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Yan H, Chu Z, Shen Z, Yuan L, Wu Y, Lu Y, Jiang H, Xu X. Disrupted functional connectivity of bilateral nucleus accumbens in major depressive disorder with and without melancholic features. Neuroreport 2024:00001756-990000000-00290. [PMID: 39292961 DOI: 10.1097/wnr.0000000000002097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
Our study aims to explore the differences in functional connectivity in the nucleus accumbens (NAc) between patients with melancholic depression and non-melancholic depression (NMD) and their relation to melancholic depression's pathogenesis. We recruited 60 melancholic depression, 58 NMD, and 80 healthy controls, all matched for gender, age, and education. Functional connectivity analysis focused on bilateral NAc as the region of interest, comparing it with the whole brain and correlating significant differences with clinical scores. Melancholic depression patients showed reduced functional connectivity between the left NAc and anterior brain regions, and between the right NAc and temporal and frontal areas, compared to healthy controls. In contrast, NMD patients displayed reduced functional connectivity only between the left NAc and the posterior cingulate cortex. Melancholic depression patients also exhibited increased functional connectivity between the right NAc and the middle frontal gyrus, unlike NMD patients. The findings suggest that melancholic depression patients exhibit unique NAc functional connectivity patterns, particularly with the default mode network and prefrontal areas, suggesting atypical reward-circuitry interactions. The right NAc's connection to the prefrontal gyrus may distinguish melancholic depression from NMD.
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Affiliation(s)
| | | | | | | | | | - Yi Lu
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
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Wang H, Lyu N, Huang J, Fu B, Shang L, Yang F, Zhao Q, Wang G. Real-world evidence from a retrospective study on suicide during depression: clinical characteristics, treatment patterns and disease burden. BMC Psychiatry 2024; 24:300. [PMID: 38641767 PMCID: PMC11031916 DOI: 10.1186/s12888-024-05726-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/27/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Suicide stands as both a primary symptom and the direst outcome of major depressive disorder (MDD). The scarcity of effective treatment strategies makes managing MDD patients with suicide especially challenging. Hence, it is crucial to investigate disease characteristics and efficacious therapeutic strategies for these patients, drawing insights from disease databases and real-world data. METHODS In this retrospective study, MDD patients hospitalized between January 2013 and December 2020 were investigated using Electronic Health Records (EHR) data from Beijing Anding Hospital. The study enrolled 4138 MDD patients with suicidal ideation or behavior (MDS) and 3848 without (MDNS). Demographic data, clinical attributes, treatment approaches, disease burden, and re-hospitalization within one year of discharge were extracted and compared. RESULTS Patients in the MDS group were predominantly younger and female, exhibiting a higher prevalence of alcohol consumption, experiencing frequent life stress events, and having an earlier onset age. Re-hospitalizations within six months post-discharge in the MDS group were significantly higher than in the MDNS group (11.36% vs. 8.91%, p < 0.001). Moreover, a more considerable fraction of MDS patients underwent combined electroconvulsive therapy treatment (56.72% vs. 43.71%, p < 0.001). Approximately 38% of patients in both groups were prescribed two or more therapeutic regimes, and over 90% used antidepressants, either alone or combined. Selective serotonin reuptake inhibitors (SSRIs) were the predominant choice in both groups. Furthermore, antidepressants were often prescribed with antipsychotics or mood stabilizers. When medication alterations were necessary, the favoured options involved combination with antipsychotics or transitioning to alternative antidepressants. Yet, in the MDS group, following these initial modifications, the addition of mood stabilizers tended to be the more prioritized alternative. CONCLUSIONS MDD patients with suicidal ideation or behaviour displayed distinctive demographic and clinical features. They exhibited intricate treatment patterns, a pronounced burden of illness, and an increased likelihood of relapse.
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Affiliation(s)
- Han Wang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China
| | - Nan Lyu
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China
| | - Juan Huang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China
| | - Bingbing Fu
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China
| | - Lili Shang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China
| | - Fan Yang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China
| | - Qian Zhao
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China.
- The Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100069, Beijing, China.
| | - Gang Wang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, 100088, Beijing, China.
- The Advanced Innovation Center for Human Brain Protection, Capital Medical University, 100069, Beijing, China.
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Chu Z, Yuan L, He M, Cheng Y, Lu Y, Xu X, Shen Z. Atrophy of bilateral nucleus accumbens in melancholic depression. Neuroreport 2023; 34:493-500. [PMID: 37270840 DOI: 10.1097/wnr.0000000000001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Evidence from previous literature suggests that the nucleus accumbens (NAc), hippocampus, and amygdala play critical roles in the reward circuit. Meanwhile, it was also suggested that abnormalities in the reward circuit might be closely associated with the symptom of anhedonia of depression. However, few studies have investigated the structural alterations of the NAc, hippocampus, and amygdala in depression with anhedonia as the main clinical manifestation. Thus, the current study aimed to explore the structural changes of the subcortical regions among melancholic depression (MD) patients, especially in the NAc, hippocampus, and amygdala, to provide a theoretical basis for understanding the pathological mechanisms of MD. Seventy-two MD patients, 74 nonmelancholic depression (NMD) patients, and 81 healthy controls (HCs) matched for sex, age, and years of education were included in the study. All participants underwent T1-weighted MRI scans. Subcortical structure segmentation was performed using the FreeSurfer software. MD and NMD patients had reduced left hippocampal volume compared with HCs. Meanwhile, only MD patients had reduced bilateral NAc volumes. Moreover, correlation analyses showed correlations between left NAc volume and late insomnia and lassitude in MD patients. The reduced hippocampal volume may be related to the pathogenesis of major depressive disorder (MDD), and the reduced volume of the NAc may be the unique neural mechanism of MD. The findings of the current study suggest that future studies should investigate the different pathogenic mechanisms of different subtypes of MDD further to contribute to the development of individualized diagnostic and treatment protocols.
