintaining sleep during the night was a significant predictor of suicidal ideation and suicide attempts (ORs: 2.0 for ideation; 3.0 for attempt). CONCLUSIONS Among community residents, chronic sleep problems are consistently associated with greater risk for suicidality. Efforts to develop comprehensive models of suicidality should consider sleep problems as potentially independent indicators of risk.
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Affiliation(s)
- Marcin Wojnar
- University of Michigan, Department of Psychiatry, 4250 Plymouth Road, Ann Arbor, MI 48109-5763, USA.
| | - Mark A. Ilgen
- University of Michigan, Department of Psychiatry, Ann Arbor, MI, VA Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI
| | - Julita Wojnar
- University of Michigan, Department of Psychiatry, Ann Arbor, MI, Medical University of Warsaw, Department of Psychiatry, Warsaw, Poland
| | - Ryan J. McCammon
- University of Michigan, Department of Psychiatry, Ann Arbor, MI, VA Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI
| | - Marcia Valenstein
- University of Michigan, Department of Psychiatry, Ann Arbor, MI, VA Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI
| | - Kirk J. Brower
- University of Michigan, Department of Psychiatry, Ann Arbor, MI
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Nakagawa A, Grunebaum MF, Oquendo MA, Burke AK, Kashima H, Mann JJ. Clinical correlates of planned, more lethal suicide attempts in major depressive disorder. J Affect Disord 2009; 112:237-42. [PMID: 18485486 PMCID: PMC3178835 DOI: 10.1016/j.jad.2008.03.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 03/16/2008] [Accepted: 03/24/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Assessment of suicide plans is standard in acute psychiatric care, but there is a limited evidence base to guide this routine clinical practice. The purpose of this study was to investigate clinical correlates of suicide planning in depressed patients. METHODS 151 patients with major depressive disorder and a lifetime history of suicide attempt were studied. Subjects received a comprehensive evaluation including structured diagnostic interview for Axis I and II disorders, current symptoms, impulsivity, and systematic assessment of suicide planning prior to the most recent suicide attempt. RESULTS Seriousness of suicide attempt planning correlated with lethality of suicidal acts. Comorbid anxiety disorder and anxiety correlated with less suicide planning. Specifically, this negative correlation was with comorbid panic disorder. Planning did not correlate with severity of depression or aggressive/impulsive traits. LIMITATIONS Cross-sectional design, retrospective recall of suicide planning data, limited applicability to completed suicide or other psychiatric disorders. CONCLUSIONS In major depression, comorbid panic disorder appears protective against more carefully planned, higher lethality suicide attempts. Surprisingly, severity of depression and aggressive impulsive traits do not predict planning or lethality of suicide attempts. We have previously reported that anxiety severity protects against the probability of a suicide attempt and now extend that observation to show there is protection against lethality of a suicide attempt. Treatment of anxiety without directly treating major depression may place patients at greater risk of suicidal behavior.
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Affiliation(s)
- Atsuo Nakagawa
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Psychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Michael F. Grunebaum
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Maria A. Oquendo
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ainsley K. Burke
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Haruo Kashima
- Department of Psychiatry, Keio University School of Medicine, Tokyo, Japan
| | - J. John Mann
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Pfeiffer PN, Ganoczy D, Ilgen M, Zivin K, Valenstein M. Comorbid anxiety as a suicide risk factor among depressed veterans. Depress Anxiety 2009; 26:752-7. [PMID: 19544314 PMCID: PMC2935592 DOI: 10.1002/da.20583] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Depressive disorders greatly increase suicide risk; however, little is known about the contribution of comorbid anxiety disorders or anxiety symptoms to the risk of suicide death among depressed patients. We examined whether depressed veterans with comorbid anxiety had higher risks of suicide death. METHODS Using VA administrative databases we identified 887,859 patients with depression. We then used univariate and multivariate logistic regression, controlling for demographics and substance use disorders, to determine the odds ratios of completed suicide associated with individual comorbid anxiety disorders, the presence of any comorbid anxiety disorder, the prescription of an antianxiety medication, or the prescription of a high dose of an antianxiety medication. RESULTS In multivariate analyses, the odds of completed suicide were significantly increased for patients with panic disorder (OR 1.26, 95% CI: 1.04-1.53), generalized anxiety disorder (OR 1.27, 95% CI: 1.09-1.47), and anxiety disorder, not otherwise specified (OR 1.25, 95% CI: 1.12-1.38). The odds of completed suicide were also greater among patients who received any antianxiety medication (OR 1.71, 95% CI: 1.55-1.88), and were further increased among those who received high dose treatment (OR 2.26, 95% CI: 1.98-2.57). Odds of completed suicide were decreased among patients with comorbid posttraumatic stress disorder (OR 0.87, 95% CI: 0.77-0.97), and there was no statistically significant relationship between social phobia, obsessive-compulsive disorder, and all other anxiety disorders and suicide. CONCLUSIONS These findings emphasize the importance of comorbid anxiety disorders and symptoms in increasing suicide risk among depressed patients and may inform suicide prevention efforts among these patients.
