Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-18T04:06:51.686Z Has data issue: false hasContentIssue false
  • English
  • Français

The anxiety disorders and suicidal ideation: accounting for co-morbidity via underlying personality traits

Published online by Cambridge University Press:  08 November 2010

K. Naragon-Gainey  and
D. Watson
K. Naragon-Gainey*
Affiliation:
Department of Psychology, University of Iowa, Iowa City, IA, USA
D. Watson
Affiliation:
Department of Psychology, University of Iowa, Iowa City, IA, USA
*
*Address for correspondence: K. Naragon-Gainey, M.A., Department of Psychology, E11 Seashore Hall, University of Iowa, Iowa City, IA 52242-1407, USA. (Email: kristin-naragon@uiowa.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The anxiety disorders are robust correlates/predictors of suicidal ideation, but it is unclear whether (a) the anxiety disorders are specifically associated with suicidal ideation or (b) the association is due to co-morbidity with depression and other disorders. One means of modeling co-morbidity is through the personality traits neuroticism/negative emotionality (N/NE) and extraversion/positive emotionality (E/PE), which account for substantial shared variance among the internalizing disorders. The current study examines the association between the internalizing disorders and suicidal ideation, after controlling for co-morbidity via N/NE and E/PE.

Method

The sample consisted of 327 psychiatric out-patients. Multiple self-report and interview measures were collected for internalizing disorders [depression, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), social anxiety, panic and specific phobia] and suicidal ideation, as well as self-report measures for N/NE and E/PE. A model was hypothesized in which each disorder and suicidal ideation was regressed on N/NE, and depression and social anxiety were regressed on E/PE. Structural equation modeling (SEM) was used to examine the unique association of suicidality with each disorder, beyond shared variance with N/NE and E/PE.

Results

The hypothesized model was an acceptable fit to the data. Although zero-order analyses indicated that suicidal ideation was moderately to strongly correlated with all of the disorders, only depression and PTSD remained significantly associated with suicidal ideation in the SEM analyses.

Conclusions

In a latent variable model that accounts for measurement error and a broad source of co-morbidity, only depression and PTSD were uniquely associated with suicidal ideation; panic, GAD, social anxiety and specific phobia were not.

