Measures matter: the relative contribution of anxiety and depression to suicidal ideation in clinically referred anxious youth using brief versus full length questionnaires

Background: A cross‐sectional design was used to examine links between suicidal ideation, depression, and anxiety using brief [Stark and Laurent, 2001: J Clin Child Psychol 30:552–567] and full length versions of the Children's Depression Inventory [CDI; Kovacs, 1980/1981: Acta Paedopsychiatr 46:305–315] and Revised Children's Manifest Anxiety Scale [RCMAS; Reynolds and Richmond, 1985: Revised Children's Manifest Anxiety Scale. California: Western Psychological Services]. Methods: The sample consisted of 252 children and adolescents (ages 7–16 years, M=9.94 years (SD=2.4)) seeking treatment at a childhood anxiety disorders specialty research clinic. Results: Using structural equation modeling, results indicated that the relative contribution of anxiety and depression in the presence of suicidal ideation varies depending on the measures used. Specifically, anxiety had a significant direct and indirect effect on suicidal ideation presence using a brief version of the RCMAS, but only an indirect effect using the full length version. Depression had a significant direct effect on suicidal ideation presence using both brief and full versions of the CDI. Conclusions: These findings suggest that anxiety may play a role in predicting suicidal ideation in clinic‐referred anxious youth, but whether this role is detected depends on the measurement strategy. Given that “measures matter,” future studies using similar as well as different samples as the one used in this study need to consider careful measurement strategies, as different findings may emerge depending on whether brief or full length versions of questionnaires are used. Depression and Anxiety 25:E27–E35, 2008. © 2008 Wiley‐Liss, Inc.     

综合医院门诊患者焦虑、抑郁症状调查

目的：分析综合医院门诊患者中,焦虑、抑郁症状的发生率及其可能的影响因素。方法：选取4所综合医院2485例门诊患者,采用自编一般情况调查表及综合医院焦虑抑郁量表进行调查。结果：门诊患者中焦虑、抑郁发生率分别达到26.0%、26.6%,焦虑抑郁共发率达12.7%,明显高于普通人群。不同级别医院、科室、男女之间焦虑、抑郁评分有显著差异。结论：综合医院门诊患者中焦虑抑郁有较高的患病率,值得引起关注。     

Gender differences in psychiatric symptoms related to suicidal ideation in Japanese patients with depression

Recent figures show that more than 30,000 people suicide each year in Japan, and that many of them are considered to suffer from depression. In addition, the suicide rate among Japanese women has been shown to be higher than in other countries. However, it is not clear whether the psychiatric symptoms leading to suicide differ by gender. The authors examined gender differences in psychiatric symptoms related to suicidal ideation (SI) in Japanese patients with depression. Study subjects were 199 new patients (66 men and 133 women) who were diagnosed with a major depressive disorder. SI and psychiatric symptoms were assessed by several psychological tests using questionnaires. Logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence interval (CI) with an adjustment for all relevant factors simultaneously. The stepwise method was also used for selecting variables. In univariate analysis, several psychosocial factors such as self-reproach, derealization, depressive moods, depersonalization, and anxiety traits were statistically significantly associated with SI in both men and women. However, multivariate analysis using the stepwise method distinguished gender differences. Low social/family support and depersonalization were statistically significantly associated with SI in men, while depressive moods and an anxiety state were significantly associated with SI in women. The relation between derealization and SI was statistically significant in women but not significant in men.     

The prevalence of suicidal ideation in the general population: results from the Outcome of Depression International Network (ODIN) study

Background Suicidal ideation is believed to be part of a constellation of suicidal behaviours that culminates in suicide. There is little information on the cross-national prevalence of all suicidal ideation or of serious suicidal ideation in spite of its likely public health importance. Methods A two-stage screening approach of over 12,000 adults from the general population were evaluated by face to face interview to identify those meeting ICD-10 criteria for depressive disorders at eight sites in five European countries. This study is a cross-sectional analysis of item 9 (suicidal ideation) of the Beck depression inventory from the total screened sample. Results The standardised period prevalence for all suicidal ideation varied from 1.1 to 19.8% while for serious suicidal ideation there was much less variation. Examining the inter-relationships between all suicide ideation, serious suicide ideation, depressive disorders and suicide failed to support a seamless transition from suicide ideation through depression and serious ideation to suicide. Conclusions Strategies to prevent suicide should be tailored to take account of site specific differences in its aetiology and understanding the path from suicidal ideation through depression to suicide is crucial to this.     

