Suicidal status during antidepressant treatment in 789 Sardinian patients with major affective disorder

Objective: Relationships between antidepressant treatment and suicidality remain uncertain in major depressive disorder (MDD), and rarely evaluated in bipolar disorder (BPD). Method: We evaluated changes in suicidality ratings (Hamilton Depression Rating Scale item‐3) at the start and after 3.59 ± 2.57 months of sustained antidepressant treatment in a systematically assessed clinical sample (n = 789) of 605 patients with MDD, 103 patients with BPD‐II and 81 patients with BPD‐I (based on DSM‐IV; 68.1% women; aged 44.3 ± 16.1 years), comparing suicidal vs. non‐suicidal and recovered vs. unrecovered initially suicidal patients. Results: Suicidal patients (103/789, 16.5%; BPD/MDD risk: 2.2) were more depressed and were ill longer. During treatment, 81.5% of suicidal patients became non‐suicidal; 0.46% of 656 initially non‐suicidal patients reported new suicidal thoughts, with no new attempts. Becoming non‐suicidal was associated with greater depression severity and greater improvement. Conclusion: Suicidal ideation was prevalent in patients with depressed major affective disorder, but most of the initially suicidal patients became non‐suicidal with antidepressant treatment, independent of diagnosis, treatment type or dose.     

Suicidal risks among 2826 Sardinian major affective disorder patients

Objective: We estimated risks of suicidal behaviors in 2826 mood‐disorder patients evaluated and followed in a Sardinian mood disorders research center over the past 30 years. Method: We determined rates of suicidal ideation, attempts, and suicides, with associated risk factors, in men and women with DSM‐IV bipolar I (BP‐I; n = 529), BP‐II; (n = 314), or major depressive disorders (MDD; n = 1983), at risk for an average of 11 years of illness. Results: Observed rates (% of patients/year) of suicide ranked: BP‐II (0.16) ≥ BP‐I (0.14) > MDD (0.05); attempts: BP‐I (1.52) > BP‐II (0.82) > MDD (0.48); ideation: BP‐II (42.7) > MDD (33.8) > BP‐I (22.7). The ratio of attempts/suicides (lethality index) ranked: BP‐II (5.12) < MDD (9.60) ≤ BP‐I (10.8). Male/female risk‐ratios were greater for suicide than attempts or ideation. One‐third of all reported acts occurred within the first year of illness, and earliest among MDD patients. Factors associated independently with suicidal acts included BP diagnosis, hospitalizations/person, and early illness‐onset; factors associated with suicidal ideation were having an affective temperament, BP‐II diagnosis, and higher suicidality‐corrected depression score at intake. Conclusion: Suicidal behaviors were more prevalent among BPD than MDD out‐patients.     

Depression and major depressive disorder in patients with Parkinson's disease

The prevalence of depression in Parkinson's disease (PD) varies greatly. In this study, we investigated major depressive disorder (MDD) and depressive symptoms without MDD in patients with PD. The psychopathological characteristics of depressive symptoms were assessed by a psychiatric interview. A total of 105 Japanese patients with PD without dementia were included. The Japanese version of the Beck Depression Inventory‐II (BDI‐II) with a cutoff score of 13/14 was used to screen for depression. Using a structured interview, a comprehensive psychiatric evaluation of patients with BDI‐II scores >13 (high BDI patients) was completed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM)‐IV‐TR. Forty patients (38%) had a BDI‐II >13, but 29 did not show any depressed mood. Five cases met the criteria for MDD (three current, two past) and one patient was diagnosed with minor depressive disorder. A slight depressed mood that was associated with worrying about PD was seen in 6 of 34 patients without any depressive disorder and fluctuated with aggravation of PD symptoms in two of these patients. For the diagnosis of MDD, the number of positive items from the DSM‐IV‐TR definition of MDD is most important and useful for differentiating MDD and non‐MDD. The low‐prevalence rate of MDD in our patient population suggests that PD may be a psychological stressor for MDD, but does not necessarily induce MDD. © 2009 Movement Disorder Society     

