PSYCHOLOGY TOPIC

Psychology

Psychology

Introduction

In the Kuwait, suicide is the third leading cause of death among adolescents, and the eighth leading cause of death among adults (Kessler, Borges, & Walters, 1999). Estimates of the lifetime prevalence of suicidal ideation vary, ranging from 5% to 21% ([Andrews and Lewinsohn, 1992], [Kessler et al., 1999], [Paykel et al., 1974] and [Weissman et al., 1999]) and estimates of lifetime prevalence suicide attempts are approximated at 2.8-4.6% (Kessler et al., 1999). Although many definitions of suicidal behavior have been described, the currently accepted nomenclature of suicidal behaviors was developed by O'Carroll et al. (1996) who identified multiple distinct suicidal behaviors, including (1) suicide; (2) suicide attempt; and (3) suicidal ideation. Suicidal ideation was defined as “any self-reported thoughts of engaging in suicide-related behavior” (p. 247). Furthermore, according to this nomenclature, “thoughts of death or wanting to die without specific thoughts of killing oneself are not considered to be suicidal ideation” (Brown, 2000, p. 5).

Traditionally, research on suicide has emphasized relationships with mood disorders, psychotic disorders, and some personality disorders. Indeed, consistent relationships between these disorders and suicide have long been established (American Psychiatric Association, 2000). However, the relationship between suicide and other forms of psychopathology, such as anxiety disorders, has received less empirical attention. Although certain features of anxiety have been incorporated into models of suicide (e.g., Shneidman's conceptualization of “psychache”; Shneidman, 1998), anxiety-related conditions such as severe psychic anxiety, agitation, and panic have typically been examined as predictors of suicidal behaviors only to the extent that they overlap with mood disorders (e.g., [Busch et al., 1993] and [Fawcett, 1992]). Even less empirical work has considered the role of syndromal anxiety disorders in suicidal behaviors. This is somewhat surprising given that anxiety-related disorders are one of the most prevalent forms of psychopathology, having an approximate lifetime prevalence of 24.9% and a 1-year prevalence of 17.2% (Kessler et al., 1994).

A key factor complicating the examination of the relationship between suicidal ideation and anxiety is that anxiety and depression are frequently comorbid (e.g., Brown, Campbell, Lehman, Grisham, & Mancill, 2001), and both appear to share a common underlying element of Negative Affectivity (NA; Clark & Watson, 1991). In addition, although less common, anxiety disorders may also be comorbid with Axis II disorders that are associated with increase risk of suicide (e.g., borderline personality disorder). As a result, it is difficult to ascertain whether any observed suicide-anxiety relationship is truly linked to anxiety, or if it is a function of co-occurring depressiveness or higher order NA.

Suicidal ideation and anxiety disorders

Since the first major examination of the relationship between panic disorder and suicide by Weissman et al. (1989), there has been a marked increase in research on the topic. Despite the increase in research examining the link between panic disorder and suicide, a consensus on the issue is yet to be reached. The first major study focusing on panic disorder and suicide (Weissman et al., 1989) reported that among individuals participating in the Epidemiologic Catchment Area survey, those with panic disorder were 20 times more likely to have made ...