Abstract
The associated factors of suicide attempts in patients with major depressive disorder (MDD) comorbid with anxiety remains unclear. To the best of our knowledge, this is the first study with a large sample size that examines the risk factors of suicide attempts in first-episode drug-naïve (FEND) MDD patients comorbid with anxiety and includes clinical correlates, metabolic parameters, and thyroid hormone levels. A total of 1718 FEDN MDD patients were enrolled. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) were used to assess the symptoms of patients. Metabolic parameters and thyroid hormone levels were measured. The prevalence of suicide attempts in MDD patients comorbid anxiety symptoms was 24.28%, which was 9.51 times higher than that in MDD patients without anxiety symptoms (3.25%). Compared to non-attempters, MDD patients with anxiety symptoms who attempted suicide scored higher on HAMD and HAMA, and had higher systolic blood pressure, higher levels of thyroid stimulating hormone (TSH), and thyroid peroxidases antibody (TPOAb), which were also correlated with suicide attempts in MDD patients comorbid anxiety symptoms. The combination of HAMA score, HAMD score, and TSH could differentiate suicide attempters from non-suicide attempters. Further, the age of onset, illness duration, BMI, TSH, and TPOAb were associated with the times of suicide attempts in MDD patients comorbid anxiety symptoms. Our results demonstrate high prevalence of suicide attempts in MDD patients comorbid anxiety symptoms. Several clinical correlates, metabolic parameters, and thyroid hormones function contribute to the suicide attempts in MDD patients comorbid anxiety symptoms.
Highlights
Major depressive disorder (MDD) is a severe mental illness with high economic burden worldwide
The main results of the study were (1) the prevalence of suicide attempts in MDD patients with anxiety symptoms (24.28%) increased by 9.51 times compared with patients without anxiety symptoms (3.25%); (2) suicide attempts were associated with Hamilton Anxiety Scale (HAMA) score, Hamilton Depression Scale (HAMD) score, systolic BP, thyroid stimulating hormone (TSH), and thyroid peroxidases antibody (TPOAb) in MDD patients with anxiety symptoms
The combination of HAMA score, HAMD score, and TSH can discriminate between suicide attempters and non-attempters (AUC was 0.76); (3) the age of onset, illness duration, body mass index (BMI), TSH, and TPOAb were associated with the times of suicide attempts in MDD patients with anxiety symptoms
Summary
Major depressive disorder (MDD) is a severe mental illness with high economic burden worldwide. Suicide attempts are Previous studies have demonstrated risk factors of suicide attempts in MDD include the male sex, severity of depression, family history of mental disorder, and. Some studies have shown that there is no link between anxiety or anxiety symptoms and suicide attempts, with even several reports that anxiety symptoms were protective factors for suicidal behavior in MDD patients[16]. These inconsistent results may be due to the heterogeneity of the samples, with variation between different episodes and psychopharmacological treatments
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