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Suicide in Anxiety Disorders

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Clinical Handbook of Anxiety Disorders

Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

Suicide constitutes a worldwide public health problem. Though previously overshadowed by the association between mood disorders and suicide, the role of anxiety disorders in conceptualizing, assessing, and treating suicidal ideation and behaviors is now a topic of considerable interest among researchers and clinicians. In this chapter we provide an overview of the empirical evidence linking anxiety disorders and symptoms to suicidal ideation and behaviors, both as an independent risk factor and in the context of comorbid disorders. We then present key considerations in conducting suicide risk assessments among individuals with anxiety presentations. A discussion of updated best-care practices for crisis management and a summary of established and emerging treatment options for patients identified as having elevated suicide risk follow. We conclude with suggestions for future research in the area of suicide and anxiety disorders.

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Notes

  1. 1.

    The National Comorbidity Survey Replication used anxiety disorder criteria from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). At that time, the DSM-IV included posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) as anxiety disorders. PTSD and OCD are no longer classified as anxiety disorders in the DSM-5.

References

  1. WHO. Public health action for the prevention of suicide. 2012. Retrieved January 11, 2019, from https://www.who.int/mental_health/publications/prevention_suicide_2012/en/

  2. CDC. CDC vital signs. 2018a, November 27. Retrieved January 11, 2019, from https://www.cdc.gov/vitalsigns/suicide/index.html

  3. CDC. CDC WISQARS. 2018b, December 3. Retrieved January 11, 2019, from https://www.cdc.gov/injury/wisqars/index.html

  4. Stone DM. Vital signs: trends in state suicide rates — United States, 1999–2016 and circumstances contributing to suicide — 27 states, 2015. MMWR Morb Mortal Wkly Rep. 2018;67:617–24.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Olfson M, Blanco C, Wall M, Liu S-M, Saha TD, Pickering RP, Grant BF. National trends in suicide attempts among adults in the United States. JAMA Psychiat. 2017;74(11):1095–103.

    Article  Google Scholar 

  6. Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry J Ment Sci. 2008;192(2):98–105.

    Article  Google Scholar 

  7. SAMHSA. Results from the 2013 national survey on drug use and health: mental health findings, HHS Publication No. (SMA) 14-4887; 2014. p. 142.

    Google Scholar 

  8. Hall RC, Platt DE, Hall RC. Suicide risk assessment: a review of risk factors for suicide in 100 patients who made severe suicide attempts. Evaluation of suicide risk in a time of managed care. Psychosomatics. 1999;40(1):18–27.

    Article  CAS  PubMed  Google Scholar 

  9. Fawcett J, Scheftner WA, Fogg L, Clark DC, Young MA, Hedeker D, Gibbons R. Time-related predictors of suicide in major affective disorder. Am J Psychiatry. 1990;147(9):1189–94.

    Article  CAS  PubMed  Google Scholar 

  10. Kessler RC, Berglund P, Borges G, Nock M, Wang PS. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA. 2005;293(20):2487–95.

    Article  CAS  PubMed  Google Scholar 

  11. Sareen J, Cox BJ, Afifi TO, de Graaf R, Asmundson GJG, ten Have M, Stein MB. Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults. Arch Gen Psychiatry. 2005;62(11):1249–57.

    Article  PubMed  Google Scholar 

  12. O’Neil Rodriguez KA, Kendall PC. Suicidal ideation in anxiety-disordered youth: identifying predictors of risk. J Clin Child Adolesc Psychol. 2014;43(1):51–62.

    Article  Google Scholar 

  13. Nepon J, Belik S-L, Bolton J, Sareen J. The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on alcohol and related conditions. Depress Anxiety. 2010;27(9):791–8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Park S, Lee Y, Youn T, Kim BS, Park JI, Kim H, et al. Association between level of suicide risk, characteristics of suicide attempts, and mental disorders among suicide attempters. BMC Public Health. 2018;18(1):477.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Busch KA, Fawcett J, Jacobs DG. Clinical correlates of inpatient suicide. J Clin Psychiatry. 2003;64(1):14–9.

