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Huang ZX, Wang Q, Lei S, Zhang W, Huang Y, Zhang C, Zhang X. Development and validation of the risk score for estimating suicide attempt in patients with major depressive disorder. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1029-1037. [PMID: 37831079 DOI: 10.1007/s00127-023-02572-3] [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: 04/27/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
Early identification of high-risk patients with Major depressive disorder (MDD) having suicide attempts (SAs) is essential for timely targeted and tailored psychological interventions and medications. This study aimed to develop and validate a web-based dynamic nomogram as a personalized predictor of SA in MDD patients. A dynamic nomogram was developed using data collected from 1718 patients in China. The dynamic model was established based on a machine learning-based regression technique in the training cohort. We validated the nomogram internally using 1000 bootstrap replications. The nomogram performance was assessed using estimates of discrimination (via the concordance index) and calibration (calibration plots). The nomogram incorporated five predictors, including Hamilton anxiety rating scale (odds ratio [OR]: 1.255), marital status (OR: 0.618), clinical global impressions (OR: 2.242), anti-thyroid peroxidase antibodies (OR: 1.002), and systolic pressure levels (OR: 1.037). The model demonstrated good overall discrimination (Harrell's C-index = 0.823). Using decision curve analysis, this model also demonstrated good clinical applicability. An online web server was constructed ( https://odywong.shinyapps.io/PRSM/ ) to facilitate the use of the nomogram. Based on these results, our study developed a nomogram to predict SA in MDD patients. The application of this nomogram may help for patients and clinicians to make decisions.
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Affiliation(s)
- Zhi-Xin Huang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
- Jinan University Faculty of Medical Science, Guangzhou, Guangdong, China
- Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Qizhang Wang
- Department of Neurology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, Guangdong, China
| | - Shasha Lei
- Jinan University Faculty of Medical Science, Guangzhou, Guangdong, China
| | - Wenli Zhang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Ying Huang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Caiping Zhang
- Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoying District, Beijing, 100101, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Ehtemam H, Sadeghi Esfahlani S, Sanaei A, Ghaemi MM, Hajesmaeel-Gohari S, Rahimisadegh R, Bahaadinbeigy K, Ghasemian F, Shirvani H. Role of machine learning algorithms in suicide risk prediction: a systematic review-meta analysis of clinical studies. BMC Med Inform Decis Mak 2024; 24:138. [PMID: 38802823 PMCID: PMC11129374 DOI: 10.1186/s12911-024-02524-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE Suicide is a complex and multifactorial public health problem. Understanding and addressing the various factors associated with suicide is crucial for prevention and intervention efforts. Machine learning (ML) could enhance the prediction of suicide attempts. METHOD A systematic review was performed using PubMed, Scopus, Web of Science and SID databases. We aim to evaluate the performance of ML algorithms and summarize their effects, gather relevant and reliable information to synthesize existing evidence, identify knowledge gaps, and provide a comprehensive list of the suicide risk factors using mixed method approach. RESULTS Forty-one studies published between 2011 and 2022, which matched inclusion criteria, were chosen as suitable. We included studies aimed at predicting the suicide risk by machine learning algorithms except natural language processing (NLP) and image processing. The neural network (NN) algorithm exhibited the lowest accuracy at 0.70, whereas the random forest demonstrated the highest accuracy, reaching 0.94. The study assessed the COX and random forest models and observed a minimum area under the curve (AUC) value of 0.54. In contrast, the XGBoost classifier yielded the highest AUC value, reaching 0.97. These specific AUC values emphasize the algorithm-specific performance in capturing the trade-off between sensitivity and specificity for suicide risk prediction. Furthermore, our investigation identified several common suicide risk factors, including age, gender, substance abuse, depression, anxiety, alcohol consumption, marital status, income, education, and occupation. This comprehensive analysis contributes valuable insights into the multifaceted nature of suicide risk, providing a foundation for targeted preventive strategies and intervention efforts. CONCLUSIONS The effectiveness of ML algorithms and their application in predicting suicide risk has been controversial. There is a need for more studies on these algorithms in clinical settings, and the related ethical concerns require further clarification.