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Affiliation(s)
- Paul N. Pfeiffer
- Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI,Corresponding Author: Paul N. Pfeiffer, University of Michigan Medical School, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109. , Phone: 734-232-0070; Fax 734-615-8739
| | - Dara Ganoczy
- Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI
| | - Mark Ilgen
- Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Kara Zivin
- Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Marcia Valenstein
- Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
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26
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Norton PJ, Temple SR, Pettit JW. Suicidal ideation and anxiety disorders: elevated risk or artifact of comorbid depression? J Behav Ther Exp Psychiatry 2008; 39:515-25. [PMID: 18294614 DOI: 10.1016/j.jbtep.2007.10.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 10/16/2007] [Accepted: 10/18/2007] [Indexed: 11/18/2022]
Abstract
Research into the possible relationship between anxiety disorders and suicidal ideation has yielded mixed results, leading some to suggest that the positive findings between anxiety and suicidal ideation might simply be a by-product of comorbid depression. Recent work has suggested that having an anxiety disorder without history of mood disorder does convey increased risk for suicidal ideation, although the study could not assess for the possible impact of subsyndromal depressiveness. This current study, therefore, examined the relationship between anxiety disorder symptoms and suicidality using continuous scales and controlling for depressiveness. Data regarding the severity of panic, social anxiety, generalized anxiety, and obsessive-compulsive symptoms were obtained from a sample of 166 college students. Results generally supported the conclusions that anxiety disorders convey risk for suicidal ideation above and beyond any co-occurring depressiveness, and anxiety and depression together conveyed an additional interactive risk.
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27
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Bolton JM, Cox BJ, Afifi TO, Enns MW, Bienvenu OJ, Sareen J. Anxiety disorders and risk for suicide attempts: findings from the Baltimore Epidemiologic Catchment area follow-up study. Depress Anxiety 2008; 25:477-81. [PMID: 17541978 DOI: 10.1002/da.20314] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Our objective was to determine whether the presence of an anxiety disorder was a risk factor for future suicide attempts. Data were drawn from the 13-year follow-up Baltimore Epidemiological Catchment Area survey (n=1,920). Multiple logistic regression analysis was used to determine the association between baseline anxiety disorders (social phobia, simple phobia, obsessive-compulsive disorder, panic attacks, or agoraphobia) and subsequent onset suicide attempts. The presence of one or more anxiety disorders at baseline was significantly associated with subsequent onset suicide attempts (adjusted odds ratio 2.20, 95% confidence interval 1.04-4.64) after controlling for sociodemographic variables and all baseline mental disorders assessed in the survey. These findings suggest that anxiety disorders are independent risk factors for suicide attempts, and underscore the importance of anxiety disorders as a serious public health problem.
