Comorbid Anxiety Increases Suicidal Risk in Bipolar Depression: Analysis of 9720 Adolescent Inpatients
Open accessAbstract
Objective: To evaluate the risk of association between suicidal behaviors and comorbid anxiety disorders in adolescents with bipolar depression. Methods: We conducted a cross-sectional study using the nationwide inpatient sample (NIS) from the United States. This study included 9720 adolescent inpatients with bipolar depression and further grouped by co-diagnosis of anxiety disorders. Logistic regression analysis was used to evaluate the odds ratio (OR) of suicidal behaviors due to comorbid anxiety after controlling demographic confounders and psychiatric comorbidities. Results: Out of total inpatients, 34.8% (n = 3385) had comorbid anxiety disorders with a predominance in females (70.3%) and White patients (67.7%). About 54.1% of inpatients with comorbid anxiety had suicidal behaviors versus 44.6% in the non-anxiety cohort (p < 0.001). Comorbid anxiety disorders were associated with 1.35 times higher odds (95% CI 1.23–1.47, p < 0.001) for suicidal behaviors. Conclusion: Suicidal behaviors are significantly prevalent in bipolar depression adolescents with comorbid anxiety disorders. Anxiety disorders are an independent risk factor in bipolar depression that increase the risk of suicidal behaviors by 35%. This necessitates careful assessment and management of comorbid anxiety disorders in bipolar youth to mitigate suicidality.
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Social anxiety disorder is associated with increased rates of suicidal ideation and behaviour in people with bipolar disorder.
“Several investigations have linked social anxiety disorder with increased rates of suicidal ideation and behaviour (Perroud et al. 2007; Kocabas et al. 2019; Amuk and Patel 2020; Masi et al. 2021), as well as with substance use problems (Yapici Eser et al. 2018) in people with bipolar disorder.”
From Cognitive behavioural therapy for social anxiety disorder in people with bipolar disorder: a case series (2024) · cites this paper as Amuk and Patel 2020
The Results (section 3; page not available) associate comorbid anxiety disorders with higher odds of suicidal behaviors among adolescent inpatients with bipolar depression. The paper does not establish this association specifically for social anxiety disorder, and the Discussion (section 4; page not available) says the study did not distinguish suicidal ideation from attempts. (LLM, conf=0.90)
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Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2010.05.017 · Cited by 6,278 · see citing works
Perlis, R. H., Miyahara, S., Marangell, L. B., Wisniewski, S. R., Ostacher, M., DelBello, M. P., Bowden, C. L., Sachs, G. S., & Nierenberg, A. A. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.01.022 · Cited by 852 · see citing works
Simon, N. M., Otto, M. W., Wisniewski, S. R., Fossey, M. D., Sagduyu, K., Frank, E., Sachs, G. S., Nierenberg, A. A., Thase, M. E., Pollack, M. H., et al. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.12.2222 · Cited by 558 · see citing works
Chen, Y.-W., & Dilsaver, S. C. (1996) · Biological Psychiatry · doi:10.1016/0006-3223(95)00295-2 · Cited by 509 · see citing works
Grant, B., Hasin, D., Stinson, F., Dawson, D., Ruan, W., Goldstein, R., Smith, S. M., Saha, T., & Huang, B.-J. (2005) · Psychological Medicine · doi:10.1017/s0033291705006069 · Cited by 437 · see citing works
Bentley, K. H., Franklin, J. C., Ribeiro, J. D., Kleiman, E. M., Fox, K. R., & Nock, M. K. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2015.11.008 · Cited by 422 · see citing works
Trends in Mental Health Care among Children and Adolescents
Olfson, M., Druss, B. G., & Marcus, S. C. (2015) · New England Journal of Medicine · doi:10.1056/nejmsa1413512 · Cited by 408 · cited 2× · see citing works
“As per a study in adolescent outpatient mental health service, BP was more prevalent in White patients, as adolescents from minority groups may have limited access to mental health services with a lower diagnosis rate [19].”
