Relationship of epilepsy-related factors to anxiety and depression scores in epileptic children

Cognitive and behavioral impairments are found more often among epileptic children than among their peers. In this study, we evaluated the anxiety and depression in epileptic children to compare their results with that of a healthy control group and to determine the relationship of anxiety and depression scores to epilepsy-related factors. The State Trait Anxiety Inventory (STAI) and Children's Depression Inventory (CDI) were applied to 35 patients with epilepsy aged 9 to 18 years (mean age 12.9 +/- 2.52 years) and to 35 healthy children who served as the control group. Both study and control groups were divided into two age groups (9 to 11 and 12 to 18 years) to exclude the effect of puberty on anxiety and depression scores. Significant depression and suicidal ideation were determined in the study group. The mean trait anxiety score was significantly higher in the 9- to 11-year age group of epileptic patients than the corresponding control group (35.90 +/- 6.90 and 29.33 +/- 2.84, P < .05). The mean state anxiety score (33.90 +/- 3.90 and 30.40 +/- 6.02, P < .05), trait anxiety score (38.20 +/- 6.84 and 32.20 +/- 3.90, P < .05), and depression score (16.65 +/- 8.32 and 8.15 +/- 3.15, P < .05) were significantly higher in the 12- to 18-year age group of epileptic children than in the control group. Among the epilepsy-related factors, whereas epilepsy duration, seizure frequency, and polytherapy were determined to increase anxiety and depression, age of seizure onset, seizure type, and electroencephalographic findings were not related to anxiety and depression. Symptoms of anxiety and depression are common among epileptic children, especially during puberty. The State Trait Anxiety Inventory and Children's Depression Inventory may be used as a tool to provide information to clinicians.     

Longitudinal evaluation of depression and anxiety in patients with clinically isolated syndrome at high risk of developing early multiple sclerosis

We investigated the relationship between emotional changes, brain lesion burden and development of multiple sclerosis (MS). Thirty-seven consecutive patients with clinically isolated syndrome (CIS) were prospectively assessed with the Expanded Disability Status Scale (EDSS), the 21-item Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI) and gadolinium enhanced (Gd+) MRI scans. BDI and STAI were also administered to 36 age-matched controls. Conversion to MS was defined as the occurrence of a clinical relapse. CIS patients were more likely to endorse symptoms of anxiety and depression than controls. Baseline scores for depression and anxiety did not correlate with the total lesion load (i.e., volume of Gd+, T2 and T1 lesions) and the number of Gd+ lesions during the first six months of follow-up. A positive correlation was found between severity of depressive scores and the lesion load in the right temporal region (P = 0.005). After 33+/-6 months of the study entry, patients who had a clinical relapse were more frequently depressed (P = 0.001) than those relapse free. Emotional disturbances are frequently observed in CIS patients and show a tendency towards a normalization in relapse-free patients. The increased rate of depressive symptoms observed in patients who developed MS seems to result from a combination of psychological and organic features. The lesion load in the right temporal region is confirmed as a key area for developing depressive symptoms, even in the early phase of the disease.     

The effects of ultrasound-guided corticosteroid injection for the treatment of hemiplegic shoulder pain on depression and anxiety in patients with chronic stroke

Purpose: We attempted to investigate whether ultrasound (US)-guided intra-articular or subacromial bursa corticosteroid injections can potentially influence the severity of depression and anxiety in patients with chronic stroke with hemiplegic shoulder pain (HSP). Methods: Thirty patients with chronic stroke with HSP received US-guided corticosteroid injections. Numeric rating scale (NRS) scores, passive shoulder range of motion (ROM), Beck Depression Inventory (BDI) scores and Spielberger State-Trait Anxiety Inventory (STAI) scores were evaluated before the injection, and one and two months after the injection. Results: NRS, passive shoulder ROM, BDI and STAI scores were significantly lower one and two months following the injection. Changes in NRS scores were significantly correlated with changes in psychological outcomes (BDI and STAI). Conclusion: US-guided intra-articular or subacromial bursa corticosteroid injections might be a beneficial treatment option for relieving depression and anxiety symptoms in patients with chronic stroke with HSP. Also, US-guided injections appear to be helpful for reducing shoulder pain and increasing shoulder ROM.     

