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Separation anxiety and measures of suicide risk among patients with mood and anxiety disorders

Separation anxiety and measures of suicide risk among patients with mood and anxiety disorders
Separation anxiety and measures of suicide risk among patients with mood and anxiety disorders
Background: Separation anxiety disorder may be important when considering risk of suicide. The aim of this study was to examine the association between both childhood and adult separation anxiety (disorder) and measures of suicide risk in a large cohort of outpatients with anxiety and mood disorders. Methods: The sample included 509 consecutive adult psychiatric outpatients with DSM-IV mood disorders or anxiety disorders as a principal diagnosis recruited at the Department of Psychiatry, University of Pisa, Italy, between 2015 and 2018. Suicide risk was evaluated by the Hamilton Depression Rating Scale (HDRS) item 3. Patients were classified in 2 groups: those with a score ≥ 1 and those with a score of 0 on HDRS item 3. Suicide risk was also evaluated by specific items within the Mood Spectrum, Self-Report (MOODS-SR), a questionnaire evaluating lifetime suicidal symptoms. Separation anxiety (disorder) was assessed based on the Structured Interview for Separation Anxiety Symptoms in Adulthood/Childhood (SCI-SAS-A/C), the Separation Anxiety Symptom Inventory (SASI), and the Adult Separation Anxiety Scale (ASA-27). Results: Of the 509 patients, 97 had an HDRS item 3 score ≥ 1, and 412 had a score of 0. Adult separation anxiety disorder was more frequent among individuals who had suicidal thoughts (53.6%) than those who did not (39.6%) (P = .01). Dimensional separation anxiety symptoms on all scales were elevated in patients with suicidality when compared to patients without (SASI: P = .02; SCI-SAS-C: P < .001; SCI-SAS-A: P < .001; ASA-27: P = .002). Logistic regression found that adult separation anxiety disorder (odds ratio [OR] = 1.86, 95% CI = 1.16–2.97), major depression (OR = 7.13, 95% CI = 3.18–15.97), bipolar I disorder (8.15, 95% CI = 3.34–19.90), and bipolar II disorder (OR = 8.16, 95% CI = 3.50–19.05) predicted suicidal thoughts. Linear regression found that depression (P = .001) and ASA-27 separation anxiety (P = .001) significantly predicted lifetime suicide risk. Mediation analysis found that separation anxiety significantly mediated the association between depression and suicide risk. Conclusions: This study indicates a substantial role of separation anxiety in predicting suicidal thoughts, both as state-related symptoms (evaluated by HDRS item 3) and as longitudinal dimensional symptoms (as evaluated by MOODS-SR). Greater understanding of the influence of separation anxiety in patients with affective disorders may encourage personalized interventions for reducing suicide risk.
0160-6689
Pini, Stefano
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Abelli, Marianna
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Costa, Barbara
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Massimetti, Gabriele
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Martini, Claudia
647490d0-d823-4c06-9c19-e5224adfb433
Schiele, Miriam A.
3ed65c71-24c9-44ba-a32d-33d630901959
Baldwin, David
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Bandelow, Borwin
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Domschke, Katharina
7c6913b2-7906-4a9e-b3ee-003437dce668
Pini, Stefano
7a849c15-0faa-4853-acd5-ed7d0faf90d0
Abelli, Marianna
78a81f68-653b-465a-a7e9-548140adb6bd
Costa, Barbara
29f19721-0ba0-4b9c-bdda-ba9611cd912c
Massimetti, Gabriele
03cd35f7-2547-4b0b-95ac-f815a0dc3cff
Martini, Claudia
647490d0-d823-4c06-9c19-e5224adfb433
Schiele, Miriam A.
3ed65c71-24c9-44ba-a32d-33d630901959
Baldwin, David
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Bandelow, Borwin
2fbbae21-629e-4d76-b5d0-7dff1282d64d
Domschke, Katharina
7c6913b2-7906-4a9e-b3ee-003437dce668

Pini, Stefano, Abelli, Marianna, Costa, Barbara, Massimetti, Gabriele, Martini, Claudia, Schiele, Miriam A., Baldwin, David, Bandelow, Borwin and Domschke, Katharina (2021) Separation anxiety and measures of suicide risk among patients with mood and anxiety disorders. The Journal of Clinical Psychiatry, 82 (2), [20m13299]. (doi:10.4088/JCP.20m13299).

Record type: Article

Abstract

Background: Separation anxiety disorder may be important when considering risk of suicide. The aim of this study was to examine the association between both childhood and adult separation anxiety (disorder) and measures of suicide risk in a large cohort of outpatients with anxiety and mood disorders. Methods: The sample included 509 consecutive adult psychiatric outpatients with DSM-IV mood disorders or anxiety disorders as a principal diagnosis recruited at the Department of Psychiatry, University of Pisa, Italy, between 2015 and 2018. Suicide risk was evaluated by the Hamilton Depression Rating Scale (HDRS) item 3. Patients were classified in 2 groups: those with a score ≥ 1 and those with a score of 0 on HDRS item 3. Suicide risk was also evaluated by specific items within the Mood Spectrum, Self-Report (MOODS-SR), a questionnaire evaluating lifetime suicidal symptoms. Separation anxiety (disorder) was assessed based on the Structured Interview for Separation Anxiety Symptoms in Adulthood/Childhood (SCI-SAS-A/C), the Separation Anxiety Symptom Inventory (SASI), and the Adult Separation Anxiety Scale (ASA-27). Results: Of the 509 patients, 97 had an HDRS item 3 score ≥ 1, and 412 had a score of 0. Adult separation anxiety disorder was more frequent among individuals who had suicidal thoughts (53.6%) than those who did not (39.6%) (P = .01). Dimensional separation anxiety symptoms on all scales were elevated in patients with suicidality when compared to patients without (SASI: P = .02; SCI-SAS-C: P < .001; SCI-SAS-A: P < .001; ASA-27: P = .002). Logistic regression found that adult separation anxiety disorder (odds ratio [OR] = 1.86, 95% CI = 1.16–2.97), major depression (OR = 7.13, 95% CI = 3.18–15.97), bipolar I disorder (8.15, 95% CI = 3.34–19.90), and bipolar II disorder (OR = 8.16, 95% CI = 3.50–19.05) predicted suicidal thoughts. Linear regression found that depression (P = .001) and ASA-27 separation anxiety (P = .001) significantly predicted lifetime suicide risk. Mediation analysis found that separation anxiety significantly mediated the association between depression and suicide risk. Conclusions: This study indicates a substantial role of separation anxiety in predicting suicidal thoughts, both as state-related symptoms (evaluated by HDRS item 3) and as longitudinal dimensional symptoms (as evaluated by MOODS-SR). Greater understanding of the influence of separation anxiety in patients with affective disorders may encourage personalized interventions for reducing suicide risk.

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Accepted/In Press date: 17 September 2020
e-pub ahead of print date: 16 March 2021

Identifiers

Local EPrints ID: 450105
URI: http://eprints.soton.ac.uk/id/eprint/450105
ISSN: 0160-6689
PURE UUID: 7d01300d-d067-4a65-8501-68e69d638694
ORCID for David Baldwin: ORCID iD orcid.org/0000-0003-3343-0907

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Date deposited: 09 Jul 2021 16:34
Last modified: 10 Jul 2021 01:36

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Contributors

Author: Stefano Pini
Author: Marianna Abelli
Author: Barbara Costa
Author: Gabriele Massimetti
Author: Claudia Martini
Author: Miriam A. Schiele
Author: David Baldwin ORCID iD
Author: Borwin Bandelow
Author: Katharina Domschke

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