Predicting six month follow‐up of suicidal thoughts and attempts among youth with anxiety presenting to an emergency department

Abstract Background Previous research has established an association between anxiety disorders and suicidal thoughts and attempts; however, much remains unknown about the role of specific anxiety symptoms, anxiety severity, and the impact of co‐occurring depression and hopelessness. This study examined (a) the independent relationship between anxiety severity and suicidal thoughts and attempts, and (b) the independent relationships between different anxiety symptoms and suicidal thoughts and attempts. Additionally, we analyzed a subset of youth with anxiety symptoms to examine, (c) depression severity and hopelessness as predictors of suicidal thoughts and attempts. Methods Participants were 2104 youth (ages 12–17) who presented to an Emergency Department (ED) from the Emergency Department Screen for Teens at Risk for Suicide (ED‐STARS) cohort. Youth self‐reported anxiety, depression, and hopelessness at baseline and reported suicidal thoughts and attempt at three‐ and/or 6‐month follow‐up. Among the subset of 652 youth with anxiety (≥3 on SCARED‐C), depression and hopelessness were examined as predictors of suicidal thoughts and attempts. Results Anxiety severity significantly predicted ideation at follow‐up, even after accounting for demographics (race/ethnicity, sex, parental education, welfare), depression, hopelessness, and previous suicide attempts (OR = 1.08, 95% CI [1.01–1.61]). However, anxiety severity did not predict suicide attempts after accounting for depression. Specific anxiety domains were not associated with attempts, and only separation anxiety was associated with ideation (OR = 1.04, 95% CI [1.00–1.08]). Among the subset of youth reporting anxiety, depression severity was associated with suicide attempts at follow‐up, (OR = 1.08, 95% CI [1.04–1.14]). Depression (OR = 1.11, 95% CI [1.08–1.15]) and hopelessness (OR = 1.03, 95% CI [1.01–1.05]) each uniquely predicted suicidal ideation. Conclusion Anxiety severity, rather than specific anxiety domains, may drive subsequent suicidal thoughts and attempts. Among youth with anxiety, depression predicted both attempts and ideation at follow‐up, whereas hopelessness predicted only ideation. Shared aspects of anxiety and depression may underlie youth suicide risk.