Factors associated with generic and disease-specific quality of life in temporal lobe epilepsy

PURPOSE: We aimed at further elucidating the association between quality of life (QOL) and sociodemographic factors, clinical seizure factors, depression and anxiety in drug-resistant temporal lobe epilepsy (TLE). METHODS: We studied 106 consecutive adult right-handed patients (mean age 35.4 +/- 9.7; 50% males; IQ> or = 70) with drug-resistant unilateral (59% right) TLE (70% hippocampal sclerosis, 30% tumors or other lesions), who underwent a comprehensive non-invasive pre-surgical protocol. They completed the Beck Depression Inventory (BDI) and the State Form of the Spielberger State-Trait Anxiety Inventory (STAI). To measure QOL, we used both a generic instrument, the WHOQOL-100, and a disease-specific instrument, the 31-item quality of life in epilepsy (QOLIE-31). Multiple linear regression analysis was used to examine the relationship between each QOL domain and age, gender, education, side of TLE, duration of epilepsy, seizure frequency, and level of depression and anxiety. RESULTS: Severity of depressive symptoms was significantly associated with lower scores across most QOL domains. Depression was consistently the strongest predictor of lower scores on almost all QOL domains. Also, severity of anxiety symptoms was significantly associated with lower scores across many QOL domains. Independent significant relationships between QOL and sociodemographic or clinical epilepsy variables were limited in number and strength. CONCLUSIONS: Our findings suggest that QOL in TLE might be substantially affected by the presence and severity of depressive symptoms and, to a lesser degree, of anxiety symptoms. While clinical seizure variables had a weaker association with QOL, the absence of seizure-free patients might have obscured a relation between seizure frequency and QOL. Healthcare professionals should be aware of the significance of patients' emotional state and of the role it plays for their QOL. Adopting a biopsychosocial approach might be useful to address patients' needs.     

Depression and anxiety symptoms are related to increased 24-hour urinary norepinephrine excretion among healthy middle-aged women

OBJECTIVE: Depression is a risk factor for morbidity and mortality in a variety of populations, and anxiety has also been associated with risk of mortality among cardiac patients. Dysfunction of the autonomic nervous system may be involved in this risk. The primary goal of this study was to evaluate the relationship between levels of self-reported symptoms of depression and anxiety and 24-hour urinary catecholamine excretion. METHOD: Ninety-one women aged 47-55 years were evaluated. Depression symptoms were assessed with the Beck Depression Inventory (BDI) and state anxiety was assessed with the state anxiety portion (SAI) of the Spielberger State-Trait Anxiety Inventory (STAI). Twenty-four hour urine collections were assayed for epinephrine (EPI), norepinephrine (NE) and cortisol (CORT). EPI, NE and CORT were indexed by body surface area to control for individual differences in body size. RESULTS: Higher levels of depression symptoms were associated with increased 24-hour NE excretion (r=.27, P=.009), with depressed women (n=17, BDI scores >/=10) exhibiting an approximately 25% higher rate of urinary NE excretion than women with BDI scores <10 (n=74), P=.007. Higher levels of state anxiety were also related to greater NE excretion (r=.28, P=.01), and CORT excretion was related to both depression (r=.23, P=.02) and anxiety (r=.22, P=.04). Depression and anxiety symptoms were unrelated to urinary EPI excretion. CONCLUSIONS: The current findings that higher levels of depression and anxiety symptoms are related to increased 24-hour urinary NE and CORT excretion among women suggests that depression and anxiety may be associated with increased sympathetic nervous system (SNS) activity, and are consistent with the possibility that SNS activity may play a role in the increased mortality associated with depression in community-dwelling older adults.     

Alexithymia and links with depression and anxiety in multiple sclerosis

OBJECTIVES: This study evaluates the prevalence of alexithymia in multiple sclerosis and examines the links between alexithymia, depression and anxiety. METHOD: Sixty-one subjects aged between 18 and 60 years and suffering from multiple sclerosis took part in the study. The psychological assessment consisted of an interview with a psychologist and three questionnaires: the Toronto Alexithymia Scale (TAS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI). RESULTS: The prevalence of alexithymia was 42.5%, 34.4% for depression and 44.3% for anxiety (high and moderate level). The alexithymic subjects were more depressed and anxious. Results indicated positive correlations between anxiety (state and trait), depression and alexithymia scores. The various dimensions of alexithymia were found to be diversely correlated with anxiety and depression. CONCLUSIONS: Our results point out the importance of anxiety in multiple sclerosis and the specificity of alexithymia.     

