The Association Between Anxiety and Suicidal Behavior in Adolescents

Can a Teen Anxiety Disorder Lead to Suicidal Behavior or a Suicide Attempt?

The short answer: yes.

That doesn’t mean a person with an anxiety disorder will attempt suicide. Nor does it mean anxiety causes suicidal behavior. In fact, data from the studies we cite below show that over 95 percent of individuals with an anxiety disorder never engage in suicidal behavior of any sort.

What it does mean, however, is that if your teen has an anxiety disorder, they’re at increased risk of attempting suicide.

The data that supports this assertion comes from the first ever large-scale meta-analysis performed on the relationship between the presence of a clinical anxiety disorder and a suicide attempt. Conducted in 2005, the study – The Relationship Between Anxiety Disorders and Suicide Attempts: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions – included records from 34,653 individuals collected over a period of two years. Study authors reported this alarming fact:

“Among individuals reporting a lifetime history of suicide attempt, over 70% had an anxiety disorder.”

To put that in context, we’ll zoom out and look at the big picture with regards to suicide and mental health disorders. Another large-scale meta-analysis, this one published in 2002 – Suicide and Psychiatric Diagnosis: A Worldwide Perspective – included data from 31 papers published between 1959 and 2001, and included records from 15,629 individuals. The authors of that study report this equally alarming fact:

“It is generally acknowledged that over 90% of those who commit suicide had a psychiatric diagnosis at the time of death…our overall results showed that 98% of those who committed suicide had a diagnosable mental disorder.”

Those are stark realities that anyone who lives with a mental health disorder – or anyone with a spouse, child, friend, or loved one who lives with a mental health disorder – should understand.

We’ll rephrase this information to make sure we’re clear:

The presence of a mental health disorder does not mean an individual will attempt suicide. However, among individuals who attempt suicide, expert analysis indicates that around 95 percent had a mental health disorder at the time of their suicide attempt. And among those, 70 percent had a diagnosed anxiety disorder.

These facts beg a critical question for parents of teens with an anxiety disorder:

When should a parent be concerned that their teen’s anxiety has risen to the level that they might consider suicide?

We’ll address that question now.

Anxiety Disorders and Suicidal Behavior: Overlapping Warning Signs

The first thing the parent of a teen with an anxiety disorder should understand is that any sudden escalation of symptoms is a red flag. An escalation of anxiety symptoms that occurs after a significant stressor or trauma is a major red flag. An escalation of symptoms that overlaps with the warning signs of suicide is more than a red flag: it may constitute a mental health emergency or crisis.

Let’s look at the symptoms of anxiety that are also warning signs for suicide:

  • Excessive or escalating anger and/or irritability
  • Withdrawal family, friends, and loved ones
  • Withdrawal from formerly favorite activities
  • Excessive or escalating agitation/restlessness
  • Extreme overreactions to small events
  • Disrupted sleep patterns
  • Extreme/sudden changes in mood or behavior
  • Excessive or escalating alcohol or drug use

[For a comprehensive list of the symptoms of anxiety, please read our article here. For a comprehensive list of the warning signs and risk factors for suicide, please read our article here.]

Parents of teens with a diagnosed anxiety disorder who show a significant increase in the overlapping symptoms listed above should consult their teen’s therapist or treatment team immediately. In other words – and in direct response to the question we pose above – we advise parents to consider the presence and/or escalation of these overlapping symptoms as an indication that their teen’s anxiety has risen to the level that they might consider suicide.

At this point, we also need to say in no uncertain terms that parents who think their teen is in danger of harming themselves or someone else should take action immediately. The best course of action is to go to the emergency room or call 911 right away. Do not wait. Mental health emergencies rarely resolve in a favorable way without professional help and support.

Clinical Anxiety and an Additional Mental Health Disorder Increases Suicide Risk

There are two more aspects of this discussion parents need to know about. First, they should be aware of the relationship between suicide and specific anxiety disorders. Second, they should be aware of the relationship between suicide, anxiety disorders, and the presence of additional mental health disorders.

When a teen has more than one mental health disorder at the same, they have what mental health professionals call co-occurring disorders. Teens with co-occurring mental health disorders receive what’s known as a dual diagnosis. The study we cite above published detailed data on the increased risk of suicide for people with anxiety and an additional mental health disorder, i.e. anxiety and a co-occurring disorder.