    Article  PubMed  Google Scholar 

  16. McGirr A, Séguin M, Renaud J, Benkelfat C, Alda M, Turecki G. Gender and risk factors for suicide: evidence for heterogeneity in predisposing mechanisms in a psychological autopsy study. J Clin Psychiatry. 2006;67(10):1612–7.

    Article  PubMed  Google Scholar 

  17. American Association of Suicidology. Warning signs & risk factors. 2019. Retrieved January 11, 2019, from http://www.suicidology.org/ncpys/warning-signs-risk-factors

  18. American Foundation for Suicide Prevention. Risk factors and warning signs. 2016. Retrieved January 11, 2019, from https://afsp.org/about-suicide/risk-factors-and-warning-signs/

  19. Weissman MM, Klerman GL, Markowitz JS, Ouellette R. Suicidal ideation and suicide attempts in PD and attacks. N Engl J Med. 1989;321(18):1209–14.

    Article  CAS  PubMed  Google Scholar 

  20. Goodwin RD, Roy-Byrne P. Panic and suicidal ideation and suicide attempts: results from the National Comorbidity Survey. Depress Anxiety. 2006;23(3):124–32.

    Article  PubMed  Google Scholar 

  21. Boden JM, Fergusson DM, Horwood LJ. Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study. Psychol Med. 2007;37(3):431–40.

    Article  PubMed  Google Scholar 

  22. Goldston DB, Daniel SS, Erkanli A, Reboussin BA, Mayfield A, Frazier PH, Treadway SL. Psychiatric diagnoses as contemporaneous risk factors for suicide attempts among adolescents and young adults: developmental changes. J Consult Clin Psychol. 2009;77(2):281–90.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nock MK, Kessler RC. Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey. J Abnorm Psychol. 2006;115(3):616–23.

    Article  PubMed  Google Scholar 

  24. Cougle JR, Keough ME, Riccardi CJ, Sachs-Ericsson N. Anxiety disorders and suicidality in the National Comorbidity Survey-Replication. J Psychiatr Res. 2009;43(9):825–9.

    Article  PubMed  Google Scholar 

  25. Torres AR, Prince MJ, Bebbington PE, Bhugra D, Brugha TS, Farrell M, et al. Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. Am J Psychiatry. 2006;163(11):1978–85.

    Article  PubMed  Google Scholar 

  26. Miché M, Hofer PD, Voss C, Meyer AH, Gloster AT, Beesdo-Baum K, Lieb R. Mental disorders and the risk for the subsequent first suicide attempt: results of a community study on adolescents and young adults. Eur Child Adolesc Psychiatry. 2018;27(7):839–48.

    Article  PubMed  Google Scholar 

  27. Kanwar A, Malik S, Prokop LJ, Sim LA, Feldstein D, Wang Z, Murad MH. The association between anxiety disorders and suicidal behaviors: a systematic review and meta-analysis. Depress Anxiety. 2013;30(10):917–29.

    PubMed  Google Scholar 

  28. Hawgood J, De Leo D. Anxiety disorders and suicidal behaviour: an update. Curr Opin Psychiatry. 2008;21(1):51–64.

    Article  PubMed  Google Scholar 

  29. Bentley KH, Franklin JC, Ribeiro JD, Kleiman EM, Fox KR, Nock MK. Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: a meta-analytic review. Clin Psychol Rev. 2016;43:30–46.

    Article  PubMed  Google Scholar 

  30. Pfeiffer PN, Ganoczy D, Ilgen M, Zivin K, Valenstein M. Comorbid anxiety as a suicide risk factor among depressed veterans. Depress Anxiety. 2009;26(8):752–7.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Seo H-J, Jung Y-E, Kim T-S, Kim J-B, Lee M-S, Kim J-M, et al. Distinctive clinical characteristics and suicidal tendencies of patients with anxious depression. J Nerv Ment Dis. 2011;199(1):42–8.