Anxiety and depression in bronchial asthma

The aim of the study was to establish the frequency and follow the clinical course of depression and anxiety in patients with bronchial asthma. 57 patients (37 atopic and 20 nonatopic) with mild and moderate bronchial asthma and 53 subjects matched for age and sex as control groups were included in the study. The following questionnaires: Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Hospital Anxiety and Depression Scale (HADS) were used to evaluate anxiety and mood state. The level and prevalence of anxiety and depression were significantly higher in both groups of asthmatics in comparison to healthy subjects. Symptoms were mild and moderate. Nonatopic patients were more depressed and anxious than atopics.     

Anxiety and depressive symptoms in clinically isolated syndrome and multiple sclerosis

Depression and anxiety have been reported in patients with multiple sclerosis (MS) and in patients with clinically isolated syndrome (CIS). However, the precise mechanisms that lead to depressive and anxiety symptoms in these patients are still unclear. In this study we evaluated with the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) patients with MS and CIS and compared them to controls. We also correlated BDI and BAI scores with clinical parameters. Kruskall-Wallis followed by Dunn's Multiple Comparison Test, Chi-square and Spearman test were used. Patients with MS had higher depressive and anxiety scores than controls. The BDI and BAI scores of patients with CIS were not significantly different from controls. There was a positive correlation between BDI, BAI and EDSS. Our results corroborate the view that MS patients have higher depression and anxiety levels than control subjects. Anxiety and depressive symptoms also seem to progress according to the severity of the disease.     

Maternal posttraumatic stress response after the birth of a very low-birth-weight infant

OBJECTIVE: For parents, the premature birth of a child represents a traumatic event for which they are poorly prepared. To date, the focus of scientific interest has been on maternal psychological stress responses, such as anxiety and depression, or on appropriate coping mechanisms, whereas only scant attention has been paid to the traumatic aspect of the maternal experience after very low-birth-weight (VLBW) birth. The present study is the first to investigate the posttraumatic stress response of mothers after the birth of a VLBW infant in a prospective longitudinal study. METHODS: Fifty mothers of VLBW infants were examined at four measuring time points (1-3 days pp, 14 days pp and 6 and 14 months pp) with respect to posttraumatic symptoms [Impact of Event Scale (IES-R)], psychiatric diagnosis (SKID I for DSM-IV) and the extent of depression [Beck Depression Inventory (BDI) and Montgomery Asberg Depression Scale (MADRS)] and anxiety [State-Trait Anxiety Inventory (STAI) and Hamilton Anxiety Scale (HAMA)]. The control group comprised a group of 30 mothers after the uncomplicated spontaneous birth of a healthy child. RESULTS: At all four measuring timepoints (except 6 months pp), the mothers of the premature infants recorded significantly higher values for traumatic experience and depressive symptoms and anxiety compared with the controls. In contrast to the mothers in the control group, the mothers of the premature infants displayed no significant reduction in posttraumatic symptoms (IES-total), even 14 months after birth. CONCLUSION: The results indicate that the situation of a mother who has given birth to a VLBW infant is a complex, with long-term traumatic event necessitating ongoing emotional support extending beyond the period immediately after the birth.     

Contribution of depression and anxiety to impaired quality of life in survivors of myocardial infarction

Objective. To quantify the adverse influence of depression and anxiety assessed at the time of myocardial infarction, on the quality of life 5 years after the infarction. Methods. The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) were completed in a group of 196 patients admitted in the hospital following non-fatal myocardial infarction, and the SF-12 quality of life questionnaire was administered during the 5- year follow-up. Results. Regression analysis showed a strong association between baseline depression and QoL in both the physical and mental domains; the higher the depression scores, the poorer the QoL. However, anxiety present at the time of myocardial infarction did not predict later QoL. Conclusions. Depression but not anxiety following MI predicts longer-term quality of life in myocardial infarction survivors.     