Somatization as a predictor of suicidal ideation in dissociative disorders

Aim: This study was concerned with correlates of suicidal ideation among patients with chronic complex dissociative disorders. Method: Participants were 40 patients diagnosed as having either dissociative identity disorder or dissociative disorder not otherwise specified according to the DSM‐IV. The Dissociative Disorders Interview Schedule, the Dissociative Experiences Scale, the Somatoform Dissociation and the Childhood Trauma Questionnaires, the Spielberger Trait Anger Inventory, the Beck Suicidal Ideation Scale, and the Borderline Personality Disorder section of the Structured Clinical Interview for DSM‐IV Personality Disorders were administered to all patients. Results: Patients with suicidal ideas (n = 15) had concurrent somatization disorder more frequently than the remaining patients. Having significantly high scores on both trait and state dissociation measures, their dissociative disorder was more severe than that of the patients with no suicidal ideation. They had elevated scores for childhood emotional abuse, physical abuse and emotional neglect. Concurrent somatization disorder diagnosis was the only predictor of suicidal ideation when childhood trauma scores and borderline personality disorder diagnosis were controlled. Conclusions: Among dissociative patients, there is an association between somatization and suicidal ideation. A trauma‐related insecure attachment pattern is considered as a common basis of this symptom cluster.     

Brain functional changes (QEEG cordance) and worsening suicidal ideation and mood symptoms during antidepressant treatment

Hunter AM, Leuchter AF, Cook IA, Abrams M. Brain functional changes (QEEG cordance) and worsening suicidal ideation and mood symptoms during antidepressant treatment. Objective: Antidepressant medications are efficacious overall; however, some individuals experience worsening mood symptoms and increased suicidal ideation (SI) during treatment. We examined the quantitative electroencephalographic (QEEG) cordance biomarker of brain function biomarker in relation to treatment‐emergent symptom worsening. Method: Seventy‐two major depressive disorder (MDD) subjects were treated with fluoxetine 20 mg (n = 13), venlafaxine 150 mg (n = 24), or placebo (n = 35) under double‐blind conditions. Behavioral ratings determined whether each subject demonstrated worsening of depressed mood, anxiety, or SI during treatment. QEEG cordance data were analyzed to determine whether symptom worsening was associated with neurophysiological changes. Results: Antidepressant treatment‐emergent SI (13.5%) was associated with a large transient decrease in midline‐and‐right‐frontal (MRF) cordance 48 h after start of medication. Conclusion: Hypothesis‐generating results suggest a pattern of functional changes in midline and right frontal brain regions associated with antidepressant treatment‐emergent SI in MDD.     

Concordance between a simpler definition of major depressive disorder and Diagnostic and statistical manual of mental disorders, fourth edition: an independent replication in an outpatient sample

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) symptom criteria for major depressive disorder (MDD) are somewhat lengthy with several studies showing that clinicians have difficulty recalling all 9 symptoms. Moreover, the criteria include somatic symptoms that are difficult to apply in patients with medical illnesses. To address these problems, a simpler definition of MDD was developed that did not include the somatic symptoms. Previous reports found high levels of agreement between the simplified and full DSM-IV definition of MDD. However, the same research group has conducted all previous studies of psychiatric patients. The goal of the present study was to determine if a high level of concordance between the 2 definitions would be replicated in an independent setting. We interviewed 2907 psychiatric outpatients presenting for treatment at the Boston University Center for Anxiety and Related Disorders. A trained diagnostic rater administered a semistructured interview and inquired about all symptoms of depression for all patients. A high level of agreement was found between the DSM-IV and the simpler definition of MDD. The absolute level of agreement between the 2 definitions was 95.5% and the κ coefficient was 0.88. Thus, consistent with previous studies, a high level of concordance was found between a simpler definition of MDD and the DSM-IV definition. This new definition offers 2 advantages over the current DSM-IV definition—it is briefer, and it is easier to apply with medically ill patients because it is free of somatic symptoms. Implications of these findings for DSM-5 are discussed.     

