Self-harm behaviors are associated with increased risk for Suicide Attempts among those with Social Anxiety Disorder: A review of “Suicide attempts versus nonsuicidal self-injury among individuals with anxiety disorders in a nationally representative sample”

Article summary provided by Kathryn Zumberg

 

THE MAIN POINT:

In a recent study, Chartand, Sareen, Toews and Bolton (2012) examined whether anxiety disorders were associated with an increased risk of self-harm behaviors and found that they were. Notably, the authors found that social phobia, also referred to as social anxiety disorder, and generalized anxiety disorder were associated with more suicide attempts versus non-suicidal self-injury. Overall, this article points to the importance of monitoring self-harm behaviors and suicide ideation in those suffering from anxiety disorder, particularly social phobia.

 

 

THE DETAILS:

What were the goals of this study?

There were three main goals for this study:

1. 1. To examine whether anxiety disorders were associated with self-harm behaviors, including non-suicidal self-injury and suicide attempts.
2. 2. To investigate whether particular anxiety disorders were more associated with more lethal self-harm behaviors.
3. 3. To examine whether particular disorders were associated with more frequent self-harm behaviors.

 

What are self-harm behaviors?

Chartrand et al. (2012) categorize self-harm behaviors as behaviors that are meant to cause harm to the self. When these behaviors are not highly lethal or are not aimed at causing death, the authors categorize them as non-suicidal self-injury, while those that are meant to cause death are deemed as suicide attempts. The authors noted that many past studies have failed to consider the distinction between these two types of self-harm behaviors, which is problematic because it limits the ability to understand whether or not anxiety disorders are associated with lethal suicide attempts.

 

How did the authors examine the study goals?

The authors used an epidemiological survey to ask a nationally representative sample of individuals questions about demographic variables, anxiety disorder diagnoses, mood disorder diagnoses, substance use disorder diagnoses, and self-harm behaviors. The responses from these questions were then analyzed so that the relationships between anxiety disorders and self-harm behaviors could be examined, after controlling for important demographic variables and other mood and substance use disorders, which are also known to be associated with self-harm behaviors.

 

What were the main findings from this study?

There were three main findings:

1. 1. Anxiety disorders were associated with great self-harm behaviors, including both non-suicidal self-injury and suicide attempts. Importantly, this relationship was found after controlling for the impact of other variables known to be associated with self-harm behaviors, such as mood and substance disorders.
2. 2. Only social phobia and generalized anxiety disorder were associated with increased risk of suicide attempts versus non-suicidal self-injury.
3. 3. Social phobia and generalized anxiety disorder were also associated with multiple incidents of deliberate self-harm, including suicide attempts.

 

What are the clinical implications of this study?

Given that this study found that sufferers of anxiety disorders are at an increased risk for self-harm behaviors (regardless of whether they also suffer from a mood or substance use disorder), it is important to assess and monitor these individuals for self-harm behaviors and suicide risk. In addition, the authors noted that social phobia and generalized anxiety disorder were associated with the most self-harm behaviors and suicide attempts, which suggests that clinicians should be especially mindful of risk assessments for individuals with these diagnoses.

How can I learn more about this study and the assessment of suicide risk?

If you would like to learn more about this study, please click the following link:

http://onlinelibrary.wiley.com/doi/10.1002/da.20882/full

 

If you would like to learn more about the assessment of suicide risk, please click the following link:

http://bestpractice.bmj.com/best-practice/monograph/1016/diagnosis/step-by-step.html

 

For more comprehensive information on this the topic of suicide assessment, you may consider purchasing the book “Suicide Risk Management: A Manual for Health Professionals”, which is available on amazon.com.

http://www.amazon.com/Suicide-Risk-Management-Manual-Professionals/dp/0470978562

 

References

Chartrand, H., Sareen, J., Toews, M., & Bolton, J. M. (2012). Suicide attempts versus nonsuicidal self-injury among individuals with anxiety disorders in a nationally representative sample. Depression and Anxiety, 29(3), 172-179. doi: 10.1002/da.20882