Improvement in depression associated with partial epilepsy in patients treated with lamotrigine

Interictal depression is common in patients with epilepsy and it significantly impacts quality of life. Previous studies indicate that lamotrigine may have antidepressant properties. Thirteen adults with uncontrolled partial seizures and concomitant depression were evaluated using measures of depression [Montgomery and Asberg Depression Rating Scale (MADRS) and the MMPI Depression Scale] and anxiety [Spielberger's State-Trait Anxiety Inventory (STAI)] to test the effects of lamotrigine on mood. Evaluations after 5 weeks and again after 3 months of lamotrigine treatment demonstrated significant improvement in depression and anxiety. Mean MADRS overall scores were significantly lower than pretreatment baseline at the 5-week and 3-month evaluations. The mean MMPI Depression score was significantly lower than baseline at the 3-month evaluation. State anxiety scores were significantly reduced from baseline after 5 weeks, but not at 3 months, whereas Trait anxiety scores were reduced from baseline at the 5-week and 3-month evaluations.     

Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample

The Hospital Anxiety and Depression Scale (HAD) was evaluated in a Swedish population sample. The purpose of the study was to compare the HAD with the Beck Depression Inventory (BDI) and Spielberger's State Trait Anxiety Inventory (STAI). A secondary aim was to examine the factor structure of the HAD. The results indicated that the factor structure was quite strong, consistently showing two factors in the whole sample as well as in different subsamples. The correlations between the total HAD scale and BDI and STAI, respectively, were stronger than those obtained using the different subscales of the HAD (the anxiety and depression subscales). As expected, there was also a stronger correlation between the HAD and the non-physical items of the BDI. It was somewhat surprising that the factor analyses were consistently extracting two factors,‘depression’ and ‘anxiety’, while on the other hand both BDI and STAI tended to correlate more strongly with the total HAD score than with the specific depression and anxiety HAD subscales. Nevertheless, the HAD appeared to be (as was indeed originally intended) a useful clinical indicator of the possibility of depression and clinical anxiety.     

Symptoms of Depression and Anxiety in Pediatric Epilepsy Patients

Summary: Purpose: We assessed rates of symptoms of anxiety and depression among pediatric patients with epilepsy.
Methods: We administered the Revised Child Manifest Anxiety Scale (RCMAS), and Child Depression Inventory (CDI) to 44 epilepsy patients aged 7–18 years (mean age 12.4 years). Demographic, socioeconomic, and epilepsy-related information was examined in relation to depression and anxiety scores.
Results: No patients had been previously identified to have depression or anxiety. However, 26% had significantly increased depression scores and 16% met critieria for significant anxiety symptomatology.
Conclusions: Symptoms of depression and anxiety are common among pediatric patients with epilepsy and appear to be overlooked by care providers.     

Associations of the Expanded Disability Status Scale with anxiety and depression in multiple sclerosis outpatients

OBJECTIVES: We evaluated cross-sectionally the associations of depression and anxiety with age, sex, duration of illness, educational level, degree of disability and treatment with interferon-beta in outpatients with relapsing-remitting multiple sclerosis (RRMS) during a clinically stable phase of their illness. MATERIALS AND METHODS: The depression status scored on the Beck Depression Inventory (BDI), the symptoms of anxiety assessed using the State Trait Anxiety Inventory (STAI) and the level of disability measured by the Expanded Disability Status Scale (EDSS) were quantified in 86 consecutive RRMS patients. RESULTS: Linear regression analyses indicated that EDSS was independently (P < 0.001) associated with BDI and STAI and accounted for 15.7% and 18.5% of the variance in BDI and STAI respectively. The former association retained its statistical significance in multiple regression models adjusting for demographic and clinical characteristics. CONCLUSIONS: Disability status is an independent but moderate determinant of depression and anxiety in MS patients.     

