05 11 2013
Suicide is among the top three causes for death among those aged between 15-44. Depression is well understood to be the main mental health problem associated with suicide. What about anxiety disorders? Though anxiety commonly co occur with depression and can be a risk factor for suicidal behaviours, less attention is given to the relationship between anxiety and suicide. Findings have been insistent in this area as well. PTSD is known to be associated with increased suicide risk. What about other anxiety disorders?
Amrit Kanwar et al report the results of a meta analysis of the association between anxiety and suicide. Controlled studies were only included.42 studies met the inclusion criteria, giving a total of 309974 patients.
Patients with anxiety were more likely to have suicidal ideations (OR = 2.89, 95% CI: 2.09, 4.00), attempted suicides (OR = 2.47, 95% CI: 1.96, 3.10), completed suicides (OR = 3.34, 95% CI: 2.13, 5.25). All anxiety disorders EXCEPT OCD shared this higher odds. Highest OR was seen for Panic disorder.There was no difference between genders.
Limitation: Studies were much heterogeneous. Publication bias is significant. Summary estimates from individual studies may not have been adjusted for patient level covariates.Effect of medications on the participants not clear.
Clinical implication– Avoidance strategies in anxiety disorders might be exacerbating the distress, disability and isolation and thus vulnerability for suicide. Assessment of anxiety may help to identify individuals with vulnerability for suicidal behaviours.
Conclusion– Rates of suicidal behaviours are higher in anxiety disorders Except OCD. Suicidal risk assessments should focus on anxiety states as well.
Summary of the article:
Kanwar A, Malik S, Prokop LJ, Sim LA, Feldstein D, Wang Z, Murad MH. Depress Anxiety. 2013 Oct;30(10):917-29.