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Affiliation(s)
- Houriyeh Ehtemam
- School of Engineering and the Built Environment, Anglia Ruskin University, Chelmsford, UK
| | | | - Alireza Sanaei
- School of Engineering and the Built Environment, Anglia Ruskin University, Chelmsford, UK
| | - Mohammad Mehdi Ghaemi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Sadrieh Hajesmaeel-Gohari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Rohaneh Rahimisadegh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fahimeh Ghasemian
- Department of Computer Engineering, Faculty of Engineering, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Hassan Shirvani
- School of Engineering and the Built Environment, Anglia Ruskin University, Chelmsford, UK
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Liu Z, Sun L, Sun F, Zhang Y, Wang J, Zhang Z, Sun G, Sun L, Yang R, Yao G, Liu Y. The abnormalities of lipid metabolism in children and adolescents with major depressive disorder and relationship with suicidal ideation and attempted suicide. Heliyon 2024; 10:e30344. [PMID: 38726112 PMCID: PMC11079100 DOI: 10.1016/j.heliyon.2024.e30344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/11/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
Background Major depressive disorder (MDD) is a widespread health issue in many countries, which has an extremely negative impact on the health of children and adolescents in particular. In the context of depression and metabolic disorders, dyslipidemia and metabolism-related problems become more prominent comorbidities. However, they continue to be the main barrier to the successful recovery of the clinical progress. In this study we investigated the rate of dyslipidemia, additional risk factors among Chinese children and adolescents with MDD, and association of the suicidal behavior with lipid levels. Methods The study took 756 people from the Third People's Hospital of Fuyang between January 2020 and December 2021, aged between 8 and 18, with major depressive disorders diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). We determined the FBG (fasting blood glucose) and lipid parameters in all subjects and also investigated the history of suicidal ideation, the cases of attempted suicide, and the scores of depressive symptoms. Sociodemographic and clinical data were gathered and analyzed using the SPSS-23.0 version. Results The prevalence of hypercholesterolemia, hypertriglyceridemia, high LDL-C, and low HDL-C were 5.42 % (41/756), 10.58 % (80/756), 3.84 % (29/756) and 5.42 % (41/756) respectively. For hypercholesterolemia and hypertriglyceridemia, they were positive associated with suicidal ideation and suicide attempts, and the positive correlation is shown between low HDL-C levels and suicide attempts. Nevertheless, non-ideation and inversely suicidal attempts were not discovered among high-LDL-C subjects. Logistic analysis showed that high levels of FBG (OR = 2.86, 95 % CI: 1.31-6.25, P = 0.008) and worse LDL-C (OR = 357.82, 95 % CI: 66.16-1935.10, P < 0.001) are the independent associated factors for hypercholesterolemia. More hospitalizations (OR = 1.89, 95 % CI: 1.07-3.35, P = 0.028), obesity (OR = 2.55, 95 % CI: 1.25-5.18, P = 0.010), high levels of TC (OR = 2.15, 95 % CI: 1.03-4.48, P = 0.042), and higher doses of antidepressants (OR = 1.02, 95 % CI: 1.00-1.04, P = 0.029) were independently associated factors for hypertriglyceridemia, while high levels of HDL-C (OR = 0.11, 95 % CI: 0.04-0.31, P < 0.001) were protective factors. In addition, high levels of TC (OR = 113.94, 95 % CI: 20.01-648.85) were statistically different (P < 0.001) and suggested that the factor was significantly related to high LDL-C. Meanwhile, older age (OR = 1.25, 95 % CI: 1.02-1.52, P = 0.030) and high levels of TG (OR = 3.00, 95 % CI: 1.98-4.55, P < 0.001) were independent factors contributing to low HDL-C. Conclusion The high prevalence of dyslipidemia in childhood and adolescence among children and adolescents with depressive disorder has become a public health issue. Hypercholesterolemia and hypertriglyceridemia showed a positive correlation with suicidal thoughts and suicidal attempts. Monitoring the incidence of suicidal thoughts and attempts among them would carry some predictor meaning in therapy and for jumping back to health.
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Affiliation(s)
- Zhiwei Liu
- Department of Psychiatry, The Third People's Hospital of Fuyang, Fuyang, 236015, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, 236015, China
| | - Liang Sun
- Department of Psychiatry, The Third People's Hospital of Fuyang, Fuyang, 236015, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, 236015, China
| | - Feng Sun
- Department of Psychiatry, The Third People's Hospital of Fuyang, Fuyang, 236015, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, 236015, China
| | - Yulong Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, 238000, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 238000, China
| | - Juan Wang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, 610036, China
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, 610036, China
| | - Zhaokun Zhang
- Department of Psychiatry, The Third People's Hospital of Fuyang, Fuyang, 236015, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, 236015, China
| | - Guangying Sun
- Department of Psychiatry, The Third People's Hospital of Fuyang, Fuyang, 236015, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, 236015, China
| | - Longlong Sun
- Department of Psychiatry, The Third People's Hospital of Fuyang, Fuyang, 236015, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, 236015, China
| | - Rongchun Yang
- Department of Psychiatry, The Third People's Hospital of Fuyang, Fuyang, 236015, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, 236015, China
| | - Gaofeng Yao
- Department of Psychiatry, The Third People's Hospital of Fuyang, Fuyang, 236015, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, 236015, China
| | - Yun Liu
- Department of Psychiatry, The Third People's Hospital of Fuyang, Fuyang, 236015, China
- Department of Psychiatry, Fuyang Mental Health Center, Fuyang, 236015, China
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Guo J, Wang L, Zhao X, Wang D, Zhang X. Sex difference in association between suicide attempts and lipid profile in first-episode and drug naive patients with major depressive disorder. J Psychiatr Res 2024; 172:24-33. [PMID: 38354544 DOI: 10.1016/j.jpsychires.2024.02.026] [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: 08/08/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND The relationship between suicide attempts and lipid profiles in patients with major depressive disorder (MDD) remains uncertain. The purpose of this study was to investigate sex differences in the relationship between suicide attempts and plasma lipid profiles in a large sample of first-episode and drug naive (FEDN) MDD patients. METHODS We recruited 1718 FEDN MDD patients and gathered demographic, clinical, and blood lipid data. The Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale and the Positive and Negative Syndrome Scale were used to assess the symptoms of patients. RESULTS There was no significant difference in the prevalence of suicide attempts between male and female MDD patients. The suicide attempt group had higher levels of depression, anxiety, psychotic symptoms, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C), but lower levels of high-density lipoprotein cholesterol (HDL-C) levels than the non-suicide attempt group. Binary logistic regression showed that TC levels were significantly correlated with suicidal attempts in both male and female patients. Correlation analysis revealed that the levels of TC, HDL-C and LDL-C were significantly associated with the number of suicide attempts in both male and female patients. Further multiple linear regression revealed that TC levels were significantly associated with the number of suicide attempts in male patients only. CONCLUSIONS Lipid biomarkers, particularly high TC levels, are associated with suicide attempts in both male and female MDD patients. However, there is gender difference in association between lipid biomarkers, especially TC levels, and the number of suicide attempts in MDD patients.
