The assessment and treatment of suicide in panic disorder

Suicide is one of the most common causes of mortality. At present, the known risk factors of suicide are mood disorders, such as, depression, substance use disorders, schizophrenia, and socioeconomic factors, such as, divorce, separation by death, and unemployment [1]. Many researchers have tried to identify a biological marker that can predict suicide. Several studies have reported low serum cholesterol level is associated with suicidality [2], but reported results are inconsistent [3, 4]. In the absence of an available biological marker of suicide, a past suicide attempt is perhaps the best predictor of increased risk of suicide, even in the 21st century [5]. However, in view of the substantial numbers of mortalities resulting from first attempts at suicide [6, 7], the idea of using a past suicide attempt as a predictor of suicidal behavior is near useless in clinical practice. Suicide is believed to have three stages (suicide ideation, suicide plan, and suicide attempt), though suicide ideation and planning could be categorized as suicidal thinking, and suicide attempt as suicidal behavior. Suicidality, a word widely used in the field of psychiatry, refers to suicidal thinking and behavior in combination. To prevent suicide in the real world, it is essential to assess the risk of suicide before suicide behavior has commenced and to start treatment intervention during the suicidal thinking phase. It is well known that depressive disorders are strongly related with suicidality. However, it remains unclear whether anxiety disorders without other psychiatric comorbidities, such as, mood disorders or substance use disorder are related with suicidality [8]. The majority of research studies on the possible relationships between anxiety disorders and suicidality have usually focused on panic disorder. Although Weissman et al. suggested that panic disorder (PD) is associated with suicidality in their analysis of Epidemiologic Catchment Area (ECA) data [9], Hornig and McNally [10] failed to confirm this association using the same data after controlling for comorbidities using a different statistical method. In this chapter, the authors describe assessment methods for identifying the risk of suicide in PD and suggest interventions for preventing suicide in affected patients.