广泛焦虑障碍的下丘脑-垂体-肾上腺轴及PRL研究

目的　研究广泛焦虑障碍 (GAD)的下丘脑 垂体 肾上腺轴 (HPA轴 )功能及催乳素 (PRL)改变。方法　研究组分别为 3 0例GAD患者 ,对照组为 2 5例抑郁性神经症 (DN)患者及 1 5例健康人。测基础状态时皮质醇及PRL浓度 ,行地塞米松抑制试验 (DST)后再检测皮质醇浓度。比较GAD与DN及正常对照组 (NC)的差别。结果　 3组基础皮质醇、PRL水平无显著差异。GAD组DST阳性率显著小于DN组而大于正常组。DST阳性率与基础皮质醇呈正相关。 3组PRL浓度均无差异。结论　GAD可能有HPA轴功能异常 ,PRL未见异常     

月经周期对重症抑郁DST的影响

重症抑郁患者常伴有下丘脑-垂体-肾上腺轴(HPA轴)的功能失调,这可从基础皮质醇含量及地塞米松试验(DST)非抑制方面得到反映。关于重症抑郁HPA轴和下丘脑-垂体-性腺轴(HPG轴)的研究已有报告。80年Yen报告排卵期雌激素活性最高,而黄体期孕激素活性最高。由于HPG轴和HPA轴相互影响,研究月经周期性激素变化与情感障碍的关系对了解月经周期对HPA轴作用非常重要。既往研究未发现卵泡期和黄体期皮质醇分泌有何差异。为了进一步研究月经周期对HPA轴的影响,本文选择了25例重症抑郁患者,在一个完整月经周期中行DST试验。     

抑郁症患者血浆瘦素水平与童年受虐及下丘脑-垂体-肾上腺轴相关研究

目的:探讨儿童期受虐与抑郁症患者血浆瘦素水平及下丘脑-垂体-肾上腺轴功能之间的相关性。方法:选取首发抑郁症患者152例,使用儿童受虐问卷(CTQ)、汉密顿抑郁量表-24(HAMD-24)、汉密顿焦虑量表(HAMA)评定儿童期受虐状况及抑郁与焦虑严重程度;根据儿童受虐问卷评分将受试者分为受虐组(55例),无受虐组(97例)。采用酶联免疫吸附法测定血浆瘦素水平。各组行地塞米松抑制试验(DST),测量各组血浆皮质醇浓度,并计算各组脱抑制率。结果:152例入组患者中55例(36.18%)有儿童期受虐史。儿童期有无受虐组在首次发病年龄、性别比、HAMD-24总分、HAMA总分等方面差异均有统计学意义。儿童期受虐组的血浆瘦素水平[(5.164±2.754) ug/L]低于无受虐组[(7.234±4.892) ug/L;P0.05]和正常对照组[(9.791±7.433) ug/L;P0.000],无受虐组的血浆瘦素水平低于正常对照组(P0.01)。儿童期受虐组和无受虐组DST前后皮质醇水平[(578±126,374±139)ng/L和562±131,333±135)ng/L)]和脱抑制率(71%和68%)高于对照组[(416±104,225±86)ng/L;43%],差异均有统计学意义(均P0.05)。结论:抑郁症患者血浆瘦素及HPA轴均存在明显异常,有儿童期虐待者表现更严重,儿童期受虐导致血浆瘦素水平下降及HPA轴异常可能是成年后罹患抑郁症的可能机制。     

经颅微电流刺激对轻度抑郁症患者HPA、BDNF水平及临床症状的影响

目的探讨经颅微电流刺激治疗(CES)对轻度抑郁症患者下丘脑-垂体-肾上腺(HPA)轴和脑源性神经营养因子(BDNF)水平,以及临床症状的影响。方法将86名轻度抑郁症患者随机分为研究组和对照组。研究组采用CES方式治疗8周,对照组进行伪刺激。两组在治疗前和治疗后采集血样测定皮质醇(COR)、促肾上腺皮质激素(ACTH)和BDNF水平;应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和失眠严重程度指数(ISI)评估临床症状变化。结果CES治疗后,研究组COR浓度、HAMA和ISI评分下降(t=-2.0538,-2.5512,-2.7228;P=0.0431,0.0125,0.0079),且明显低于对照组(t=2.3613,2.1188,3.2795;P=0.0205,0.0371,0.0015);其余各项指标变化无统计学意义(P﹥0.05)。对照组治疗前后各项指标变化无统计学意义(P>0.05)。结论CES治疗引起HPA轴相关激素的血液水平的改变,这可能是其改善焦虑和失眠症状机制之一,但对抑郁症状无明显效果。     

