Which mental health conditions are most likely to lead to suicidal thoughts and behavior? According to several recent studies, anxiety, more than depression, is a strong risk factor for suicide. Suicide is one of the three leading causes of death for Americans ages 15 to 44.
Anxiety and Suicide
In an October 2013 study, researchers, led by Amrit Kanwar, evaluated the evidence about the link between anxiety and suicidal behavior. The researchers systematically reviewed forty two studies that researched this topic. The various studies assessed the data about people with anxiety disorders, along with data about their suicidal thoughts, attempts, and completed suicides.
Dr. Kanwar and his associates learned that patients with anxiety were more likely than those without anxiety to report suicidal thoughts. Furthermore, those with anxiety were also more likely to have attempted suicide, completed suicide, or demonstrated any suicidal behaviors at all. This was true of all anxiety disorders, other than OCD (Obsessive Compulsive Disorder). Specifically, people diagnosed with GAD (Generalized Anxiety Disorder), PD (Panic Disorder), and PTSD (Post-Traumatic Stress Disorder) are at risk.
Anxious in Australia
In another 2013 study, a group of Australian researchers, led by Dr. Philip Batterham of the University of Melbourne, examined which anxiety and depression symptoms seemed most likely to lead to suicidal thoughts in most people. To do so, they reviewed the statistics of people participating in the Personality and Total Health (PATH) Through Life project, which is an on-going, large study that aims to better understand mental health. Among other tasks, the PATH project tracks and defines the course of depression and anxiety across the lifespan, as well as identifies environmental risk factors related to depression and anxiety. The PATH Through Life project comprises 7500 participants who were between the ages of 20 and 64 at the outset of the study.
Dr. Batterham and his colleagues assessed participants who had reported one or more of 18 symptoms of anxiety and depression. At a four year follow-up, he checked how many reported suicidal ideation, or thoughts about suicide. They found that anxiety was more likely than depression to lead to suicidal ideation. 23% of people with anxiety symptoms reported suicidal thoughts after four years, while 16% of people with anxiety symptoms reported them. Anxiety was even more likely to lead to suicidal thoughts among younger people.
Depression and PTSD: A Risky Combination
Daniel Stevens and Dr. Holly C. Wilcox, two researchers at the Johns Hopkins University School of Medicine, looked at the combination of depression and PTSD as a risk factor for suicide. In an October 2013 study, they reviewed information about participants in the Genetics of Recurrent Early-Onset Depression study (GenRED II). GenRED II, a nationwide research study sponsored by the National Institute of Mental Health, aims to find a gene for depression by analyzing information about two or more members of the same family who have depression.
In this October 2013 study, Stevens and Wilcox examined the history of 1,433 people with recurrent Major Depressive Disorder (MDD) who developed Post Traumatic Stress Disorder (PTSD) following an assaultive trauma. MDD, or clinical depression, is marked by a loss of interest in typical activities and relationships, as well as a depressed mood most of the day, every day for two weeks. PTSD is an anxiety disorder that develops following the experience of life-threatening events, and is marked by seemingly real flashbacks, poor sleep, and a feeling of detachment. They tested the hypothesis that the combination of the two disorders would increase the risk of suicide attempts.
The Johns Hopkins’ researchers found that 28% of the population who had both recurrent MDD and assault-related PTSD had attempted suicide at least once in their lives. Traumatic events that involved a violent assault had a high association with the development of PTSD and later suicide attempts.
Self-Harm: Prevention is Key
Given that anxiety disorders are stand-alone risk factors for suicidal behavior, it is important to recognize and treat anxiety. The rates of suicide are higher in patients with anxiety disorders, so people who report symptoms such as irritability or worrying, even if they don’t have depression, should be assessed for suicidal thoughts. Furthermore, suicide prevention programs should focus on anxiety symptoms, and not only on depression.