    Article  PubMed  Google Scholar 

  32. Diaconu G, Turecki G. PD and suicidality: is comorbidity with depression the key? J Affect Disord. 2007;104(1–3):203–9.

    Article  PubMed  Google Scholar 

  33. Kim H, Choi KW, Na EJ, Hong JP, Fava M, Mischoulon D, et al. Anxiety attacks with or without life-threatening situations, major depressive disorder, and suicide attempt: a nationwide community sample of Korean adults. Psychiatry Res. 2018;270:257–63.

    Article  PubMed  Google Scholar 

  34. Kilbane EJ, Gokbayrak NS, Galynker I, Cohen L, Tross S. A review of panic and suicide in bipolar disorder: does comorbidity increase risk? J Affect Disord. 2009;115(1–2):1–10.

    Article  PubMed  Google Scholar 

  35. Bolton J, Cox B, Clara I, Sareen J. Use of alcohol and drugs to self-medicate anxiety disorders in a nationally representative sample. J Nerv Ment Dis. 2006;194(11):818–25.

    Article  PubMed  Google Scholar 

  36. Friedman S, Jones JC, Chernen L, Barlow DH. Suicidal ideation and suicide attempts among patients with PD: a survey of two outpatient clinics. Am J Psychiatry. 1992;149(5):680–5.

    Article  CAS  PubMed  Google Scholar 

  37. Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, Beautrais A, et al. Cross-national analysis of the associations among mental disorders and suicidal behavior: findings from the WHO world mental health surveys. PLoS Med. 2009;6(8):e1000123.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Fawcett J. Suicide risk factors in depressive disorders and in PD. J Clin Psychiatry. 1992;53(3, Suppl):9–13.

    PubMed  Google Scholar 

  39. Fawcett J. Comorbid anxiety and suicide in mood disorders. Psychiatr Ann. 2007;37(10):667–71.

    Google Scholar 

  40. Fava M, Alpert JE, Carmin CN, Wisniewski SR, Trivedi MH, Biggs MM, et al. Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR∗D. Psychol Med. 2004;34(7):1299–308.

    Article  PubMed  Google Scholar 

  41. Nock MK, Hwang I, Sampson NA, Kessler RC. Mental disorders, comorbidity and suicidal behavior: results from the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15(8):868–76.

    Article  CAS  PubMed  Google Scholar 

  42. Lento RM, Carson-Wong A, Green JD, AhnAllen CG, Kleespies PM. Is suicidal behavior in mood disorders altered by comorbid PTSD? Crisis. 2019;40:62–6.

    Article  PubMed  Google Scholar 

  43. Klonsky ED, May AM. Differentiating suicide attempters from suicide ideators: a critical frontier for suicidology research. Suicide Life Threat Behav. 2014;44(1):1–5.

    Article  PubMed  Google Scholar 

  44. Joiner T. Why people die by suicide. Cambridge, MA: Harvard University Press; 2005. Retrieved from http://www.hup.harvard.edu/catalog.php?isbn=9780674025493

    Google Scholar 

  45. Klonsky ED, May AM. The three-step theory (3ST): a new theory of suicide rooted in the “ideation-to-action” framework. Int J Cogn Ther. 2015;8(2):114–29.

    Article  Google Scholar 

  46. O’Connor RC. The integrated motivational-volitional model of suicidal behavior. Crisis. 2011;32:295. https://doi.org/10.1027/0227-5910/a000120.

    Article  PubMed  Google Scholar 

  47. Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite S, Selby EA, Joiner TE Jr. The interpersonal theory of suicide. Psychol Rev. 2010;117(2):575–600.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Shneidman ES. A psychological approach to suicide. In: Cataclysms, crises, and catastrophes: psychology in action. Washington, DC: American Psychological Association; 1987. p. 147–83.

    Chapter  Google Scholar 

  49. Wenzel A, Beck AT. A cognitive model of suicidal behavior: theory and treatment. Appl Prev Psychol. 2008;12(4):189–201.