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Affiliation(s)
- Zhaosong Chu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University
- Yunnan Clinical Research Center for Mental Disorders
| | - Lijin Yuan
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University
- Yunnan Clinical Research Center for Mental Disorders
| | - Mengxin He
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University
- Yunnan Clinical Research Center for Mental Disorders
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University
- Yunnan Clinical Research Center for Mental Disorders
| | - Yi Lu
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiufeng Xu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University
- Yunnan Clinical Research Center for Mental Disorders
| | - Zonglin Shen
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University
- Yunnan Clinical Research Center for Mental Disorders
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4
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Shunkai L, Su T, Zhong S, Chen G, Zhang Y, Zhao H, Chen P, Tang G, Qi Z, He J, Zhu Y, Lv S, Song Z, Miao H, Hu Y, Jia Y, Wang Y. Abnormal dynamic functional connectivity of hippocampal subregions associated with working memory impairment in melancholic depression. Psychol Med 2023; 53:2923-2935. [PMID: 34870570 DOI: 10.1017/s0033291721004906] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Previous studies have demonstrated structural and functional changes of the hippocampus in patients with major depressive disorder (MDD). However, no studies have analyzed the dynamic functional connectivity (dFC) of hippocampal subregions in melancholic MDD. We aimed to reveal the patterns for dFC variability in hippocampus subregions - including the bilateral rostral and caudal areas and its associations with cognitive impairment in melancholic MDD. METHODS Forty-two treatment-naive MDD patients with melancholic features and 55 demographically matched healthy controls were included. The sliding-window analysis was used to evaluate whole-brain dFC for each hippocampal subregions seed. We assessed between-group differences in the dFC variability values of each hippocampal subregion in the whole brain and cognitive performance on the MATRICS Consensus Cognitive Battery (MCCB). Finally, association analysis was conducted to investigate their relationships. RESULTS Patients with melancholic MDD showed decreased dFC variability between the left rostral hippocampus and left anterior lobe of cerebellum compared with healthy controls (voxel p < 0.005, cluster p < 0.0125, GRF corrected), and poorer cognitive scores in working memory, verbal learning, visual learning, and social cognition (all p < 0.05). Association analysis showed that working memory was positively correlated with the dFC variability values of the left rostral hippocampus-left anterior lobe of the cerebellum (r = 0.338, p = 0.029) in melancholic MDD. CONCLUSIONS These findings confirmed the distinct dynamic functional pathway of hippocampal subregions in patients with melancholic MDD, and suggested that the dysfunction of hippocampus-cerebellum connectivity may be underlying the neural substrate of working memory impairment in melancholic MDD.
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Affiliation(s)
- Lai Shunkai
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Ting Su
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Guangmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, China
| | - Yiliang Zhang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Hui Zhao
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Pan Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, China
| | - Guixian Tang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, China
| | - Zhangzhang Qi
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, China
| | - Jiali He
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Yunxia Zhu
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Sihui Lv
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Zijin Song
- School of Management, Jinan University, Guangzhou 510316, China
| | - Haofei Miao
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, China
| | - Yilei Hu
- School of Management, Jinan University, Guangzhou 510316, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, China
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Zhang L, Cui X, Ou Y, Liu F, Li H, Xie G, Li P, Zhao J, Xie G, Guo W. Abnormal long- and short-range functional connectivity in patients with first-episode drug-naïve melancholic and non-melancholic major depressive disorder. J Affect Disord 2023; 320:360-369. [PMID: 36206876 DOI: 10.1016/j.jad.2022.09.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND We attempted to explore the common and distinct long- and short-range functional connectivity (FC) patterns of melancholic and non-melancholic major depressive disorder (MDD) and their associations with clinical characteristics. METHODS Fifty-nine patients with first-episode drug-naïve MDD, including 31 patients with melancholic features and 28 patients with non-melancholic features, underwent resting-state functional magnetic resonance imaging (fMRI) scanning to examine long- and short-range FC. Thirty-two healthy volunteers were recruited as controls. The support vector machines (SVM) was applied to distinguish the melancholic patients from the non-melancholic patients by using the FC of abnormal brain regions. RESULTS Compared to healthy volunteers, patients with MDD showed increased long-range positive FC (lpFC) in the right insula/inferior frontal gyrus and left insula. Relative to non-melancholic patients, melancholic patients displayed decreased lpFC in the right lingual gyrus, decreased short-range positive FC (spFC) in the right middle temporal gyrus and right superior parietal lobule, increased lpFC in the left inferior parietal lobule, and increased spFC in the left middle occipital gyrus/inferior occipital gyrus, left cerebellum VII/IX, and bilateral cerebellum CrusII. Increased lpFC in the left inferior parietal lobule in melancholic patients was correlated with the TEPS abstract anticipatory scores. SVM results showed that FCs of five combinations within different brain regions could distinguish melancholic patients from non-melancholic patients. CONCLUSIONS FC abnormalities in the default mode network and parietal-occipital brain regions may underlie the neurobiology of melancholic MDD. An increased lpFC in the left inferior parietal lobule correlated with anhedonia may be a distinctive neurobiological feature of melancholic MDD.
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Affiliation(s)
- Lulu Zhang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; Department of Psychiatry, Guangzhou First People's Hospital, Guangzhou 510180, Guangdong, China
| | - Xilong Cui
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yangpan Ou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Huabing Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Guojun Xie
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong 528000, China
| | - Ping Li
- Department of Psychiatry, Qiqihar Medical University, Qiqihar, Heilongjiang 161006, China
| | - Jingping Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Guangrong Xie
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Wenbin Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
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Xu P, Sun Y. Risk factors for suicidal attempt in patients with the melancholic subtype of depressive disorder: Implication for nursing care. Medicine (Baltimore) 2022; 101:e29713. [PMID: 35960126 PMCID: PMC9371559 DOI: 10.1097/md.0000000000029713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The incidence of suicide in patients with depressive order is much higher than other population. We aimed to evaluate the current status and risk of suicidal attempt in patients with the melancholic subtype of depressive disorder, to provide evidence for the clinical management and nursing care of depressive disorder. Patients diagnosed as the melancholic subtype of depressive disorder and treated in our hospital from June 1, 2018 to August 31, 2021 were included. The characteristics of included patients were collected and analyzed. Pearson correlation analysis and logistic regression analysis with odd ratio and 95% confidence interval were conducted to analyze the influencing factors of suicidal attempt in patients with the melancholic subtype of depressive disorder. A total of 446 patients with melancholic subtype of depressive disorder were included, the incidence of suicidal attempt was 18.83%. Pearson correlation analysis indicated that gender (R = 0.611), alcohol drinking (R = 0.719), living situation (R = 0.812), number of previous admission to hospital (R = 0.547), sleep disorder (R = 0.612) and frequent depressive episodes (R = 0.559) were all correlated with the suicidal attempt in patients with melancholic subtype of depressive disorder (all P < 0.05). Logistic regression analysis showed that female (OR 3.115, 95%CI 2.493-3.906), alcohol drinking(OR 1.946, 95%CI 1.684-2.763), living alone (OR 2.401, 95%CI 1.915-3.008), number of previous admission to hospital ≥ 3 (OR 2.342, 95%CI 1.601-2.742), sleep disorder (OR 1.821, 95%CI 1.328-2.215) and frequent depressive episodes (OR 3.128, 95%CI 2.421-3.779) were the independent risk factors of suicidal attempt (all P < 0.05). Suicidal attempt is common in the patients with melancholic subtype of depressive disorder, and there are many related risk factors for suicidal attempt in patients with the melancholic subtype of depressive disorder.
