An interactive model of anxiety sensitivity relevant to suicide attempt history and future suicidal ideation

Recent reports of increasing suicide rates among military personnel indicate a need for increased work in understanding processes relevant to suicide risk in the military. Anxiety, along with anxiety-related risk factors have been implicated in suicidality as well as posttraumatic stress disorder (PTSD). One such risk factor, anxiety sensitivity (AS), refers to fear of anxiety-related symptoms. Subfactors of AS, notably the physical and cognitive concerns factors, appear to be relevant to the construct of acquired capability for suicidal behavior, a risk factor for death by suicide postulated by the Interpersonal-Psychological Theory of Suicide (Joiner, 2005; Van Orden et al., 2010). Study 1 examined the interaction of AS-cognitive concerns and AS-physical concerns in an outpatient sample with PTSD symptomatology (N = 128). Analyses were consistent with our a priori model and indicated that the interaction of AS-cognitive concerns by AS-physical concerns predicted previous suicide attempt. Specifically, those with high AS-cognitive concerns and low AS-physical concerns were at increased risk for suicide attempt. Study 2 prospectively examined the associations between AS and suicidal ideation in a sample of military cadets undergoing basic training (N = 1081). A similar interaction emerged such that high AS-cognitive and low AS-physical scores at Time 1 significantly predicted suicidal ideation several months later, even after controlling for Time 1 suicidal ideation and psychopathology. These findings suggest that suicide potential may be related to interactions between cognitive risk factors for anxiety among individuals with PTSD symptomatology as well as individuals experiencing stressful life events.