自杀行为患者血小板5-HT浓度

目的 通过测定伴自杀行为的精神病患者血小板5-HT浓度,以探讨其5-HT功能与自杀行为的关系。方法 研究组65例(男21例,女44例);疾病对照组60例(男25例,女35例)。采用HAMD及PANSS评定证状。在治疗前及治疗后6周检测血小板5-HT浓度,采用HPLC及电化学检测仪测定浓度。结果 治疗前两组血小板5-HT浓度的差异无统计意义,治疗后两组差异有统计学意义(P为0.012)。自杀1次与自杀至少2次者之间治疗前血小板5-HT的差异有统计学意义(P为0.035)。治疗后HAMD及PANSS评分的变化与血小板5-HT浓度变化之间无显著相关性。结论 精神疾病伴自杀行为者血小板5-HT浓度未见显著下降。自杀至少2次者的浓度明显降低,提示与1次自杀者之间存在异质性。精神症状的变化与血小板5-HT浓度的变化之间无显著相关性。     

焦虑症的生化病理机制探讨

目的：从神经递质与神经内分泌角度探讨焦虑症的生化病理机制。方法：采用高效液相色谱法及放射免疫测定法，分别测定25例焦虑症患者和28例正常对照者血小板5—羟色胺(5—HT)含量及血浆催乳素(PRL)含量、地塞米松抑制实验(DST)皮质醇含量。结果：广泛性焦虑(GAD)组血小板5—HT水平高于正常对照组，惊恐障碍(PD)组与正常对照组无显著差异；GAD组与对照组血浆PRL均极显著低于PD组；GAD组与PD组血浆基础皮质醇含量均显著高于正常对照组，两组DST阳性率均为20％，正常对照组为14．3％，3组阳性率无显著性差异；汉密尔顿焦虑量表(HAMA)评分与血浆皮质醇浓度呈显著正相关。结论：焦虑症患者存在神经递质和神经内分泌功能的紊乱，但不同亚型间可能存在不同的病理机制，皮质醇浓度可能是焦虑水平的标志因子。     

抑郁症患者自杀的危险因素研究

目的:探讨抑郁症患者自杀的危险因素及生物学指标.方法:以抑郁症患者入院时有无自杀行为分为自杀组和无自杀组.用汉密尔顿抑郁量表(HAMD,24项)、生活事件量表(LES)及自行编制的自杀行为调查表对入组患者进行调查;酶法测定两组患者的总胆固醇(CHO)、三酰甘油(TG)、高密度脂蛋白(HDL-C)和低密度脂蛋白(LDL-C)水平.结果:共107例.多因素Logistic回归分析发现,自杀与既往自杀行为、内向性格、生活事件、严重的抑郁(尤其是绝望感明显,存在严重的认识障碍)有关;两组的血脂水平差异无显著.结论:既往自杀行为、内向性格、生活事件、严重的抑郁是抑郁症患者自杀的主要危险因素;抑郁症患者的自杀可能与血脂水平无关.     

逍遥散与帕罗西汀联合治疗老年抑郁症的临床疗效及其对HPA轴功能的影响

目的探讨逍遥散联合帕罗西汀治疗老年抑郁症的临床疗效及对HPA轴功能的影响。方法我院2014-01—2015-01收治的老年抑郁症患者50例为研究对象,随机分成观察组与对照组,观察组给予逍遥散联合帕罗西汀治疗,对照组仅给予帕罗西汀治疗,比较2组临床疗效及对HPA轴功能的影响。结果观察组治愈率明显高于对照组;治疗前2组皮质醇与ACTH水平差异无统计学意义,治疗后观察组皮质醇水平、ACTH水平均明显低于对照组,差异具有统计学意义(P0.05)。结论逍遥散联合帕罗西汀治疗老年抑郁症的效果显著,能有效改善老年患者的抑郁状态,同时其药物机制可能与抑制HPA轴功能亢进有关系。     

