The Mediating Role of Insomnia Severity in the Relationship Between Anxiety Symptoms and Suicidal Ideation: A Real-World Study in a Psychiatric Inpatient Setting

ABSTRACT

Insomnia and anxiety symptoms are independent clinical variables involved in suicidal ideation in psychiatric inpatients. In this article, we investigated the relationship among insomnia severity, severity of anxiety symptoms, and suicidal ideation in a sample of psychiatric inpatients with severe mental disorders. We used a mediation model considering insomnia severity as the possible mediator of the relationship between anxiety severity and suicidal ideation. We administered the Columbia Suicide Severity Rating Scale, the Insomnia Severity Index, and the Hamilton Anxiety Rating Scale to 116 consecutive inpatients to the psychiatric unit of Sant'Andrea Hospital in Rome. The effect of anxiety symptoms was mediated by insomnia severity; patients who perceive higher anxiety symptoms were more likely to experience higher levels of insomnia and, thus, higher suicidal ideation intensity. Results showed the importance of assessing and treating both insomnia and anxiety in clinical practice.

The Relationship Among Anxiety Sensitivity, Psychache, and Suicidality in Patients With Generalized Anxiety Disorder

Although generalized anxiety disorder (GAD) is associated with suicide, not all dimensions of this relationship have been addressed. This study aimed to investigate the relationship between psychache and anxiety sensitivity with suicidality in patients with GAD. We included 80 patients with GAD (17 of whom had previous suicide attempts). The Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Scale (HAM-D), Beck Scale for Suicidal Ideation (BSIS), Psychache Scale (PS), and Anxiety Sensitivity Index-3 (ASI) were applied to the participants. The patients with previous suicide attempts had significantly higher scores on ASI total, ASI-physical and cognitive subdimensions, HAM-A total and psychic subscale, PS, and BSIS than those without ( p < 0.05 for each). Mediation analyses revealed that psychache was a full mediator in the relationship between ASI-cognitive subdimension and suicidal ideation. Therapeutic interventions for anxiety sensitivity and psychache in patients with GAD will help reduce the risk of suicide.

Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review

Suicidal thoughts and behaviors are highly prevalent public health problems with devastating consequences. There is an urgent need to improve our understanding of risk factors for suicide to identify effective intervention targets. The aim of this meta-analysis was to examine the magnitude and clinical utility of anxiety and its disorders as risk factors for suicide ideation, attempts, and deaths. We conducted a literature search through December 2014; of the 65 articles meeting our inclusion criteria, we extracted 180 cases in which an anxiety-specific variable was used to longitudinally predict a suicide-related outcome. Results indicated that anxiety is a statistically significant, yet weak, predictor of suicide ideation (OR=1.49, 95% CI: 1.18, 1.88) and attempts (OR=1.64, 95% CI: 1.47, 1.83), but not deaths (OR=1.01, 95% CI: 0.87, 1.18). The strongest associations were observed for PTSD. Estimates were reduced after accounting for publication bias, and diagnostic accuracy analyses indicated acceptable specificity but poor sensitivity. Overall, the extant literature suggests that anxiety and its disorders, at least when these constructs are measured in isolation and as trait-like constructs, are relatively weak predictors of suicidal thoughts and behaviors over long follow-up periods. Implications for future research priorities are discussed.

The role of impulsivity in the relationship between anxiety and suicidal ideation

BACKGROUND

The purpose of the present study was to examine the degree to which trait and cognitive (looming cognitive style) measures of anxiety are associated with suicidal ideation (SI), as well as whether trait and cognitive (time misperception) measures of impulsivity moderate the association between these variables.

METHODS

The sample included 100 undergraduate students (72% female) who completed the Spielberger State-Trait Anxiety Inventory, Looming Maladaptive Style Questionnaire, Barratt Impulsiveness Scale, Time Paradigm Version 1.0 Task, Beck Scale for Suicidal Ideation, and the Brief Symptom Inventory.

RESULTS

Trait anxiety and looming cognitive style were found to be positively associated with SI. Further, both trait impulsivity and time misperception moderated the association between these variables and SI, but in a different manner. Consistent with study hypotheses, among those high in trait anxiety, greater overestimation of time was associated with a higher likelihood of SI. Contrary to study hypotheses, among those low in trait anxiety, high trait impulsivity was associated with a greater likelihood of SI. The same pattern of results was found when looming cognitive style served as the independent variable.

LIMITATIONS

The use of a cross-sectional design limits the ability to determine the temporal relationship of the study variables. Further, the sample included predominantly Caucasian undergraduates and thus study results may not generalize to other populations.

CONCLUSIONS

Clinically, results suggest that high trait anxiety, looming cognitive style, time misperception, and trait impulsivity may be important risk factors for SI among college students and thus should be assessed when students present for treatment. Treatments that focus on problem solving, cognitive restructuring, and affect regulation strategies may help decrease anxiety and impulsivity, which in turn may help reduce the likelihood of suicidal thoughts.

Suicide-related behaviors and anxiety in children and adolescents: a review

This paper reviews empirical evidence of the association between suicide-related behaviors and anxiety among children and adolescents. It begins with a review of suicide-related behaviors and anxiety, discusses methodological issues related to measurement, and reviews empirical findings published since the last review of this topic in 1988. Evidence is summarized on four criteria necessary to establish anxiety as a causal risk factor for suicide-related behaviors among children and adolescents. There is consistent evidence for a significant association between anxiety and suicide-related behaviors (Criterion 1). Evidence that the influence of anxiety on suicide-related behaviors is not due to a third variable (Criterion 2) is mixed and hindered by methodological limitations. The literature is also unclear as to whether anxiety temporally precedes suicide-related behaviors (Criterion 3). Finally, this review found no evidence to support or refute anxiety's stability independent of and across instances of suicide-related behaviors (Criterion 4). Theoretical and clinical implications of these findings and directions for future research are discussed.