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Affiliation(s)
- James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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28
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Nakagawa A, Grunebaum MF, Sullivan GM, Currier D, Ellis SP, Burke AK, Brent DA, Mann JJ, Oquendo MA. Comorbid anxiety in bipolar disorder: does it have an independent effect on suicidality? Bipolar Disord 2008; 10:530-8. [PMID: 18452449 PMCID: PMC2746654 DOI: 10.1111/j.1399-5618.2008.00590.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Comorbid anxiety disorder is reported to increase suicidality in bipolar disorder. However, studies of the impact of anxiety disorders on suicidal behavior in mood disorders have shown mixed results. The presence of personality disorders, often comorbid with anxiety and bipolar disorders, may explain these inconsistencies. This study examined the impact of comorbid Cluster B personality disorder and anxiety disorder on suicidality in bipolar disorder. METHODS A total of 116 depressed bipolar patients with and without lifetime anxiety disorder were compared. Multiple regression analysis tested the association of comorbid anxiety disorder with past suicide attempts and severity of suicidal ideation, adjusting for the effect of Cluster B personality disorder. The specific effect of panic disorder was also explored. RESULTS Bipolar patients with and without anxiety disorders did not differ in the rate of past suicide attempt. Suicidal ideation was less severe in those with anxiety disorders. In multiple regression analysis, anxiety disorder was not associated with past suicide attempts or with the severity of suicidal ideation, whereas Cluster B personality disorder was associated with both. The results were comparable when comorbid panic disorder was examined. CONCLUSIONS Comorbid Cluster B personality disorder appears to exert a stronger influence on suicidality than comorbid anxiety disorder in persons with bipolar disorder. Assessment of suicide risk in patients with bipolar disorder should include evaluation and treatment of Cluster B psychopathology.
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Affiliation(s)
- Atsuo Nakagawa
- Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Michael F Grunebaum
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Gregory M Sullivan
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Dianne Currier
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Steven P Ellis
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Ainsley K Burke
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
| | - David A Brent
- Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - J John Mann
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Maria A Oquendo
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
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Rector NA, Kamkar K, Riskind JH. Misappraisal of Time Perspective and Suicide in the Anxiety Disorders: The Multiplier Effect of Looming Illusions. Int J Cogn Ther 2008. [DOI: 10.1521/ijct.2008.1.1.69] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Panic disorder (PD) is a disabling condition which appears in late adolescence or early adulthood and affects more frequently women than men. PD is frequently characterized by recurrences and sometimes by a chronic course and, therefore, most patients require long-term treatments to achieve remission, to prevent relapse and to reduce the risks associated with comorbidity. Pharmacotherapy is one of the most effective treatments of PD. In this paper, the pharmacological management of PD is reviewed. Many questions about this effective treatment need to be answered by the clinician and discussed with the patients to improve her/his collaboration to the treatment plan: which is the drug of choice; when does the drug become active; which is the effective dose; how to manage the side effects; how to manage nonresponse; and how long does the treatment last. Moreover, the clinical use of medication in women during pregnancy and breastfeeding or in children and adolescents was reviewed and its risk-benefit balance discussed.
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Affiliation(s)
- Carlo Marchesi
- Psychiatric Section, Department of Neuroscience, University of Parma Parma, Italy.
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31
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Diaconu G, Turecki G. Panic disorder and suicidality: is comorbidity with depression the key? J Affect Disord 2007; 104:203-9. [PMID: 17442399 DOI: 10.1016/j.jad.2007.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 03/05/2007] [Accepted: 03/13/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relation between panic disorder and suicidal behavior has been surrounded by perennial controversy. A significant number of reports suggest that PD is associated with suicidal behavior. Alternatively, it has been proposed that comorbid depression may account for the increased suicidality identified in this population. METHOD A total of n=474 consecutive psychiatric outpatient subjects were assessed for Axes I and II psychopathology and personality traits, as well as suicidal behavior, using structured interviews. RESULTS Approximately half of the sample (n=250) reported suicidal ideation, either lifetime or during the 6 months prior to evaluation. In total, 200 subjects reported a history of suicide attempts. When comorbidity with depressive disorders (DD) was not taken into account, patients with Panic Disorder (PD) did not differ from those with a primary diagnosis of depressive disorder in terms of age, current or lifetime suicide ideation or number of suicide attempts. After separating the group characterized by PD comorbid with DD, PD only subjects had significantly lower number of suicide attempts compared to either DD (p<0.01) or comorbid PD-DD (p<0.05). Similar levels of SI were noted between PD, DD and PD-DD, both current and lifetime. Suicide attempters with PD, DD or both did not differ in terms of suicide intent or lethality. They were also similar on impulsivity, aggressive behavior and state-trait anxiety measures. LIMITATIONS Cross-sectional design, the limited sample size in the PD only group, retrospectively collected data with the possibility of recall bias. CONCLUSIONS In this clinical outpatient sample, the association between panic disorder and suicidal behavior was primarily explained by comorbidity with depressive disorders. No differences were observed between different groups for measures of severity of the suicidal behavior. Physicians should be aware of these associations when assessing adults with panic disorder for suicidality.
