Bipolar Disorder Research Program (PROMAN), Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil.
New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA.
Eur Psychiatry. 2018 Jan;47:19-24. doi: 10.1016/j.eurpsy.2017.09.005. Epub 2017 Sep 29.
Comorbid anxiety disorders have been considered a risk factor for suicidal behavior in patients with mood disorders, although results are controversial. The aim of this two-year prospective study was to determine if lifetime and current comorbid anxiety disorders at baseline were risk factors for suicide attempts during the two-year follow-up.
We evaluated 667 patients with mood disorders (504 with major depression and 167 with bipolar disorder) divided in two groups: those with lifetime comorbid anxiety disorders (n=229) and those without (n=438). Assessments were performed at baseline and at 3, 12, and 24 months. Kaplan-Meier survival analysis and log-rank test were used to evaluate the relationship between anxiety disorders and suicide attempts. Cox proportional hazard regression was performed to investigate clinical and demographic variables that were associated with suicide attempts during follow-up.
Of the initial sample of 667 patients, 480 had all three follow-up interviews. During the follow-up, 63 patients (13.1%) attempted suicide at least once. There was no significant difference in survival curves for patients with and without comorbid anxiety disorders (log-rank test=0.269; P=0.604). Female gender (HR=3.66, P=0.001), previous suicide attempts (HR=3.27, P=0.001) and higher scores in the Buss-Durkee Hostility Inventory (HR=1.05, P≤0.001) were associated with future suicide attempts.
Our results suggest that comorbid anxiety disorders were not risk factors for suicide attempts. Further studies were needed to determine the role of anxiety disorders as risk factors for suicide attempts.
合并焦虑障碍被认为是心境障碍患者自杀行为的一个危险因素，尽管结果存在争议。本为期两年的前瞻性研究旨在确定基线时是否存在终生和当前合并的焦虑障碍是否是两年随访期间自杀未遂的危险因素。
我们评估了 667 名心境障碍患者（504 名患有重度抑郁症，167 名患有双相情感障碍），分为两组：有终生合并焦虑障碍的患者（n=229）和没有的患者（n=438）。评估在基线时和 3、12 和 24 个月进行。采用 Kaplan-Meier 生存分析和对数秩检验评估焦虑障碍与自杀未遂之间的关系。采用 Cox 比例风险回归分析调查与随访期间自杀未遂相关的临床和人口统计学变量。
在最初的 667 名患者中，有 480 名患者完成了所有三次随访。在随访期间，63 名患者（13.1%）至少有一次自杀未遂。有合并焦虑障碍和没有合并焦虑障碍的患者的生存曲线没有显著差异（对数秩检验=0.269；P=0.604）。女性（HR=3.66，P=0.001）、既往自杀未遂（HR=3.27，P=0.001）和 Buss-Durkee 敌意量表得分较高（HR=1.05，P≤0.001）与未来自杀未遂有关。
我们的研究结果表明，合并焦虑障碍不是自杀未遂的危险因素。需要进一步的研究来确定焦虑障碍作为自杀未遂的危险因素的作用。
