University of Wisconsin-Madison, Madison, Wisconsin.
Depress Anxiety. 2013 Oct;30(10):917-29. doi: 10.1002/da.22074. Epub 2013 Feb 13.
Although anxiety has been proposed to be a potentially modifiable risk factor for suicide, research examining the relationship between anxiety and suicidal behaviors has demonstrated mixed results. Therefore, we aimed at testing the hypothesis that anxiety disorders are associated with suicidal behaviors and evaluate the magnitude and quality of supporting evidence.
A systematic literature search of multiple databases was conducted from database inception through August 2011. Two investigators independently reviewed and determined the eligibility and quality of the studies based upon a priori established inclusion criteria. The outcomes of interest were suicidal ideations, suicide attempts, completed suicides, and a composite outcome of any suicidal behaviors. We pooled odds ratios from the included studies using random effects models.
Forty-two observational studies were included. The studies had variable methodological quality due to inconsistent adjustment of confounders. Compared to those without anxiety, patients with anxiety were more likely to have suicidal ideations (OR = 2.89, 95% CI: 2.09, 4.00), attempted suicides (OR = 2.47, 95% CI: 1.96, 3.10), completed suicides (OR = 3.34, 95% CI: 2.13, 5.25), or have any suicidal behaviors (OR = 2.85, 95% CI: 2.35, 3.46). The increase in the risk of suicide was demonstrated for each subtype of anxiety except obsessive-compulsive disorder (OCD). The quality of this evidence is considered low to moderate due to heterogeneity and methodological limitations.
This systematic review and meta-analysis provides evidence that the rates of suicides are higher in patients with any type of anxiety disorders excluding OCD.
尽管焦虑被认为是自杀的一个潜在可改变的风险因素，但研究焦虑与自杀行为之间的关系得出的结果却不一致。因此，我们旨在检验焦虑障碍与自杀行为有关的假设，并评估支持证据的强度和质量。
从数据库创建开始到 2011 年 8 月，我们对多个数据库进行了系统的文献检索。两名研究人员根据事先确定的纳入标准独立审查并确定研究的合格性和质量。感兴趣的结果是自杀意念、自杀企图、自杀完成和任何自杀行为的综合结果。我们使用随机效应模型汇总了纳入研究的优势比。
共纳入 42 项观察性研究。由于混杂因素的调整不一致，这些研究的方法学质量存在差异。与没有焦虑的患者相比，患有焦虑症的患者更有可能有自杀意念（OR=2.89，95%CI：2.09，4.00）、自杀企图（OR=2.47，95%CI：1.96，3.10）、自杀完成（OR=3.34，95%CI：2.13，5.25）或有任何自杀行为（OR=2.85，95%CI：2.35，3.46）。除强迫症（OCD）外，每种焦虑症亚型的自杀风险都有所增加。由于存在异质性和方法学限制，该证据的质量被认为是低到中等。
本系统评价和荟萃分析提供的证据表明，除强迫症外，任何类型的焦虑症患者的自杀率都更高。