Keywords

Anxiety disordersco-morbiditydepressionpersonalitysuicidal ideation
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 7 , July 2011 , pp. 1437 - 1447
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beck, AT, Steer, RA (1990). Beck Anxiety Inventory Manual. Psychological Corporation: San Antonio, TX.Google Scholar
Beck, AT, Steer, RA, Brown, GK (1996). Beck Depression Inventory Manual (2nd edn). Psychological Corporation: San Antonio, TX.Google Scholar
Bienvenu, OJ, Hettema, JM, Neale, MC, Prescott, CA, Kendler, KS (2007). Low extraversion and high neuroticism as indices of genetic and environmental risk for social phobia, agoraphobia, and animal phobia. American Journal of Psychiatry 164, 1714–1721.CrossRefGoogle ScholarPubMed
Boden, JM, Fergusson, DM, Horwood, LJ (2006). Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study. Psychological Medicine 37, 431–440.CrossRefGoogle Scholar
Bolton, JM, Cox, BJ, Afifi, TO, Enns, MW, Bienvenu, OJ, Sareen, J (2008). Anxiety disorders and risk for suicide attempts: findings from the Baltimore Epidemiologic Catchment Area follow-up study. Depression and Anxiety 25, 477–481.CrossRefGoogle ScholarPubMed
Brezo, J, Paris, J, Turecki, G (2006). Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review. Acta Psychiatrica Scandinavica 113, 180–206.CrossRefGoogle ScholarPubMed
Brown, TA, Chorpita, BF, Barlow, DH (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology 107, 179–192.CrossRefGoogle ScholarPubMed
Browne, MW, Cudeck, R (1993). Alternative ways of assessing model fit. In Testing Structural Equation Models (ed. Bollen, K. A. and Long, J. S.), pp. 136–161. Sage Publications: Newbury Park.Google Scholar
Cavanagh, JT, Carson, AJ, Sharpe, M, Lawrie, SM (2003). Psychological autopsy studies of suicide: a systematic review. Psychological Medicine 33, 395–405.CrossRefGoogle ScholarPubMed
Chioqueta, AP, Stiles, TC (2003). Suicide risk in outpatients with specific mood and anxiety disorders. Crisis 24, 105–112.CrossRefGoogle ScholarPubMed
Chioqueta, AP, Stiles, TC (2005). Personality traits and the development of depression, hopelessness, and suicide ideation. Personality and Individual Differences 38, 1283–1291.CrossRefGoogle Scholar
Cox, BJ, Cohen, E, Direnfeld, DM, Swinson, RP (1996). Does the Beck Anxiety Inventory measure anything beyond panic attack symptoms? Behavior Research and Therapy 34, 949–954.CrossRefGoogle ScholarPubMed
Cougle, JR, Keough, ME, Riccardi, CJ, Sachs-Ericsson, N (2009 a). Anxiety disorders and suicidality in the National Comorbidity Survey-Replication. Journal of Psychiatric Research 43, 825–829.CrossRefGoogle ScholarPubMed
Cougle, JR, Resnick, H, Kilpatrick, DG (2009 b). PTSD, depression, and their comorbidity in relation to suicidality: cross-sectional and prospective analyses of a national probability sample of women. Depression and Anxiety 26, 1151–1157.CrossRefGoogle ScholarPubMed
Cutshall, C, Watson, D (2004). The phobic stimuli response scales: a new self-report measure of fear. Behaviour Research and Therapy 42, 1193–1201.CrossRefGoogle Scholar
Diefenbach, GJ, Woolley, SB, Goethe, JW (2009). The association between self-reported anxiety symptoms and suicidality. Journal of Nervous and Mental Disease 197, 92–97.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1997). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition (SCID-I/P). Biometrics Research, New York State Psychiatric Institute: New York.Google Scholar
Gradus, JL, Qin, P, Lincoln, AK, Miller, M, Lawler, E, Sørensen, HT, Lash, TL (2010). Posttraumatic stress disorder and completed suicide. American Journal of Epidemiology 171, 721–727.CrossRefGoogle ScholarPubMed
Hettema, JM, Neale, MC, Myers, JM, Prescott, CA, Kendler, KS (2006). A population-based twin study of the relationship between neuroticism and internalizing disorders. American Journal of Psychiatry 163, 857–864.CrossRefGoogle ScholarPubMed
Hornig, CD, McNally, RJ (1995). Panic disorder and suicide attempt: a reanalysis of data from the Epidemiologic Catchment Area study. British Journal of Psychiatry 167, 76–79.CrossRefGoogle ScholarPubMed
Hu, L, Bentler, PM (1999). Cutoff criteria for fit indices in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling 6, 1–55.CrossRefGoogle Scholar
Jakupcak, M, Cook, J, Imel, Z, Fontana, A, Rosenheck, R, McFall, M (2009). Posttraumatic stress disorder as a risk factor for suicidal ideation in Iraq and Afghanistan war veterans. Journal of Traumatic Stress 22, 303–306.CrossRefGoogle ScholarPubMed
John, OP, Srivastava, S (1999). The big five trait taxonomy: history, measurement, and theoretical perspectives. In Handbook of Personality: Theory and Research (2nd edn) (ed. Pervin, L. A. and John, O. P.), pp. 102–138. Guilford Press: New York.Google Scholar
Kline, RB (2010). Principles and Practice of Structural Equation Modeling (3rd edn). Guilford Press: New York.Google Scholar
Kotov, R, Gamez, W, Schmidt, FL, Watson, D (2010). Linking ‘big’ personality traits to anxiety, depressive, and substance use disorders: a meta-analysis. Psychological Bulletin 136, 768–821.CrossRefGoogle ScholarPubMed
