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Am J Psychiatry 1993; 150:928-934
Copyright © 1993 by American Psychiatric Association
Diagnostic comorbidity in persons with suicidal ideation and behavior
MD Rudd, PF Dahm and MH Rajab
Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center, College of Medicine, College Station.
OBJECTIVE: An initial finding of heightened risk of suicidal ideation or
behavior among individuals in a random community sample who met diagnostic
criteria for panic disorder or panic attacks was not replicated in later
studies of both general and specific groups of psychiatric outpatients. The
present study represented another effort to validate the finding. METHOD:
The participants included 209 outpatients who had attempted suicide or were
at high risk for continued suicidal behavior or eventual suicide. All
subjects were evaluated with a structured clinical interview for assigning
DSM-III-R diagnoses, the Modified Scale for Suicidal Ideation, the suicidal
ideation subscale of the Suicide Probability Scale, and the Beck
Hopelessness Scale. RESULTS: The findings indicated the relative complexity
and importance of diagnostic comorbidity among these suicidal subjects.
Mood disorders were the most frequent primary diagnoses, followed by
phobias, posttraumatic stress disorder (PTSD), generalized anxiety
disorder, and panic disorder. Panic disorder was not present as an
isolated, independent diagnosis; on the contrary, all of the patients with
panic disorder also received at least one additional comorbid diagnosis.
Mean scores for suicidal ideation and hopelessness were greatest for
patients with current comorbid primary mood disorder and panic disorder.
However, a critical and equally important role was played by comorbid PTSD,
generalized anxiety disorder, and phobias. CONCLUSIONS: The findings
represent another failure to validate, with a specific clinical group,
panic disorder as an independent risk factor for suicidal ideation or
behavior. However, they highlight the possibility that panic disorder and
other anxiety disorders are risk factors when they co-occur with a primary
mood disorder.
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