BackgroundResultLeverich, G. S., Altshuler, L. L., Frye, M. A., Suppes, T. M., Keck, P. E., McElroy, S. L., Denicoff, K. D., Obrocea, G. V., Nolen, W. A., Kupka, R., et al. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n0503 · Cited by 354 · see citing works
KAWAKAMI, N., TAKESHIMA, T., ONO, Y., UDA, H., HATA, Y., NAKANE, Y., NAKANE, H., IWATA, N., FURUKAWA, T. A., & KIKKAWA, T. (2005) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2005.01397.x · Cited by 340 · see citing works
Kendler, K. S. (1996) · PubMed · Cited by 340 · see citing works
Cultural differences in perceived social norms and social anxiety
Heinrichs, N., Rapee, R. M., Alden, L., Bögels, S. M., Hofmann, S. G., Oh, K. J., & Sakano, Y. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.09.006 · Cited by 333 · see citing works
A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders
Asnaani, A., Richey, J. A., Dimaite, R., Hinton, D. E., & Hofmann, S. G. (2010) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e3181ea169f · Cited by 331 · see citing works
Berkson's Bias, Selection Bias, and Missing Data
Westreich, D. J. (2011) · Epidemiology · doi:10.1097/ede.0b013e31823b6296 · Cited by 323 · see citing works
Kendler, K. S. (1996) · British Journal of Psychiatry · doi:10.1192/s0007125000298437 · Cited by 262 · see citing works
Caldwell-Harris, C., & Ayçiçeği, A. (2006) · Transcultural Psychiatry · doi:10.1177/1363461506066982 · Cited by 219 · see citing works
Simon, N. M., Zalta, A. K., Otto, M. W., Ostacher, M. J., Fischmann, D., Chow, C. W., Thompson, E. H., Stevens, J., Demopulos, C. M., Nierenberg, A. A., et al. (2006) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2006.08.004 · Cited by 180 · see citing works
Anxious and non-anxious bipolar disorder
Trevor Young, L., Cooke, R. G., Robb, J. C., Levitt, A. J., & Joffe, R. T. (1993) · Journal of Affective Disorders · doi:10.1016/0165-0327(93)90118-4 · Cited by 178 · see citing works
ROBERTS, R. E., Roberts, C. R., & Xing, Y. (2007) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2006.12.010 · Cited by 177 · see citing works
Hauser, M., Galling, B., & Correll, C. U. (2013) · Bipolar Disorders · doi:10.1111/bdi.12094 · Cited by 168 · see citing works
Marangell, L. B., Bauer, M. S., Dennehy, E. B., Wisniewski, S. R., Allen, M. H., Miklowitz, D. J., Oquendo, M. A., Frank, E., Perlis, R. H., Martinez, J. M., et al. (2006) · Bipolar Disorders · doi:10.1111/j.1399-5618.2006.00369.x · Cited by 139 · see citing works
Anxiety in Major Depression: Relationship to Suicide Attempts
Placidi, G. P. A., Oquendo, M. A., Malone, K. M., Brodsky, B. S., Ellis, S. P., & Mann, J. J. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.10.1614 · Cited by 138 · see citing works
Prospective study of risk factors for attempted suicide among patients with bipolar disorder
Valtonen, H. M., Suominen, K. H., Mantere, O., Leppämäki, S., Arvilommi, P., & Isometsä, E. T. (2006) · Bipolar Disorders · doi:10.1111/j.1399-5618.2006.00341.x · Cited by 132 · see citing works
Craney, J. L., & Geller, B. (2003) · Bipolar Disorders · doi:10.1034/j.1399-5618.2003.00044.x · Cited by 124 · see citing works
Comorbidity in pediatric bipolar disorder: Prevalence, clinical impact, etiology and treatment
Frías, Á., Palma, C., & Farriols, N. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.12.008 · Cited by 110 · see citing works
Suicide in bipolar disorder: a review.