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Affiliation(s)
- Junru Guo
- School of Psychology, Guizhou Normal University, Guiyang, 550025, China; Department of Psychology, Guizhou Minzu University, Guiyang, 550025, China
| | - Li Wang
- School of Psychology, Guizhou Normal University, Guiyang, 550025, China; CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Xiaoqing Zhao
- Student Affairs Office, Guizhou University, Guiyang, 550025, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China.
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Peng P, Wang Q, Zhou Y, Hao Y, Chen S, Wu Q, Li M, Wang Y, Yang Q, Wang X, Liu Y, Ma Y, He L, Xu H, Li Z, Lang X, Liu T, Zhang X. Association of subclinical hypothyroidism with metabolic syndrome and its components among outpatients with first-episode drug-naïve major depressive disorder: a large-scale cross-sectional study. Eur Arch Psychiatry Clin Neurosci 2024; 274:573-582. [PMID: 36961565 DOI: 10.1007/s00406-023-01588-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/06/2023] [Indexed: 03/25/2023]
Abstract
Both metabolic syndrome (MetS) and subclinical hypothyroidism (SCH) are prevalent in major depressive disorder (MDD) patients. However, their relationship in this population remains unknown. The study assessed the association between SCH and MetS in 1706 first-episode drug-naïve (FEDN) MDD patients. We also compared the relationship between MetS and clinical symptoms in patients with and without comorbid SCH. The Positive and Negative Syndrome Scale positive subscale, the Hamilton Anxiety Rating Scale, and the Hamilton Depression Rating Scale were used to detect clinical symptoms. Serum levels of free triiodothyronine, free thyroxine, thyroid stimulating hormone (TSH), anti-thyroglobulin, thyroid peroxidases antibody, cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting glucose were measured. The Area Under the Curve (AUC) was used to test the performance of serum TSH in identifying MetS patients. The prevalence of MetS and SCH was 34.5% (n = 585) and 61% (n = 1034), respectively. The presence of SCH increased the risk of MetS, hyperglycemia, hypertension, obesity, and low HDL-C by 4.91, 3.51, 3.54, 2.02, and 2.34 times, respectively. Serum TSH had a nice ability to distinguish MetS patients from non-MetS patients (AUC value = 0.77). MetS and its components exhibited a positive association with clinical profiles only in SCH patients, but not in non-SCH patients. Taken together, our study suggested SCH was closely related to MetS and might play a vital role in the relationship between MetS and clinical symptoms. Regular thyroid function checks might help early detect MetS.
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Affiliation(s)
- Pu Peng
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qianjin Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yanan Zhou
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Yuzhu Hao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Shubao Chen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qiuxia Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Manyun Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yunfei Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qian Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xin Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yueheng Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuejiao Ma
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Li He
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Huixue Xu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zejun Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - XiaoE Lang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Tieqiao Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Civardi SC, Besana F, Carnevale Miacca G, Mazzoni F, Arienti V, Politi P, Brondino N, Olivola M. Risk factors for suicidal attempts in a sample of outpatients with treatment-resistant depression: an observational study. Front Psychiatry 2024; 15:1371139. [PMID: 38585482 PMCID: PMC10995380 DOI: 10.3389/fpsyt.2024.1371139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Treatment-resistant depression (TRD) is commonly defined as the failure of at least two trials with antidepressant drugs, given at the right dose and for an appropriate duration. TRD is associated with increased mortality, compared to patients with a simple major depressive episode. This increased rate was mainly attributed to death from external causes, including suicide and accidents. The aim of our study is to identify socio-demographic and psychopathological variables associated with suicidal attempts in a sample of outpatients with TRD. Material and methods We performed a monocentric observational study with a retrospective design including a sample of 63 subjects with TRD referred to an Italian outpatient mental health centre. We collected socio-demographic and psychopathological data from interviews and clinical records. Results 77.8% of the sample (N=49) were females, the mean age was 49.2 (15.9). 33.3% (N=21) of patients had attempted suicide. 54% (N=34) of patients had a psychiatric comorbidity. Among the collected variables, substance use (p=0.031), psychiatric comorbidities (p=0.049) and high scores of HAM-D (p=0.011) were associated with the occurrence of suicide attempts. In the regression model, substance use (OR 6.779), psychiatric comorbidities (OR 3.788) and HAM-D scores (OR 1.057) were predictive of suicide attempts. When controlling for gender, only substance use (OR 6.114) and HAM-D scores (OR 1.057) maintained association with suicide attempts. Conclusion The integrated treatment of comorbidities and substance abuse, which involves different mental health services, is fundamental in achieving the recovery of these patients. Our study supports the importance of performing a careful clinical evaluation of patients with TRD in order to identify factors associated with increased risk of suicide attempts.
