The Connection Between Anxiety Disorders and Suicidality

Trigger warning: this post involves frank discussion of anxiety and suicidality.

Anxiety disorders and suicidality are connected, but when I think about how anxiety is perceived by society, I think about what I've seen on tv and in movies. I've seen so many shows where anxiety was portrayed with someone sweating a lot on a first date or being unable to speak when asked to talk in public. Some forms of anxiety are even used for comedy, like in Parks and Recreation where Leslie's mom meets a former love interest whose anxiety led to a comedy of errors after Leslie brings him to a party. There isn't anything wrong with these portrayals, but it is striking to me that none of the imagery associated with an anxiety disorder implies suicidality.

Suicidality is often seen as related exclusively to depression, not anxiety, so our collective consciousness as a society has built up the connection between depression and suicidality very well but has, perhaps, neglected its connection with anxiety. So today, I wanted to share some of the evidence demonstrating a link between anxiety disorders and suicidality to address this apparent gap in our collective awareness. Taking anxiety disorders seriously really does make a difference, so if you are suffering from anxiety please seek support from your primary care provider or community.

Understanding Anxiety Disorders and Suicidality 

The National Survey of Comorbidity-Replication (NSC-R) is a survey study of 10,000 adults in the U.S. that sought to evaluate the prevalence of mental health disorders. It evaluated many Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses, but we will focus on their findings for anxiety and suicidality.¹

This study's results suggest that generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), social anxiety disorder (SAD), and panic disorder (PD) are each predictive of suicidal ideation. Additionally, GAD, PTSD, and SAD were associated with suicide attempts. Intriguingly, these associations varied by gender.

For women, the associations cited above were the same as in general. However, for men, only PTSD predicted suicidal ideation, and only PD was associated with suicide attempts. (This gender difference may be due in part to the relatively low rate of suicide attempts, particularly in men, reducing power to detect significant differences).

Another study found that in psychiatric outpatients, individuals who reported at least moderate difficulty with anxiety symptoms were 3.5 times more likely to also report at least moderate difficulty with suicidal thoughts or suicidality.² This finding is particularly impactful because it suggests that suicidal thoughts and suicidality are not just more likely in individuals with a diagnosis of an anxiety disorder, but may also be increased in individuals who just experience anxiety symptoms. This study focused on psychiatric outpatients, so these results may be limited to similar populations rather than generalizing to the public overall. 

The connection between anxiety disorders and suicidality is not limited to adults. In one study of adolescents, Drs. O'Neil Rodriguez and Kendall found that youth-reported broad anxiety symptomatology was independently related to youth-reported suicidal ideation, even after account for youth-reported depressive symptoms.³ This finding suggests that even when you take into account adolescents' depressive symptoms, anxiety symptoms are still predictive of suicidal ideation.

Anxiety disorders also appear to be related to suicidal ideation and attempts in adolescents. One study found that a single anxiety disorder in adolescence increased the odds of suicidal ideation by 2.8 times, and of suicide attempts by 1.9 times after controlling for other factors related to suicidality.⁴ Suicidal behavior increased as the number of anxiety disorders increased, suggesting additional risk of suicidal behavior with more anxiety disorders. 

The Takeaway 

I hope the research cited above provides you a clear picture of the risks for suicidality associated with anxiety disorders. My intent in sharing this information is to acknowledge that suicide is not just a product of depression and that seeking treatment for anxiety is really important for protecting against suicidality.

This does not mean, however, that you will necessarily experience suicidal ideation or suicide attempts if you have anxiety. Rather, the evidence suggests that the risks for suicidal ideation and attempts may be elevated in adolescents and adults suffering from anxiety. I hope you found this article helpful for learning about anxiety disorders and suicidality, please share any thoughts or concerns in the comments below.

If you feel that you may hurt yourself or someone else, call 9-1-1 immediately.

For more information on suicide, see our suicide information, resources and support section. For additional mental health help, please see our mental health hotline numbers and referral information section.

Sources

1. Cougle, J.R., "Anxiety Disorders and Suicidality in the National Comorbidity Survey-Replication." Journal of Psychiatric Research, June 2009. 
2. Diefenbach, G. J., "The Association Between Self-Reported Anxiety Symptoms and Suicidality." The Journal of Nervous and Mental Disease, February 2009. 
3. O'Neil Rodriguez, K.A., "Suicidal Ideation in Anxiety-Disordered Youth: Identifying Predictors of Risk." Journal of Clinical Child & Adolescent Psychology, October 2013.
4. Boden, J. M., "Anxiety Disorders and Suicidal Behaviours in Adolescence and Young Adulthood: Findings from a Longitudinal Study." Psychological Medicine, November 2006.