Unique relations among anxiety sensitivity factors and anxiety,depression, and suicidal ideation

Anxiety sensitivity (AS) is composed of three lower-order dimensions, cognitive concerns, physical concerns, and social concerns. We examined the relations between AS dimensions using a more adequate assessment of subscales (ASI-3) than has previously been used, and measures of anxiety and mood disorders as well as suicidal ideation in a sample of 256 (M age = 37.10 years, SD = 16.40) treatment-seeking individuals using structural equation modeling. AS cognitive concerns was uniquely associated with generalized anxiety disorder (GAD), obsessive–compulsive disorder (OCD), major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and suicidal ideation. AS physical concerns was uniquely associated with OCD, social anxiety disorder (SAD), panic disorder (PD), and specific phobia. AS social concerns was uniquely associated with SAD, GAD, OCD, and MDD. These results highlight the importance of considering the lower-order AS dimensions when examining the relations between AS and psychopathology.     

意外伤骨科住院患者急性焦虑抑郁影响因素调查

背景:意外伤害事件易致受伤者产生强烈的情绪反应.国内对此类心理状况变化越来越重视,但针对该人群情绪反应的调查不足.综合医院骨科病房存在大量意外伤患者,目前缺少针对该人群情绪反应调查.目的:探讨意外伤骨科住院患者急性焦虑抑郁表现及影响因素.方法:对323例意外伤骨科住院患者进行创伤严重度评分(Injury Severity Score,ISS)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评估.结果:本调查共入组患者323例,其中男性213例,女性110例,平均年龄44.32(13.17)岁;住院时间2-40天,平均住院时间11.09(5.64)天.轻度创伤299人,中度创伤20人,重度创伤4人.ISS评分1-38分,平均8.09(4.86)分.HAMA量表报告人数最多的前3位症状分别为睡眠障碍、胃肠道症状和焦虑心境;HAMD量表报告人数最多的前三位症状为睡眠障碍、抑郁情绪和精神性焦虑.非条件Logistic回归分析显示女性(焦虑:OR=2.738,95%CI=1.511-4.962;抑郁:OR=2.622,95%CI=1.504-4.570)、住院时间长(焦虑:OR=1.091,95%CI=1.040-1.145;抑郁:OR=1.093,95%CI=1.044-1.144)为骨科意外伤患者发生焦虑抑郁的危险因素.结论:意外伤骨科住院患者急性焦虑抑郁症状集中在睡眠紊乱、胃肠道症状和焦虑抑郁情绪,女性患者对于意外伤的情绪反应较男性更强烈,焦虑抑郁症状持续存在与患者住院时间长相关,提示需要对意外伤骨科住院患者进行早期心理评估及干预.     

Past suicidal ideation as an independent risk factor for suicide behaviours in patients with depression

Objectives: As South Korea has the highest incidence of completed suicides, the present study aimed to investigate the predictive power of the variables that have been associated with suicide attempts in Korean patients diagnosed with depression.

Methods: Hundred participants were divided into two groups: suicide attempters (31%) and suicide non-attempters (69%). Participants with a history of more than one suicidal attempt were assigned to the suicide attempter group. A hierarchical logistic regression analysis was performed to determine the predictive strengths of the variables that were likely to be associated with suicide attempts.

Results: After controlling for the effects of such variables as the severity of depressive symptoms, life stress events and impulsivity, the severity of past suicidal ideation was the most important predictive factor for discriminating suicide attempters from suicide non-attempters. The odds ratio for attempting suicide relative to not attempting suicide increased by a factor of 4.408 for each unit of increase in suicidal ideation.

Conclusions: The present study suggests that the most severe suicidal ideation throughout one’s entire life should not be overlooked and may be a major predictor of the risk of suicide.     

Disagreement between self-reported and clinician-ascertained suicidal ideation and its correlation with depression and anxiety severity in patients with major depressive disorder or bipolar disorder

