Suicide constitutes a worldwide public health problem. Though previously overshadowed by the association between mood disorders and suicide, the role of anxiety disorders in conceptualizing, assessing, and treating suicidal ideation and behaviors is now a topic of considerable interest among researchers and clinicians. In this chapter we provide an overview of the empirical evidence linking anxiety disorders and symptoms to suicidal ideation and behaviors, both as an independent risk factor and in the context of comorbid disorders. We then present key considerations in conducting suicide risk assessments among individuals with anxiety presentations. A discussion of updated best-care practices for crisis management and a summary of established and emerging treatment options for patients identified as having elevated suicide risk follow. We conclude with suggestions for future research in the area of suicide and anxiety disorders.

Background: Suicide is a leading cause of death among US veterans. Associations between depression, posttraumatic stress disorder (PTSD), and suicidal behaviors have been found in this population, yet minimal research has explored how manifestations of self-injurious behavior (SIB) may vary among different diagnostic presentations. Aims: This study aimed to identify clinically useful differences in SIB among veterans who experience comorbid mood disorder and PTSD (CMP) compared with those who experience a mood disorder alone (MDA). Method: Participants were 57 US military veterans who reported an incident of intentional SIB. The semistructured Post Self-Injury/Attempted Self-Injury Debriefing Interview was used to examine characteristics of the SIB. Results: Veterans diagnosed with CMP were more likely than those with MDA to (a) report that the SIB was impulsive and (b) to be under the influence of substances at the time of self-injury. Limitations: Generalizability may be limited by small sample size and predominantly European American, male demographics. While highly relevant to routine clinical practice, caution is recommended, as study diagnoses were attained from medical records rather than structured interviews. Conclusion: Safety planning that emphasizes protection against impulsive suicide attempts (e.g., means restriction) may be especially important among veterans with comorbid mood disorder and PTSD.

Individuals with multiple suicide attempts have a greater risk for eventual suicide death. We investigated clinical differences in participants with single versus multiple suicide attempts. Individuals with multiple attempts were more likely to have severe depressive symptoms, drug use disorder, and a higher wish to die. Borderline personality disorder traits and drug use disorder were significant predictors of multiple attempts when adjusting for other psychiatric disorders. Participants with multiple attempts sustained higher suicidal ideation-worst and wish to die/wish to live-worst scores during the 3-month assessment period. Clinical differences between individuals with multiple versus single attempts point to the need of tailored suicide prevention efforts.

From 2004 to 2008, the suicide rate among US Army Soldiers increased 80%, reaching a record high in 2008 and surpassing the civilian rate for the first time in recorded history. In recent years, the rate of Army suicides rose again; the year 2012 reflects the highest rate of military suicides on record. There is a need to assess current behavioral health practices to identify both effective and ineffective practices, and to adapt services to meet the needs of the Army behavioral health patient population. This paper discusses a process improvement initiative developed in an effort to improve clinical processes for suicide risk mitigation in an Army behavioral health clinic located in the catchment area of the US Army Southern Regional Medical Command.

Attachment style may be related to variations in hookup experiences; however, we do not know if attachment style is associated with hookup motives. College students (N = 266) completed questionnaires that assessed attachment style and hookup motives. Avoidant attachment was negatively associated with intimacy motives, while anxious attachment was positively related to intimacy. Insecure attachment styles were positively related to coping motives and self-affirmation motives, but gender interacted with attachment style. Anxious attachment was positively associated with peer pressure motives in men only. The role of attachment style and hookup motives in understanding young adults' hookup experiences will be discussed.

The studies presented compare two methodologies for categorizing suicidal patients based on clinical data. Discussion follows regarding implications for risk assessment and treatment. In these studies, 52 outpatient subjects were placed into different groups based on coding their “suicidal motivation” (Study 1) and their “internal struggle” ratings (Study 2) using data collected at intake. Self-report ratings of 6 Suicide Status Form (SSF) Core Constructs (Psychological Pain, Stress, Agitation, Hopelessness, Self-Hate, and Overall Risk of Suicide) recorded both at intake and at completion of treatment were then compared to determine differences in Core Construct ratings among groups at different time points. In Study 1, overall differences among motivation groups (Life-motivated, Ambivalent, and Death-motivated) were significant for ratings at treatment completion of Overall Risk of Suicide, Self-Hate, and Psychological Pain. In Study 2, overall differences among groups (Wish to live, Ambivalent, and Wish to die) were significant for ratings at intake of Overall Risk of Suicide. At completion of treatment, overall differences among groups were significant for ratings of Overall Risk of Suicide, Hopelessness, and Self-Hate. In addition, significant interactions were found between test time and group for Overall Risk of Suicide and Self-Hate. Results suggest that categorizing suicidal patients by motivation and by the nature of their internal struggle could be beneficial to differential risk assessment with implications for clinical treatment.

For many suicidal people, the desire to die is moderated by a competing desire to live. This study aimed to demonstrate the ability of a wish-to-live versus wish-to-die index score to measure ambivalence and trichotomize suicidal inpatients into distinct stratified risk groups. Analyses revealed that index scores calculated for patients at treatment start significantly discriminated among the groups at index and uniquely predicted suicidal ideation, hopelessness, and depression scores across treatment. On average, patients with wish-to-live and wish-to-die orientations resolved suicidal ideation by discharge. Changes in suicidal ideation among ambivalently oriented patients were more variable. Clinical and research implications are discussed.

There are few evidence-based approaches for the treatment of suicidality particularly within the Department of Defense settings (DoD) (Schoenbaum, Heinssen, & Pearson, 2009). This article describes a relatively new suicide-specific approach called the "Collaborative Assessment and Management of Suicidality" (CAMS). There is growing evidence that CAMS can meaningfully impact suicidal ideation, overall symptom distress, increase hope, and may positively impact non-mental health utilization. The prospect of using CAMS within military treatment facilities is discussed as a means of clinically assessing and treating suicidal ideation and related behaviors for military personnel.