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Affiliation(s)
- Gabriel Diaconu
- McGill Group for Suicide Studies, Douglas Hospital Research Centre, McGill University, Montréal, Québec, Canada H4H 1R3
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32
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Simon NM, Zalta AK, Otto MW, Ostacher MJ, Fischmann D, Chow CW, Thompson EH, Stevens JC, Demopulos CM, Nierenberg AA, Pollack MH. The association of comorbid anxiety disorders with suicide attempts and suicidal ideation in outpatients with bipolar disorder. J Psychiatr Res 2007; 41:255-64. [PMID: 17052730 DOI: 10.1016/j.jpsychires.2006.08.004] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Revised: 08/11/2006] [Accepted: 08/15/2006] [Indexed: 11/21/2022]
Abstract
Individuals with bipolar disorder are at increased risk for suicide attempts and completion. Although anxiety may be a modifiable suicide risk factor among bipolar patients, anxiety disorder comorbidity has not been highlighted as critical in identification of high-risk individuals nor has its treatment been integrated into suicide prevention strategies. In this study, ancillary to the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), 120 outpatients with bipolar disorder completed detailed assessment of suicidal ideation and behaviors. We examined the association of current and lifetime comorbid anxiety disorders with suicidal ideation and behaviors univariately and with adjustment for potential confounders in regression models. Lifetime anxiety disorders were associated with a more than doubling of the odds of a past suicide attempt, and current anxiety comorbidity was associated with a more than doubling of the odds of current suicidal ideation. Individuals with current anxiety disorders had more severe suicidal ideation, a greater belief suicide would provide relief, and a higher expectancy of future suicidal behaviors. However, some of these associations appeared to be better accounted for by measures of bipolar severity including an earlier age at bipolar onset and a lack of current bipolar recovery. Comorbid anxiety disorders may play a role in characteristics of bipolar disorder that then elevate risk for suicidal ideation and attempts. While further research is needed to establish the precise nature of these associations, our data support that the presence of comorbid anxiety disorders in individuals with bipolar disorder should trigger careful clinical assessment of suicide risk.
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Affiliation(s)
- Naomi M Simon
- Department of Psychiatry, Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Suite 2200, Boston, MA 02114, USA.
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33
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Claassen CA, Trivedi MH, Rush AJ, Husain MM, Zisook S, Young E, Leuchter A, Wisniewski SR, Balasubramani GK, Alpert J. Clinical differences among depressed patients with and without a history of suicide attempts: findings from the STAR*D trial. J Affect Disord 2007; 97:77-84. [PMID: 16824617 DOI: 10.1016/j.jad.2006.05.026] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 05/21/2006] [Accepted: 05/25/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study sought to determine whether a history of suicide attempts among outpatients diagnosed with nonpsychotic major depressive disorder (MDD) is correlated with any difference in clinical presentation that should influence patient care. METHODS Baseline data from the Sequenced Treatment Alternatives to Relieve Depression (STAR()D) trial on outpatients with MDD treated in primary and specialty care settings were used to model significant demographic and clinical correlates of suicide attempter status. RESULTS Altogether, 16.5% of participants (n=667) reported prior suicide attempts. Controlling for age, gender, and depressive symptom severity, previous attempters had more current general medical conditions (micro=3.2 vs. 2.9, p<.0001), more current alcohol/substance abuse (p<.0001), and more work hours missed in the past week (26.2% vs. 18.2%, p<.0001) than non-attempters. On average, for the previously suicidal, the onset of MDD occurred 8.9 years earlier in life (p<.0001) and had included 1.2 additional depressive episodes (p=0.001) compared to those without prior suicidal behavior. Previous attempters also reported more current suicidal ideation (61.3% of previous attempters, adjusted OR 1.6, vs. 45.5% of nonattempters, p<.0001). LIMITATIONS Presence or absence of a history of suicide attempts was determined only through self report. CONCLUSIONS Those with a history of suicidal behavior suffer a greater burden of depressive illness. Earlier intervention and ongoing, aggressive care, including maintenance-phase pharmacotherapy, may be critical to mitigating the long-term consequences associated with this increased disease burden.