Suicidal behavior and parental psychopathology in hospitalized depressed children.

This study describes the suicidal behavior of hospitalized depressed children and assesses its relationship to psychopathology and suicidal behavior in their parents. Subjects were 58 consecutively hospitalized prepubertal children with a primary diagnosis of major depressive disorder (MDD), and 58 age- and gender-matched children hospitalized for psychiatric diagnoses other than a mood disorder. Clinical interviews and structured diagnostic instruments were reviewed to determine the children's suicidal behavior and their parents' history of psychopathology. Suicidal ideation, suicidal intent, suicidal plans, and suicide attempts were more frequent in MDD children compared to nondepressed children. When MDD and control samples were stratified as to presence of suicidal behavior in the child, psychopathology was high in parents from all subgroups. Intensity of suicidal behavior in the depressed and non-depressed children was not associated with an altered pattern of psychopathology in their parents. Hospitalized MDD children had increased suicidal behavior compared to inpatient psychiatric control children. However, suicidal behavior in the children was not associated with increased psychopathology or an altered pattern of psychopathology in their parents.     

The prediction of suicidal intent in depressed patients

The aim of the present study was to examine the relationships between suicidal ideation or suicidal attempts and severity of depression, presence of personality disorders, and sociodemographic factors in a population of depressed in-patients. A total of 338 adult depressed psychiatric in-patients were examined and classified according to DSM-III criteria as having major depression with or without melancholic or psychotic features, adjustment disorder with depressed mood or dysthymic disorder. Scores on the Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI) and Zung Self-Rating Depression and Anxiety Scales (SDS and SAS) were measured. We found that suicidal ideation was significantly related to severity of depression (according to the HDRS and all self-rating scales), a lower global assessment of functioning the year before hospitalization, and previous psychiatric hospitalizations. The items with the strongest predictive value for suicidal ideation were hopelessness, depressed mood, feelings of guilt, loss of interest and low self-esteem. These symptoms predicted 43% of the variance in suicidal ideation. None of the above predictors of suicidal ideation was related to suicidal attempts. Depressed patients with a personality disorder attempted significantly more suicidal attempts and showed more suicidal ideation than depressed patients without personality disorder. No significant correlations were found between suicidal ideation or suicide attempts and gender, marital status, employment status or psychosocial stressors during the previous 6 months.     

A validation study of depressive syndromes in Parkinson's disease

The validity, sensitivity, and specificity of depressive symptoms for the diagnosis of major depression, minor depression, dysthymic disorder, and subsyndromal depression in Parkinson's disease (PD) were examined. A consecutive series of 173 patients with PD attending a Movement Disorders Clinic underwent a comprehensive psychiatric and neurological assessment. The symptoms of loss of interest/pleasure, changes in appetite or weight, changes in sleep, low energy, worthlessness or inappropriate guilt, psychomotor retardation/agitation, concentration deficits, and suicide ideation were all significantly associated with the presence of the DSM‐IV depressed mood criterion for major depression. The symptoms of changes in appetite, changes in sleep, low energy, low self‐esteem, poor concentration, and hopelessness were all significantly associated with the presence of the DSM‐IV criterion of sad mood for dysthymic disorder. Thirty percent of our sample met DSM‐IV diagnostic criteria for major depression, 20% met diagnostic criteria for dysthymic disorder, 10% met diagnostic criteria for minor depression, and 8% met clinical criteria for subsyndromal depression. Patients with either major or minor depression had significantly more severe deficits in activities of daily living, more severe cognitive impairments, and more severe Parkinsonism than patients with either dysthymic disorder or no depression. This study provides validation to the DSM‐IV diagnostic criteria for major depression and dysthymic disorder for use in PD. The categories of minor and subsyndromal depression may need further validation. © 2007 Movement Disorder Society     