单相抑郁与双相障碍住院患者地塞米松抑制试验的对照研究

目的 通过地塞米松抑制试验(DST)了解单相抑郁和双相障碍患者在不同情绪状态下的下丘脑-垂体-肾上腺轴功能改变情况. 方法对38例单相抑郁住院患者和63例双相障碍住院患者(双相障碍Ⅰ型19例,双相障碍Ⅱ型44例;双相障碍抑郁发作者33例,双相障碍躁狂发作者18例,双相障碍混合发作者12例)进行DST,其中17例单相抑郁、35例双相障碍患者在治疗4周后再次行DST,比较各组DST脱抑制率差异.结果 治疗前,单相抑郁的DST脱抑制率(36.8%)与双相障碍(14.3%)、双相障碍Ⅰ型(10.5%)、双相障碍Ⅱ型(15.9%)以及双相障碍抑郁发作(15.2%)之间比较差异有统计学意义(P<0.05);双相障碍Ⅰ型(10.5%)与双相障碍Ⅱ型(15.9%)之间,双相障碍抑郁发作(15.2%)、双相障碍混合发作(16.7%)和双相障碍躁狂发作(11.1%)两两比较差异均无统计学意义(P>0.05).治疗后,DST脱抑制率在上述各组间差异无统计学意义(P>0.05).治疗后单相抑郁的DST脱抑制率随着病情改善而降低,但较治疗前差异无统计学意义(P>0.05),双相障碍的DST脱抑制率在治疗前后比较差异无统计学意义(P>0.05).结论在疾病期,单相抑郁的DST脱抑制率高于双相障碍;双相障碍的DST脱抑制率与临床分型、发作类型、病情无关.     

精神分裂症患者的焦虑抑郁症状与血浆皮质醇水平观察

目的观察不同病期精神分裂症患者的焦虑抑郁症状与血浆皮质醇水平的变化及两者的关系。方法以精神分裂症患者60例为研究组,于治疗前0周、治疗后2周末和4周末应用汉密顿焦虑量表（HAMA）和汉密顿抑郁量表（HAMD）分别评定患者发病期和好转期的焦虑抑郁症状,并同步测定血浆皮质醇水平,观察其焦虑抑郁程度与血浆皮质醇水平变化及分析两者的关系,同时与30名健康者作对照。结果研究组的HAMA和HAMD总分在发病期（0周和2周末）和好转期（第4周末）均显著高于正常对照组（P〈0.05或P〈0.01）;研究组的血浆皮质醇水平在发病期显著升高（P〈0.01）,随着病情的好转而恢复正常;研究组血浆皮质醇水平的变化（0周与2周末,2周末与4周末）与HAMA、HAMD总分的变化无显著相关性（P〉0.05）。结论精神分裂症患者在不同病期均可出现焦虑抑郁症状,发病期伴有血浆皮质醇水平升高,但焦虑抑郁症状与血浆皮质醇水平无明显关联。     

Neurosteroid Levels in Patients with Obsessive-Compulsive Disorder

Objective

Changes in serum neurosteroid levels have been reported in stress-related disorders such as anxiety and depression, but not in patients with obsessive-compulsive disorder (OCD). We thus investigated such changes in patients with OCD.

Methods

We compared the serum levels of progesterone, pregnanolone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEA-S), cortisol and testosterone in 30 patients with OCD and 30 healthy controls.

Results

When male and female patients were evaluated together, DHEA and cortisol levels were significantly higher in patients with OCD than the control group. When the genders were evaluated separately, DHEA and cortisol levels were higher in female patients than the female controls. The increase in DHEA levels in female patients is likely an effect of the hypothalamic-pituitary-adrenal (HPA) axis. In contrast, cortisol levels in male patients were higher than the control group, while testosterone levels were lower. The increased cortisol and decreased testosterone levels in male patients likely involves the hypothalamic-pituitary-gonadal (HPG) axis.

Conclusion

These findings suggest that neurosteroid levels in patients with OCD should be investigated together with the HPA and HPG axes in future studies.     

Dysregulation of the sympathetic nervous system,hypothalamic–pituitary–adrenal axis and executive function in individuals at risk for suicide

Background

Suicidal behaviour aggregates in families, and the hypothalamic–pituitary–adrenal (HPA) axis and noradrenergic dysregulation may play a role in suicide risk. It is unclear whether stress dysregulation is a heritable trait of suicide or how it might increase risk. We investigated stress reactivity of the autonomic nervous system and the HPA axis in suicide predisposition and characterized the effect of this dysregulation on neuropsychologic function.

