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Adult Separation Anxiety Raises Suicidality Risk

Separation nervousness performs a considerable function in suicidality in sufferers with temper and anxiety disorders, new analysis suggests.

Outcomes of a research that included 500 outpatients with temper or nervousness problems confirmed grownup separation anxiety disorder (ASAD) was extra frequent in sufferers with suicidal ideas vs those that didn’t have the dysfunction. As well as, depression and separation nervousness additionally considerably predicted lifetime suicide danger.

“This research signifies a considerable function of separation nervousness in predicting suicidal ideas, each as state-related signs…and as longitudinal dimension signs,” say the investigators, led by Stefano Pini, MD of the Division of Scientific and Experimental Medication, Part of Psychiatry, College of Pisa, Italy.

“Larger understanding of the affect of separation nervousness in sufferers with affective problems could encourage personalised interventions for lowering suicide danger,” they add.

The study was published within the March/April subject of the Journal of Scientific Psychiatry.

Ceaselessly Underdiagnosed

The authors describe a “shut hyperlink between suicidal behaviors and interpersonal difficulties extending past the standard strategy of comprehending suicide as a phenomenon primarily associated to melancholy.”

Earlier analysis signifies that insecure grownup attachment type is likely to be related to a higher chance of suicidal ideas and makes an attempt, and there is likely to be an affiliation between particular person irregular attachment sensitivity and suicide.

“Suicidal ideation or suicide makes an attempt could also be related to disturbances in attachment, which can lead not solely to a devastating expertise of shedding the sensation of interdependence and closeness but additionally to a rejection of life itself,” the authors counsel.

ASAD could also be a “key issue” in understanding the connection between particular person attachment sensitivity to separation and suicidality.

An ASAD prognosis was historically reserved for youngsters and adolescents, however DSM-5 expanded the prognosis to incorporate adults over age 18 years as a result of analysis had “discovered a later onset to be frequent,” spanning the life course, even within the absence of a historical past of separation nervousness in childhood.

“Separation nervousness is a crucial medical dimension, typically with roots in childhood, however prone to manifest throughout the lifespan,” the authors word, including that it’s “ceaselessly underdiagnosed.”

The connection between ASAD and suicidality has not been explored extensively, so the researchers got down to study the affiliation.

The research included 509 consecutively recruited grownup psychiatric outpatients with temper or nervousness problems as a precept prognosis.

Individuals accomplished an array of scales, together with merchandise Three on the Hamilton Despair Ranking Scale (HDRS), which measures suicidality, in addition to the Temper Spectrum Self-Report (MOODS-SR), a questionnaire evaluating lifetime suicidal signs.

Three scales have been used to measure separation nervousness dysfunction: the Structured Interview for Separation Nervousness Signs in Maturity/Childhood (SCI-SAS-A/C); the Separation Nervousness Symptom Stock (SASI); and the Grownup Separation Nervousness Scale (ASA-27).

Waxing and Waning

Of the overall pattern, 215 sufferers have been identified with separation nervousness dysfunction (imply age at onset 15 years). Of the overall pattern, 19.9% scored ≥ 1 on the HDRS merchandise 3, indicating the presence of suicidality.

Sufferers with suicidal ideas extra ceaselessly skilled ASAD, in contrast with these with out suicidal ideas (53.6% vs 39.6%, respectively, P = .01).

“All measures of grownup in addition to childhood separation nervousness have been considerably elevated within the group of sufferers with present suicidality, based mostly on HDRS merchandise 3,” the authors report.

Desk 1. Separation nervousness in temper and nervousness/OCD sufferers with vs with out present suicidality.

Scale Suicidality (n = 97) No Suicidality (n = 412) P worth
SASI 15.31 ± 9.4 12.88 ± 8.9 .017
SCI-SAS-C whole rating 7.93 ± 3.68 5.93 ± 3.87 < .001
SCI-SAS-A complete rating 9.11 ± 4.20 6.62 ± 4.40 < .001
ASA-27 34.82 ± 16.6 29.11 ± 15.6 .002

KEY: SASI = Separation Nervousness Symptom Stock; SCI-SAS-C = Structured Interview for Separation Nervousness Signs in Childhood; SCI-SAS-A = Structured Interview for Separation Nervousness Signs in Maturity; ASA-27 = Grownup Separation Nervousness Scale


Logistic regression discovered that ASAD, main melancholy, bipolar I, and bipolar II problems all predicted suicidal ideas.

Desk 2.

Dysfunction Odds ratio (95% CI)
Grownup separation nervousness 1.86 (1.16 – 2.97)
Main melancholy 7.13 (3.18 – 15.97)
Bipolar I dysfunction 8.15 (3.34 – 19.90)
Bipolar II dysfunction 8.16 (3.50 – 19.05)


A linear regression mannequin discovered that melancholy (P = .001) and ASA-27 separation nervousness (P = .001) considerably predicted lifetime suicide danger, based mostly on the MOODS-SR scale.

As well as, “mediation evaluation confirmed that, apart from a direct impact, there’s additionally an oblique impact of melancholy severity on the MOODS-SR suicidality rating via the ASA-27 rating, indicating that separation nervousness could act as an necessary mediating issue within the relationship between melancholy and suicidality,” the authors state.

The authors observe that separation nervousness “is a crucial medical dimension, typically with roots in childhood, however prone to wax and wane throughout the lifespan and even to manifest for the primary time throughout maturity.”

Therapy Goal?

Commenting on the research for Medscape Medical Information, Megan Rogers, PhD, postdoctoral analysis fellow, Mount Sinai Beth Israel, Mount Sinai Beth Israel, New York Metropolis, mentioned the findings “level to signs of separation nervousness as a possible indicator of suicidal ideation, and may these findings be replicated and prolonged via longitudinal analysis, it means that signs of separation nervousness could also be a related remedy goal in sure populations to mitigate suicide danger.”

Rogers, who’s the coed division director on the American Affiliation of Suicidology and was not concerned with the research, mentioned she thinks that research of suicide have centered extra on “particular person signs of separation nervousness, reminiscent of extreme fear about family members or misery when anticipating separation from family members, relatively than on separation nervousness as a categorical prognosis.”

Nonetheless, the research has necessary take-home message for working towards clinicians, Rogers mentioned. “In people with separation nervousness problems, significantly these with comorbid temper situations, it might be price conducting a extra thorough evaluation of suicide danger, given the potential of elevated suicidality in these sufferers.”

The research was supported partly by the German Analysis Basis and the Fondazione Cassa di Risparmio di la Spezia. The authors and Rogers have disclosed no related monetary relationships.

J Clin Psychiatry. Printed in March/April 2021 subject. Abstract

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