    Article  Google Scholar 

  50. Taylor S. Anxiety sensitivity: theory, research, and treatment of the fear of anxiety. London: Routledge; 2014.

    Book  Google Scholar 

  51. Stanley IH, Boffa JW, Rogers ML, Hom MA, Albanese BJ, Chu C, et al. Anxiety sensitivity and suicidal ideation/suicide risk: a meta-analysis. J Consult Clin Psychol. 2018;86(11):946–60.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Allan NP, Capron DW, Raines AM, Schmidt NB. Unique relations among anxiety sensitivity factors and anxiety, depression, and suicidal ideation. J Anxiety Disord. 2014;28(2):266–75.

    Article  PubMed  Google Scholar 

  53. Stanley IH, Hom MA, Spencer-Thomas S, Joiner TE. Examining anxiety sensitivity as a mediator of the association between PTSD symptoms and suicide risk among women firefighters. J Anxiety Disord. 2017;50:94–102.

    Article  PubMed  Google Scholar 

  54. Capron DW, Fitch K, Medley A, Blagg C, Mallott M, Joiner T. Role of anxiety sensitivity subfactors in suicidal ideation and suicide attempt history. Depress Anxiety. 2012;29(3):195–201.

    Article  PubMed  Google Scholar 

  55. Capron DW, Norr AM, Macatee RJ, Schmidt NB. Distress tolerance and anxiety sensitivity cognitive concerns: testing the incremental contributions of affect dysregulation constructs on suicidal ideation and suicide attempt. Behav Ther. 2013;44(3):349–58.

    Article  PubMed  Google Scholar 

  56. Allan NP, Norr AM, Boffa JW, Durmaz D, Raines AM, Schmidt NB. Examining the unique relations between anxiety sensitivity factors and suicidal ideation and past suicide attempts. Psychiatry Res. 2015;228(3):441–7.

    Article  PubMed  Google Scholar 

  57. Stanley IH, Smith LJ, Boffa JW, Tran JK, Schmidt NB, Joiner TE, Vujanovic AA. Anxiety sensitivity and suicide risk among firefighters: a test of the depression-distress amplification model. Compr Psychiatry. 2018;84:39–46.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Berman AL. Risk management with suicidal patients. J Clin Psychol. 2006;62(2):171–84.

    Article  PubMed  Google Scholar 

  59. The Joint Commission. Sentinel Event Alert 56: detecting and treating suicide ideation in all settings. 2016. Retrieved January 21, 2019, from http://www.jointcommission.org/sea_issue_56/

  60. Practice Guideline for the Assessment and Treatment of Patients With Suicidal Behaviors. American Psychiatric Association, APA practice guidelines for the treatment of psychiatric disorders: comprehensive guidelines and guideline watches, vol. 1. 1st ed. Arlington: American Psychiatric Association; 2006.

    Google Scholar 

  61. National Action Alliance for Suicide Prevention: Transforming Health Systems Initiative Work Group. Recommended standard care for people with suicide risk: making health care suicide safe | Suicide Prevention Resource Center. 2018. Retrieved January 21, 2019, from https://www.sprc.org/resources-programs/recommended-standard-care-people-suicide-risk-making-health-care-suicide-safe

  62. Pisani AR, Murrie DC, Silverman MM. Reformulating suicide risk formulation: from prediction to prevention. Acad Psychiatry. 2016;40(4):623–9.

    Article  PubMed  Google Scholar 

  63. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, et al. Suicide prevention strategies: a systematic review. JAMA. 2005;294(16):2064–74.

    Article  CAS  PubMed  Google Scholar 

  64. Kaplan ML, Asnis GM, Sanderson WC, Keswani L, De Lecuona JM, Joseph S. Suicide assessment: clinical interview vs. self-report. J Clin Psychol. 1994;50(2):294–8.

    Article  CAS  PubMed  Google Scholar 

  65. Suicide Prevention Resource Center. Zero suicide – in health and behavioral healthcare. 2019. Retrieved January 21, 2019, from http://zerosuicide.sprc.org/

  66. Suicide Prevention | VA Community Provider Toolkit. n.d. Retrieved January 21, 2019, from https://www.mentalhealth.va.gov/communityproviders/clinic_suicideprevention.asp

  67. Jobes DA. The collaborative assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk. Suicide Life Threat Behav. 2012;42(6):640–53. https://doi.org/10.1111/j.1943-278X.2012.00119.x.