Methods

In this family-based study of first-degree relatives (n = 14) of suicide completers and matched controls with no family or personal history of suicidal behaviour (n = 14), participants underwent the Trier Social Stress Test (TSST). We used salivary α-amylase and cortisol levels to characterize stress reactivity and diurnal variation. We administered a series of neuropsychologic and executive function tests before and after the TSST.

Results

Despite normal diurnal variation, relatives of suicide completers exhibited blunted cortisol and α-amylase TSST reactivity. Although there were no baseline differences in conceptual reasoning, sustained attention or executive function, the relatives of suicide completers did not improve on measures of inhibition upon repeated testing after TSST. Secondary analyses suggested that these effects were related to suicide vulnerability independent of major depression.

Limitations

The sample size was small, and the design prevents us from disentangling our findings from the possible traumatic consequences of losing a relative by suicide.

Conclusions

Blunted stress response may be a trait of suicide risk, and impairment of stress-induced executive function may contribute to suicide vulnerability.     

Impaired frontothalamic circuitry in suicidal patients with depression revealed by diffusion tensor imaging at 3.0 T

Background

The neurobiology of suicide is largely unknown. Studies of white matter tracts in patients with a history of suicidal behaviour have shown alteration in the left anterior limb of the internal capsule (ALIC). Our aim was to determine whether particular target fields of fibre projections through the ALIC are affected in depressed patients who recently attempted suicide.

Methods

We studied patients with major depressive disorder (MDD) with and without a history of suicide attempts and healthy controls using diffusion tensor imaging (DTI) and deterministic tractography to generate fibre tract maps for each participant. Tract voxels were coded as being unique to the left ALIC. We compared the mean percentage of fibres projecting to relevant brain regions in the 3 groups using analysis of covariance.

Results

We included 63 patients with MDD (23 with and 40 without a history of suicide attempts) and 46 controls in our study. Both groups of depressed patients had reduced fibre projections through the ALIC to the left medial frontal cortex, orbitofrontal cortex and thalamus. Those with a history of suicide attempts had greater abnormalities than those without suicide attempts in the left orbitofrontal cortex and thalamus.

Limitations

Diffusion tensor imaging deterministic tracking is unable to distinguish between afferent and efferent pathways, limiting our ability to distinguish the directionality of altered fibre tracts.

Conclusion

Frontothalamic loops passing through the ALIC are abnormal in patients with depression and significantly more abnormal in depressed patients with a history of suicide attempts than in those without a history of suicide attempts. Abnormal projections to the orbitofrontal cortex and thalamus may disrupt affective and cognitive functions to confer a heightened vulnerability for suicidal behaviour.     

Possible Association between Serotonin Transporter Gene Polymorphism and Suicide Behavior in Major Depressive Disorder

Objective

The serotonin transporter (5-HTT) genes are major candidate genes for modulating the suicidal behavior. We investigated the association between serotonin transporter polymorphisms and suicidal behavior in patients with major depressive disorder (MDD).

Methods

Serotonin transporter intron 2 VNTR polymorphism (5-HTTVNTR) and serotonin transporter linked polymorphic region polymorphism (5-HTTLPR) were analyzed in 132 depressed patients with suicidal attempt as well as in 122 normal controls. Hamilton''s 17-item Depression Rating Scale (HDRS), the Risk-Rescue rating system (RRR) and the Lethality Suicide Attempt Rating Scale updated (LSARS-II) were assessed for the depressed patients.

Results

Although not statistically significant, a trend was found such that the 10/10 and 10/12 alleles of 5-HTTVNTR were more common in suicidal subjects than in control subjects. Comparing allele frequency, those with a 10 allele or 10 allele carriers were higher in suicidal subjects than in control subjects. No difference was noted in 5-HTTLPR genotypes and haplotype distribution between the suicidal subjects and control subjects. The RRR scores in subjects with the 10/10 5-HTTVNTR genotype or 10 5-HTTVNTR allele were significantly lower than those in subjects with other genotypes.

Conclusion

These results show the possibility that 10 allele of 5-HTTVNTR is related to suicidal behavior in the suicidal subjects with MDD and suggest that 12 allele of 5-HTTVNTR might be related to more lethality in the suicidal subjects with MDD.     