Age at onset in 3014 Sardinian bipolar and major depressive disorder patients

Tondo L, Lepri B, Cruz N, Baldessarini RJ. Age at onset in 3014 Sardinian bipolar and major depressive disorder patients. Objective: To test if onset age in major affective illnesses is younger in bipolar disorder (BPD) than unipolar‐major depressive disorder (UP‐MDD), and is a useful measure. Method: We evaluated onset‐age for DSM‐IV‐TR major illnesses in 3014 adults (18.5% BP‐I, 12.5% BP‐II, 69.0% UP‐MDD; 64% women) at a mood‐disorders center. Results: Median and interquartile range (IQR) onset‐age ranked: BP‐I = 24 (19–32) < BP‐II = 29 (20–40) < UP‐MDD = 32 (23–47) years (P < 0.0001), and has remained stable since the 1970s. In BP‐I patients, onset was latest for hypomania, and depression presented earlier than in BP‐II or UP‐MDD cases. Factors associated with younger onset included: i) being unmarried, ii) more education, iii) BPD‐diagnosis, iv) family‐history, v) being employed, vi) ever‐suicidal, vii) substance‐abuse and viii) ever‐hospitalized. Onset‐age distinguished BP‐I from UP‐MDD depressive onsets with weak sensitivity and specificity. Conclusion: Onset age was younger among BPD than MDD patients, and very early onset may distinguish BPD vs. UP‐MDD with depressive‐onset.     

Clinical features of depressed children and adolescents with various forms of suicidality

OBJECTIVE: To examine various forms of suicidality specified in DSM-IV and their clinical characteristics in a large sample of children and adolescents with major depressive disorder (MDD). METHOD: Subjects included 553 children and adolescents (aged 7.0-14.9 years) recruited between April 2000 and December 2004 from 23 mental health facilities in Hungary. Subjects received standardized clinical evaluations and best-estimate consensus DSM-IV diagnoses of MDD. All subjects were in a current episode of MDD at their assessment date. RESULTS: Approximately 68% of the sample had recurrent thoughts of death, 48% had suicidal ideation, 30% had suicide plan, and 12% had attempted suicide. Compared with nonsuicidal peers, suicidal children and adolescents were more severely depressed, had more depressive symptoms, and more likely had comorbid disorders. However, depressed children and adolescents with various forms of suicidality were very similar in clinical characteristics. Feelings of worthlessness, depressed mood, psychomotor agitation, and comorbid separation anxiety and conduct disorders were independent correlates of at least 1 form of suicidality. Only feelings of worthlessness was related to all 4 suicidal behaviors, after adjustment for other depressive symptoms, comorbid disorders, and demographics. CONCLUSION: Clinical characteristics differ between nonsuicidal and suicidal children and adolescents but are very similar across various forms of suicidality. Feelings of worthlessness may play a central role in the development of suicidal behavior. Interventions toward the enhancement of self-esteem and amelioration of underlying psychopathology may be crucial for the prevention of suicide attempts in depressed children and adolescents.     

Psychopathologic correlates of suicidal ideation in major depressive outpatients: is it all due to unrecognized (bipolar) depressive mixed states?

