Character configuration, major depressive episodes, and suicide-related ideation among Japanese undergraduates.

Keisuke Takanobu,Nobuyuki Mitsui,Yuki Kako,Shinya Watanabe,Ichiro Kusumi,Satoshi Asakura,Yutaka Fujii,Kuniyoshi Toyoshima,C Robert Cloninger

doi:10.1371/journal.pone.0251503

Abstract

To enable early identification of university students at high risk for suicide, we examined personality as a predictive factor for major depressive episodes and suicide-related ideation. From 2011 to 2013, we administered the Patient Health Questionnaire-9 (PHQ-9) and the Temperament and Character Inventory (TCI) to 1,997 university students at enrollment (T1). We previously conducted a study using the same data set; this is a re-analysis of the dataset. To prevent contamination of data, participants diagnosed with a depressive episode were excluded at T1. Three years after enrollment (T2), we re-administered the PHQ-9 to the same students. We statistically compared TCI scores at T1 among depressive episode groups and suicide-related ideation groups. Two-way ANOVA and Cochran-Armitage trend tests were used to analyze the relationships between personality traits, depressive episodes, and suicide-related ideation. The PHQ-9 summary scores at baseline (T1) were 3.0 (±2.7), with female students scoring 4.6 (±2.9) and male students 2.9 (±2.6, p = 0.025). The major depressive episode group at T2 had lower self-directedness (SD) scores at T1 than the non-depressive episode control group. The suicide-related ideation (SI) group at T2 also had higher harm avoidance (HA), lower SD, and lower cooperativeness (C) scores than the non-SI group at T1. The Cochran-Armitage trend tests revealed significant associations between character configurations composed of SD and C, and both depressive episodes at T2 and SI at T2. The temperament feature of high HA at baseline and character configurations of low SD and low C at baseline are the most contributory predictors for the novel development of depressive episodes and SI among Japanese university students.

Highlights

Suicide is a major public health concern [1] and has been the leading cause of death among young adults in Japan during the past decade [2]
The CochranArmitage trend tests revealed significant associations between character configurations composed of SD and C, and both depressive episodes at T2 and suicide-related ideation (SI) at T2
The Patient Health Questionnaire-9 (PHQ-9) and the Temperament and Character Inventory (TCI) were administered to students who enrolled at the university in 2011, 2012, and 2013

Summary

Introduction

Suicide is a major public health concern [1] and has been the leading cause of death among young adults in Japan during the past decade [2]. A recent study revealed that only a small percentage of suicide completers had previously been diagnosed with psychiatric disorders and received services through a university health center [5]. This suggests that early identification and intervention could prevent suicides among high-risk students, prompting the need for studies on the predictors of major depressive episodes (MDEs) and suicide-related ideation (SI, encompassing ideation of both suicide and self-harm). According to Silverman’s definition [6], SI has three subcategories—no suicidal intent, an undetermined degree of suicidal intent, and some suicidal intent—that are almost consistent with the ninth item of Patient Health Questionnaire-9 (PHQ-9)

Objectives

Methods

Results

Conclusion