Magazine article Clinical Psychiatry News

Severe Anxiety Presages Suicide Risk, Data Show: Expert Questions Traditional Indicators

Magazine article Clinical Psychiatry News

Severe Anxiety Presages Suicide Risk, Data Show: Expert Questions Traditional Indicators

Article excerpt

SANTA ANA PUEBLO, N.M.--A growing body of evidence shows that severe anxiety often precedes suicide attempts in psychiatric patients, Dr. Jan Fawcett said at the annual meeting of the Anxiety Disorders Association of America.

In some studies, suicidal patients have documented anxiety disorders; in others, anxiety is comorbid with depression, he said in a plenary talk. Overall, the pattern is of heightened anxiety being associated with suicide attempts and suicides.

The traditional indicators of chronic suicide risk do not predict acute risk, warned Dr. Fawcett, leading investigator and a professor of psychiatry at the University of New Mexico, Albuquerque. And the common practice of having patients sign no-harm contracts does not prevent them from committing suicide.

"We all know they don't work and are misleading, and yet people do them all over the country," said Dr. Fawcett, a co-author of the American Psychiatric Association Practice Guidelines on the assessment and management of suicidal patients.

He cited a study of 100 outpatients who had made serious suicide attempts--83% had signed no-harm contracts (Psychosomatics 1999;40:18-27). In a study of 76 people who committed suicide as inpatients or immediately after discharge, chart reviews showed that 78% had denied suicidal ideation in their last communication with a nurse, and 28% had signed no-suicide contracts (J. Clin. Psychiatry 2003;64:14-9). In both studies, most patients were severely anxious or agitated before their attempts.

"This is a real problem, and pretending it's not there by doing contracts doesn't get us anyplace." Dr. Fawcett said, urging clinicians to be persistent if they think a patient is at immediate risk. "What you've got to do is go with your gut."

But when questioned by the audience, he acknowledged that no judge will agree to psychiatric commitment on grounds that a patient is extremely anxious. In such cases, Dr. Fawcett said he does his best, and writes in the patient's chart: "This patient is at acute risk for suicide, but is not committable."

Among recent epidemiologic studies, Dr. Fawcett cited a 60,000-person study from Norway that found monthly variations in the national suicide rate correlated with monthly variations in comorbid anxiety and depression rates (J. Affect. Disord. 2008;106:273-8). An earlier population-based survey in the Netherlands showed the presence of any anxiety disorder was significantly associated with increased risk of suicidal ideation and suicide attempts (Arch. …

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