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Affiliation(s)
- Pengfei Xu
- Department of Psychiatry, Tianjin Anding Hospital
| | - Ying Sun
- Department of Psychiatry, Tianjin Anding Hospital
- *Correspondence: Ying Sun, No. 13, Liulin Road, Hexi District, Tianjin, China (e-mail: )
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Baeken C, Xu Y, Wu GR, Dockx R, Peremans K, De Raedt R. Hostility in medication-resistant major depression and comorbid generalized anxiety disorder is related to increased hippocampal-amygdala 5-HT 2A receptor density. Eur Arch Psychiatry Clin Neurosci 2021; 271:1369-1378. [PMID: 33904978 PMCID: PMC8429407 DOI: 10.1007/s00406-021-01243-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/24/2021] [Indexed: 11/03/2022]
Abstract
Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are severe and difficult-to-treat psychiatric illnesses with high rates of comorbidity. Although both disorders are treated with serotonergic based psychotropic agents, little is known on the influence of the serotonergic neurotransmitter system on the occurrence of comorbid GAD when clinically depressed. To investigate this poorly understood clinical question, we examined the involvement of frontolimbic post-synaptic 5-HT2A receptors in 20 medication-resistant depressed (MRD) patients with half of them diagnosed with comorbid GAD with 123I-5-I-R91150 SPECT. To explore whether 5-HT2A receptor-binding indices (BI) associated with comorbid GAD could be related to distinct psychopathological symptoms, all were assessed with the symptom Checklist-90-Revised (SCL-90-R). MRD patients with comorbid GAD displayed significantly higher 5-HT2A receptor BI in the hippocampal-amygdala complex, compared to MRD patients without GAD. Correlation analyses revealed that the 5-HT2A receptor BI in these areas were significantly related to the SCL-90-R subscale hostility (HOS), especially for those MRD patients with comorbid GAD. Comorbid MRD-GAD may be characterized with increased hippocampal-amygdala 5-HT2A receptor BI which could represent enhanced levels in hostility in such kinds of patients. Adapted psychotherapeutic interventions may be warranted.
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Affiliation(s)
- Chris Baeken
- grid.5342.00000 0001 2069 7798Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium ,grid.8767.e0000 0001 2290 8069Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZBrussel), Laarbeeklaan 101, 1090 Brussels, Belgium ,grid.6852.90000 0004 0398 8763Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Yanfeng Xu
- grid.5342.00000 0001 2069 7798Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Guo-Rong Wu
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Southwest University, Chongqing, China.
| | - Robrecht Dockx
- grid.5342.00000 0001 2069 7798Department of Nutrition, Genetics and Ethology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Kathelijne Peremans
- grid.5342.00000 0001 2069 7798Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Rudi De Raedt
- grid.5342.00000 0001 2069 7798Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Profiles of depressive symptoms and the association with anxiety and quality of life in breast cancer survivors: a latent profile analysis. Qual Life Res 2019; 29:421-429. [PMID: 31628647 DOI: 10.1007/s11136-019-02330-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to examine profiles of depressive symptoms and the association with anxiety and quality of life (QOL) in breast cancer survivors. METHODS A cross-sectional multicenter survey involving 5 hospitals in Korea was implemented between February 2015 and January 2017. A self-report survey included the Patient Health Questionnaire-9, Short Form 36, and State and Trait Anxiety Scale. Data from 347 patients were analyzed. RESULTS Latent profile analysis identified five profiles of depressive symptoms: (1) "no depression" (63.98%); (2) "mild depression with sleep problems" (16.43%); (3) "mild depression" (8.65%); (4) "moderate depression with anhedonia" (7.78%); and (5) "moderately severe depression" (3.17%). Results from Fisher's exact test and analysis of variance (ANOVA) to examine whether sociodemographic and clinical characteristics distinguish the classes indicated that marital status, income and education as well as C-reactive protein distinguished a few classes. Multivariate analysis of covariance and analysis of covariance results indicated that both types of anxiety as well as several dimensions of QOL differed between the identified classes. CONCLUSIONS The current results suggest that although identified classes were characterized overall by severity of depression, a few classes also reflected pronounced individual symptom patterns, warranting tailored interventions for these symptom patterns, along with overall severity of depression.
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Xin LM, Chen L, Su YA, Yang FD, Wang G, Fang YR, Lu Z, Yang HC, Hu J, Chen ZY, Huang Y, Sun J, Wang XP, Li HC, Zhang JB, Si TM. Risk Factors for Recent Suicide Attempts in Major Depressive Disorder Patients in China: Results From a National Study. Front Psychiatry 2018; 9:300. [PMID: 30018575 PMCID: PMC6037843 DOI: 10.3389/fpsyt.2018.00300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 06/15/2018] [Indexed: 02/05/2023] Open
Abstract
Objective: To analyze the factors associated with recent suicide attempts including socio-demographic and clinical characteristics in major depressive disorder (MDD) patients in China. Methods: The data were from a nationwide sample from 13 major psychiatric hospitals or the psychiatric units of general hospitals in China, from September 1, 2010 to February 28, 2011. Melancholic features and suicide attempts in the past month were defined according to the melancholic feature module and the suicide module of the Mini International Neuropsychiatric Interview (MINI). Socio-demographic and clinical characteristics were compared between MDD patients with and without recent suicide attempts. Further analyses regarding the factors associated with recent suicide attempts in MDD patients were performed via multivariate logistic regression analysis. Results: Among 1,172 MDD patients, 57 (4.9%) were reported to have made a suicide attempt in the past month. Compared to the MDD patients without recent suicide attempt, significantly higher percentage of patients in the recent suicide attempters group had previous suicide attempts (χ2 = 171.861, p < 0.001) and depressive episodes with melancholic features (χ2 = 22.837, p < 0.001). Logistic regression analysis indicated that previous suicide attempts (OR = 20.81, 95% CI: 11.12-38.94, p < 0.001) and depressive episodes with melancholic features (OR = 4.43, 95% CI: 2.09-9.43, p < 0.001) were independently associated with recent suicide attempts in MDD patients. Limitations: Cross-sectional design, retrospective recall of suicide attempt data. Conclusion: Recent suicide attempts are associated with melancholic features and previous suicide attempts in MDD patients in China. These data may help clinicians to identify MDD patients at high risk of suicide attempt behavior.