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Affiliation(s)
| | - Filippo Besana
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | | | - Filippo Mazzoni
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Vincenzo Arienti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Addictions, Azienda Socio-Sanitaria Territoriale (ASST), Pavia, Pavia, Italy
| | - Natascia Brondino
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Addictions, Azienda Socio-Sanitaria Territoriale (ASST), Pavia, Pavia, Italy
| | - Miriam Olivola
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Addictions, Azienda Socio-Sanitaria Territoriale (ASST), Pavia, Pavia, Italy
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Su Y, Ye C, Xin Q, Si T. Major depressive disorder with suicidal ideation or behavior in Chinese population: A scoping review of current evidence on disease assessment, burden, treatment and risk factors. J Affect Disord 2023; 340:732-742. [PMID: 37619652 DOI: 10.1016/j.jad.2023.08.106] [Citation(s) in RCA: 3] [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: 02/23/2023] [Revised: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Identifying and managing major depressive disorder (MDD) patients with suicidal ideation or behavior (MDSI) is critical for reducing the disease burden. This scoping review aims to map the existing evidence related to MDSI in the Chinese population. METHOD A scoping review was conducted to summarize the published evidence regarding epidemiology or disease burden, evaluation, diagnosis, management, and prognosis of MDSI. The search strategy imposed restriction on English or Chinese publications between 1 January 2011 and 28 February 2022. RESULTS Of the 14,005 identified records, 133 met the eligibility criteria and were included for analysis. The included studies were characterized as high heterogeneity in evaluation of suicidal ideation or behavior. Compared with MDD patients without suicidal ideation or behavior, MDSI patients were more likely to suffer from psychological and somatic symptoms, social function impairment, and lower quality of life. Younger age, female gender, longer disease course, and comorbid psychological or physical symptoms were consistently found to be risk factors of suicidal ideation or behavior. Relevant research gaps remain regarding comprehensive evaluation of standard clinical diagnosis, disease burden, social-cultural risk factors, and effectiveness of interventions targeting MDSI. Studies with large sample size, representative population are warranted to provide high-quality evidence. CONCLUSIONS MDD patients with suicidal ideation or behavior should be prioritized in treatment and resource allocation. Heterogeneity exists in the definition and evaluation of MDSI in different studies. To better inform clinical practice, it is imperative to establish a unified standard for evaluation and diagnosis of suicidal ideation or behavior among MDD population.
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Affiliation(s)
- Yun'Ai Su
- Peking University Sixth Hospital, Beijing, China; Peking University Institute of Mental Health, Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Chong Ye
- Xi'an Janssen Pharmaceutical Ltd, Beijing, China
| | - Qin Xin
- Xi'an Janssen Pharmaceutical Ltd, Beijing, China
| | - Tianmei Si
- Peking University Sixth Hospital, Beijing, China; Peking University Institute of Mental Health, Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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8
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Song X, Liu X, Zhou Y, Zhang X. Prevalence and correlates of suicide attempts in young patients with first-episode and drug-naïve major depressive disorder: A large cross-sectional study. J Affect Disord 2023; 340:340-346. [PMID: 37541596 DOI: 10.1016/j.jad.2023.08.006] [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: 03/27/2023] [Revised: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Few studies in China have reported factors influencing suicide attempt in young first-episode drug-free (FEDN) MDD patients. This study aimed to investigate the incidence and potential relevant factors of suicide attempt among young Chinese patients with FEDN MDD to prevent suicidal behavior in this population. METHODS We recruited 1076 FEDN MDD outpatients aged 18-45 years. Patients' mental states were measured by the Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Positive and Negative Syndrome Scale (PANSS) positive subscale, and Clinical Global Impression Severity Scale (CGIS). Fasting blood glucose, lipid levels, and thyroid function parameters were also measured. RESULTS The prevalence of suicide attempt for FEDN MDD patients was 18.31 %. Compared to patients without suicide attempt, patients with suicide attempt had an older age of onset, higher HAMA, HAMD, PANSS-positive subscale and CGI-S scores, higher blood pressure, fasting blood glucose, thyroid peroxidases antibody (A-TPO), anti-thyroglobulin (A-TG), thyroid stimulating hormone (TSH), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC), but lower high-density lipoprotein cholesterol (HDLC) (all p < 0.05). Logistic regression analysis showed that duration of illness, hypertension, PANSS-positive subscale, HAMA and CGI-S scores, and A-TPO, LDL-C, TC, and HDL-C were associated with suicide attempt in patients with MDD. LIMITATIONS The main limitations are cross-sectional design and inability to control selection bias. CONCLUSIONS This study suggests that young patients with FEDN MDD have a high rate of suicide attempts. Several clinical and metabolic indicators related to lipids and thyroid function may be involved in suicide attempts in FEDN MDD patients.
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Affiliation(s)
- Xiuli Song
- Clinical psychology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Xiaoran Liu
- School of Nursing, Binzhou Medical University, Yantai, China
| | | | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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Liu J, Jia F, Li C, Yuan H, Yang H, Yang R, Yue Y, Zhang G, Zhang X, Ye G, Li Z, Du X, Zhang X. Association between body mass index and suicide attempts in Chinese patients of a hospital in Shanxi district with first-episode drug-naïve major depressive disorder. J Affect Disord 2023; 339:377-383. [PMID: 37393956 DOI: 10.1016/j.jad.2023.06.064] [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: 12/14/2022] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE In patients with major depressive disorder (MDD), the relationship between body mass index (BMI) and risk of suicide attempts (SA) remains unclear, and findings are controversial. The aim of this study was to investigate the relationship between BMI and SA in a Chinese population with first-episode drug-naïve (FEDN) MDD. METHODS A total of 1718 patients with FEDN MDD were enrolled in this cross-sectional study. Their socio-demographic characteristics as well as anthropometric data were collected. The 17-item Hamilton Rating Scale (HAMD-17) and Hamilton Anxiety Scale (HAMA) were used to assess the severity of depression and anxiety symptoms in all participants. Thyroid hormones, lipid profile, and fasting blood glucose (FBG) were measured. A history of suicide attempts was verified based on medical records and interviews with patients and their family members. Multiple logistic regression analysis was used to estimate the association between BMI and the risk of SA. Threshold effects were examined by a two-piecewise logistic regression model. RESULTS Multiple logistic regression analysis showed that BMI was independently and negatively correlated with SA (OR = 0.91, 95%CI: 0.85 to 0.98, P = 0.01) in patients with FEDN MDD after adjusting for covariates. Smoothing plots also revealed a non-linear (L-shaped) relationship between BMI and SA, and a two-piecewise logistic regression model was used to calculate the inflection point of BMI as 22.1 kg/m2. On the left of the inflection point, a negative association between BMI and SA was detected (OR = 0.54, 95%CI: 0.42 to 0.70, P < 0.001), while no significant association was observed on the right side of the inflection point (OR = 1.01, 95%CI: 0.93 to 1.10, P = 0.75). CONCLUSIONS Our results suggest that lower BMI is associated with a higher risk of recent SA in Chinese patients with FEDN MDD, especially in those with BMI below 22.1 kg/m2.