The effects of forest therapy on depression and anxiety in patients with chronic stroke

Objective: To assess whether forest therapy is effective for treating depression and anxiety in patients with chronic stroke by using several psychological tests. We measured reactive oxygen metabolite (d-ROM) levels and biological antioxidant potentials (BAPs) associated with psychological stress. Methods: Fifty-nine patients with chronic stroke were randomly assigned to either a forest group (staying at a recreational forest site) or to an urban group (staying in an urban hotel); the duration and activities performed by both groups were the same. Scores on the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D17), Spielberger State-Trait Anxiety Inventory (STAI), d-ROMs and BAPs were evaluated both before and after the treatment programs. Results: In the forest group, BDI, HAM-D17 and STAI scores were significantly lower following treatment, and BAPs were significantly higher than baseline. In the urban group, STAI scores were significantly higher following treatment. Moreover, BDI, HAM-D17 and STAI scores of the forest group were significantly lower, and BAPs were significantly higher following treatment (ANCOVA, p <0.05). Conclusion: Forest therapy is beneficial for treating depression and anxiety symptoms in patients with chronic stroke, and may be particularly useful in patients who cannot be treated with standard pharmacological or electroconvulsive therapies.     

Clinical correlates of pathological gambling symptoms in patients with epilepsy

Pathological gambling symptoms (PGS), that is, the subjective urge to gamble and the actual gambling behaviors, are currently acknowledged as relatively common symptoms among Western countries, with an estimated point prevalence of 0.6–1.1% in the general population. Converging evidence suggests that PGS are overrepresented in patients with neurological conditions affecting dopaminergic reward pathways, and can be expressed in both impulse control disorders and obsessive-compulsive spectrum disorders. This study explored the clinical correlates of PGS in patients with epilepsy. Eighty-eight consecutive adult outpatients recruited at three epilepsy clinics in northern Italy were assessed using the Gambling-Symptom Assessment Scale (G-SAS), along with a battery of psychometric instruments to index depression (Beck Depression Inventory [BDI]), anxiety (Spielberger State-Trait Anxiety Inventory [STAI]), and obsessionality (Yale-Brown Obsessive Compulsive Scale [YBOCS]) symptoms. On the G-SAS, patients with a diagnosis of temporal lobe epilepsy (TLE) reported a mean [sd] G-SAS score of 2.0 [5.7], significantly higher than patients with frontal lobe epilepsy (FLE) (0.6 [1.7]) and idiopathic generalized epilepsy (IGE) (0.4 [1.4]). Moreover, multiple regression analysis showed that G-SAS scores were selectively predicted by YBOCS scores, thus suggesting an association between the expression of obsessional spectrum symptoms and PGS in patients with TLE. Alterations in the mesolimbic reward system could represent the putative neuropathological substrate for this multifaceted clinical picture.     

Clinical Psychopharmacology Guidelines: Different Strokes for Different Folks

Background: Gilles de la Tourette syndrome (GTS) is a neurobehavioural disorder of genetic origin, although the precise inheritance pattern is as yet undetermined. This study was designed to describe symptomatology in GTS subjects. It describes the severity of depressive, anxiety and obsessional symptoms when compared to other samples of GTS patients, matched controls and normative data.

Methods: 87 consecutive GTS clinic referrals (children and adults) were interviewed in 1996 and 1997 using the National Hospital Interview Schedule, the Yale Global Tourette Severity Score, the Diagnostic Confidence Index, Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Index (STAI) and Leyton Obsessional Inventory (LOI). 52 healthy controls were interviewed using the BDI, STAI and LOI. The clinical status of the subjects was described and ratings of psychopathology were compared with the control group and with normative data. Data were compared with previous data from similar clinic samples.

Results: In this controlled study, GTS subjects scored highly on ratings of depression, state anxiety and obsessionality when compared with controls and with normative data. Scores in the subjects group were similar to previous findings in clinic samples of people with GTS.

Conclusions: People with GTS who attend clinics have a variety of psychological symptoms that are significantly more severe than controls. Accessory symptoms (e.g. coprophenomena, echophenomena) were also very common in the subject group. Psychological symptoms may occur as part of the disease, a reaction to disability or as a result of ascertainment bias.     