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Affiliation(s)
- Cynthia A Claassen
- Department of Psychiatry and Division of Clinical Psychology, University of Texas Southwestern Medical School, Dallas, Texas 75235-9119, United States.
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Simon NM, Pollack MH, Ostacher MJ, Zalta AK, Chow CW, Fischmann D, Demopulos CM, Nierenberg AA, Otto MW. Understanding the link between anxiety symptoms and suicidal ideation and behaviors in outpatients with bipolar disorder. J Affect Disord 2007; 97:91-9. [PMID: 16820212 DOI: 10.1016/j.jad.2006.05.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 05/15/2006] [Accepted: 05/25/2006] [Indexed: 01/12/2023]
Abstract
BACKGROUND Prior studies suggest an association between anxiety comorbidity and suicidal ideation and behaviors in bipolar disorder. However, the nature of this association remains unclear. METHODS We examined a range of anxiety symptoms, including panic, phobic avoidance, anxiety sensitivity, worry and fear of negative evaluation, in 98 patients with bipolar disorder. We predicted that each anxiety dimension would be linked to greater suicidal ideation and behavior as measured by Linehan's Suicide Behaviors Questionnaire (SBQ), greater depressive rumination, and poorer emotional processing and expression. RESULTS Each anxiety dimension except fear of negative evaluation was associated with greater SBQ score, greater rumination, and lower levels of emotional processing in univariate analyses. Depressive rumination was a significant predictor of higher SBQ scores in a stepwise multivariate model controlling for age, gender, bipolar subtype, and bipolar recovery status; the association between the anxiety symptom dimensions and SBQ score was found to be redundant with depressive rumination. Emotional processing emerged as protective against suicidal ideation and behaviors in men only, while emotional expression was a significant predictor of lower SBQ scores for women and for the full sample; however, emotional expression was not significantly correlated with anxiety symptoms. Confirmatory analyses examining only those in recovery or recovered (n=68) indicated that the link between rumination and suicidality was not explained by depression. LIMITATIONS Interpretation is limited by the cross-sectional study design. CONCLUSIONS These findings indicate that increased ruminations may mediate the association between anxiety and suicidal ideation/behavior. In men, lower emotional processing may also play a role in this relationship.
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Affiliation(s)
- Naomi M Simon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114, United States.
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35
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Abstract
Panic disorder is a common mental disorder that affects up to 5% of the population at some point in life. It is often disabling, especially when complicated by agoraphobia, and is associated with substantial functional morbidity and reduced quality of life. The disorder is also costly for individuals and society, as shown by increased use of health care, absenteeism, and reduced workplace productivity. Some physical illnesses (eg, asthma) commonly occur with panic disorder, and certain lifestyle factors (eg, smoking) increase the risk for the disorder, but causal pathways are still unclear. Genetic and early experiential susceptibility factors also exist, but their exact nature and pathophysiological mechanisms remain unknown. Despite an imprecise, although increased, understanding of cause, strong evidence supports the use of several effective treatments (eg, pharmacological, cognitive-behavioural). The adaptation and dissemination of these treatments to the frontlines of medical-care delivery should be urgent goals for the public-health community.
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Affiliation(s)
- Peter P Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine at Harborview Medical Center, Seattle, WA 98104-2499, USA.
