SUICIDE AND MORTALITY PATTERNS IN ANXIETY NEUROSIS AND DEPRESSIVE NEUROSIS

Background: The diverging views on suicide risk in patients with morbi d anxiety called for a sufficiently large study to estimate the suicid e risk in patients with anxiety neurosis and depressive neurosis. Meth ods: The identities of all 9912 patients with anxiety neurosis and all 38529 patients with depressive neurosis in the national Psychiatric C ase Register in Sweden between 1973 and 1983, without any other psychi atric diagnoses, were matched with the national Cause-of-Death Registe r. The observed causes of death among the 9910 patients who died in 19 90 or earlier were compared with those expected in the general populat ion. Results: There were 1481 determined and 265 undetermined suicides among the patients; ie, 18% of all deaths. The standardized mortality ratio of suicide before the age of 45 years among men and women with anxiety neurosis was 6.7 and 4.9, respectively; for depressive neurosi s, 12.6 and 15.7, respectively. The suicide risk was much higher withi n 3 months of leaving the hospital. Standardized mortality ratios of d eath caused by ischemic heart disease and traumatic injury were margin ally elevated among men in both diagnostic groups. Women in both categ ories were at increased risk for death caused by alcohol abuse and cir rhosis of the liver. Obstructive pulmonary disease was another notable cause of death, reflecting the aggravation of anxiety-depressive symp toms by airway obstruction or the effects of tobacco smoking. Conclus ions: The risk of completed suicide among former inpatients with prima ry anxiety neurosis was higher than in previous, smaller studies and h igher yet in patients with depressive neurosis. This hazard may hopefu lly be reduced by optimizing immediate and longterm treatment for the severely affected.