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Affiliation(s)
- Li-Min Xin
- Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital and Peking University Institute of Mental Health, Beijing, China.,Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Lin Chen
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Yun-Ai Su
- Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital and Peking University Institute of Mental Health, Beijing, China
| | - Fu-De Yang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Gang Wang
- Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yi-Ru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Lu
- Shanghai Tongji Hospital, Tongji University Medical School, Shanghai, China
| | - Hai-Chen Yang
- Division of Mood Disorders, Shenzhen Mental Health Centre, Shenzhen, China
| | - Jian Hu
- The First Hospital of Harbin Medical University, Harbin, China
| | - Zhi-Yu Chen
- Hangzhou Seventh People's Hospital, Hangzhou, China
| | - Yi Huang
- West China Hospital, Sichuan University, Chengdu, China
| | - Jing Sun
- The Affiliated Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Ping Wang
- Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hui-Chun Li
- The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jin-Bei Zhang
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Tian-Mei Si
- Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital and Peking University Institute of Mental Health, Beijing, China
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10
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Maneeton N, Suttajit S, Maneeton B, Likhitsathian S, Eurviyanukul K, Udomratn P, Chan ESY, Si TM, Sulaiman AH, Chen CH, Bautista D, Srisurapanont M. Clinical and socio-demographic correlates of anxious distress in Asian outpatients with major depressive disorder. Nord J Psychiatry 2017. [PMID: 28632428 DOI: 10.1080/08039488.2017.1335344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Anxious distress in major depressive disorder (MDD) is common and associated with poor outcomes and management difficulties. AIMS This post hoc analysis aimed to examine the socio-demographic and clinical correlates of anxiety distress in Asian outpatients with MDD. METHODS Instead of two out of five specifiers defined by the Diagnostic and Statistical Manual Version-5, anxious distress defined in this study was operationalized as the presence of at least two out of four proxy items drawn from the 90-item Symptom Checklist, Revised (SCL-90-R). Other measures included the Montgomery-Asberg Depression Rating Scale (MADRS), the Fatigue Severity Scale, the Sheehan Disability Scale and the Multidimensional Scale of Perceived Social Support. RESULTS The data of 496 patients with MDD were included. Anxious distress was found in 371 participants (74.8%). The binary logistic regression analysis found that anxious distress was independently and significantly correlated with working status, higher MADRS scores, severe insomnia and functional impairment. CONCLUSIONS Three-fourths of Asian patients with MDD in tertiary care settings may have DSM-5 anxious distress of at least moderate distress. Its prevalence may vary among working groups. The specifier was associated with greater depressive symptom severity, severe insomnia and functional impairment.
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Affiliation(s)
- Narong Maneeton
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Sirijit Suttajit
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Benchalak Maneeton
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Surinporn Likhitsathian
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Kanokkwan Eurviyanukul
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Pichet Udomratn
- b Department of Psychiatry, Faculty of Medicine , Prince of Songkla University , Songkhla , Thailand
| | | | - Tian-Mei Si
- d National Clinical Research Center for Mental Disorders and the Key Laboratory of Mental Health , Ministry of Health (Peking University) , Beijing , China.,e Peking University Institute of Mental Health (The Sixth Hospital) , Beijing , China
| | - Ahmad Hatim Sulaiman
- f Department of Psychological Medicine, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Chia-Hui Chen
- g Department of Psychiatry , Taipei Medical University Shuang-Ho Hospital , Taipei , Taiwan
| | - Dianne Bautista
- c Singapore Clinical Research Institute , Singapore.,h Duke-NUS Medical School , Singapore
| | - Manit Srisurapanont
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
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11
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Examining the role of psychological factors in the relationship between sleep problems and suicide. Clin Psychol Rev 2017; 54:1-16. [PMID: 28371648 PMCID: PMC5434037 DOI: 10.1016/j.cpr.2017.03.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/29/2016] [Accepted: 03/27/2017] [Indexed: 01/08/2023]
Abstract
We sought to conduct the first systematic review of empirical evidence investigating the role of psychological factors in the relationship between sleep problems and suicidal thoughts and behaviours. Twelve studies were identified which examined psychological factors grouped into four categories of cognitive appraisals, psychosocial factors, emotion regulation strategies, and risk behaviours. Although there was substantial heterogeneity across studies with respect to measurement, sampling, and analysis, preliminary evidence indicated that negative cognitive appraisals, perceived social isolation, and unhelpful emotion regulation strategies may contribute to the association between sleep problems and suicidal thoughts and behaviours. Given that findings in this area are currently restricted to studies with cross-sectional designs, the directionality of the interrelationships between these psychological factors, sleep problems and suicidality, remains unclear. We integrate the findings of our review with contemporary psychological models of suicidal behaviour to develop a clear research agenda. Identified pathways should now be tested with longitudinal and experimental designs. In addition, a more thorough investigation of the complexities of sleep, psychological factors, and suicidal thoughts and behaviours is crucial for the development of targeted psychological interventions. Systematic review of the role of psychological factors in sleep/suicide relationships Review findings integrated with suicide theory to define a clear research agenda. Reliance on cross-sectional designs limits interpretation of directionality of pathways. Identified pathways should be investigated with longitudinal and experimental designs.
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12
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Jeon HJ, Woo JM, Kim HJ, Fava M, Mischoulon D, Cho SJ, Chang SM, Park DH, Kim JW, Yoo I, Heo JY, Hong JP. Gender Differences in Somatic Symptoms and Current Suicidal Risk in Outpatients with Major Depressive Disorder. Psychiatry Investig 2016; 13:609-615. [PMID: 27909451 PMCID: PMC5128348 DOI: 10.4306/pi.2016.13.6.609] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 11/10/2015] [Accepted: 11/22/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Although somatic symptoms are common complaints of patients with major depressive disorder (MDD), their associations with suicide are still unclear. METHODS A total of 811 MDD outpatients of aged between 18 to 64 years were enrolled nationwide in Korea with the suicidality module of the Mini-International Neuropsychiatric Interview (MINI) and the Depression and Somatic Symptom Scale (DSSS). RESULTS On stepwise regression analysis, current suicidality scores were most strongly associated with chest pain in men, and neck or shoulder pain in women. Severe chest pain was associated with higher current suicidality scores in men than in women, whereas severe neck or shoulder pain showed no significant differences between the genders. In conclusion, MDD patients of both sexes with suicidal ideation showed significantly more frequent and severe somatic symptoms than those without. Current suicidal risk was associated with chest pain in men, and neck or shoulder pain in women. CONCLUSION We suggest that clinicians pay attention to patients' somatic symptoms in real world practice.
