Increasingly strong evidence links anxiety disorders in general and panic attacks in particular to suicidality. The underlying causes and specifics of this relation, however, remain unclear. The present article sought to begin addressing this question by clarifying the association between panic symptoms and suicidality. Data were sampled from the NESARC epidemiological data set from the US and analyzed as four independently, randomly selected subsets of 1000 individuals using structural equation modeling analyses and replicating results across samples. Evidence is presented for four symptom clusters (cognitive symptoms, respiratory distress, symptoms of alpha and beta adrenergic activation) and the differential association of each with suicidal ideation and attempts. Symptoms of alpha adrenergic activation predicted prior suicide attempt whereas cognitive symptoms predicted prior suicidal ideation. These findings were independent of comorbid major depressive disorder. It is suggested that assessment of suicide risk in the community includes the presentation of cognitive symptoms and symptoms related to alpha adrenergic activation.
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