    Article  PubMed  Google Scholar 

  68. Jobes DA. Managing suicidal risk: second edition: a collaborative approach. 2016. Retrieved from https://www.guilford.com/books/Managing-Suicidal-Risk/David-Jobes/9781462526901/reviews

  69. VA Suicide Risk Management Consultation Program – MIRECC/CoE. n.d. [general information]. Retrieved January 21, 2019, from https://www.mirecc.va.gov/visn19/consult/

  70. Cerel J, Currier GW, Conwell Y. Consumer and family experiences in the emergency department following a suicide attempt. J Psychiatr Pract. 2006;12(6):341–7.

    Article  PubMed  Google Scholar 

  71. Richards JE, Whiteside U, Ludman EJ, Pabiniak C, Kirlin B, Hidalgo R, Simon G. Understanding why patients May not report suicidal ideation at a health care visit prior to a suicide attempt: a qualitative study. Psychiatr Serv (Washington, DC). 2019;70(1):40–5. https://doi.org/10.1176/appi.ps.201800342.

    Article  Google Scholar 

  72. Anestis MD, Green BA. The impact of varying levels of confidentiality on disclosure of suicidal thoughts in a sample of United States National Guard Personnel. J Clin Psychol. 2015;71(10):1023–30.

    Article  PubMed  Google Scholar 

  73. Bolton JM, Gunnell D, Turecki G. Suicide risk assessment and intervention in people with mental illness. BMJ (Clinical Research Ed). 2015;351:h4978.

    Google Scholar 

  74. Michel K, Jobes DA. Building a therapeutic Alliance with the suicidal patient. Washington, DC: American Psychological Association; 2011. Retrieved from https://www.apa.org/pubs/books/4317248.aspx

    Book  Google Scholar 

  75. Lento RM, Ellis TE, Hinnant BJ, Jobes DA. Using the suicide index score to predict treatment outcomes among psychiatric inpatients. Suicide Life Threat Behav. 2013;43(5):547–61.

    PubMed  Google Scholar 

  76. O’Connor SS, Jobes DA, Yeargin MK, Fitzgerald ME, Rodríguez VM, Conrad AK, Lineberry TW. A cross-sectional investigation of the suicidal spectrum: typologies of suicidality based on ambivalence about living and dying. Compr Psychiatry. 2012;53(5):461–7.

    Article  PubMed  Google Scholar 

  77. Kovacs M, Beck AT. The wish to die and the wish to live in attempted suicides. J Clin Psychol. 1977;33(2):361–5.

    Article  CAS  PubMed  Google Scholar 

  78. Harvard. Means matter. 2016. Retrieved January 21, 2019, from https://www.hsph.harvard.edu/means-matter/

  79. Mérelle S, Foppen E, Gilissen R, Mokkenstorm J, Cluitmans R, Van Ballegooijen W. Characteristics associated with non-disclosure of suicidal ideation in adults. Int J Environ Res Public Health. 2018;15(5):pii: E943.

    Article  Google Scholar 

  80. Beck AT, Brown G, Berchick RJ, Stewart BL, Steer RA. Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. Am J Psychiatry. 1990;147(2):190–5.

    Article  CAS  PubMed  Google Scholar 

  81. Dazzi T, Gribble R, Wessely S, Fear NT. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychol Med. 2014;44(16):3361–3.

    Article  CAS  PubMed  Google Scholar 

  82. Hawton K. Restricting access to methods of suicide. Crisis. 2007;28(S1):4–9.

    Article  Google Scholar 

  83. Kaplan MS, McFarland BH, Huguet N, Conner K, Caetano R, Giesbrecht N, Nolte KB. Acute alcohol intoxication and suicide: a gender-stratified analysis of the National Violent Death Reporting System. Inj Prev. 2013;19(1):38–43.