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Affiliation(s)
- Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jong-Min Woo
- Department of Psychiatry, Seoul Paik Hospital, Inje University School of Medicine, Seoul, Republic of Korea
- Stress Research Institute, Inje University, Seoul, Republic of Korea
| | - Hyo-Jin Kim
- OR/RWD Team, Corporate Affairs·Health & Value Division, Pfizer Korea, Seoul, Republic of Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Seong Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon Medical School, Incheon, Republic of Korea
| | - Sung Man Chang
- Department of Psychiatry, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Doo-Heum Park
- Department of Psychiatry, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jong Woo Kim
- Department of Psychiatry, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ikki Yoo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung-Yoon Heo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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13
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Termorshuizen F, Smeets HM, Boks MP, Heerdink ER. Comparing episodes of antidepressants use with intermittent episodes of no use: A higher relative risk of suicide attempts but not of suicide at young age. J Psychopharmacol 2016; 30:1000-7. [PMID: 27005310 DOI: 10.1177/0269881116639752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Food and Drug Administration has issued a number of advisories regarding a possible causal link between antidepressants and suicide behaviour among young persons. We investigated the age dependency of (fatal) suicide attempts associated with antidepressants (N=232,561). By linking insurance claims with the death register of Statistics Netherlands (2002-2011), rates of (fatal) suicide attempts were estimated during antidepressant use and intermittent episodes without use. The age dependency of the relative risk of attempts and of suicide during episodes with compared with episodes without antidepressants was investigated by testing the {age × episode} interaction.The attempt rate during antidepressant use decreased with increasing age, concurrently with a decrease of the relative risk from 3.62 to 1.86 (p for interaction <0.001). This age dependency was found both at the early (<0.5 year) and at later stages after the first prescription (>5 years). No suicides were found among those aged <18 years, and no age dependency for the relative risk of suicide at ages ⩾ 18 was established (p>0.46). The association between antidepressants and suicide attempts at a young age does not necessarily point to a causal relationship, and, most importantly, did not translate to a similar age dependency for suicide.
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Affiliation(s)
- Fabian Termorshuizen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Hugo M Smeets
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands Achmea Health Insurance, Zeist, the Netherlands
| | - Marco Pm Boks
- Brain Centre Rudolf Magnus, Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Eibert R Heerdink
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands Altrecht Institute for Mental Health Care, Utrecht, the Netherlands Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands
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14
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Wakefield JC, Schmitz MF. Feelings of worthlessness during a single complicated major depressive episode predict postremission suicide attempt. Acta Psychiatr Scand 2016; 133:257-65. [PMID: 26538107 DOI: 10.1111/acps.12521] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To establish which symptoms of major depressive episode (MDE) predict postremission suicide attempts in complicated single-episode cases. METHOD Using the nationally representative two-wave National Epidemiologic Survey on Alcohol and Related Conditions data set, we identified wave 1 lifetime single-episode MDE cases in which the episode remitted by the beginning of the wave 2 three-year follow-up period (N = 2791). The analytic sample was further limited to 'complicated' cases (N = 1872) known to have elevated suicide attempt rates, defined as having two or more of the following: suicidal ideation, marked role impairment, feeling worthless, psychomotor retardation, and prolonged (>6 months) duration. RESULTS Logistic regression analyses showed that, after controlling for wave 1 suicide attempt which significantly predicted postremission suicide attempt (OR = 10.0), the additional complicated symptom 'feelings of worthlessness' during the wave 1 index episode significantly and very substantially predicted postremission suicide attempt (OR = 6.96). Neither wave 1 psychomotor retardation nor wave 1 suicidal ideation nor any of the other wave 1 depressive symptoms were significant predictors of wave 2 suicide attempt. CONCLUSION Among depressive symptoms during an MDE, feelings of worthlessness is the only significant indicator of elevated risk of suicide attempt after the episode has remitted, beyond previous suicide attempts.
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Affiliation(s)
- J C Wakefield
- Silver School of Social Work and Department of Psychiatry, School of Medicine, New York University, New York, NY, USA
| | - M F Schmitz
- School of Social Work, Temple University, Philadelphia, PA, USA
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15
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Kim K, Hong JP, Cho MJ, Fava M, Mischoulon D, Lee DW, Heo JY, Jeon HJ. Loss of sexual interest and premenstrual mood change in women with postpartum versus non-postpartum depression: A nationwide community sample of Korean adults. J Affect Disord 2016; 191:222-9. [PMID: 26682491 DOI: 10.1016/j.jad.2015.11.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 11/04/2015] [Accepted: 11/30/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is a type of clinical depression that can affect women after childbirth. Few previous studies have explored the association of depressive and physical symptoms among women with PPD in a nationwide community study. METHOD A total of 18,807 adults, randomly selected, completed a face-to-face interview using the Korean version of Composite International Diagnostic Interview (K-CIDI) (response rate 80.2%). PPD was defined as a major depressive episode that began within 4 weeks after delivery. RESULTS Of 679 female subjects with major depressive disorder (MDD), 14.0% (n=95) experienced PPD. Subjects with PPD were significantly more likely to have higher income, education, and reside in an urban area, compared to those with non-PPD. No significant differences were found in number of children. Multiple logistic regression revealed that the loss of sexual interest was the only symptom among 23 depressive symptoms that was significantly associated with depressive episodes among individuals with PPD (AOR=1.91, 95% CI 1.01-3.60) when compared with non-PPD. Loss of sexual interest was also significantly associated with the subjects with lifetime PPD regardless of depressive episode (AOR=1.93, 95% CI 1.12-3.31). Conversely, loss of confidence and loss of pleasure were less frequent in subjects with PPD. Premenstrual mood change (χ(2)=5.57, p=0.0036) and comorbid alcohol use disorder (χ(2)=5.11, p=0.031) showed a valid association with PPD. CONCLUSIONS Loss of sexual interest and premenstrual mood change were associated with women with PPD, whereas those with non-PPD were not, thereby suggesting the possible link between sexual hormones and PPD.
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Affiliation(s)
- Kiwon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Maeng Je Cho
- Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Dong-Woo Lee
- Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Jung-Yoon Heo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Department of Health Sciences & Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea; Department of Medical Device Management & Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea; Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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16
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Park S, Hatim A, Si TM, Jeon HJ, Srisurapanont M, Bautista D, Liu SI, Chua HC, Hong JP. Stressful life events preceding the onset of depression in Asian patients with major depressive disorder. Int J Soc Psychiatry 2015; 61:735-42. [PMID: 25846010 DOI: 10.1177/0020764015577842] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have identified the significant role of stressful life events in the onset of depressive episodes. However, there is a paucity of cross-national studies on stressful life events that precede depression. AIMS We aimed to compare types of stressful life events associated with the onset of depressive episodes in patients with major depressive disorder (MDD) in five Asian countries. METHOD A total of 507 outpatients with MDD were recruited in China (n = 114), South Korea (n = 101), Malaysia (n = 90), Thailand (n = 103) and Taiwan (n = 99). All patients were assessed with the Mini-International Neuropsychiatric Interview and the List of Threatening Experiences. The prevalence of each type of stressful life events was calculated and compared between each country. RESULTS The type of stressful life event that preceded the onset of a depressive episode differed between patients in China and Taiwan and those in South Korea, Malaysia and Thailand. Patients in China and Taiwan were less likely to report interpersonal relationship problems and occupational/financial problems than patients in South Korea, Malaysia and Thailand. CONCLUSION Understanding the nature and basis of culturally determined susceptibilities to specific stressful life events is critical for establishing a policy of depression prevention and providing effective counseling services for depressed patients.
