Comorbid anxiety as a suicide risk factor among depressed veterans.
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.
Pfeiffer
Paul N
PN
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, Michigan, USA. ppfeiffe@umich.edu
Ganoczy
Dara
D
Ilgen
Mark
M
Zivin
Kara
K
Valenstein
Marcia
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D003130:Combat Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*; D014728:Veterans / Q000523:psychology*; D055815:Young Adult; D000092864:Suicide Prevention
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents