Comorbid anxiety and anxiety disorders appear to be associated with increased suicidal behavior in bipolar disorder. Simon et al. (2004) found that a history of an anxiety disorder was an independent risk factor for a more severe and debilitative course of bipolar illness, and brought on higher risk of attempting suicide (odds ratio = 2.45, 95% CI = 1.4-4.2). Anxiety disorders were highly prevalent in this study, with a lifetime history of an anxiety disorder in 51.2% of the sample. A current anxiety disorder was present in 30.5% of subjects.
Henry et al. (2003) did not find such an association in a smaller sample of 318 subjects with bipolar disorder. Only 24% of this sample had a lifetime anxiety disorder, and there was no increase in suicide attempts in the subjects with a history of an anxiety disorder. This sample may not have had enough statistical power to find such a difference, and their negative finding may represent a type II error (i.e., failing to find a difference when one actually exists).
A high level of lifetime panic symptoms appears to be associated with both suicidal ideation, increased depression, and a much delayed time to recover from an index mood episode in subjects with bipolar I disorder (Frank et al. 2002). They postulate that panic spectrum symptoms in patients with bipolar disorder represent a high-risk group, even if they do not meet DSM-IV-TR syndromal criteria for panic disorder. The delay to recovery is striking, with the high-panic group taking 44 weeks to recover from an acute mood episode compared with 17 weeks in the low-panic group.
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