Suicide attempts versus nonsuicidal self-injury among individuals with anxiety disorders in a nationally representative sample

Background: This study is aimed to determine whether anxiety disorders are associated with suicide attempts with intent to die and to further investigate the characteristics of deliberate self-harm (DSH) among anxiety disorders. Method: Data came from the Collaborative Psychiatric Epidemiological Surveys (N=20,130; age 18 years and older; response rate=72.3%). DSM-IV anxiety disorders were assessed using the World Mental Health Composite International Diagnostic Interview. People with an anxiety disorder endorsing a history of DSH were subcategorized as those who made suicide attempts (n=159; individuals who intended to die), versus those who made nonsuicidal self-injuries (n=85; individuals who did not intend to die). Results: Anxiety disorders were associated with both suicide attempts and nonsuicidal self-injury (NSSI). People with generalized anxiety disorder and social phobia who engaged in DSH were more likely to have made a suicide attempt than a NSSI, independent of the effects of mood and substance use disorders. In addition, individuals with generalized anxiety disorder and social phobia who engaged in DSH were more likely to engage in this behavior multiple times, and at least one of those times was a suicide attempt. Conclusion: This study suggests that anxiety disorders are associated with suicide attempts with intent to die. Social phobia and generalized anxiety disorder appear to be associated with the more worrisome patterns of DSH including multiple suicide attempts. Depression and Anxiety 29:172-179, 2012. (C) 2011 Wiley-Liss, Inc.