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36
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Affiliation(s)
- Wayne J Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195-6560, USA. . edu
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37
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Nock MK, Kessler RC. Prevalence of and risk factors for suicide attempts versus suicide gestures: Analysis of the National Comorbidity Survey. JOURNAL OF ABNORMAL PSYCHOLOGY 2006; 115:616-23. [PMID: 16866602 DOI: 10.1037/0021-843x.115.3.616] [Citation(s) in RCA: 361] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Definitions and classification schemes for suicide attempts vary widely among studies, introducing conceptual, methodological, and clinical problems. We tested the importance of the intent to die criterion by comparing self-injurers with intent to die, suicide attempters, and those who self-injured not to die but to communicate with others, suicide gesturers, using data from the National Comorbidity Survey (n = 5,877). Suicide attempters (prevalence = 2.7%) differed from suicide gesturers (prevalence = 1.9%) and were characterized by male gender, fewer years of education, residence in the southern and western United States; psychiatric diagnoses including depressive, impulsive, and aggressive symptoms; comorbidity; and history of multiple physical and sexual assaults. It is possible and useful to distinguish between self-injurers on the basis of intent to die.
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Affiliation(s)
- Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA.
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38
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Crowell SE, Beauchaine TP, McCauley E, Smith CJ, Stevens AL, Sylvers P. Psychological, autonomic, and serotonergic correlates of parasuicide among adolescent girls. Dev Psychopathol 2005; 17:1105-27. [PMID: 16613433 DOI: 10.1017/s0954579405050522] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although parasuicidal behavior in adolescence is poorly understood, evidence suggests that it may be a developmental precursor of borderline personality disorder (BPD). Current theories of both parasuicide and BPD suggest that emotion dysregulation is the primary precipitant of self-injury, which serves to dampen overwhelmingly negative affect. To date, however, no studies have assessed endophenotypic markers of emotional responding among parasuicidal adolescents. In the present study, we compare parasuicidal adolescent girls (n=23) with age-matched controls (n=23) on both psychological and physiological measures of emotion regulation and psychopathology. Adolescents, parents, and teachers completed questionnaires assessing internalizing and externalizing psychopathology, substance use, trait affectivity, and histories of parasuicide. Psychophysiological measures including electrodermal responding (EDR), respiratory sinus arrhythmia, and cardiac pre-ejection period (PEP) were collected at baseline, during negative mood induction, and during recovery. Compared with controls, parasuicidal adolescents exhibited reduced respiratory sinus arrhythmia (RSA) at baseline, greater RSA reactivity during negative mood induction, and attenuated peripheral serotonin levels. No between-group differences on measures of PEP or EDR were found. These results lend further support to theories of emotion dysregulation and impulsivity in parasuicidal teenage girls.
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Affiliation(s)
- Sheila E Crowell
- Department of Psychology, University of Washington, Seattle, WA 98195-1525, USA.
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39
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Allen MH, Chessick CA, Miklowitz DJ, Goldberg JF, Wisniewski SR, Miyahara S, Calabrese JR, Marangell L, Bauer MS, Thomas MR, Bowden CL, Sachs GS. Contributors to suicidal ideation among bipolar patients with and without a history of suicide attempts. Suicide Life Threat Behav 2005; 35:671-80. [PMID: 16552982 DOI: 10.1521/suli.2005.35.6.671] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study was designed to develop models for vulnerability to suicidal ideation in bipolar patients. Logistic regression models examined correlates of suicidal ideation in patients who had versus had not attempted suicide previously. Of 477 patients assessed, complete data on demographic, illness history, and personality variables were available on 243. The regression models achieved positive predictive values of 55% and 59% for the attempter (N = 92) and nonattempter groups (N = 151), respectively. Depression was cross-sectionally associated with suicidal ideation in both the attempter and nonattempter groups but made a smaller contribution among attempters. Poor psychosocial adaptation and the personality factor "openness" were stronger contributors to suicidal ideation among prior attempters while anxiety and extraversion appeared protective against ideation. Among nonattempters, depression, anxiety, and neuroticism were the predominant influences on suicidal ideation. Bipolar patients with suicidal ideation may benefit from different treatment strategies depending on their prior attempt status.
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Affiliation(s)
- Michael H Allen
- University of Colorado Health Science Center, University North Pavilion, 4455 East 12th Avenue, Denver, CO, USA.
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