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Affiliation(s)
- Junjun Liu
- Medical College of Soochow University, Suzhou 215137, PR China; Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China; Nanjing Meishan Hospital, Nanjing 210041, PR China
| | - Fennan Jia
- Medical College of Soochow University, Suzhou 215137, PR China; Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Chuanwei Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | | | - Haidong Yang
- The Fourth People's Hospital of Lianyungang, The Affiliated KangDa College of Nanjing Medical University, Lianyungang 222003, PR China
| | - Ruchang Yang
- Medical College of Soochow University, Suzhou 215137, PR China; Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Yan Yue
- Medical College of Soochow University, Suzhou 215137, PR China; Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Guangya Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Gang Ye
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China
| | - Xiangdong Du
- Medical College of Soochow University, Suzhou 215137, PR China; Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100000, PR China.
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Sun Z, Yang J, Zhou J, Zhou J, Feng L, Feng Y, He Y, Liu M, Li Y, Wang G, Li R. Tissue-Specific Oxysterols as Predictors of Antidepressant (Escitalopram) Treatment Response in Patients With Major Depressive Disorder. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:663-672. [PMID: 37881566 PMCID: PMC10593904 DOI: 10.1016/j.bpsgos.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/22/2022] [Accepted: 01/08/2023] [Indexed: 02/03/2023] Open
Abstract
Background There is growing evidence that disturbances in cholesterol metabolism may be involved in major depressive disorder (MDD). However, it is not known if cholesterol metabolites present in the brain and periphery can be used to diagnose and predict an MDD patient's response to antidepressant treatment. Methods A total of 176 subjects (85 patients with MDD and 91 healthy control subjects) were included in this study. The expression of peripheral and brain-specific oxysterols and related gene polymorphisms were investigated in all subjects. The severity of depression was measured using the 17-item Hamilton Depression Rating Scale, 16-item Quick Inventory of Depressive Symptoms-Self-Report, and Patient Health Questionnaire-9 for all patients with MDD before and after 12 weeks of antidepressant treatment. Results Patients with MDD expressed higher plasma levels of 24(S)-hydroxycholesterol (24OHC) (mainly secreted from the brain) compared with healthy control subjects, and the higher levels of 24OHC were associated with 24OHC synthetase (CYP46A1) gene polymorphisms. In patients with MDD, an improved response to the 12-week antidepressant treatment was associated with a reduction of both 24OHC and 27OHC (mainly secreted from the peripheral system) levels relative to baseline levels. Nonresponders exhibited increased levels of oxysterols at the end of treatment compared with baseline. The superior reduction in oxysterol levels correlated with better outcomes from the antidepressant treatment. Conclusions These data suggest a potential role for oxysterols as diagnostic and treatment response-related indicators for MDD.
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Affiliation(s)
- Zuoli Sun
- National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jian Yang
- National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jia Zhou
- National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jingjing Zhou
- National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Lei Feng
- National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi He
- National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Min Liu
- National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yuhong Li
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Gang Wang
- National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Rena Li
- National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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11
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Liu J, Zhu X, Liu Y, Jia F, Yuan H, Wang Q, Zhang X, Li Z, Du X, Zhang X. Association between triglyceride glucose index and suicide attempts in patients with first-episode drug-naïve major depressive disorder. Front Psychiatry 2023; 14:1231524. [PMID: 37575577 PMCID: PMC10416446 DOI: 10.3389/fpsyt.2023.1231524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Objective Triglyceride glucose (TyG) index has been suggested as an alternative indicator of insulin resistance (IR); however, the association between TyG index and suicide attempts (SA) in major depressive disorder (MDD) is unclear. The aim of this study was to investigate the relationship between TyG index and SA in Chinese patients with first-episode drug-naïve (FEDN) MDD. Methods This cross-sectional study enrolled 1,718 patients with FEDN MDD aged 34.9 ± 12.4 years from the First Hospital of Shanxi Medical University (Taiyuan, Shanxi Province, China) from September 2016 to December 2018. Multivariable binary logistic regression analysis was used to estimate the association between TyG index and the risk of SA. A two-piecewise linear regression model was used to investigate the threshold effects if non-linearity associations existed. Interaction and stratified analyses were performed based on sex, education, marital status, comorbid anxiety, and psychotic symptoms. Results Multivariable logistic regression analysis revealed that TyG index was positively associated with the risk of SA after adjusting for confounders (OR = 1.35, 95% CI: 1.04-1.75, p = 0.03). Smoothing plots also showed a nonlinear relationship between TyG index and SA, with the inflection point of TyG index being 9.29. On the right of the inflection point, a positive association between TyG index and SA was detected (OR = 3.47, 95% CI: 1.81 to 6.66, p < 0.001), while no significant association was observed on the left side of the inflection point (OR = 1.14, 95% CI: 0.79 to 1.66, p = 0.476). Conclusion The relationship between TyG index and SA risk was non-linear and exhibited a threshold effect in Chinese patients with FEDN MDD. When TyG index was greater than 9.29, they showed a significant positive correlation.