Látalová, K., Kamarádová, D., & Praško, J. P. (2014) · PubMed · Cited by 102 · see citing works
Anxiety disorders in adolescence: Characteristics, prevalence, and comorbidities
Clark, D. B., Smith, M. G., Neighbors, B., Skerlec, L. M., & Randall, J. (1994) · Clinical Psychology Review · doi:10.1016/0272-7358(94)90012-4 · Cited by 93 · see citing works
Bipolar disorder in children and adolescents
Birmaher, B. B. (2013) · Child and Adolescent Mental Health · doi:10.1111/camh.12021 · Cited by 92 · see citing works
Does psychosis increase the risk of suicide in patients with major depression? A systematic review
Zalpuri, I., & Rothschild, A. J. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.03.035 · Cited by 82 · see citing works
Dilsaver, S. C., Akiskal, H. S., Akiskal, K. K., & Benazzi, F. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.07.008 · Cited by 75 · see citing works
Symptom components of standard depression scales and past suicidal behavior
Grunebaum, M. F., Keilp, J. G., Li, S., Ellis, S. P., Burke, A. K., Oquendo, M. A., & Mann, J. J. (2005) · Journal of Affective Disorders · doi:10.1016/j.jad.2005.03.002 · Cited by 67 · see citing works
Ethnic Differences in Adolescent Suicide in the United States.
Balis, T. G., & Postolache, T. T. (2008) · PubMed · Cited by 64 · see citing works
Comorbid Anxiety in Children and Adolescents With Bipolar Spectrum Disorders
Sala, R., Axelson, D., Castro‐Fornieles, J., Goldstein, T. R., Ha, W., Liao, F., Gill, M. K., Iyengar, S., Strober, M. A., Goldstein, B. I., et al. (2010) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.09m05845gre · Cited by 58 · see citing works
Suicidality in Pediatric Bipolar Disorder
Goldstein, T. R. (2009) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2008.11.005 · Cited by 44 · see citing works
Comorbid sleep disorders and suicide risk among children and adolescents with bipolar disorder
Stanley, I. H., Hom, M. A., Luby, J. L., Joshi, P. T., Wagner, K. D., Emslie, G. J., Walkup, J. T., Axelson, D., & Joiner, T. E. (2017) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.07.027 · Cited by 43 · see citing works
Comorbid anxiety in bipolar disorder: does it have an independent effect on suicidality?
Nakagawa, A., Grunebaum, M. F., Sullivan, G. M., Currier, D., Ellis, S. P., Burke, A. K., Brent, D. A., Mann, J. J., & Oquendo, M. A. (2008) · Bipolar Disorders · doi:10.1111/j.1399-5618.2008.00590.x · Cited by 39 · see citing works
Patel, R. S., Onyeaka, H., & Youssef, N. A. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113231 · Cited by 38 · see citing works
Self-citationThe effect of comorbid substance use disorders on treatment outcome for anxiety disorders
McEvoy, P. M., & Shand, F. (2008) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2007.11.007 · Cited by 33 · see citing works
Malhi, G. S., Outhred, T., & Irwin, L. (2019) · The Canadian Journal of Psychiatry · doi:10.1177/0706743719847341 · Cited by 30 · see citing works
Hawke, L. D., Provencher, M. D., Parikh, S. V., & Zagorski, B. (2013) · The Canadian Journal of Psychiatry · doi:10.1177/070674371305800704 · Cited by 28 · see citing works
The inventory of suicide orientation-30: Further validation with adolescent psychiatric inpatients
Osman, A., Gutierrez, P. M., Barrios, F. X., Bagge, C. L., Kopper, B. A., & Linden, S. C. (2004) · Journal of Clinical Psychology · doi:10.1002/jclp.20086 · Cited by 25 · see citing works
Anxiety disorders and childhood maltreatment as predictors of outcome in bipolar disorder
Pavlová, B., Perroud, N. A., Cordera, P., Uher, R., Alda, M., Dayer, A. G., & Aubry, J. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.08.048 · Cited by 24 · see citing works
Association Between Migraine and Suicidal Behaviors: A Nationwide Study in the USA
Friedman, L. E., Zhong, Q., Gelaye, B., Williams, M. A., & Peterlin, B. L. (2017) · Headache The Journal of Head and Face Pain · doi:10.1111/head.13235 · Cited by 24 · see citing works
Bipolar depression in children and adolescents
DeFilippis, M., & Wagner, K. D. (2013) · CNS Spectrums · doi:10.1017/s1092852913000217 · Cited by 21 · see citing works
Depression in Asian American children.
