Generalized anxiety disorder, psychiatric comorbidities, and suicide

Several studies have suggested a positive association between generalized anxiety disorder (GAD) and suicidal symptoms, particularly suicidal thoughts. Nevertheless, whether GAD is an independent risk factor for subsequent suicide is poorly understood. Analyzing data on the entire Taiwanese population (N = 29,077,426), we followed 322,855 patients with GAD and 1,291,420 individuals without GAD matched for birth date and sex over the period from 2003 to 2017. Deaths by suicide were confirmed using Taiwan’s Database of All-cause Mortality. Psychiatric disorders comorbid with GAD were also assessed, specifically schizophrenia, bipolar disorder, major depression, alcohol use disorder, substance use disorders, obsessive-compulsive disorder, and neurodevelopmental disorders. A total of 2,051 (0.64%) individuals died by suicide in the GAD group, and 1,378 (0.11%) died by suicide in the control group. Cox regression models with adjustments for demographic characteristics, psychiatric comorbidities, and Charlson Comorbidity Index scores demonstrated that both men (hazard ratio [HR]: 2.64, 95% confidence interval [CI]: [2.29, 3.05]) and women (HR: 2.70, 95% CI: [2.33, 3.13]) with GAD were more likely to die by suicide than individuals in the control group GAD was a risk factor for death by suicide when controlling for various sociodemographic and clinical factors,including comorbid schizophrenia, bipolar disorder, major depressive disorder, and alcohol and substance use disorders.Suicide prevention strategies must be developed for individuals with GAD and associated psychiatric comorbidities.