    Article  PubMed  Google Scholar 

  84. Wongpakaran N, Wongpakaran T, Lerttrakarnnon P, Jiraniramai S, Sirirak T, Assanangkornchai S, et al. Prevalence, clinical and psychosocial variables of depression, anxiety and suicidality in geriatric tertiary care settings. Asian J Psychiatr. 2019;41:38–44.

    Article  PubMed  Google Scholar 

  85. Jeste ND, Hays JC, Steffens DC. Clinical correlates of anxious depression among elderly patients with depression. J Affect Disord. 2006;90(1):37–41.

    Article  PubMed  Google Scholar 

  86. Franklin JC, Ribeiro JD, Fox KR, Bentley KH, Kleiman EM, Huang X, et al. Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychol Bull. 2017;143(2):187–232.

    Article  PubMed  Google Scholar 

  87. McLean J, Maxwell M. Risk and protective factors for suicide and suicidal behaviour: a literature review. Edinburgh, Scotland: Scottish Government Social Research; 2008. p. 145.

    Google Scholar 

  88. Klonsky ED, Saffer BY, Bryan CJ. Ideation-to-action theories of suicide: a conceptual and empirical update. Curr Opin Psychol. 2018;22:38–43.

    Article  PubMed  Google Scholar 

  89. Tucker RP, Crowley KJ, Davidson CL, Gutierrez PM. Risk factors, warning signs, and drivers of suicide: what are they, how do they differ, and why does it matter? Suicide Life Threat Behav. 2015;45(6):679–89.

    Article  PubMed  Google Scholar 

  90. Conrad AK, Jacoby AM, Jobes DA, Lineberry TW, Shea CE, Arnold Ewing TD, et al. A psychometric investigation of the suicide status form II with a psychiatric inpatient sample. Suicide Life Threat Behav. 2009;39(3):307–20.

    Article  PubMed  Google Scholar 

  91. Linehan MM, Goodstein JL, Nielsen SL, Chiles JA. Reasons for staying alive when you are thinking of killing yourself: the reasons for living inventory. J Consult Clin Psychol. 1983;51(2):276–86.

    Article  CAS  PubMed  Google Scholar 

  92. Jobes DA, Mann RE. Reasons for living versus reasons for dying: examining the internal debate of suicide. Suicide Life Threat Behav. 1999;29(2):97–104.

    CAS  PubMed  Google Scholar 

  93. Rudd MD, Mandrusiak M, Joiner TE. The case against no-suicide contracts: the commitment to treatment statement as a practice alternative. J Clin Psychol. 2006;62(2):243–51.

    Article  PubMed  Google Scholar 

  94. Bryan CJ, Mintz J, Clemans TA, Leeson B, Burch TS, Williams SR, et al. Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army soldiers: a randomized clinical trial. J Affect Disord. 2017;212:64–72.

    Article  PubMed  Google Scholar 

  95. Stanley B, Brown GK. Safety planning intervention: a brief intervention to mitigate suicide risk – ScienceDirect. 2012. Retrieved January 22, 2019, from https://www.sciencedirect.com/science/article/pii/S1077722911000630

  96. Stanley B, Chaudhury SR, Chesin M, Pontoski K, Bush AM, Knox KL, Brown GK. An emergency department intervention and follow-up to reduce suicide risk in the VA: acceptability and effectiveness. Psychiatr Serv (Washington, DC). 2016;67(6):680–3.

    Article  Google Scholar 

  97. Stanley B, Brown GK. The safety plan treatment manual to reduce suicide risk: veteran version. Washington, DC: United States Department of Veterans Affairs; 2008. Retrieved from http://suicidesafetyplan.com/uploads/VA_Safety_planning_manual.pdf

    Google Scholar 

  98. Comtois KA, Linehan MM. Psychosocial treatments of suicidal behaviors: a practice-friendly review. J Clin Psychol. 2006;62(2):161–70.