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Affiliation(s)
- Junjun Liu
- Nanjing Meishan Hospital, Nanjing, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
- Medical College of Soochow University, Suzhou, China
| | - Xiaomin Zhu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yang Liu
- Nanjing Meishan Hospital, Nanjing, China
| | - Fengnan Jia
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
- Medical College of Soochow University, Suzhou, China
| | | | - Qingyuan Wang
- Clinical Medical Department, The Second Clinical Medical College, Nanjing Medical University, Nanjing, China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
- Medical College of Soochow University, Suzhou, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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12
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Li Y, Liao Z, Huang Q, Wang Q, Ren H, Chen X, Lin S, Wang C, Tang Y, Hao J, Wang X, Shen H, Zhang X. Prevalence and influencing factors of suicide in first-episode and drug-naive young major depressive disorder patients with impaired fasting glucose: a cross-sectional study. Front Psychiatry 2023; 14:1171814. [PMID: 37363165 PMCID: PMC10289199 DOI: 10.3389/fpsyt.2023.1171814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background An association exists between major depression disorder (MDD), suicide attempts, and glucose metabolism, but suicide attempts in young MDD patients with comorbid impaired fasting glucose (IFG) have been less well studied. The purpose of this study was to examine the prevalence and risk factors for suicide attempts in young, first-episode, drug-naive (FEDN) MDD patients with comorbid IFG. Methods We recruited 917 young patients with FEDN MDD, 116 of whom were judged to have combined IFG because their blood glucose was >6.0. We collected anthropological and clinical data on all of them. The Hamilton Depression Scale (HAMD) score, the Hamilton Anxiety Scale (HAMA) score and the Positive and Negative Syndrome Scale (PANSS) positive subscale score were used to assess their clinical symptoms. Blood glucose, plasma thyroid function and lipid indicators were measured. Results The prevalence of suicide attempts in young MDD patients with IFG was 32.8% (38/116). Furthermore, among young MDD patients with comorbid IFG, suicide attempters had more severe depression and anxiety symptoms, more comorbid psychotic symptom, higher levels of antibody of thyroid stimulating hormone and thyroid peroxidases (TPOAb), and more severe lipid metabolism disorders than those without suicide attempts. In addition, HAMA scores and TPOAb were independently associated with suicide attempts in young patients with FEDN MDD. Conclusion Our study suggests that young MDD patients with IFG have a high rate of suicide attempts. Some clinical symptoms and thyroid function parameters may be the risk factor for suicide attempts in young MDD patients with impaired glucose metabolism.
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Affiliation(s)
- Yifan Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhenjiang Liao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qiuping Huang
- Department of Applied Psychology, School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, China
| | - Qianjin Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Honghong Ren
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xinxin Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Shuhong Lin
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chenhan Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Ying Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jingyue Hao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xuhao Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hongxian Shen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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13
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Chen SW, Li X, Lang X, Li J, Zhang XY. Metabolic parameters and thyroid hormones in relation to suicide attempts in patients with first-episode and drug-naive major depressive disorder with comorbid glucose disturbances: a large cross-sectional study. Eur Arch Psychiatry Clin Neurosci 2023; 273:199-207. [PMID: 36127506 DOI: 10.1007/s00406-022-01490-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/29/2022] [Indexed: 12/01/2022]
Abstract
The factors associated with suicide attempts in major depressive disorder (MDD) patients with comorbid glucose disturbances remain unclear. To the best of our knowledge, this is the first study with a large sample size to examine risk factors of suicide attempts in first-episode drug-naïve (FEDN) MDD patients with comorbid glucose disturbances, including clinically relevant factors, 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 clinical symptoms of patients. Fasting blood glucose, metabolic parameters, and thyroid hormone levels were measured. After controlling for HAMA and HAMD scores, the suicide attempt rate was 1.88 times higher in MDD patients with glucose disturbances than in MDD patients without glucose disturbances. Compared to non-suicide attempters, suicide attempters among the MDD patients with glucose disturbances had higher scores on HAMD and HAMA, PANSS positive symptoms, as well as higher levels of systolic and diastolic blood pressure, TC, LDL-C, thyroid stimulating hormone (TSH), TgAb, and thyroid peroxidases antibody (TPOAb). The combination of positive symptom score, HDL-C, systolic blood pressure, and marital status distinguished suicide attempters from non-suicide attempters. In addition, HAMA score, HAMD score, and TPOAb were associated with the number of suicide attempts in MDD patients with comorbid glucose disturbances. Our results suggest a high incidence of suicide attempts in MDD patients with comorbid glucose disturbances. Several clinically relevant factors, metabolic parameters, and thyroid hormone function have an impact on suicide attempts in MDD patients with comorbid glucose disturbances.
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Affiliation(s)
- Shi Wang Chen
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
| | - Xue Li
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
| | - XiaoE Lang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Li
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
| | - Xiang-Yang Zhang
- Institute of Psychology, Chinese Academy of Science, Department of Psychology, University of Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.