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Affiliation(s)
- Subin Park
- Department of Psychiatry, Seoul National Hospital, Seoul, South Korea
| | - Ahmad Hatim
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tian-Mei Si
- Peking University Institute of Mental Health, Beijing, China
| | - Hong Jin Jeon
- Department of Psychiatry, Samsung Medical Center, Seoul, South Korea
| | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Dianne Bautista
- Singapore Clinical Research Institute, Singapore Duke-National University of Singapore, Singapore
| | - Shen-ing Liu
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | | | - Jin Pyo Hong
- Department of Psychiatry, Samsung Medical Center, Seoul, South Korea
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17
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Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R, Singh AB. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015; 49:1087-206. [PMID: 26643054 DOI: 10.1177/0004867415617657] [Citation(s) in RCA: 511] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. METHODS Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSIONS The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. INTERNATIONAL EXPERT ADVISORS Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O'Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. AUSTRALIAN AND NEW ZEALAND EXPERT ADVISORS Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O'Connor, Dr Nick O'Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.
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Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Darryl Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia School of Medicine, University of Notre Dame, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia
| | - Kristina Fritz
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Bill Lyndon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia Mood Disorders Unit, Northside Clinic, Greenwich, NSW, Australia ECT Services Northside Group Hospitals, Greenwich, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Greg Murray
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard Porter
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Ajeet B Singh
- School of Medicine, Deakin University, Geelong, VIC, Australia
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18
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Liu YH, Chen L, Su YA, Fang YR, Srisurapanont M, Hong JP, Hatim A, Chua HC, Bautista D, Si TM. Is early-onset in major depression a predictor of specific clinical features with more impaired social function? Chin Med J (Engl) 2015; 128:811-5. [PMID: 25758278 PMCID: PMC4833988 DOI: 10.4103/0366-6999.152654] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Early-onset major depressive disorder (MDD) (EOD) is often particularly malignant due to its special clinical features, accompanying impaired social function, protracted recovery time, and frequent recurrence. This study aimed to observe the effects of age onset on clinical characteristics and social function in MDD patients in Asia. Methods: In total, 547 out-patients aged 18–65 years who were from 13 study sites in five Asian countries were included. These patients had MDD diagnose according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. Clinical features and social function were assessed using Symptom Checklist-90-revised (SCL-90-R) and Sheehan Disability Scale (SDS). Quality of life was assessed by a 36-item Short-form Health Survey (SF-36). Analyses were performed using a continuous or dichotomous (cut-off: 30 years) age-of-onset indicator. Results: Early-onset MDD (EOD, <30 years) was associated with longer illness (P = 0.003), unmarried status (P < 0.001), higher neuroticism (P ≤ 0.002) based on the SCL-90-R, and more limited social function and mental health (P = 0.006, P = 0.007) based on the SF-36 and SDS. The impairment of social function and clinical severity were more prominent at in-patients with younger onset ages. Special clinical features and more impaired social function and quality of life were associated with EOD, as in western studies. Conclusions: EOD often follows higher levels of neuroticism. Age of onset of MDD may be a predictor of clinical features and impaired social function, allowing earlier diagnosis and treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tian-Mei Si
- Key Laboratory of Mental Health, Ministry of Mental Health and Peking University Institute of Mental Health, Beijing 100191, China
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19
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Park S, Hatim Sulaiman A, Srisurapanont M, Chang SM, Liu CY, Bautista D, Ge L, Choon Chua H, Pyo Hong J. The association of suicide risk with negative life events and social support according to gender in Asian patients with major depressive disorder. Psychiatry Res 2015; 228:277-82. [PMID: 26160206 DOI: 10.1016/j.psychres.2015.06.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 02/25/2015] [Accepted: 06/07/2015] [Indexed: 11/18/2022]
Abstract
We investigated the associations between negative life events, social support, depressive and hostile symptoms, and suicide risk according to gender in multinational Asian patients with major depressive disorder (MDD). A total of 547 outpatients with MDD (352 women and 195 men, mean age of 39.58±13.21 years) were recruited in China, South Korea, Malaysia, Singapore, Thailand, and Taiwan. All patients were assessed with the Mini-International Neuropsychiatric Interview, the Montgomery-Asberg Depression Rating Scale, the Symptoms Checklist 90-Revised, the Multidimensional Scale of Perceived Social Support, and the List of Threatening Experiences. Negative life events, social support, depressive symptoms, and hostility were all significantly associated with suicidality in female MDD patients. However, only depressive symptoms and hostility were significantly associated with suicidality in male patients. Depression severity and hostility only partially mediated the association of negative life events and poor social support with suicidality in female patients. In contrast, hostility fully mediated the association of negative life events and poor social support with suicidality in male patients. Our results highlight the need of in-depth assessment of suicide risk for depressed female patients who report a number of negative life events and poor social supports, even if they do not show severe psychopathology.
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Affiliation(s)
- Subin Park
- Department of Psychiatry, Seoul National Hospital, Seoul, South Korea
| | - Ahmad Hatim Sulaiman
- Department of Psychiatry, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | | | - Sung-man Chang
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, South Korea
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital, Taiwan
| | - Dianne Bautista
- Singapore Clinical Research Institute, Singapore; Duke-National University of Singapore, Singapore
| | - Lan Ge
- Lundbeck China, Beijing, China
| | - Hong Choon Chua
- Institute of Mental Health, Woodbridge Hospital, Hospital, Singapore
| | - Jin Pyo Hong
- Department of Psychiatry, Samsung Medical Center, 81 Irwon-Ro Gangnam-gu, Seoul 135-710, South Korea.
