An interactive model of anxiety sensitivity relevant to suicide attempt history and future suicidal ideation

doi:10.1016/j.jpsychires.2011.10.009

Journal of Psychiatric Research

Volume 46, Issue 2, February 2012, Pages 174-180

https://doi.org/10.1016/j.jpsychires.2011.10.009 Get rights and content

Abstract

Recent reports of increasing suicide rates among military personnel indicate a need for increased work in understanding processes relevant to suicide risk in the military. Anxiety, along with anxiety-related risk factors have been implicated in suicidality as well as posttraumatic stress disorder (PTSD). One such risk factor, anxiety sensitivity (AS), refers to fear of anxiety-related symptoms. Subfactors of AS, notably the physical and cognitive concerns factors, appear to be relevant to the construct of acquired capability for suicidal behavior, a risk factor for death by suicide postulated by the Interpersonal-Psychological Theory of Suicide (Joiner, 2005, Van Orden et al., 2010). Study 1 examined the interaction of AS-cognitive concerns and AS-physical concerns in an outpatient sample with PTSD symptomatology (N = 128). Analyses were consistent with our a priori model and indicated that the interaction of AS-cognitive concerns by AS-physical concerns predicted previous suicide attempt. Specifically, those with high AS-cognitive concerns and low AS-physical concerns were at increased risk for suicide attempt. Study 2 prospectively examined the associations between AS and suicidal ideation in a sample of military cadets undergoing basic training (N = 1081). A similar interaction emerged such that high AS-cognitive and low AS-physical scores at Time 1 significantly predicted suicidal ideation several months later, even after controlling for Time 1 suicidal ideation and psychopathology. These findings suggest that suicide potential may be related to interactions between cognitive risk factors for anxiety among individuals with PTSD symptomatology as well as individuals experiencing stressful life events.

Section snippets

Sample and setting

The sample in this study consisted of 128 adult outpatients receiving psychological services at a university clinic who screened positive for PTSD during an initial screening interview. This positive screen for PTSD indicated that the patient endorsed the following 3 questions: 1) Did something terrible ever happen to you that kept coming back to you in some way like nightmares or flashbacks? 2) Do you try to avoid thinking about it? 3) Do you experience physical and anxiety symptoms, such as

Study 1 – results

History of a suicide attempt was found in 36.7% of the sample. In terms of diagnostic co-occurrence, 31.9% of previous attempters received a Major Depressive Disorder (MDD) diagnosis compared with 40.7% of non-attempters (χ² (1, n = 128) = .65, p = .421). A significantly higher percentage of past attempters received a personality disorder diagnosis (42.6%) than did non-attempters (12.3%; χ² (1, n = 128) = 13.49, p < .001).

Bivariate correlations between the measures are shown in Table 1. As

Study 2

One limitation of the findings from Study 1 is that the data are cross-sectional, so no inferences can be made about causality. As a more stringent test of the AS-suicidality association, we prospectively evaluated whether baseline levels of the AS subscales interacted to predict changes in suicidal ideation in a military sample undergoing a stressful life event.

Participants and procedure

Participants included 1081 first year cadets from the United States Air Force Academy (USAFA; see Schmidt et al. (1997) for more details on admission criteria of the USAFA). The cadets begin military training upon arrival with basic cadet training (BCT). BCT consists of five weeks of training, designed to continuously expose cadets to a variety of unpredictable and uncontrollable physical and mental stressors. Cadets are not given schedules and have no access to clocks or watches. New stressors

Study 2 – results

Time 2 suicidal ideation was found in 7.3% of the sample. T2 suicidal ideators were significantly higher on baseline depressive symptoms (t (86.63) = −6.49, p < .001), anxiety (t (94.75) = −5.08, p = < .001) and T1 suicidal ideation (t (84.70) = −9.56, p < .001). Bivariate correlations between the measures are shown in Table 4. As expected due to the similarity of the constructs, all measures were significantly correlated.

Direct logistic regression was performed to assess the impact of a number

Discussion

The findings of this study suggest that a combination of low physical AS concerns and high cognitive AS concerns are associated with increased rates of suicide attempt among those with significant PTSD symptoms and are a risk factor for suicidal ideation among individuals undergoing a stressful life event. Our results from Study 2 are consistent with those from Schmidt et al. (2001), who found that AS-cognitive was highly predictive of suicidal ideation in a sample of patients with panic

Role of funding source

Study 2 was supported by Uniformed Services University of the Health Sciences Grant RO72CF. The uniformed services university of the health sciences had no further role in study design, analysis and interpretation of the data; in the writing of the report; and in the decision to submit the paper for publication. The opinions or assertions construed herein are the private ones of the authors and are not to be construed as official or reflecting the views of the Department of Defense, the United

Contributors

Daniel Capron designed the idea for the manuscript, wrote the majority of the introduction, results and conclusion for study 1 and study 2 and coordinated the co-authors contributions.

Jesse Cougle helped write the introduction and discussion sections for both studies.

Jessica Ribeiro wrote the methods section for study 1 and provided feedback on the drafts.

Thomas Joiner provided feedback on all sections of the manuscript.

Brad Schmidt collected the data for study 2 and provided feedback on all

Conflict of interest

All authors declare they have no conflicts of interest.

Acknowledgment

We have no acknowledgments for the current manuscript.

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An interactive model of anxiety sensitivity relevant to suicide attempt history and future suicidal ideation

Abstract

Section snippets

Sample and setting

Study 1 – results

Study 2

Participants and procedure

Study 2 – results

Discussion

Role of funding source

Contributors

Conflict of interest

Acknowledgment

Clinical Psychology Review

Journal of Psychiatric Research

Journal of Anxiety Disorders

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Anxiety Disorders

Journal of Psychiatric Research

Behaviour Research and Therapy

Journal of Anxiety Disorders

Journal of Anxiety Disorders

Behaviour Research and Therapy

Measures for panic disorder and agoraphobia

An inventory for measuring clinical anxiety – psychometric properties

Journal of Consulting and Clinical Psychology

Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder

Journal of Abnormal Psychology

10 leading causes of injury related death – center for disease control

Psychological autopsy studies of suicide: a systematic review

Psychological Medicine

PTSD, depression, and their comorbidity in relation to suicidality: cross-sectional and prospective analyses of a national probability sample of women

Depression and Anxiety

Posttraumatic-stress-disorder in the community – an epidemiologic-study

Psychological Medicine

Structured clinical interview for the DSM-IV axis I disorders-patient edition (SCID-I/P-version 2)

Structured clinical interview for DSM-IV personality disorders (SCID-II)

Psychiatric diagnoses, trauma, and suicidiality

Annals of General Psychiatry