    Article  PubMed  Google Scholar 

  99. Brown GK, Jager-Hyman S. Evidence-based psychotherapies for suicide prevention: future directions. Am J Prev Med. 2014;47(3 Suppl 2):S186–94.

    Article  PubMed  Google Scholar 

  100. Ahmedani BK, Vannoy S. National pathways for suicide prevention and health services research. Am J Prev Med. 2014;47(3 Suppl 2):S222–8.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Batterham PJ, Christensen H, Calear AL. Anxiety symptoms as precursors of major depression and suicidal ideation. Depress Anxiety. 2013;30(10):908–16.

    PubMed  Google Scholar 

  102. Brown LA, Gallagher T, Petersen J, Benhamou K, Foa EB, Asnaani A. Does CBT for anxiety-related disorders alter suicidal ideation? Findings from a naturalistic sample. J Anxiety Disord. 2018;59:10–6.

    Article  PubMed  Google Scholar 

  103. Barlow DH, Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Allen LB, Ehrenreich-May J. Unified protocol for transdiagnostic treatment of emotional disorders: therapist guide. 1st ed. Oxford: Oxford University Press; 2011.

    Google Scholar 

  104. Bentley KH, Sauer-Zavala S, Stevens KT, Washburn JJ. Implementing an evidence-based psychological intervention for suicidal thoughts and behaviors on an inpatient unit: process, challenges, and initial findings. Gen Hosp Psychiatry. 2018; in press.

    Google Scholar 

  105. Norr AM, Allan NP, Reger GM, Schmidt NB. Exploring the pathway from anxiety sensitivity intervention to suicide risk reduction: chained mediation through anxiety and depressive symptoms. J Affect Disord. 2018;231:27–31.

    Article  PubMed  Google Scholar 

  106. Bolton J, Gunnell D, Turecki G. Suicide risk assessment and intervention in people with mental illness. 2015. PubMed – NCBI. Retrieved January 21, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/26552947

  107. Ballard ED, Ionescu DF, Vande Voort JL, Niciu MJ, Richards EM, Luckenbaugh DA, et al. Improvement in suicidal ideation after ketamine infusion: relationship to reductions in depression and anxiety. J Psychiatr Res. 2014;58:161–6.

    Article  PubMed  Google Scholar 

  108. DiazGranados N, Ibrahim LA, Brutsche NE, Ameli R, Henter ID, Luckenbaugh DA, et al. Rapid resolution of suicidal ideation after a single infusion of an N-methyl-D-aspartate antagonist in patients with treatment-resistant major depressive disorder. J Clin Psychiatry. 2010;71(12):1605–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  109. Duman RS, Aghajanian GK. Synaptic dysfunction in depression: potential therapeutic targets. Science (New York, NY). 2012;338(6103):68–72.

    Article  CAS  Google Scholar 

  110. Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006;63(7):757–66.

    Article  PubMed  Google Scholar 

  111. Brown GK, Have TT, Henriques GR, Xie SX, Hollander JE, Beck AT. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA. 2005;294(5):563–70.

    Article  CAS  PubMed  Google Scholar 

  112. Stanley B, Brown G, Brent D, Wells K, Poling K, Curry J, et al. Cognitive behavior therapy for suicide prevention (CBT-SP): treatment model, feasibility and acceptability. J Am Acad Child Adolesc Psychiatry. 2009;48(10):1005–13.

    Article  PubMed  PubMed Central  Google Scholar 

  113. Comtois KA, Jobes DA, O’Connor SS, Atkins DC, Janis K, Chessen CE, et al. Collaborative assessment and management of suicidality (CAMS): feasibility trial for next-day appointment services. Depress Anxiety. 2011;28(11):963–72.

    Article  PubMed  Google Scholar 

  114. Rudd MD, Bryan CJ, Wertenberger EG, Peterson AL, Young-McCaughan S, Mintz J, et al. Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: results of a randomized clinical trial with 2-year follow-up. Am J Psychiatr. 2015;172:441–9.

    Article  PubMed  Google Scholar 

  115. McCauley E, Berk MS, Asarnow JR. Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial. JAMA Psychiat. 2018;75(8):777–85.