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20
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Armitage CJ, Panagioti M, Abdul Rahim W, Rowe R, O'Connor RC. Completed suicides and self-harm in Malaysia: a systematic review. Gen Hosp Psychiatry 2015; 37:153-65. [PMID: 25636361 DOI: 10.1016/j.genhosppsych.2014.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 12/01/2014] [Accepted: 12/11/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Most of the research into suicide and self-harm has been conducted in the United States and Europe, yet the volume of research does not reflect the distribution of suicide globally, with Asia accounting for up to 60% of all suicides. The present study systematically reviews the literature to assess the prevalence and correlates of suicidal acts in Malaysia in Southeast Asia. METHODS Five relevant databases were searched from inception up to February 2014, and a narrative synthesis of the results from the included studies was performed. Studies were eligible for inclusion if they were correlational survey research and archival/observational research describing self-harm and suicide. Outcomes included completed suicides and self-harm including suicide attempts and self-poisoning, suicide plans and suicidal ideation. RESULTS In total, 39 studies met the inclusion criteria. The principal findings were that the prevalence of suicide in Malaysia is approximately 6-8 per 100,000 population per year and that there is an excess of suicide among men, people younger than 40 years and the Indian minority group. The past-month prevalence rates of suicidal ideation, plans and attempts are 1.7, 0.9% and 0.5%, respectively, whereas the past-year prevalence rates of suicidal ideation range between 6% and 8%. CONCLUSIONS The present research marks a first step towards understanding the prevalence and correlates of suicide and self-harm in Malaysia. However, the heterogeneity of the included studies was high. Further research into the antecedents, consequences and interventions for suicide and self-harm in the Malaysian context is required.
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Park SC, Lee SK, Oh HS, Jun TY, Lee MS, Kim JM, Kim JB, Yim HW, Park YC. Hazardous drinking-related characteristics of depressive disorders in Korea: the CRESCEND study. J Korean Med Sci 2015; 30:74-81. [PMID: 25552886 PMCID: PMC4278031 DOI: 10.3346/jkms.2015.30.1.74] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 08/12/2014] [Indexed: 11/20/2022] Open
Abstract
This study aimed to identify clinical correlates of hazardous drinking in a large cohort of Korean patients with depression. We recruited a total of 402 depressed patients aged > 18 yr from the Clinical Research Center for Depression (CRESCEND) study in Korea. Patients' drinking habits were assessed using the Korean Alcohol Use Disorder Identification Test (AUDIT-K). Psychometric scales, including the HAMD, HAMA, BPRS, CGI-S, SSI-Beck, SOFAS, and WHOQOL-BREF, were used to assess depression, anxiety, overall psychiatric symptoms, global severity, suicidal ideation, social functioning, and quality of life, respectively. We compared demographic and clinical features and psychometric scores between patients with and without hazardous drinking behavior after adjusting for the effects of age and sex. We then performed binary logistic regression analysis to identify independent correlates of hazardous drinking in the study population. Our results revealed that hazardous drinking was associated with current smoking status, history of attempted suicide, greater psychomotor retardation, suicidal ideation, weight loss, and lower hypochondriasis than non-hazardous drinking. The regression model also demonstrated that more frequent smoking, higher levels of suicidal ideation, and lower levels of hypochondriasis were independently correlates for hazardous drinking in depressed patients. In conclusion, depressed patients who are hazardous drinkers experience severer symptoms and a greater burden of illness than non-hazardous drinkers. In Korea, screening depressed patients for signs of hazardous drinking could help identify subjects who may benefit from comprehensive therapeutic approaches.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Yong-In Mental Hospital, Yongin, Korea
- Institute of Mental Health, Hanyang University, Seoul, Korea
| | - Sang Kyu Lee
- Department of Psychiatry, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Hong Seok Oh
- Department of Psychiatry, Yong-In Mental Hospital, Yongin, Korea
| | - Tae-Youn Jun
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Min-Soo Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University School of Medicine, Gwangju, Korea
| | - Jung-Bum Kim
- Department of Psychiatry, Keimyung University School of Medicine, Daegu, Korea
| | - Hyeon-Woo Yim
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Chon Park
- Institute of Mental Health, Hanyang University, Seoul, Korea
- Department of Psychiatry, Hanyang University College Guri Hospital, Guri, Korea
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Jeon HJ, Park JI, Fava M, Mischoulon D, Sohn JH, Seong S, Park JE, Yoo I, Cho MJ. Feelings of worthlessness, traumatic experience, and their comorbidity in relation to lifetime suicide attempt in community adults with major depressive disorder. J Affect Disord 2014; 166:206-12. [PMID: 25012433 DOI: 10.1016/j.jad.2014.05.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) and traumatic experience are independent risk factors for lifetime suicide attempt (LSA). However, the relationships between trauma history and depressive symptomatology as they relate to LSA are not fully understood. METHODS A total of 12,532 adults, randomly selected through one-person-per-household method, completed a face-to-face interview using the Korean version of Composite International Diagnostic Interview (K-CIDI) and a questionnaire for LSA (response rate 80.2%). RESULTS Among 825 subjects with MDD, 141 subjects reported an LSA (17.1%). LSAs were significantly greater in those who had experienced any trauma than in those who had not (χ(2)=34.66, p<0.0001). Multivariate logistic regression showed that only feelings of worthlessness were significantly associated with LSA among 20 depression symptoms in individuals with MDD (AOR=3.08, 95% CI 1.70-5.60). Feelings of worthlessness was associated with LSA in those who had experienced serious trauma (AOR=5.02, 95% CI 3.35-7.52), but not in those who had not. Serious traumas associated with LSA included military combat, witnessing a violent crime, rape or sexual assault, a bad beating, being threatened by others, and learning about traumas to others. Serious trauma showed no significant association with LSA in those who did not have feelings of worthlessness. PTSD was a comorbidity that showed the highest odds ratio with LSA in individuals with MDD. CONCLUSIONS Feelings of worthlessness are more strongly associated with LSA than other depression symptoms in individuals with MDD, and it is significantly associated with LSA in those who experienced serious trauma but not in those who did not.
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Affiliation(s)
- Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, South Korea; Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jong-Ik Park
- Department of Psychiatry, Kangwon National University College of Medicine, Chuncheon, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jee Hoon Sohn
- Department of Psychiatry & Behavioral Science, Seoul National University College of Medicine, 28 Yeongeon-dong, Chongno-gu, Seoul 110-744, South Korea
| | - Sujeong Seong
- Department of Psychiatry & Behavioral Science, Seoul National University College of Medicine, 28 Yeongeon-dong, Chongno-gu, Seoul 110-744, South Korea
| | - Jee Eun Park
- Department of Psychiatry & Behavioral Science, Seoul National University College of Medicine, 28 Yeongeon-dong, Chongno-gu, Seoul 110-744, South Korea
| | - Ikki Yoo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Maeng Je Cho
- Department of Psychiatry & Behavioral Science, Seoul National University College of Medicine, 28 Yeongeon-dong, Chongno-gu, Seoul 110-744, South Korea.
