Comorbid anxiety in bipolar disorder: does it have an independent effect on suicidality?

Authors

  • Atsuo Nakagawa,

    1. Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
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  • Michael F Grunebaum,

    1. Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
    2. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
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  • Gregory M Sullivan,

    1. Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
    2. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
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  • Dianne Currier,

    1. Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
    2. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
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  • Steven P Ellis,

    1. Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
    2. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
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  • Ainsley K Burke,

    1. Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
    2. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
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  • David A Brent,

    1. Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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  • J John Mann,

    1. Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
    2. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
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  • Maria A Oquendo

    1. Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute
    2. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
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  • The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.

Corresponding author: Michael F Grunebaum, MD, Department of Neuroscience, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY 10032, USA. Fax: +1 212 543 6017; e-mail: mfg14@columbia.edu

Abstract

Objective:  Comorbid anxiety disorder is reported to increase suicidality in bipolar disorder. However, studies of the impact of anxiety disorders on suicidal behavior in mood disorders have shown mixed results. The presence of personality disorders, often comorbid with anxiety and bipolar disorders, may explain these inconsistencies. This study examined the impact of comorbid Cluster B personality disorder and anxiety disorder on suicidality in bipolar disorder.

Methods:  A total of 116 depressed bipolar patients with and without lifetime anxiety disorder were compared. Multiple regression analysis tested the association of comorbid anxiety disorder with past suicide attempts and severity of suicidal ideation, adjusting for the effect of Cluster B personality disorder. The specific effect of panic disorder was also explored.

Results:  Bipolar patients with and without anxiety disorders did not differ in the rate of past suicide attempt. Suicidal ideation was less severe in those with anxiety disorders. In multiple regression analysis, anxiety disorder was not associated with past suicide attempts or with the severity of suicidal ideation, whereas Cluster B personality disorder was associated with both. The results were comparable when comorbid panic disorder was examined.

Conclusions:  Comorbid Cluster B personality disorder appears to exert a stronger influence on suicidality than comorbid anxiety disorder in persons with bipolar disorder. Assessment of suicide risk in patients with bipolar disorder should include evaluation and treatment of Cluster B psychopathology.

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