Abright, A. R., & Chung, H. (2002) · PubMed · Cited by 10 · see citing works
Bipolar II Disorder: Not So Sure It Is Time for Something New
Post, R. M. (2019) · The Canadian Journal of Psychiatry · doi:10.1177/0706743719852097 · Cited by 6 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [18]Petersen A.C. Craighead W.E. Emotional and personality development in normal adolescents and young adults Suicide and Depression among Adolescents and Young Adults Klerman G. American Psychiatric Press New York, NY, USA 1986 1239 1243
Cited by
Sorted by citations
Comorbidities in Youth with Bipolar Disorder: Clinical Features and Pharmacological Management
Sesso, G., Brancati, G. E., & Masi, G. (2022) · Current Neuropharmacology · doi:10.2174/1570159x20666220706104117 · Cited by 30 · see citing works
de la Barrera, U., Montoya‐Castilla, I., Pérez‐Albéniz, A., Lucas‐Molina, B., & Fonseca‐Pedrero, E. (2020) · Archives of Suicide Research · doi:10.1080/13811118.2020.1823918 · Cited by 24 · see citing works
Amanollahi, M., Jameie, M., Looha, M. A., Basti, F. A., Cattarinussi, G., Moghaddam, H. S., Camillo, F. D., Akhondzadeh, S., Pigoni, A., Sambataro, F., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.06.061 · Cited by 23 · see citing works
Vilmosh, N., Delev, D. P., Kostadinov, I., Zlatanova, H., Georgieva-Kotetarova, M., Kandilarov, I., & Kostadinova, I. I. (2022) · Journal of Integrative Neuroscience · doi:10.31083/j.jin2105124 · Cited by 21 · see citing works
Masi, G., Lupetti, I., D’Acunto, G., Milone, A., Fabiani, D., Madonia, U., Berloffa, S., Lenzi, F., & Mucci, M. (2021) · Brain Sciences · doi:10.3390/brainsci11060790 · Cited by 19 · see citing works
Basith, S. A., Nakaska, M. M., Sejdiu, A., Shakya, A., Namdev, V., Gupta, S., Mathialagan, K., & Makani, R. D. (2021) · Cureus · doi:10.7759/cureus.15602 · Cited by 10 · see citing works
Pavlova, B., Warnock-Parkes, E., Alda, M., Uher, R., & Clark, D. M. (2024) · International Journal of Bipolar Disorders · doi:10.1186/s40345-023-00321-8 · Cited by 5 · see citing works
Primavera, D., Urban, A., Cantone, E., Nonnis, M., González, C. I. A., Perra, A., Tusconi, M., & Sancassiani, F. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13144203 · Cited by 5 · see citing works
Deng, Y., & He, J. (2022) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001572 · Cited by 2 · see citing works
Troubles bipolaires et risque suicidaire
Lengvenytė, A., & Courtet, P. (2023) · Elsevier eBooks · doi:10.1016/b978-2-294-77180-4.00028-7
The role of social anxiety in suicidal risk among university students in Northern Morocco
Echater, S., Bousgheïri, F., Sammoud, K., Benhaddouch, Y., Lemrabett, S., Senhaji, M., Najdi, A., & Ammouri, A. E. (2025) · BJPsych International · doi:10.1192/bji.2025.10055
- Authors
- Amuk, O. C., & Patel, R. S.
- Affiliations
- Department of Psychiatry, School of Medicine, Koç University, Davutpaşa Caddesi No. 4 Topkapı, İstanbul 34010, Turkey
- Department of Psychiatry, Griffin Memorial Hospital, Norman, OK 73071, USA
- Corresponding author
- Patel, Rikinkumar S.
- ORCID
- Patel, Rikinkumar S.
- Venue
- Behavioral Sciences
- Publisher
- MDPI AG
- Published
- 2020-07-04
- Volume
- 10
- Issue
- 7
- Pages
- 108
- ISSN
- 2076-328X (ISSN-L)
- PMC
- PMC7408112
- OpenAlex
- W3038375109
- Cited by
- 11
- References
- 45
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 1
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- Behavioral Sciences (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Collections portal (Koç University) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- bipolar depression, comorbid anxiety disorders, suicidal behavior, suicide risk, adolescents, psychiatric comorbidity, psychiatric inpatients
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