Prediction of suicide attempts in depressive disorder and panic disorder with/without agoraphobia: multivariate analysis of clinical predictors

Introduction: Suicide risk in patients with depressive disorder (DD) and panic disorder with or without agoraphobia (PD/A) is often associated with depression, hopelessness, and anxiety-related factors, but their predictive roles remain unclear. Aim: To identify the strongest clinical predictors of suicide attempts in patients with DD and PD/A, and to assess the applicability of a predictive model within and across diagnostic groups. Methods: A total of 94 patients (48 with DD- acute or recurrent, 46 with PD/A) were assessed using the Beck Scale for Suicide Ideation (BSSI), Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), Anxiety Sensitivity Index-Revised (ASI-R), and Beck Anxiety Inventory (BAI). Univariate and multivariate analyses were conducted to evaluate the relative predictive value of these factors for suicide attempts within and across diagnostic groups. Results: Suicide attempts were reported by 23 patients with DD (48%) and only one patient with PD/A (2.17%). In DD sample, suicidal ideation was the strongest predictor of suicide attempts, followed by depression severity. ROC analyses indicated optimal cut-offs of 11 for BSSI and 35 for BDI-II, yielding high sensitivity (82.6%) and specificity (92%). Hopelessness and anxiety sensitivity did not retain predictive value in multivariate analysis, whereas panic/agoraphobic symptoms showed a suppressor effect, reducing risk by 11%. When applied to the PD/A group, the model estimated an average predicted risk of 9.3%, but failed to identify the single attempter, resulting in zero sensitivity. Conclusions: High levels of suicidal ideation and depressive symptoms were the strongest predictors of suicide attempts in DD. Panic and agoraphobic symptoms exerted a suppressor effect on suicide risk. In the PD/A group, however, the model's predictive utility was extremely limited due to the very low number of suicide attempts, and these findings should therefore be considered preliminary.