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Understanding the link between anxiety symptoms and suicidal ideation and behaviors in outpatients with bipolar disorder.
J Affect Disord. 2007 Jan; 97(1-3):91-9.JA

Abstract

BACKGROUND

Prior studies suggest an association between anxiety comorbidity and suicidal ideation and behaviors in bipolar disorder. However, the nature of this association remains unclear.

METHODS

We examined a range of anxiety symptoms, including panic, phobic avoidance, anxiety sensitivity, worry and fear of negative evaluation, in 98 patients with bipolar disorder. We predicted that each anxiety dimension would be linked to greater suicidal ideation and behavior as measured by Linehan's Suicide Behaviors Questionnaire (SBQ), greater depressive rumination, and poorer emotional processing and expression.

RESULTS

Each anxiety dimension except fear of negative evaluation was associated with greater SBQ score, greater rumination, and lower levels of emotional processing in univariate analyses. Depressive rumination was a significant predictor of higher SBQ scores in a stepwise multivariate model controlling for age, gender, bipolar subtype, and bipolar recovery status; the association between the anxiety symptom dimensions and SBQ score was found to be redundant with depressive rumination. Emotional processing emerged as protective against suicidal ideation and behaviors in men only, while emotional expression was a significant predictor of lower SBQ scores for women and for the full sample; however, emotional expression was not significantly correlated with anxiety symptoms. Confirmatory analyses examining only those in recovery or recovered (n=68) indicated that the link between rumination and suicidality was not explained by depression.

LIMITATIONS

Interpretation is limited by the cross-sectional study design.

CONCLUSIONS

These findings indicate that increased ruminations may mediate the association between anxiety and suicidal ideation/behavior. In men, lower emotional processing may also play a role in this relationship.

Authors+Show Affiliations

Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114, United States. NSIMON@Partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16820212

Citation

Simon, Naomi M., et al. "Understanding the Link Between Anxiety Symptoms and Suicidal Ideation and Behaviors in Outpatients With Bipolar Disorder." Journal of Affective Disorders, vol. 97, no. 1-3, 2007, pp. 91-9.
Simon NM, Pollack MH, Ostacher MJ, et al. Understanding the link between anxiety symptoms and suicidal ideation and behaviors in outpatients with bipolar disorder. J Affect Disord. 2007;97(1-3):91-9.
Simon, N. M., Pollack, M. H., Ostacher, M. J., Zalta, A. K., Chow, C. W., Fischmann, D., Demopulos, C. M., Nierenberg, A. A., & Otto, M. W. (2007). Understanding the link between anxiety symptoms and suicidal ideation and behaviors in outpatients with bipolar disorder. Journal of Affective Disorders, 97(1-3), 91-9.
Simon NM, et al. Understanding the Link Between Anxiety Symptoms and Suicidal Ideation and Behaviors in Outpatients With Bipolar Disorder. J Affect Disord. 2007;97(1-3):91-9. PubMed PMID: 16820212.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Understanding the link between anxiety symptoms and suicidal ideation and behaviors in outpatients with bipolar disorder. AU - Simon,Naomi M, AU - Pollack,Mark H, AU - Ostacher,Michael J, AU - Zalta,Alyson K, AU - Chow,Candice W, AU - Fischmann,Diana, AU - Demopulos,Christina M, AU - Nierenberg,Andrew A, AU - Otto,Michael W, Y1 - 2006/07/03/ PY - 2006/03/21/received PY - 2006/05/15/revised PY - 2006/05/25/accepted PY - 2006/7/6/pubmed PY - 2007/3/21/medline PY - 2006/7/6/entrez SP - 91 EP - 9 JF - Journal of affective disorders JO - J Affect Disord VL - 97 IS - 1-3 N2 - BACKGROUND: Prior studies suggest an association between anxiety comorbidity and suicidal ideation and behaviors in bipolar disorder. However, the nature of this association remains unclear. METHODS: We examined a range of anxiety symptoms, including panic, phobic avoidance, anxiety sensitivity, worry and fear of negative evaluation, in 98 patients with bipolar disorder. We predicted that each anxiety dimension would be linked to greater suicidal ideation and behavior as measured by Linehan's Suicide Behaviors Questionnaire (SBQ), greater depressive rumination, and poorer emotional processing and expression. RESULTS: Each anxiety dimension except fear of negative evaluation was associated with greater SBQ score, greater rumination, and lower levels of emotional processing in univariate analyses. Depressive rumination was a significant predictor of higher SBQ scores in a stepwise multivariate model controlling for age, gender, bipolar subtype, and bipolar recovery status; the association between the anxiety symptom dimensions and SBQ score was found to be redundant with depressive rumination. Emotional processing emerged as protective against suicidal ideation and behaviors in men only, while emotional expression was a significant predictor of lower SBQ scores for women and for the full sample; however, emotional expression was not significantly correlated with anxiety symptoms. Confirmatory analyses examining only those in recovery or recovered (n=68) indicated that the link between rumination and suicidality was not explained by depression. LIMITATIONS: Interpretation is limited by the cross-sectional study design. CONCLUSIONS: These findings indicate that increased ruminations may mediate the association between anxiety and suicidal ideation/behavior. In men, lower emotional processing may also play a role in this relationship. SN - 0165-0327 UR - https://www.unboundmedicine.com/medline/citation/16820212/Understanding_the_link_between_anxiety_symptoms_and_suicidal_ideation_and_behaviors_in_outpatients_with_bipolar_disorder_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(06)00259-X DB - PRIME DP - Unbound Medicine ER -