Suicidal Ideation in Anxiety-Disordered Youth: Identifying Predictors of Risk

Abstract

Evidence is mixed regarding an independent association between anxiety and suicidality. Beyond associations with demographic factors and depression, do anxiety disorders increase risk for suicidality in youth? Given that not all anxiety-disordered youth experience suicidal ideation, potential predictors of risk also require investigation. The present study examined (a) the independent relationship between anxiety and suicidal ideation and (b) emotion dysregulation and distress intolerance as predictors of risk for suicidal ideation in a sample of anxiety-disordered youth aged 7 to 17 (N = 86, M = 11.5). Youth and their parents reported on suicidality, emotion dysregulation, and distress intolerance. Distress tolerance was also measured by a computerized behavioral task. Results support an independent relationship between anxiety symptomatology and youth-reported suicidal ideation, controlling for depressive symptoms. Youth self-report of emotion dysregulation and distress intolerance predicted higher levels of suicidal ideation in univariate analyses. In a multivariate analysis including all significant predictors, only anxiety symptomatology uniquely predicted suicidal ideation. Results provide recommendations for the assessment and treatment of suicidality in anxiety-disordered youth. Suggestions for future research investigating the relationship between anxiety and suicidal ideation are offered.

Acknowledgments

This article was supported by a Fellowship from the American Psychological Foundation awarded to Kelly A. O'Neil Rodriguez and facilitated by funding from NIMH (MH063747) awarded to Philip C. Kendall.

Notes

Note. N = 86. AD-SI = Anxiety Disorder with Suicidal Ideation; AD-NSI = Anxiety Disorder without Suicidal Ideation; GAD = Generalized Anxiety Disorder; SAD = Separation Anxiety Disorder; OCD = Obsessive Compulsive Disorder; AD-NOS = Anxiety Disorder; Not Otherwise Specified; CDI = Child Depression Inventory; CGAS = Clinician Global Assessment Scale; CSR = Clinician Severity Rating.

^a n = 50.

^b n = 36.

*p < .05.

¹Given concerns about the nonnormal distribution of the SIQ scores, all analyses involving SIQ scores were also conducted using a categorical approach (SIQ score of zero or nonzero) in logistic regression, as well as using a log transformation of the SIQ scores in multiple regression. There were no differences in the significance of any reported findings using these alternate analytic approaches. Thus, multiple regression analyses using nontransformed SIQ scores are presented for ease of interpretation.

Note. SIQ-JR = Suicidal Ideation Questionnaire–Junior; MASC = Multidimensional Anxiety Scale for Children; CDI = Children's Depression Inventory; CEMS = Children's Emotion Management Scales; ERC = Emotion Regulation Checklist; DTS = Distress Tolerance Scale; BIRD = Behavioral Indicator of Resiliency to Distress.

*p < .05. **p < .01.

Note. N = 86. CDI = Children's Depression Inventory; MASC = Multidimensional Anxiety Scale for Children.

*p < .05. ***p < .001.

Note. N = 86. Nagelkerke R ² = .14. CDI = Children's Depression Inventory; MASC = Multidimensional Anxiety Scale for Children.

*p < .05.

Note. n = 64. CDI = Children's Depression Inventory; MASC = Multidimensional Anxiety Scale for Children; CEMS = Children's Emotion Management Scales; DTS = Distress Tolerance Scale.

**p < .01. ***p < .001.