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Risk factors for suicide among 34,671 patients with psychotic and non-psychotic severe depression. J Affect Disord 2014; 156:119-25. [PMID: 24388683 DOI: 10.1016/j.jad.2013.12.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 11/25/2013] [Accepted: 12/03/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Severe unipolar depression is associated with increased risk of suicide, but it remains unknown whether the same risk factors are present in the non-psychotic (non-PD) and psychotic (PD) subtypes respectively. Therefore, this study aimed to identify risk factors for suicide in non-PD and PD separately, and to investigate if the presence of psychotic symptoms is an independent risk factor for suicide in severe depression. METHODS This register-based, nationwide, historical prospective cohort study used logistic regression analyses to ascertain risk factors for suicide among all adults diagnosed with severe depression at Danish psychiatric hospitals between January 1, 1994 and December 31, 2010. The risk for suicide was expressed as adjusted odds ratios (AOR). RESULTS A total of 34,671 individuals with severe depression (non-PD: n=26,106 and PD: n=12,101) were included in the study. Of these, 755 completed suicide during follow up. PD was not found to be an independent risk factor for suicide in severe depression (AOR=0.97 [0.83-1.15]). Older age (non-PD AOR=1.05 [per year], PD AOR=1.04 [per year]), male sex (non-PD AOR=1.89, PD AOR=1.98), and a previous incident of self-harm (non-PD AOR=5.02, PD AOR=5.17) were significant risk factors for both groups. LIMITATIONS As the study population was comprised only of patients with contact to psychiatric hospitals, the results cannot be extrapolated to the primary care setting. CONCLUSION The following risk factors for non-PD and PD were identified: older age, male gender and previous incidents of self-harm. In suicide prevention efforts, equal attention should be paid to non-PD and PD patients.
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Lim AY, Lee AR, Hatim A, Tian-Mei S, Liu CY, Jeon HJ, Udomratn P, Bautista D, Chan E, Liu SI, Chua HC, Hong JP. Clinical and sociodemographic correlates of suicidality in patients with major depressive disorder from six Asian countries. BMC Psychiatry 2014; 14:37. [PMID: 24524225 PMCID: PMC3937022 DOI: 10.1186/1471-244x-14-37] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND East Asian countries have high suicide rates. However, little is known about clinical and sociodemographic factors associated with suicidality in Asian populations. The aim of this study was to evaluate the factors associated with suicidality in patients with major depressive disorder (MDD) from six Asian countries. METHODS The study cohort consisted of 547 outpatients with MDD. Patients presented to study sites in China (n = 114), South Korea (n = 101), Malaysia (n = 90), Singapore (n = 40), Thailand (n = 103), and Taiwan (n = 99). All patients completed the Mini-International Neuropsychiatric Interview (MINI), the Montgomery-Asberg Depression Rating Scale (MADRS), the Global Severity Index(SCL-90R), the Fatigue Severity Scale, the 36-item short-form health survey, the Sheehan Disability Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). Patients were classified as showing high suicidality if they scored ≥ 6 on the MINI suicidality module. Multivariate logistic regression analysis was used to examine sociodemographic and clinical factors related to high suicidality. RESULTS One hundred and twenty-five patients were classed as high suicidality. Unemployed status (adjusted odds ratio [OR] 2.43, p < 0.01), MADRS score (adjusted OR 1.08), p < 0.001, and GSI (SCL-90R) score (adjusted OR 1.06, p < 0.01) were positively related to high suicidality. Hindu (adjusted OR 0.09, p < 0.05) or Muslim (adjusted OR 0.21, p < 0.001) religion and MSPSS score (adjusted OR 0.82, p < 0.05) were protective against high suicidality. CONCLUSIONS A variety of sociodemographic and clinical factors were associated with high suicidality in Asian patients with MDD. These factors may facilitate the identification of MDD patients at risk of suicide.
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Affiliation(s)
- Ah-Young Lim
- Department of Psychiatry, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Ah-Rong Lee
- Department of Psychiatry, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Ahmad Hatim
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Si Tian-Mei
- Peking University Institute of Mental Health, Beijing, China
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Medical Center and Chang Gung University, Tao-Yuan County, Taiwan
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Dianne Bautista
- Singapore Clinical Research Institute, Singapore, Singapore,Duke-National University of Singapore, Singapore, Singapore
| | - Edwin Chan
- Singapore Clinical Research Institute, Singapore, Singapore,Duke-National University of Singapore, Singapore, Singapore
| | - Shen-Ing Liu
- Department of Psychiatry, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Hong Choon Chua
- Institute of Mental Health, Woodbridge Hospital, Singapore, Singapore
| | - Jin Pyo Hong
- Department of Psychiatry, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea.
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Malhi GS, Fritz K, Coulston CM, Lampe L, Bargh DM, Ablett M, Lyndon B, Sapsford R, Theodoros M, Woolfall D, van der Zypp A, Hopwood M. Severity alone should no longer determine therapeutic choice in the management of depression in primary care: findings from a survey of general practitioners. J Affect Disord 2014; 152-154:375-80. [PMID: 24268593 DOI: 10.1016/j.jad.2013.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The treatment of depression in primary care remains suboptimal for reasons that are complex and multifactorial. Typically GPs have to make difficult decisions in limited time and therefore, the aim of this study was to examine the management of depression of varying severity and the factors associated with treatment choices. METHOD Nested within a primary care educational initiative we conducted a survey of 1760 GPs. The GPs each identified four patients with clinical depression whom they had treated recently and then answered questions regarding their diagnosis and management of each patient. RESULTS Comorbid anxiety, sadness and decreased concentration appeared to direct the management of depression toward psychological therapy, whereas comorbid pain and a patient's overall functioning, such as the ability to do simple everyday activities, directed the initiation of pharmacological treatment. The use of antidepressants with a broader spectrum of actions (acting on multiple neurotransmitters) increased from mild to severe depression, whereas this did not occur with the more selective agents. SSRIs were prescribed more frequently compared with all other antidepressants, irrespective of depression severity. LIMITATIONS GPs chose the RADAR programme and therefore they were potentially more likely to have an interest in mental health compared to GPs who did not participate. CONCLUSIONS GPs do not appear to be determining pharmacological treatment based on depression subtype and specificity, but rather on the basis of the total number of symptoms and overall severity. While acknowledging important differences between primary care and specialist practice, it is suggested that guidelines to assist GPs in matching treatment to depression subtype may be of practical assistance in decision-making, and the delivery of more effective treatments.
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Affiliation(s)
- G S Malhi
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonard's, Sydney 2065, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, NSW, Australia.
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