134 Ghaziuddin et al. © 2000 WILEY-LISS, INC. DEPRESSION AND ANXIETY 11:134–138 (2000) DA 00464 ANXIETY CONTRIBUTES TO SUICIDALITY IN DEPRESSED ADOLESCENTS Neera Ghaziuddin, M.D., 1 * Cheryl A. King, Ph.D., 2 Michael W. Naylor, M.D., 3 and Mohammad Ghaziuddin, M.D. 2 Several studies have suggested a positive association between anxiety symptoms and suicidality in adults. However, relatively little is known about this topic in adolescents. To investigate this issue, we examined a group of adolescents ad- mitted to our psychiatric inpatient unit. Fifty-six adolescents (mean age = 14.8±1.4; females = 34, males = 22; race = 95% Caucasians) participated in the study. Diagnoses were made using the DSM-III-R criteria and a diagnos- tic interview. Anxiety was found to significantly correlate with depression (r = .60; P = < .05) and suicidality (r = .72; P < .05). A multiple regression analy- sis revealed that anxiety and depression together accounted for more than half (55%) of the variance in suicidal ideation [F(2,46) = 28.4; P < .0001]. In addition, anxiety had an independent ability to predict suicidality (t = 5.01; P < .0001). Self-rated but not clinician-rated suicidality was positively corre- lated with both anxiety and depression. Clinical and research implications of these findings are discussed. Depression and Anxiety 11:134–138, 2000. © 2000 Wiley-Liss, Inc. Key words: adolescents; depression; suicide; anxiety INTRODUCTION Suicide is the third leading cause of death among adolescents and young adults between the ages of 15 and 24 years (National Center for Health Statistics, 1990). Psychiatric disorders generally found to predis- pose toward suicidal behavior in adults are depression, alcohol and substance abuse, and psychotic disorders [Hall et al., 1999]. Some studies have also suggested a link between both trait and state measures of anxiety dis- orders and suicidality [Apter et al., 1993; Johnson et al., 1990; Coryell et al., 1990; Fawcett et al., 1990; Hall et al., 1999]. Findings are, however, inconsistent and some have discounted the role of anxiety. For example, Noyes [1991] stated that “those with anxiety disorders infrequently express thought of ending their lives.” While several studies of suicidal adolescents have highlighted the role of mood disorders, substance abuse, antisocial aggressive behaviors, and conduct disorders [Carlson and Cantwell, 1980; Pfeffer et al., 1982], relatively little is known about the role of anxi- ety symptoms. The available information regarding the role of anxiety is sparse and conflicting. Kashani et al. [1990], using the Revised Children Manifest Anxi- ety Scale [RCMAS; Reynolds and Richmond, 1978], found higher levels of anxiety in a suicidal group of hospitalized children when compared with the non- suicidal sub-group. In a recent study of pre-pubertal children (age range = 8–11 years), Allan et al. [1998], also using the RCMAS among a group of suicidal chil- dren, identified a sub-group who were highly anxious. The suicidal-anxious children differed from the non- anxious-suicidal children in experiencing a greater number of adverse life-events, possessed poor social skills, and the parents identified themselves as being anxious and hostile. The authors concluded that there might exist a sub-group of “anxious-suicidal” youth who are significantly impaired and possibly at high risk for self-harm. Bettes and Walker [1986], using a clinical interview method among 7,828 black children, ranging in age from 11 to 18 years, identified a higher prevalence of anxiety among those who reported sui- cidal ideation compared with those without suicidal ideation. They also found that the suicidal boys were 1 Division of CHild and Adolescent Psychiatry, University of Michigan, Ann Arbor, Michigan 2 University of Michigan, Ann Arbor, Michigan 3 University of Chicago, Illinois *Correspondence to: Dr. Neera Ghaziuddin, University of Michi- gan Hospitals, 1500 East Medical Center Drive, Box 0390, Ann Arbor, MI 48l09-0390. E-mail: Neerag@umich.edu Received for publication 24 January 2000; Accepted 4 Febru- ary 2000