The psychological effects of forced emigration on Muslim Albanian children and adolescents

Objectives: The object of this study was to investigate the psychological effects of forced emigration on Muslim Albanian children and adolescents who were forced to emigrate due to the war in Kosova. Method: The sample of the study consisted of 150 children between the ages 9–12 and 100 adolescents between the ages 15–19 living in the Gaziosmanpaa Refugee Shelter in Turkey, and as a control group, 66 children and 52 adolescents; making a total of 368 subjects were included in the study. We applied State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Children's Depression Inventory (CDI) as well as a semi-structured open-ended questionnaire investigating the socio-demographic characteristics and psychiatric symptoms of the study and control groups. Results: Trait anxiety (TAI) levels of the children in the study group are higher than these in the control group. The analysis of the average Depressive Symptom scores of study group children (M = 15.70) and control group children (M = 7.37) was conducted with the application of t-test. The highly significant values of t = 7.73 p < 0.0001 indicate depressive symptoms among study group. Trait anxiety (TA) scores of study group adolescents were higher than these in the control group (M = 43.56) and (M = 35.59), respectively and the values of t = 5.95, p < 0.0001 show that this is a highly significant difference. The comparison of the average depressive (BDI) symptom scores of study group and control group adolescents (M = 17.57 and M = 4.59 respectively) revealed the very significant values of t = 7.88, p < 0.0001. The evaluation of the semi-structured questionnaires also revealed that depressive symptoms, somatic symptoms and other psychiatric symptoms were also higher in the study group. Conclusion: Our findings support the common opinion that war and terror incidents severely hurt children.     

A controlled study of psychopathology and associated symptoms in Tourette syndrome.

BACKGROUND: Gilles de la Tourette syndrome (GTS) is a neurobehavioural disorder of genetic origin, although the precise inheritance pattern is as yet undetermined. This study was designed to describe symptomatology in GTS subjects. It describes the severity of depressive, anxiety and obsessional symptoms when compared to other samples of GTS patients, matched controls and normative data. METHODS: 87 consecutive GTS clinic referrals (children and adults) were interviewed in 1996 and 1997 using the National Hospital Interview Schedule, the Yale Global Tourette Severity Score, the Diagnostic Confidence Index, Beck Depression Inventory (BDI), Spielberger State-Trait anxiety Index (STAI) and Leyton Obsessional Inventory (LOI). 52 healthy controls were interviewed using the BDI, STAI and LOI. The clinical status of the subjects was described and ratings of psychopathology were compared with the control group and with normative data. Data were compared with previous data from similar clinic samples. RESULTS: In this controlled study, GTS subjects scored highly on ratings of depression, state anxiety and obsessionality when compared with controls and with normative data. Scores in the subjects group were similar to previous findings in clinic samples of people with GTS. CONCLUSIONS: People with GTS who attend clinics have a variety of psychological symptoms that are significantly more severe than controls. Accessory symptoms (e.g. coprophenomena, echophenomena) were also very common in the subject group. Psychological symptoms may occur as part of the disease, a reaction to disability or as a result of ascertainment bias.     

History of suicide attempt in male substance-dependent inpatients and relationship to borderline personality features, anger, hostility and aggression

The aim of this study was to investigate the relationship between severity of borderline personality features and history of suicide attempt (HSA) in male substance-dependent inpatients and the effect of anger, hostility and aggression on this relationship. Further, the effect of some variables that may be related to suicide and/or borderline personality, such as age at inception of regular substance use, substance of dependence (alcohol/drug), depression, and both state and trait anxiety, were controlled. Participants were 200 consecutively admitted male substance-dependent inpatients. Patients were investigated with the Borderline Personality Inventory (BPI), the Buss-Perry Aggression Questionnaire (AQ), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Among substance-dependent inpatients, 33.0% (n = 66) were identified as the group with HSA. Mean scores employment status, marital status and duration of education did not differ between groups, whereas current age and age at onset of regular substance use were lower in group with HSA. Mean scores of BPI, AQ and its subscales (anger, hostility and physical/verbal aggression), BDI and STAI were higher in the HSA group. In addition, the rates of drug dependency and borderline personality disorder were higher in this group. The severity of borderline personality symptoms was highly correlated with subscales of the AQ, depression and anxiety, whereas it was negatively correlated with age at onset of regular substance use. The severity of anger and borderline personality features predicted HSA in the logistic regression model. Results suggest that, to reduce the risk of suicide attempt among substance-dependent patients, the feeling of anger must be the target of evaluation and treatment among those with borderline personality features.