Cortical folding in patients with bipolar disorder or unipolar depression

Background

Analysis of cortical folding may provide insight into neurodevelopment deviations, which, in turn, can predispose to depression that responds particularly poorly to medications. We hypothesized that patients with treatment-resistant depression would exhibit measurable alterations in cortical folding.

Methods

We computed hemispheric global sulcal indices (g-SIs) in T₁-weighted magnetic resonance images obtained from 76 patients and 70 healthy controls. We separately searched for anatomic deviations in patients with bipolar disorder (16 patients with treatment-resistant depression, 25 with euthymia) and unipolar depression (35 patients with treatment-resistant depression).

Results

Compared with healthy controls, both groups of patients with treatment-resistant depression exhibited reduced g-SIs: in the right hemisphere among patients with bipolar disorder and in both hemispheres among those with unipolar depression. Patients with euthymic bipolar disorder did not differ significantly from depressed patients or healthy controls. Among patients with bipolar disorder who were taking lithium, we found positive correlations between current lithium dose and g-SIs in both hemispheres.

Limitations

We cannot estimate the extent to which the observed g-SI reductions are linked to treatment resistance and to what extent they are state-dependent. Furthermore, we cannot disentangle the impact of medications from that of the affective disorder. Finally, there is interindividual variation and overlap of g-SIs among patients and healthy controls that need to be considered when interpreting our results.

Conclusion

Reduced global cortical folding surface appears to be characteristic of patients with treatment-resistant depression, either unipolar or bipolar. In patients with bipolar disorder, treatment with lithium may modify cortical folding surface.     

老年抑郁症患者抗抑郁药治疗期间认知与抑郁症状的变化及其与ApoEε4等位基因的关系

Background

Co-occurring cognitive impairment in geriatric depression may not improve with antidepressant treatment and it may progress to dementia.

Aim

Assess the relationship between changes in cognitive and depressive symptoms among patients with geriatric depression and their association with the APOE epsilon 4 allele before and after antidepressant treatment.

Methods

The presence of the APOE epsilon 4 allele was assessed in 64 incident cases of geriatric depression and 31 elderly individuals without depression and the Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), digit span test, and Trail Making Tests A and B (TMT-A, TMT-B) were administered to these subjects at baseline and 12 months after baseline, during which time the depressed group received standardized treatment with selective serotonin reuptake inhibitors (SSRIs).

Results

Prior to treatment patients with geriatric depression had significantly worse cognitive functioning than control subjects and 31 (48%) met criteria for mild cognitive impairment (MCI). After treatment depressed patients with and without comorbid MCI both had significant improvements in their depressive and cognitive symptoms, but those with MCI had more residual symptoms. The severity of cognitive symptoms was not associated with the severity of depressive symptoms at baseline, but they were positively correlated at the 12-month follow-up. The APOE epsilon 4 allele was identified in 14% (9/64) of the patients and in 3% (1/31) of the controls (Fisher''s Exact Test, p=0.158). Compared to depressed patients without the allele, depressed patients with the allele had more severe cognitive deficits both before and after treatment, though only some of these differences were statistically significant.

Conclusions

There is substantial cognitive impairment in elderly individuals with geriatric depression. Both the depressive and cognitive symptoms improve with standard SSRI treatment, but individuals with comorbid MCI have more residual depressive and cognitive symptoms after treatment. The APOE epsilon 4 allele is associated with greater cognitive impairment in geriatric depressed patients and may be associated with less responsiveness of cognitive symptoms to antidepressant treatment.     

Depressed REM Sleep Behavior Disorder Patients Are Less Likely to Recall Enacted Dreams than Non-Depressed Ones

Objective

REM sleep behavior disorder (RBD) is associated with psychiatric symptoms, such as anxiety and alexithymia. However, only a few studies on the relationship between depression and RBD have been published. In this study, we investigated the occurrence of depression and associated factors in patients with RBD.

Methods

In total 94 patients (mean age: 61.9±12.7 years, male: 70.2%) diagnosed as RBD were examined using detailed clinical histories, the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale (ESS), and nocturnal polysomnography (PSG).

Results

The mean BDI score of all patients was 12.4±10.3 and 44.7% of RBD patients showed depressed mood (BDI >11 points). Depressed RBD patients were less able to recall enacted dreams than were non-depressed patients (61.9% vs. 86.5%, p=0.008). Logistic regression analysis showed that failure to recall enacted dreams was significantly associated with depression, after controlling for confounding variables including the respiratory disturbance index and a history of psychiatric disorders (odds ratio=0.323, p=0.041).