ObjectivesTo study the disagreement between self-reported suicidal ideation (SR-SI) and clinician-ascertained suicidal ideation (CA-SI) and its correlation with depression and anxiety severity in patients with major depressive disorder (MDD) or bipolar disorder (BPD).MethodsRoutine clinical outpatients were diagnosed with the MINI-STEP-BD version. SR-SI was extracted from the 16 Item Quick Inventory of Depression Symptomatology Self-Report (QIDS-SR-16) item 12. CA-SI was extracted from a modified Suicide Assessment module of the MINI. Depression and anxiety severity were measured with the QIDS-SR-16 and Zung Self-Rating Anxiety Scale. Chi-square, Fisher exact, and bivariate linear logistic regression were used for analyses.ResultsOf 103 patients with MDD, 5.8% endorsed any CA-SI and 22.4% endorsed any SR-SI. Of the 147 patients with BPD, 18.4% endorsed any CA-SI and 35.9% endorsed any SR-SI. The agreement between any SR-SI and any CA-SI was 83.5% for MDD and 83.1% for BPD, with weighted Kappa of 0.30 and 0.43, respectively. QIDS-SR-16 score, female gender, and ≥4 year college education were associated with increased risk for disagreement, 15.44 ± 4.52 versus 18.39 ± 3.49 points (p = 0.0026), 67% versus 46% (p = 0.0783), and 61% versus 29% (p = 0.0096). The disagreement was positively correlated to depression severity in both MDD and BPD with a correlation coefficient R² = 0.40 and 0.79, respectively, but was only positively correlated to anxiety severity in BPD with a R² = 0.46.ConclusionSelf-reported questionnaire was more likely to reveal higher frequency and severity of SI than clinician-ascertained, suggesting that a combination of self-reported and clinical-ascertained suicidal risk assessment with measuring depression and anxiety severity may be necessary for suicide prevention.     

Living arrangements and suicidal ideation among the Korean older adults

Objectives: This study examines how living arrangements are associated with suicidal ideation for older adults in South Korea, which has the highest suicide rate among OECD countries, and a particularly high suicide rate for older persons.

Methods: Analyzing a sample of 5795 women and 3758 men aged 65 and older from a nationwide representative cross-sectional data-set, we examined how many older adults think about suicide over a one-year period, why they think about suicide, and whether living arrangements are associated with suicidal ideation.

Results: About 1 out of 12 respondents in our sample reported suicidal ideation. While women and men did not differ in the prevalence of suicidal ideation, women attributed their suicidal feelings to health problems, while men attributed theirs to economic difficulties. Logistic regression results indicated that living arrangements are associated with suicidal ideation for men but not women. Older men living with a spouse were less likely to have suicidal ideation than older men with other living arrangements (i.e., living alone, living with children without spouse, living with spouse, and others).

Conclusions: Our results highlight the importance of living arrangements to older men's suicidal ideation. We discuss gender differences in the implications of living arrangements to suicidal ideation within the context of Confucian culture.     

Panic and suicidal ideation in primary care.

The objective of this article is to examine the relationship between panic attacks, panic disorder, and suicidal ideation among primary care patients. A probability sample of 1,007 primary care attenders from a large urban university practice was assessed for current mental disorders and suicidal ideation (past 2 week prevalence) with the PRIME-MD Patient Health Questionnaire. Controlling for major depression, substance use disorders, and sociodemographic variables simultaneously, patients with either panic attacks or panic disorder had significantly increased risks of suicidal ideation. Suicidal ideation was highly associated with major depression and comorbid panic disorder (OR = 15.4) or panic attacks (OR = 7.9). There is need for detection and possible treatment of patients with panic attacks or disorder in primary care, especially among those with co-occurring major depression.     

Evaluation of the hospital anxiety and depression scale as a screening instrument in geriatric medical inpatients

The Hospital Anxiety and Depression Scale (HAD) was developed as a screening instrument for use in medical patients. The depression subscale has been validated as a measure of severity in elderly depressed psychiatric inpatients. This study assessed its usefulness as a screening instrument in inpatients in a geriatric medical unit. One hundred geriatric inpatients were evaluated using the Geriatric Mental State (Community Version) to identify cases. The HAD lacked sensitivity and specificity in this situation.     

Panic and suicidal ideation and suicide attempts: results from the National Comorbidity Survey

Our objective was to determine the association between panic attacks (PAs) and panic disorder (PD), and suicidal ideation (SI) and suicide attempts (SAs) in a nationally representative sample of adults in the community. Data were drawn from the National Comorbidity Survey (n=5,877), a representative household sample of adults ages 15-54 in the United States. Multiple logistic regression analyses were used to examine the relationship between current and lifetime PA and PD and SI and SA, adjusting for differences in demographic characteristics, comorbid mental disorders (major depression, alcohol dependence, and substance dependence), childhood trauma (physical and sexual abuse), and number of lifetime mental disorders. Past-year and lifetime PA and PD were associated with increased SI (both past year and lifetime), and persisted after adjusting for comorbidity and early trauma. Associations between PA and SA were no longer statistically significant after adjusting for comorbidity. Past-year and lifetime PD were associated with lifetime SA, but these associations were no longer statistically significant after adjusting for comorbidity. Past-year and lifetime PD were associated with past-year SA, and this association persisted after adjusting for demographics, comorbidity, and number of lifetime mental disorders. These findings are consistent with previous results, and further help to clarify the relationships between panic and suicide behavior by identifying potential methodological reasons for inconsistencies in results from previous studies.