Relationship Between Adult Separation Anxiety Disorder and Suicide in Patients with Bipolar Disorder

Abstract

The present study aimed to investigate the comorbidity of Adult Separation Anxiety Disorder (ASAD) and the relationship between this comorbidity and suicide in patients with bipolar disorder (BD). A total of 138 outpatients with BD at remission between the ages of 18-65 years and 63 healthy controls were included in our study. All participants were administered a sociodemographic data form, Hamilton Depression Scale (HMDS), Young Mania Rating Scale (YMRS), Adult Separation Anxiety Questionnaire, and Structured Clinical Interview for Separation Anxiety Symptoms (ASAD-SCI). The age and gender of the participants did not differ significantly between the control group, the BD and BD+ASAD groups. The mean age of the participants was 42.3±11.9 years. When categorized according to gender, 42.3% of the participants were male and 57.7% were female. ASAD was detected in 46.3% of the participants. The suicide attempt rate was significantly higher in the BD and BD+ASAD groups than in the control group. The rate of suicide attempt was significantly higher in the BD+ASAD group than in the BD group. We demonstrated that the comorbidity of ASAD was associated with previous suicide attempts in patients with BD. Recognizing and treating ASAD in patients with BD may reduce suicide attempts in these patients.

Keywords

• Bipolar disorder
• suicidality
• separation anxiety

Bipolar Bozukluk Tanılı Hastalarda Yetişkin Ayrılma Anksiyete Bozukluğu ve İntihar Arasındaki İlişki

Abstract

Çalışmamızda bipolar bozukluk (BB) tanılı hastalarda Yetişkin Ayrılma Anksiyete Bozukluğu (YAAB) komorbiditesi ve bu komorbiditenin intihar ile ilişkisinin araştırılması amaçlanmıştır. Çalışmamıza ayaktan izlenen remisyonda BB tanılı 18-65 yaşları arasındaki 138 hasta ve 63 sağlıklı kontrol alınmıştır. Tüm katılımcılara tarafımızca hazırlanmış sosyodemografik veri formu, Hamilton Depresyon Ölçeği (HMDÖ), Young Mani Derecelendirme Ölçeği (YMDÖ), Yetişkin ayrılma anksiyete anketi, Ayrılma Anksiyetesi Belirtileri için Yapılandırılmış Klinik Görüşme (AAB-YKG) verilmiştir. Kontrol grubu, BB ve BB+YAAB grupları arasında katılımcıların yaşları ve cinsiyetleri anlamlı farklılık göstermemiştir. Katılımcıların yaş ortalaması 42,3±11,9 olarak tespit edilmiştir. Cinsiyet durumuna göre kategorize edildiğinde katılımcıların % 42,3’ü erkek olup % 57,7’si kadınlardan oluşmaktadır. Katılımcıların % 46,3’ünde YAAB tepit edilmiştir.BB ve BB+YAAB gruplarında intihar girişim oranı kontrol grubundan anlamlı olarak daha yüksekti. BB+YAAB olan grupta intihar girişim oranı BB grubundan anlamlı olarak daha yüksekti. Sonuçlarımız, BB tanılı hastalarda YAAB komorbiditesinin önceki intihar girişimleriyle ilişkili olduğunu göstermiştir. BB tanılı hastalarda YAAB’nin tanınması ve tedavi edilmesi bu hastalarda intihar girişimini azaltabilir.

Keywords

• bipolar bozukluk
• intihar
• ayrılma anksiyetesi
• Bipolar disorder
• suicidality
• separation anxiety

References

1. Abreu LND, Lafer B, Baca-Garcia E, Oquendo M A (2009) Suicidal ideation and suicide attempts in bipolar disorder type I: an update for the clinician. Brazilian Journal of Psychiatry, 31(3): 271-280.
2. Akdemir A, Örsel SD, Dağ İ, Türkçapar MH, İşcan N, Özbay H (1996) Hamilton depresyon derecelendirme ölçeği (HDDO)’nin geçerliliği-güvenilirliği ve klinikte kullanımı. Psikofarmakoloji Dergisi, 251–259.
3. American Psychiatric Association. (2013). DSM-5 Diagnostic Classification. In Diagnostic and Statistical Manual of Mental Disorders. https://doi.org/10.1176/appi.books.9780890425596.x00diagnosticclassification.
4. Angst F, Stassen HH, Clayton P J, Angst J (2002) Mortality of patients with mood disorders: follow-up over 34–38 years. Journal of affective disorders, 68(2-3): 167-181. Baldassano CF (2006) Illness course, comorbidity, gender, and suicidality in patients with bipolar disorder. In Journal of Clinical Psychiatry,67(11);8-11.
5. Cyranowski JM, Shear MK, Rucci P, Fagiolini A, Frank E, Grochocinski V J, et al. (2002) Adult separation anxiety: Psychometric properties of a new structured clinical interview. Journal of Psychiatric Research, 36(2): 77–86. https://doi.org/10.1016/S0022-3956(01)00051-6
6. Diriöz M, Alkin T, Yemez B, Eminaǧaoǧlu N, Onur E (2012) Psychometric properties of the Turkish version of the structured clinical interview for separation anxiety symptoms. Noropsikiyatri Arsivi, 49(1): 6–13. https://doi.org/10.4274/npa.5955
7. Diriöz M, Alkin T, Yemez B, Onur E, Eminaǧaoǧlu N (2012) The validity and reliability of turkish version of separation anxiety symptom inventory and adult separation anxiety questionnaire. Turk Psikiyatri Dergisi. https://doi.org/10.5080/u6364
8. Gesi C, Abelli M, Cardini A, Lari L, Di Paolo L, Silove D, Pini S (2013) Separation anxiety disorder from the perspective of DSM-5: Clinical investigation among subjects with panic disorder and associations with mood disorders spectrum. CNS Spectrums, 21(1): 70–75. https://doi.org/10.1017/S1092852914000807

