Anxiety symptoms and suicidal thoughts and behaviors among patients with mood disorders

Marsal Sanches, Linh K. Nguyen, Tong Han Chung, Paul Nestadt, Holly C. Wilcox, William H. Coryell, Jair C. Soares, Sudhakar Selvaraj

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Though the association between anxiety disorders and suicidal behavior is well-described, the impact of anxiety symptoms on suicidal thoughts and behaviors (STB) across different mood disorders is still unclear. Methods: We performed a registry-based retrospective study utilizing outcome measure data collected by the National Network of Depression Centers (NNDC), a nationwide nonprofit consortium of 26 leading clinical and academic member centers in the United States. The sample consisted of 2607 outpatients with mood disorders (major depressive disorder or bipolar disorders). Demographic and clinical variables were compared based on the presence or absence of STB and severity of anxiety symptoms (minimal, mild, moderate, and severe). Univariate and multivariable logistic regressions were conducted to examine the correlations of STB, considering multicollinearity. Results: Patients with mild, moderate, and severe anxiety symptoms had higher odds of STB than those with minimal symptoms. Gender, marital status, age, and depressive symptoms were other strong predictors of STB. There was no difference in the odds of STB between patients with major depressive disorder (MDD) and those with bipolar disorders (BD). However, the odds of suicidal ideation were slightly lower among patients with BD than those with MDD. Limitations: Our sample was comprised only of outpatients, limiting the generalization of our findings. Other limitations include the lack of structured interviews for diagnostic characterization of the patients and the utilization of data on anxiety and mood obtained solely through self-report scales. Conclusions: We found a cross-sectional association between the severity of anxiety symptoms and STB among patients with mood disorders. This study demonstrates the need for a suicide risk assessment in patients with mood disorders reporting anxiety symptoms.

Original languageEnglish (US)
Pages (from-to)171-177
Number of pages7
JournalJournal of Affective Disorders
StatePublished - Jun 15 2022


  • Anxiety
  • Bipolar disorder
  • Depression
  • Major depressive disorder
  • Suicidal attempts
  • Suicidal ideation
  • Mood Disorders/epidemiology
  • Cross-Sectional Studies
  • Humans
  • Risk Factors
  • Suicidal Ideation
  • Depressive Disorder, Major/epidemiology
  • Retrospective Studies

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology


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