Krueger, RF, McGue, M, Iacono, WG (2001). The higher-order structure of common DSM mental disorders: internalization, externalization, and their connections to personality. Personality and Individual Differences 30, 1245–1259.CrossRefGoogle Scholar
Mann, JJ, Arango, VA, Avenevoli, S, Brent, DA, Champagne, FA, Clayton, P, Currier, D, Dougherty, DM, Haghighi, F, Hodge, SE, Kleinman, J, Lehner, T, McMahon, F, Mościcki, EK, Oquendo, MA, Pandey, GN, Pearson, J, Stanley, B, Terwilliger, J, Wenzel, A (2009). Candidate endophenotypes for genetic studies of suicidal behavior. Biological Psychiatry 65, 556–563.CrossRefGoogle ScholarPubMed
Marshall, RD, Olfson, M, Hellman, F, Blanco, C, Guardino, M, Struening, EL (2001). Comorbidity, impairment and suicidality in subthreshold PTSD. American Journal of Psychiatry 158, 1467–1473.CrossRefGoogle ScholarPubMed
Mineka, S, Watson, D, Clark, LA (1998). Comorbidity of anxiety and unipolar mood disorders. Annual Review of Psychology 49, 377–412.CrossRefGoogle ScholarPubMed
Muthén, LK, Muthén, BO (1998–2007). Mplus User's Guide (5th edn). Muthén & Muthén: Los Angeles, CA.Google Scholar
Nock, MK, Borges, G, Bromet, EJ, Alonso, J, Angermeyer, M, Beautrais, A, Bruffaerts, R, Chiu, WT, de Girolamo, G, Gluzman, S, de Graaf, R, Gureje, O, Haro, JM, Huang, Y, Karam, E, Kessler, RC, Lepine, JP, Levinson, D, Medina-Mora, ME, Ono, Y, Posada-Villa, J, Williams, D (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry 192, 98–105.CrossRefGoogle ScholarPubMed
Norton, PJ, Temple, SR, Pettit, JW (2008). Suicidal ideation and anxiety disorders: elevated risk or artifact of comorbid depression? Journal of Behavior Therapy and Experimental Psychiatry 39, 515–525.CrossRefGoogle ScholarPubMed
Oquendo, MA, Friend, JM, Halberstam, B, Brodsky, BS, Burke, AK, Grunebaum, MF, Malone, KM, Mann, JJ (2003). Association of comorbid posttraumatic stress disorder and major depression with greater risk for suicidal behavior. American Journal of Psychiatry 160, 580–582.CrossRefGoogle ScholarPubMed
Reynolds, WM (1991 a). Adult Suicidal Ideation Questionnaire (ASIQ) Professional Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Reynolds, WM (1991 b). Psychometric characteristics of the Adult Suicidal Ideation Questionnaire in college students. Journal of Personality Assessment 56, 289–307.CrossRefGoogle ScholarPubMed
Sareen, J, Cox, BJ, Afifi, TO, de Graaf, R, Asmundson, GJ, ten Have, M, Stein, MB (2005 a). Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults. Archives of General Psychiatry 62, 1249–1257.CrossRefGoogle ScholarPubMed
Sareen, J, Houlahan, T, Cox, BJ, Asmundson, GJ (2005 b). Anxiety disorders associated with suicidal ideation and suicide attempts in the National Comorbidity Survey. Journal of Nervous and Mental Disease 193, 450–454.CrossRefGoogle ScholarPubMed
Useda, JD, Duberstein, PR, Conner, KR, Conwell, Y (2004). Personality and attempted suicide in depressed adults 50 years of age and older: a facet level analysis. Comprehensive Psychiatry 45, 353–361.CrossRefGoogle Scholar
Velting, DM (1999). Suicidal ideation and the five-factor model of personality. Personality and Individual Differences 27, 943–952.CrossRefGoogle Scholar
Watson, D (2009). Differentiating the mood and anxiety disorders: a quadripartite model. Annual Review of Clinical Psychology 5, 221–247.CrossRefGoogle ScholarPubMed
Watson, D (2010). Further validation of the Phobic Stimuli Response Scales (PSRS) in an outpatient sample. Manuscript in preparation.Google Scholar
Watson, D, Clark, LA (1999). The PANAS-X: Manual for the Positive and Negative Affect Schedule – Expanded Form. University of Iowa, Iowa City, IA (http://www.psychology.uiowa.edu/faculty/watson/PANAS-X.pdf). Accessed 1 October 2008.Google Scholar
Watson, D, Gamez, W, Simms, LJ (2005). Basic dimensions of temperament and their relation to anxiety and depression: a symptom-based perspective. Journal of Research in Personality 39, 46–66.CrossRefGoogle Scholar
Watson, D, O'Hara, MW, Chmielewski, M, McDade-Montez, EA, Koffel, E, Naragon, K, Stuart, S (2008). Further validation of the IDAS: evidence of convergent, discriminant, criterion, and incremental validity. Psychological Assessment 20, 248–259.CrossRefGoogle ScholarPubMed
Watson, D, O'Hara, MW, Simms, LJ, Kotov, R, Chmielewski, M, McDade-Montez, EA, Gamez, W, Stuart, S (2007). Development and validation of the Inventory of Depression and Anxiety Symptoms (IDAS). Psychological Assessment 19, 253–268.CrossRefGoogle ScholarPubMed
Wilcox, HC, Storr, CL, Breslau, N (2009). Posttraumatic stress disorder and suicide attempts in a community sample of urban American young adults. Archives of General Psychiatry 66, 305–311.CrossRefGoogle Scholar
Yen, S, Shea, MT, Sanislow, CA, Skodol, AE, Grilo, CM, Edelen, MO, Stout, RL, Morey, LC, Zanarini, MC, Markowitz, JC, McGlashan, TH, Daversa, MT, Gunderson, JG (2009). Personality traits as prospective predictors of suicide attempts. Acta Psychiatrica Scandinavica 120, 222–229.CrossRefGoogle ScholarPubMed
Yu, CY (2002). Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes. Ph.D. Thesis, University of California, Los Angeles.Google Scholar
Supplementary material: File

Naragon-Gainey Supplementary Material

Tables.doc

Download Naragon-Gainey Supplementary Material(File)
File 25.6 KB