9. Goodwin F, Jamison K (2007) Manic-depressive illness: bipolar disorders and recurrent depression.
10. Israel JA (2006) Remission in depression: Definition and initial treatment approaches. In Journal of Psychopharmacology, 20(3):5-10.
11. Karadağ F, Oral T, Yalçin FA, Erten E (2002) Young Mani Derecelendirme Ölçeğinin Türkiye’de Geçerlik ve Güvenilirliği. Turk Psikiyatri Dergisi, 13(2): 107–114.
12. Karaytuğ MO, Tamam L, Demirkol ME, Namlı Z, Gürbüz M (2021) The related factors with functionality and the comorbidity in the patients with adult seperation anxiety disorder. Klinik Psikiyatri Dergisi, 24(4): 481–490. https://doi.org/10.5505/KPD.2021.82957
13. Laursen TM (2011) Life expectancy among persons with schizophrenia or bipolar affective disorder. Schizophrenia Research, 131(1–3): 101–104. https://doi.org/10.1016/j.schres.2011.06.008
14. Manicavasagar V, Silove D, Wagner R, Drobny J (2003) A self-report questionnaire for measuring separation anxiety in adulthood. Comprehensive Psychiatry, https://doi.org/10.1053/comp.2003.50024
15. Patel NC, Patrick DM, Youngstrom EA, Strakowski SM, DelBello MP (2007) Response and remission in adolescent mania: Signal detection analyses of the young mania rating scale. Journal of the American Academy of Child and Adolescent Psychiatry, 46(5): 628–635. https://doi.org/10.1097/chi.0b013e3180335ae4
16. Pini S, Abelli M, Shear KM, Cardini A, Lari L, Gesi C, et al.(2010) Frequency and clinical correlates of adult separation anxiety in a sample of 508 outpatients with mood and anxiety disorders. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/j.1600-0447.2009.01480.x
17. Pini S, Mauri M, Muti M, Iazzetta P, Banti S, Cassano GB (2005) Clinical correlates and significance of separation anxiety in patients with bipolar disorder. Bipolar Disorders, 7(4): 370–376. https://doi.org/10.1111/j.1399-5618.2005.00216.x
18. Pini S, Abelli M, Muti M, Lari L, Cardini A, Manicavasagar V, et al. (2012) The relationship between adult separation anxiety disorder and complicated grief in a cohort of 454 outpatients with mood and anxiety disorders. Journal of Affective Disorders, 143(1–3): 64–68. https://doi.org/10.1016/j.jad.2012.05.026
19. Shear K, Jin R, Ruscio AM, Walters EE, Kessler RC.(2006). Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication. American Journal of Psychiatry. https://doi.org/10.1176/ajp.2006.163.6.1074
20. Simon NM, Otto MW, Wisniewski SR, Fossey M, Sagduyu K, Frank E, et al. (2004) Anxiety disorder comorbidity in bipolar disorder patients: Data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). American Journal of Psychiatry, 161(12): 2222–2229. https://doi.org/10.1176/appi.ajp.161.12.2222
21. Tasdemir A, Tamam L, Keskin N, Evlice YE (2016) Assessment of co-morbidity of adult separation anxiety in patients with bipolar disorder. Nordic Journal of Psychiatry. https://doi.org/10.3109/08039488.2015.1053098
22. Toni C, Perugi G, Frare F, Tusini G, Fountoulakis KN, Akiskal KK, et al.(2008) The clinical-familial correlates and naturalistic outcome of panic-disorder-agoraphobia with and without lifetime bipolar II comorbidity. Annals of General Psychiatry, 7. https://doi.org/10.1186/1744-859X-7-23
23. Young RC, Biggs JT, Ziegler VE, Meyer DA (1978) A rating scale for mania: Reliability, validity and sensitivity. British Journal of Psychiatry, 133(11): 429–435. https://doi.org/10.1192/bjp.133.5.429
24. Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K (2013) Severity classification on the Hamilton depression rating scale. Journal of Affective Disorders, 150(2): 384–388. https://doi.org/10.1016/j.jad.2013.04.028