Abstract

ObjectiveThe aim of this study was to evaluate the odds of association between suicidal behaviors and comorbid anxiety disorders in adolescents with major depressive disorder (MDD).MethodsWe included 122,020 adolescent inpatients with MDD from the Nationwide Inpatient Sample (NIS) and further grouped them by co-diagnosis of anxiety disorders. Logistic regression analysis was used to evaluate the odds ratio (OR) of suicidal behaviors due to comorbid anxiety disorders.ResultsOut of total MDD inpatients, 45.8% had comorbid anxiety disorders. Around 53.5% MDD inpatients with anxiety disorders had suicidal behaviors, which were significantly higher than seen in 52.6% non-anxiety cohort (P = 0.002). Comorbid anxiety disorders had a minimally positive association with suicidal behaviors and were not statistically significant (OR: 1.01; P = 0.710) after controlling the logistic regression analysis for demographic confounders and psychiatric comorbidities. MDD inpatients with comorbid psychotic disorders were positively associated (OR: 1.16; P = 0.007) with suicidal behaviors.ConclusionsMDD with comorbid anxiety had a statistically non-significant association with suicidal behaviors in adolescents. Depression has a direct and independent effect on adolescent suicidal behaviors, whereas anxiety has a direct effect only on perpetuating depression. Early diagnosis and management of comorbid anxiety and psychosis with MDD reduce functional impairment and suicide risk in at-risk populations.

Highlights

  • Major depressive disorder (MDD) in adolescents is a serious and potentially fatal problem

  • The aim of this study was to evaluate the odds of association between suicidal behaviors and comorbid anxiety disorders in adolescents with major depressive disorder (MDD)

  • Around 53.5% MDD inpatients with anxiety disorders had suicidal behaviors, which were significantly higher than seen in 52.6% non-anxiety cohort (P = 0.002)

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Summary

Introduction

Major depressive disorder (MDD) in adolescents is a serious and potentially fatal problem. Earlier age of onset is associated with a prolonged and severe course and greater illness burden [1]. Over the past 25 years, the age of onset of MDD appears to have consistently decreased, and several etiologies have been implicated in early-onset MDD including genetic, familial, and environmental factors [1,2]. By 2017, an estimated 3.2 million (13.3%) adolescents aged 12 to 17 years in the United States had at least one major depressive episode [3]. The prevalence of MDD was higher among adolescent females (20%) when compared with adolescent males (6.8%) and was highest among adolescents reporting two or more races (16.9%) [3]. A confluence of hormonal and neurodevelopmental changes that vary by sex during the pubertal transition seems to influence the gender difference in depression [4]

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