    Article  Google Scholar 

  116. Alavi A, Sharifi B, Ghanizadeh A, Dehbozorgi G. Effectiveness of cognitive-behavioral therapy in decreasing suicidal ideation and hopelessness of the adolescents with previous suicidal attempts. Iran J Pediatr. 2013;23(4):467–74.

    PubMed  PubMed Central  Google Scholar 

  117. Nielsen AC, Alberdi F, Rosenbaum B. Collaborative assessment and management of suicidality method shows effect. Dan Med Bull. 2011;58(8):A4300.

    PubMed  Google Scholar 

  118. Linehan MM, Korslund KE, Harned MS, Gallop RJ, Lungu A, Neacsiu AD, et al. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiat. 2015;72:475–82.

    Article  CAS  Google Scholar 

  119. Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, et al. Two year randomized controlled trial and follow-up of DBT vs therapy by experts for suicidal behaviors and BPD. JAMA Psychiat. 2006;63:757–66.

    Google Scholar 

  120. Linehan MM, Heard HL, Armstrong HE. Naturalistic follow-up of a behavioral treatment for chronically suicidal parasuicidal borderline patients. Arch Gen Psychiatry. 1993;50:971–4.

    Article  CAS  PubMed  Google Scholar 

  121. Mehlum L, Ramberg M, Tormoen AJ, Haga E, Diep LM. Dialectical behavior therapy compared with enhanced usual care for adolescents with repeated suicidal and self-harming behavior: outcomes over a one-year follow-up. J Am Acad Child Adolesc Psychiatry. 2016;55:295–300.

    Article  PubMed  Google Scholar 

  122. Jobes DA, Au JS, Siegelman A. Psychological approaches to suicide treatment and prevention. Curr Treat Options Psychiatry. 2015;2(4):363–70.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    René M. Lento & Heidi Boland

  2. Department of Psychiatry, Harvard University, Boston, MA, USA

    René M. Lento

Authors
  1. René M. Lento
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  2. Heidi Boland
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Corresponding author

Correspondence to René M. Lento .

Editor information

Editors and Affiliations

  1. Department of Psychiatry Massachusetts General Hospital, Boston, MA, USA

    Eric Bui

  2. Department of Psychiatry Massachusetts General Hospital, Boston, MA, USA

    Meredith E. Charney

  3. Department of Psychiatry Massachusetts General Hospital, Boston, MA, USA

    Amanda W. Baker

Appendix

Appendix

Safety Plan

Step 1: Warning signs:

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

Step 2: Internal coping strategies – Things I can do first to take my mind off my problems without contacting another person:

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

Step 3: People and social settings that provide distraction:

1. Name_________________________________ Phone____________________

2. Name_________________________________ Phone____________________

3. Place________________________ 4. Place __________________________

Step 4: People whom I can ask for support:

1. Name_________________________________ Phone____________________

2. Name_________________________________ Phone____________________

3. Name_________________________________ Phone____________________

Step 5: Professionals or agencies I can contact during a crisis:

1. Clinician Name: ________________ _________ Phone: __________________

   Clinician Pager or Emergency Contact #________________________________

2. Clinician Name__________________________ Phone____________________

   Clinician Pager or Emergency Contact #________________________________

3. Local Urgent Care Services __________________________________________

   Urgent Care Services Address________________________________________

   Urgent Care Services Phone _________________________________________

4. Mental Health Crisis Hotline: 1-800-273-TALK (8255)

5. Online chat: www.suicidepreventionlifeline.org

Step 6: Making the environment safe:

1. _______________________________________________________________

2. _______________________________________________________________

  1. Adapted from Stanley and Brown [97]

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Lento, R.M., Boland, H. (2020). Suicide in Anxiety Disorders. In: Bui, E., Charney, M., Baker, A. (eds) Clinical Handbook of Anxiety Disorders. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-030-30687-8_11

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  • DOI: https://doi.org/10.1007/978-3-030-30687-8_11

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