The fact that depression increases the risk of suicide should come as no surprise. Less well known are the suicidal risks of anxiety and the synergistic effect of co-occurring depression and anxiety. Additional life factors can function as triggers and increase those risks even more. We will look at those risks and how they can be mitigated.
Guze and Robins (1970) found that 12% to 19%, or an average of 15%, of those with major depressive disorders would die by suicide. Their studies, however, were based on hospitalized people with depression and Blair-West, et al. (1997) challenged those numbers. Angst, et al. (1999) in their own analysis concurred that the numbers were not representative but concluded: “Little is known about the suicide risk …from general practice or community samples; it seems to be much lower.” [p. 61]. However, Orsolini, et al. (2020) were still citing the 15% number fifty years later. The Depression and Bipolar Support Alliance (2025) report a lifetime risk of 20% for untreated depression. Despite challenges to the statistics, for more than 50 years, the consensus seems to be between 15% and 20% of those with depression will die by suicide. Perhaps a better measure is the DBSA claim that depression is the cause of more than two-thirds of reported suicides.
When it comes to anxiety and suicide risk, things become even less clear. According to Kircanski, et al. (2017), approximately half of those diagnosed with depression or anxiety will have both co-occurring. Sareen, et al. (2005) reported the first study to adjust for other factors and look at anxiety alone as a suicide risk. They were able to demonstrate that anxiety on its own is an independent risk factor for suicide. Until their study, there was debate whether anxiety was a risk factor for suicide. Meier, et al. (2016) report that 2.1% of those with anxiety disorders will die by suicide within 10 years, meaning the lifetime prevalence is even higher. The most recent Diagnostic and Statistical Manual of Mental Disorders, the DSM-5-TR (2022), now includes a paragraph for each diagnosis on its association with suicidal thoughts or behaviors. All anxiety disorders have a statement about increased risk of suicidal behaviors.
When you combine depression and anxiety, suicide risks increase even more. We have already stated that half of those with one disorder will also have the other. Sareen, et al. (2005), were the first to study anxiety on its own as a risk factor but also noted: “the data clearly demonstrate that comorbid anxiety disorders amplify the risk of suicide attempts in persons with mood disorders.” [p. 1249].
There are other contributing factors we must take into consideration, for example, loneliness. Moon, et al. (2025) reported that individuals with depression that were living alone had a 290% increased risk of suicide. Individuals living alone who had co-occurring depression and anxiety had a 558% increased risk. Fernandez-Rodrigues (2022) highlighted that poor health can also increase the risk of suicide for those with depression, particularly among older adults who already have a higher risk. Favril, et al. (2022) added to this list interpersonal conflicts. These should be obvious as risk factors for suicide but here we are listing them as contributing factors. The difference being that contributing factors can be more readily addressed. Naturally, we would want to address the depression and/or anxiety, but the presence of these contributing factors heightens the risk of suicide and removing them can lower that risk.
More importantly. Orsolini, et al. (2020) concluded: “the identification of a range of suicide risk factors…is clinically relevant for clinicians and should always be considered for prevention” [P. 216]. We simply cannot ignore the contributing factors that increase the risk of suicide even further. We must assess if there are contributing factors present. If we identify the individual is also experiencing loneliness, we should also address the loneliness, perhaps considering the use of peer support as a protective factor. Often, there may be a peer specialist available, but groups of similar individuals can also be considered.
Interpersonal conflicts, especially among people with close relationships, should also be addressed. Counseling for marital or other relationship issues should be combined with therapy to address depression and/or anxiety. I recently participated in a psychological autopsy for an individual experiencing depression and situational anxiety. A discussion with his wife about potential divorce seems to have been the final straw before he took his life.
Berardeli, et al. (2018) also identified lifestyle behaviors as possible contributing factors. They identified factors such as substance use, occupational difficulties, social isolation, and sedentary lifestyles as contributing factors. We have always tended to silo mental health and substance use issues, but it is becoming increasingly clear that both must be addressed together. Not one first and the other- together. It is vital to dig deeper for contributing factors to the depression and/or anxiety so they can be made part of therapy. It is important to know about occupational difficulties or sedentary lifestyles. We are more likely to have identified these risk factors and perhaps even addressed them in therapy, but it is important they not be overlooked.
Suicide rates continue to be unacceptably high. We must look beyond simple diagnoses and look at contributing factors. Only by addressing both can we make a serious dent in those numbers.
Thomas Grinley, MS, MBA, CMQ/OE, LSSGB, CCISM, is Health Services Evaluation Planning and Review Specialist of Bureau of Program Quality – Health Services Assessment Unit at NH Department of Health and Human Services. For more information, email Thomas.Grinley@dhhs.nh.gov.
References
Berardelli, I., Corigliano, V., Hawkins, M., Comparelli, A., Erbuto, D., & Pompili, M. (2018). Lifestyle interventions and prevention of suicide. Frontiers in psychiatry, 9, 567.
Blair‐West, G. W., Mellsop, G. W., & Eyeson‐Annan, M. L. (1997). Down‐rating lifetime suicide risk in major depression. Acta Psychiatrica Scandinavica, 95(3), 259-263.
Favril, L., Yu, R., Uyar, A., Sharpe, M., & Fazel, S. (2022). Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies. Evidence Based Mental Health, 25(4).
Fernandez-Rodrigues, V., Sanchez-Carro, Y., Lagunas, L. N., Rico-Uribe, L. A., Pemau, A., Diaz-Carracedo, P., … & de la Torre-Luque, A. (2022). Risk factors for suicidal behaviour in late-life depression: a systematic review. World journal of psychiatry, 12(1), 187.
Guze, S. B., & Robins, E. L. I. (1970). Suicide and primary affective disorders. The British Journal of Psychiatry, 117(539), 437-438.
Meier, S. M., Mattheisen, M., Mors, O., Mortensen, P. B., Laursen, T. M., & Penninx, B. W. (2016). Increased mortality among people with anxiety disorders: total population study. British Journal of Psychiatry, 209(3), 216–221. doi:10.1192/bjp.bp.115.171975
Moon, D. U., Kim, H., Jung, J. H., Han, K., & Jeon, H. J. (2025). Suicide Risk and Living Alone With Depression or Anxiety. JAMA Network Open, 8(3), e251227-e251227.
Orsolini, L., Latini, R., Pompili, M., Serafini, G., Volpe, U., Vellante, F., … & De Berardis, D. (2020). Understanding the complex of suicide in depression: from research to clinics. Psychiatry investigation, 17(3), 207.
Sareen, J., Cox, B. J., Afifi, T. O., De Graaf, R., Asmundson, G. J., Ten Have, M., & Stein, M. B. (2005). Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults. Archives of general psychiatry, 62(11), 1249-1257.
