Separation anxiety significantly predicts suicidal thoughts in mood, anxiety disorders

Separation anxiety may significantly predict suicidal thoughts among patients with mood and anxiety disorders, according to study results published in Journal of Clinical Psychiatry.

“The relationship between separation anxiety and suicidality has not been explored extensively,” Stefano Pini, MD, of the department of clinical and experimental medicine at University of Pisa in Italy, and colleagues wrote. “One study found an association between separation anxiety disorder and increased risk [for] suicidal behaviors in a prospective study of 500 Indian adolescents in a rural community. Another study reported an association between severity of separation anxiety symptoms and suicidal ideation in a small sample (n = 31) of patients with social anxiety disorder, although the observed association was dependent on comorbidity with major depression and avoidant personality disorder.”

In the current study, the researchers sought to assess the link between both childhood and adult separation anxiety and suicide risk measures among 509 consecutive psychiatric outpatients with anxiety and mood disorders according to DSM-IV criteria. They recruited participants from a single academic institution between 2015 and 2018 and measured suicide risk using the Hamilton Depression Rating Scale (HDRS) item three. Further, they classified patients with a score of one or higher and those with a score of zero on HDRS item three into separate groups.

Pini and colleagues also measured suicide risk by specific items within the Mood Spectrum, Self-Report, which evaluated lifetime suicidal symptoms. They used the Structured Interview for Separation Anxiety in Adulthood/Childhood, the Separation Anxiety Symptom Inventory and the Adult Separation Anxiety Scale (ASA-27) to assess separation anxiety.

A total of 97 patients scored one or higher on the HDRS item three, and 412 scored zero. Those with suicidal thoughts (53.6%) had a higher prevalence of adult separation anxiety disorder than those without suicidal thoughts (39.6%). All scales showed increased dimensional separation anxiety symptoms among individuals with suicidality compared with those without it. Adult separation anxiety disorder (OR = 1.86; 95% CI, 1.16-2.97), major depression (OR = 7.13; 95% CI, 3.18-15.97), bipolar I disorder (OR = 8.15; 95% CI, 3.34-19.9) and bipolar II disorder (OR = 8.16; 95% CI, 3.5-19.05) served as predictors of suicidal thoughts, according to results of logistic regression. Results of linear regression showed depression and ASA-27 separation anxiety were significant predictors of lifetime suicide risk. Mediation analysis showed a significant mediating role of separation anxiety on the link between depression and suicide risk.

“Separation anxiety is an important clinical dimension, often with roots in childhood but likely to wax and wane across the lifespan and even to manifest for the first time during adulthood,” Pini and colleagues wrote. “The present study indicates that adult separation anxiety disorder and dimensional symptoms of separation anxiety, both in childhood and in adulthood, are associated with suicidal risk in outpatients with mood and anxiety disorders.”