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14
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Choi W, Kang HJ, Kim JW, Kim HK, Kang HC, Lee JY, Kim SW, Stewart R, Kim JM. Age-specific associations between serum cholesterol levels and suicidal behaviors in patients with depressive disorders: A naturalistic prospective observational cohort study. Front Psychiatry 2023; 14:1095579. [PMID: 37139327 PMCID: PMC10150039 DOI: 10.3389/fpsyt.2023.1095579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction This study investigated the effects of total cholesterol levels on prevalent, and incident suicidal behaviors according to age group (<60 vs. ≥60 years) in depressed patients. Methods Consecutive outpatients with depressive disorders who visited the Chonnam National University Hospital between March 2012 and April 2017 were recruited. Among 1,262 patients assessed at baseline, 1,094 agreed to blood sampling for measurement of serum total cholesterol levels. Among the patients, 884 completed the 12-week acute treatment phase and were followed up at least once during the 12-month continuation treatment phase. Suicidal behaviors assessed at baseline included baseline suicidal severity; behaviors assessed at the 1-year follow-up included increased suicidal severity and fatal/non-fatal suicide attempts. Associations of baseline total cholesterol levels with the above-mentioned suicidal behaviors were analyzed using logistic regression models after adjustment for relevant covariates. Results Of 1,094 depressed patients, 753 (68.8%) were women. The mean (SD) age of patients was 57.0 (14.9) years. Lower total cholesterol levels (87-161 mg/dl) were associated with increased suicidal severity (Linear Wald = 4.478, p < 0.05) and fatal/non-fatal suicide attempt (Linear Wald = 7.490, p < 0.01) in patients <60 years of age. U-shaped associations between total cholesterol levels and 1-year follow-up suicidal outcomes (increased suicidal severity, Quadratic Wald = 6.299, p < 0.05; fatal/non-fatal suicide attempt, Quadratic Wald = 5.697, p < 0.05) were observed in patients ≥60 years of age. Conclusions These findings suggest that differential consideration of serum total cholesterol levels according to age group may have clinical utility for predicting suicidality in patients with depressive disorders. However, because our research participants came from a single-hospital, the generalizability of our findings may be limited.
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Affiliation(s)
- Wonsuk Choi
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Robert Stewart
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
- *Correspondence: Jae-Min Kim,
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15
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Vasupanrajit A, Jirakran K, Tunvirachaisakul C, Solmi M, Maes M. Inflammation and nitro-oxidative stress in current suicidal attempts and current suicidal ideation: a systematic review and meta-analysis. Mol Psychiatry 2022; 27:1350-1361. [PMID: 34997194 DOI: 10.1038/s41380-021-01407-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022]
Abstract
A meta-analysis showed a significant association between activated immune-inflammatory and nitro-oxidative (IO&NS) pathways and suicide attempts (SA). There is no data on whether recent suicidal ideation (SI) is accompanied by activated IO&NS pathways and whether there are differences between recent SA and SI. The current study searched PubMed, Google Scholar, and Web of Science, for articles published from inception until May 10, 2021, and systematically reviewed and meta-analysed the association between recent SA/SI (<3 months) and IO&NS biomarkers. We included studies which compared psychiatric patients with and without SA and SI and controls (either healthy controls or patients without SA/SI) and used meta-analysis (random-effect model with restricted maximum-likelihood) to delineate effect sizes with 95% confidence intervals (CI). Our search included 59 studies comprising 4.034 SA/SI cases and 12.377 controls. Patients with SA/SI showed activated IO&NS pathways (SMD: 0.299; CI: 0.200; 0.397) when compared to controls. The immune profiles were more strongly associated with SA than with SI, particularly when compared to healthy controls, as evidenced by activated IO&NS (SMD: 0.796; CI: 0.503; 1.089), immune (SMD: 1.409; CI: 0.637; 1.462), inflammatory (SMD: 1.200; CI: 0.584; 1.816), and neurotoxic (SMD: 0.904; CI: 0.431; 1.378) pathways. The effects sizes of the IO&NS, immune and inflammatory profiles were significantly greater in SA than in SI. In conclusion: activated IO&NS pathways are associated with recent SA and SI, and inflammation, T helper-1 activation, nitro-oxidative stress, lowered neuroprotection, and increased neurotoxicity explain at least in part why psychiatric patients show increased suicidal behaviours, especially SA.
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Affiliation(s)
- Asara Vasupanrajit
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Ketsupar Jirakran
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Maximizing Thai Children's Developmental Potential Research Unit, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chavit Tunvirachaisakul
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Cognitive Impairment and Dementia Research Unit, Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Marco Solmi
- University of Ottawa, Psychiatry Department, Ottawa, ON, Canada.,The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,Cognitive Impairment and Dementia Research Unit, Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,IMPACT Strategies Research Center, Deakin University, Geelong, VIC, Australia. .,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria.
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16
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Lipid Biomarkers in Depression: Does Antidepressant Therapy Have an Impact? Healthcare (Basel) 2022; 10:healthcare10020333. [PMID: 35206947 PMCID: PMC8872589 DOI: 10.3390/healthcare10020333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 12/22/2022] Open
Abstract
Studies have revealed mixed results on how antidepressant drugs affect lipid profiles of patients with major depression disorder (MDD). Even less is known about how patients respond to a switch of antidepressant medication with respect to their metabolic profile. For this, effects of a switch in antidepressants medication on lipid markers were studied in MDD patients. 15 participants (females = 86.67%; males = 13.33%; age: 49.45 ± 7.45 years) with MDD and a prescribed switch in their antidepressant medication were recruited at a psychosomatic rehabilitation clinic. Participants were characterized (with questionnaires and blood samples) at admission to the rehabilitation clinic (baseline, T0) and followed up with a blood sample two weeks (T1) later. HDL, LDL, total cholesterol, and triglycerides were determined (T0), and their change analyzed (Wilcoxon test) at follow up (T1). Decrements in HDL (p = 0.041), LDL (p < 0.001), and total cholesterol (p < 0.001) were observed two weeks after a switch in antidepressant medication. Triglycerides showed no difference (p = 0.699). Overall, LDL, HDL, and total cholesterol are affected by a change in antidepressant drugs in patients with MDD. These observations are of clinical relevance for medical practitioners in the planning and management of treatment strategies for MDD patients.