Conclusion

In this study, 44.7% of RBD patients were found to suffer from depressed mood. And, depression was found to be associated with reduced ability to recall enacted dreams. We suggest that routine evaluation of depression be performed in RBD patients, particularly when failure to recall enacted dreams is evident. We speculate that such failure may be associated with emotional dysregulation or neurodegeneration.     

Serum Ghrelin and Leptin Levels in Patients with Depression and the Effects of Treatment

Objective

Ghrelin and leptin, appetite-regulating hormones, play a role in mood regulation. Current data about the relation between leptin/ghrelin and depression are still controversial. This study aimed to investigate serum leptin and ghrelin levels in patients with depression and the effects of treatment on these levels.

Methods

Serum ghrelin and leptin levels were measured before and after treatment with antidepressant drugs and/or electroconvulsive therapy in 28 patients with depression and once in 21 healthy controls.

Results

Serum ghrelin levels of the patients were high in the pre-treatment. After the treatment, ghrelin levels were not different from those of the controls. We found no difference in serum levels of leptin between the patients and controls and no change with treatment. body mass index of the patients increased after the treatment especially in the drug-treated group.

Conclusion

The present study found increased serum ghrelin levels in depressive patients and normalization with improving of depression but no alteration in leptin levels.     

Orbitofrontal volume reductions during emotion recognition in patients with major depression

Background

Major depressive disorder is associated with both structural and functional alterations in the emotion regulation network of the central nervous system. The relation between structural and functional changes is largely unknown. Therefore, we sought to determine the relation between structural differences and functional alterations during the recognition of emotional facial expressions.

Methods

We examined 13 medication-free patients with major depression and 15 healthy controls by use of structural T₁-weighted high-resolution magnetic resonance imaging (MRI) and functional MRI during 1 session. We set the statistical threshold for the analysis of imaging data to p < 0.001 (uncorrected).

Results

As shown by voxel-based morphometry, depressed patients had reductions in orbitofrontal cortex volume and increases in cerebellar volume. Additionally, depressed patients showed increased activity during emotion recognition in the middle frontal cortex, caudate nucleus, precuneus and lingual gyrus. Within this cerebral network, the orbitofrontal volumes were negatively correlated in depressed patients but not in healthy controls with changes in blood oxygen level–dependent signal in the middle frontal gyrus, caudate nucleus, precuneus and supplementary motor area.

Limitations

Our results are limited by the relatively small sample size.

Conclusions

This combined functional and structural MRI study provides evidence that the orbitofrontal cortex is a key area in major depression and that structural changes result in functional alterations within the emotional circuit. Whether these alterations in the orbitofrontal cortex are also related to persistent emotional dysfunction in remitted mental states and, therefore, are related to the risk of depression needs further exploration.     

Associations of School Connectedness With Adolescent Suicidality: Gender Differences and the Role of Risk of Depression

Objective:

Previous studies have not examined associations of school connectedness with adolescent suicidal behaviours stratified by gender, while including a measure of depression. We analyzed survey data to determine whether there are independent protective associations of higher school connectedness with suicidal behaviours in Canadian adolescents, while controlling for potential confounders, including risk of depression; and whether such associations differ by gender.

Method:

Using data from a stratified cluster sample of randomly selected classes of students in schools in 3 of Canada’s Atlantic provinces, we used multiple logistic regression to examine whether associations of risk of depression, measured using the 12-item Center for Epidemiologic Studies–Depression scale, lessened protective associations of higher school connectedness with suicidal behaviours in grades 10 and 12 students, while stratifying by gender.

Results:

After adjusting for risk of depression, higher school connectedness was independently associated with decreased suicidal ideation in both genders and with suicidal attempt in females. In males, higher connectedness was no longer protective for suicide attempt when risk of depression was included in the model.

Conclusions:

School connectedness, which is felt to have positive influences on many types of adolescent behaviour, appears to also be both directly and indirectly protective for suicidality. These effects may occur through different pathways in females and males. Given the protection it offers both genders, including those at risk and not at risk of depression, increasing school connectedness should be considered as a universal adolescent mental health strategy. Studies that examine school connectedness should include analyses that examine potential differences between males and females.