A Naturalistic, European Multi-Center Clinical Study of Electrodermal Reactivity and Suicide Risk Among Patients With Depression.

Vladimir Carli,Patrizia Zeppegno,Nuhamin Gebrewold Petros,Carla Gramaglia,Philippe Courtet,Joakim Ekstrand,Guido Di Sciascio,Marco Sarchiapone,Hanga Galfalvy,Miriam Iosue,Anil Batra,Doina Cosman,Maria João Heitor,Ricardo Gusmão,Marcin Wojnar,Miguel Constante,Mario Amore,Pouya Movahed ,Enrique Baca‐García ,Gergö Hadlaczky ,Pilar A Sáiz ,Catarina Jesus

doi:10.3389/fpsyt.2021.765128

Abstract

Background: Electrodermal hyporeactivity has been proposed as a marker of suicidal risk. The EUDOR-A study investigated the prevalence of electrodermal hyporeactivity among patients with depression and its association with attempted and completed suicide.Methods: Between August 2014 and March 2016, 1,573 in- and outpatients with a primary diagnosis of depression (active or remission phase) were recruited at 15 European psychiatric centers. Each patient was followed-up for 1 year. Electrodermal activity was assessed at baseline with the ElectroDermal Orienting Reactivity Test. Data on the sociodemographic characteristics, clinical diagnoses, and treatment of the subjects were also collected. The severity of the depressive symptoms was assessed through the Montgomery–Asberg Depression Rating Scale. Information regarding number, time, and method of suicide attempts was gathered at baseline and at the end of the 1-year follow-up. The same data were collected in case of completed suicide.Results: Hyporeactive patients were shown to be significantly more at risk of suicide attempt compared to reactive patients, both at baseline and follow-up. A sensitivity of 29.86% and a positive predictive value (PPV) of 46.77% were found for attempted suicide at baseline, while a sensitivity of 35.36% and a PPV of 8.92% were found for attempted suicide at follow-up. The sensitivity and PPV for completed suicide were 25.00 and 0.61%, respectively. However, when controlled for suicide attempt at baseline, the association between hyporeactivity and follow-up suicide attempt was no longer significant. The low number of completed suicides did not allow any analysis.

Highlights

Suicidal behavior is one of the most common and serious psychiatric emergencies [1], and suicide risk assessment is one of the main challenges for mental health professionals [2]
No significant differences were found among the patients lost to follow-up and the rest of those included in the analyses with regards to age, gender, inpatient status, psychiatric and somatic diagnoses, Montgomery–Asberg Depression Rating Scale (MADRS) scores, reactivity, and suicidal attempts before the ElectroDermal Orienting Reactivity (EDOR) Test
This study found a statistically significant increased risk of suicide attempt at baseline and suicide attempt at follow-up in hyporeactive patients compared to reactive patients

Summary

Introduction

Suicidal behavior is one of the most common and serious psychiatric emergencies [1], and suicide risk assessment is one of the main challenges for mental health professionals [2]. Valid and reliable objective methods to support suicide risk assessment are still lacking [3]. Electrodermal activity (EDA) refers to electrical events in the skin caused by the activity of eccrine sweat glands in palmar skin [4]. EDA is characterized by a tonic and phasic component. The tonic component represents the basic level of conductance, while the phasic component is related to the faster changing elements of the signal that can be associated with a stimulus or be “spontaneous” or “non-specific” [7, 8]. Electrodermal hyporeactivity has been proposed as a marker of suicidal risk. The EUDOR-A study investigated the prevalence of electrodermal hyporeactivity among patients with depression and its association with attempted and completed suicide

Methods

Results

Discussion

Conclusion