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17
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Zhang Q, Zhao S, Liu Z, Luo B, Yang Y, Shi Y, Geng F, Xia L, Zhang K, Liu H. Association of thyroid-stimulating hormone and lipid levels with suicide attempts among adolescents with major depressive disorder in China. Front Psychiatry 2022; 13:1031945. [PMID: 36733417 PMCID: PMC9887045 DOI: 10.3389/fpsyt.2022.1031945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Evidence suggested that thyroid-stimulating hormone (TSH) and lipid levels were associated with major depressive disorder (MDD). However, its role in suicide attempts in adolescents with MDD was unclear. This investigation was to probe into the relationship between TSH, lipid levels, and attempted suicide in adolescents with MDD. METHODS A total of 179 adolescents with MDD were included from January 2021 to January 2022. Socio-demographic data and clinical data were obtained through self-made questionnaires. TSH and lipid levels were analyzed by a recognized laboratory. The Epidemiological Studies Depression Scale (CES-D) was used to assess the severity of depression. Questions about whether there was a behavior of suicide attempts were completed through conversation interviews. RESULTS Results showed that the CES-D total score, TSH, and low-density lipoprotein cholesterol (LDL-C) of suicide attempters were significantly higher than those of non-suicide attempters. Ordinary family relationships were more likely to attempt suicide than good family relationships. The CES-D total score, ordinary family relationships, TSH and LDL-C were still significant in binary logistic regression, with an adjusted odds ratio (OR) of 1.04, 3.42, 5.14, and 1.76, respectively. The area under the receiver operating characteristic (ROC) curve showed that the area under the ROC curve (AUC) ranged from 0.60 to 0.74. CONCLUSION Suicide attempts are common among adolescents with MDD and were associated with CES-D total score, ordinary family relationships, TSH, and LDL-C. Given the association between suicide attempts and TSH and LDL-C, the dynamic changes in TSH and LDL-C levels should be detected regularly.
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Affiliation(s)
- Qing Zhang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Shuyi Zhao
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Zhichun Liu
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Bei Luo
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yingying Yang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yudong Shi
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Feng Geng
- Department of Psychiatry, Hefei Fourth People's Hospital, Hefei, China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Kai Zhang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
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18
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Yu C, Zhang T, Shi S, Wei T, Wang Q. Potential biomarkers: differentially expressed proteins of the extrinsic coagulation pathway in plasma samples from patients with depression. Bioengineered 2021; 12:6318-6331. [PMID: 34488523 PMCID: PMC8806736 DOI: 10.1080/21655979.2021.1971037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Depression is a severe disabling psychiatric illness and the pathophysiological mechanisms remain unknown. In previous work, we found the changes in extrinsic coagulation (EC) pathway proteins in depressed patients compared with healthy subjects were significant. In this study, we screened differentially expressed proteins (DEPs) in the EC pathway, and explored the molecular mechanism by constructing a protein-protein interaction (PPI) network. The DEPs of the EC pathwaywere initially screened by isobaric tags for relative and absolute quantification (iTRAQ) in plasma samples obtained from 20 depression patients and 20 healthy controls, and were then identified by Enzyme-linked immunosorbent assays (ELISAs). Ingenuity Pathway Analysis (IPA) software was used to analyse pathway. The differentially expressed genes (DEGs) were identified by analyzing the GSE98793 microarray data from the Gene Expression Omnibus database using the Significance Analysis for Microarrays (SAM, version 4.1) statistical method. Cytoscape version 3.4.0 software was used to construct and visualize PPI networks. The results show that Fibrinogen alpha chain (FGA), Fibrinogen beta chain (FGB), Fibrinogen gamma chain (FGG) and Coagulation factor VII (FVII) were screened in the EC pathway from depression patient samples. FGA, FGB, and FGG were significantly up-regulated, and FVII was down-regulated. Thirteen DEGs related to depression and EC pathways were identified from the microarray database. Among them NF-κB Inhibitor Beta (NFKBIB) and Heat shock protein family B (small) member 1 (HSPB1) were highly correlated with EC pathway. We conclude that EC pathway is associated with depression, which provided clues for the biomarker development and the pathogenesis of depression.
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Affiliation(s)
- Chunyue Yu
- College of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Teli Zhang
- Department of Pharmacy, The People's Hospital of Daqing, Daqing, China
| | - Shanshan Shi
- College of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Taiming Wei
- College of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Qi Wang
- College of Pharmacy, Harbin Medical University-Daqing, Daqing, China
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19
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Kułak-Bejda A, Bejda G, Lech M, Waszkiewicz N. Are Lipids Possible Markers of Suicide Behaviors? J Clin Med 2021; 10:jcm10020333. [PMID: 33477435 PMCID: PMC7830691 DOI: 10.3390/jcm10020333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 01/26/2023] Open
Abstract
Suicides and suicidal behaviors are very important causes of mortality and morbidity and have become a serious global problem. More than 800,000 people die from suicide every year. Previous researches have established that lipids play an important role in the pathogenesis of suicide. Moreover, lipid levels might be a biological marker of suicide. A lot of researchers have tried to identify biological markers that might be related to depressive disorder, bipolar disorder or schizophrenia and suicidal behavior. It was also important to consider the usefulness of an additional tool for prevention actions. Metabolic deregulation, particularly low total cholesterol and low-density lipoproteins-cholesterol levels may cause higher suicide risk in patients with these psychiatric disorders.
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Affiliation(s)
- Agnieszka Kułak-Bejda
- Department of Psychiatry, Medical University of Bialystok, 16-070 Choroszcz, Poland; (M.L.); (N.W.)
- Correspondence:
| | - Grzegorz Bejda
- Faculty of General Medicine, School of Medical Science in Bialystok, 15-875 Bialystok, Poland;
| | - Magdalena Lech
- Department of Psychiatry, Medical University of Bialystok, 16-070 Choroszcz, Poland; (M.L.); (N.W.)
| | - Napoleon Waszkiewicz
- Department of Psychiatry, Medical University of Bialystok, 16-070 Choroszcz, Poland; (M.L.); (N.W.)
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