We’ll present that data now, beginning with the data on suicide attempts and specific anxiety disorders.

Relationship of Specific Anxiety Disorders with Suicide Attempts (SA)

  • Any anxiety disorder: 143% increased likelihood of SA
  • Panic disorder: 100% increased likelihood of SA
  • Social anxiety disorder: 110% increased likelihood of SA
  • Specific phobia: 58% increased likelihood of suicide attempt
  • Generalized anxiety disorder: 97% increased likelihood of SA
  • Posttraumatic stress disorder: 166% increased likelihood of SA

For the sake of clarity, we’ll make sure we’re on the same page with how to read/think of the items on the list above, using the first bullet as an example: an individual diagnosed with any anxiety disorder is 2.43 times more likely to attempt suicide than a person without any anxiety disorder. This is an odds ratio that translates to a 143% increased likelihood of attempting suicide.

We use the same language in the list below. The bullets contain data on how the presence of an anxiety disorder and other specific mental health disorders increases risk of a suicide attempt. In other words, the following list provides data on how the presence of an anxiety disorders and specific co-occurring disorders increase suicide risk.

Relationship Between Anxiety Disorders, Mood Disorders, Substance Disorders (SUD), Personality Disorders, and Suicide Attempts (SA)

  • Anxiety disorder + mood disorder (e.g. depression, bipolar disorder) compared to individuals with no mental health disorder:
    • 450% increased likelihood of SA
  • Mood disorder only, compared to individuals with no mental health disorder:
    • 285% increased likelihood of SA
  • Anxiety disorder + SUD (e.g. alcohol use disorder, opioid use disorder), compared to individuals with no anxiety, mental health, or substance use disorder:
    • 219% increased likelihood of SA
  • SUD only, compared to individuals with no mental health disorder:
    • 98% increased likelihood of SA
  • Anxiety disorder + personality disorder (e.g. borderline personality disorder, psychosis) compared to individuals with no mental health disorder:
    • 499% increased likelihood of SA
  • Personality disorder only, compared to individuals with no mental health disorder:
    • 212% increased likelihood of SA

The data clearly indicates that the presence of an additional mental health disorder alongside an anxiety disorder substantially increases risk of suicide attempt. The increased risk is shocking: in almost all the examples, risk of suicide is double or more when an individual has anxiety and an additional mental health disorder.

That’s the last of the data we have to share on this subject. To sum up this article, we’ll reiterate the big picture takeaways for parents of teens with an anxiety disorder.

Teen Anxiety Disorders and Suicide Risk

Evidence from decades of research shows that a significant percentage of people who attempt suicide have a mental health disorder. That figure is somewhere between 90 and 98 percent. The same research indicates that among people who attempt suicide, 70 percent have/had an anxiety disorder at the time of their suicide attempt.

Those numbers are scary: that’s why we present the warning signs of suicide as they specifically overlap with the signs and symptoms of anxiety. Parents who observe these warning signs in their teens with a diagnosed anxiety disorder should take them very seriously. As we mention above, when the symptoms of anxiety that overlap with the warning signs of suicide appear, parents should consider taking two important steps. First, if their child is not in immediate danger, we recommend contacting their teen’s therapist or treatment team. Second, if their child is in immediate danger, we recommend calling 911 or going to the emergency room immediately.

With all of that said, we’ll end this article by reminding parents of something we mentioned at the beginning of the article. Although a significant percentage of people who attempt suicide have a mental heath disorder, only a small percentage – 3.4% – of people with an anxiety disorder attempt suicide.

Why?

Our position is that treatment works – and treatment for anxiety is particularly effective.

Teens diagnosed with anxiety – whether it’s general anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder, or posttraumatic stress disorder (PTSD) – can learn to manage the symptoms of their anxiety and go on to live productive and fulfilling lives. The most effective treatment for anxiety is a combination of therapy, medication, and lifestyle changes. To learn specific steps you can take to help your teen manage their anxiety, please read our article here.

Parents seeking professional support for their teen with anxiety can find the best available evidence-based treatment by consulting the resources we offer below.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.