BACKGROUND: Recent transatlantic concern about suicidality in patients receiving antidepressants prompted us to examine the psychopathologic correlates of suicidal ideation occurring in clinically depressed patients. METHODS: The study sample, which consisted of 644 consecutive major depressive outpatients, of which 58.0% had bipolar II disorder (BP-II), was systematically interviewed with the SCID, in order to delineate the diagnostic and psychopathologic correlates of suicidal ideation. RESULTS: Such ideation, which was present in 49.5% [and favoring BP-II vs. major depressive disorder (MDD)] at an odds ratio (OR) of 1.3 (95% confidence interval = 0.98-1.8), was clinically significantly associated with depressive mixed state (racing/crowded thoughts and psychomotor agitation/activation during index depression), mood lability, decreased self-esteem, anorexia, as well as melancholic and psychotic features. Multiple logistic regression of suicidal ideation versus depressive symptoms and intradepressive excitatory symptoms revealed that decreased self-esteem (OR = 3.3), racing/crowded thoughts (OR = 1.5), and psychomotor agitation/activation (OR = 1.4) were independent and clinically significant correlates of suicidal ideation, irrespective of depression severity. DISCUSSION: From a psychopathologic standpoint, suicidality might be conferred by a combination of both the excited (mixed) depressive and agitated (melancholic) clusters. Trait mood lability appears to favor the genesis of these affective clusters. Within the framework of Kraepelinian psychiatry, both clusters represent depressive mixed states. Given that such states are more prevalent in BP-II, our data provide a possible explanation for the greater suicidality in BP-II patients reported in the literature. In light of the higher odds of suicidal ideation in BP-II versus MDD patients, we hypothesize that the higher prevalence of mental and psychomotor activation in BP-II might be one factor among others that favors the greater likelihood of the transition from suicidal ideation to suicidal action in BP-II. Our analyses delineate a mixed depressive substrate at risk for suicidality. To what extent, if any, antidepressant monotherapy might contribute to the genesis of such states and/or suicidality cannot be answered with the methodology of the present study.     

Reproduction among 1975 Sardinian women and men diagnosed with major mood disorders

Tondo L, Lepri B, Baldessarini RJ. Reproduction among 1975 Sardinian women and men diagnosed with major mood disorders. Objective: Disability varies in patients with major affective disorders [type I and II bipolar disorders (BPD) and recurrent unipolar major depressive disorder (UP‐MDD)]. It may include reproductive functioning, which has rarely been studied systematically. Method: We compared information acquired over several years pertaining to marital/reproductive status among 1975 systematically evaluated, treated, and followed women (n = 1351) and men (n = 624) diagnosed with DSM‐IV type I (n = 300) or II BPD (n = 223), or MDD (n = 1452). We compared factors between patients with vs. without children and associated with fertility rate (children/fertile years × 100), using standard bivariate methods followed by multivariate modeling. Results: Childless patients were younger at illness onset, more likely men, diagnosed with type I BPD, more educated, and unmarried, but similar in many aspects of clinical history to those with children. Fertility rate ranked: BP‐I < BP‐II ≤ MDD, and men < women. Mood‐disorder patients had 17% fewer children/person than in the comparable general population of Sardinia. Among mood‐disorder patients, fertility appeared to decline in Sardinia in recent decades, more in men than women. Conclusion: Type I BPD was associated with lower fertility than BP‐II or UP‐MDD, consistent with their relatively high levels of other disabilities.     

Suicidal ideation and depressive symptoms among bipolar patients as predictors of the health and well‐being of caregivers

Objectives: Few studies have addressed the physical and mental health effects of caring for a family member with bipolar disorder. This study examined whether caregivers’ health is associated with changes in suicidal ideation and depressive symptoms among bipolar patients observed over one year. Methods: Patients (N = 500) participating in the Systematic Treatment Enhancement Program for Bipolar Disorder and their primary caregivers (N = 500, including 188 parental and 182 spousal caregivers) were evaluated for up to one year as part of a naturalistic observational study. Caregivers’ perceptions of their own physical health were evaluated using the general health scale from the Medical Outcomes Study 36‐item Short‐Form Health Survey. Caregivers’ depression was evaluated using the Center for Epidemiological Studies of Depression Scale. Results: Caregivers of patients who had increasing suicidal ideation over time reported worsening health over time compared to caregivers of patients whose suicidal ideation decreased or stayed the same. Caregivers of patients who had more suicidal ideation and depressive symptoms reported more depressed mood over a one‐year reporting period than caregivers of patients with less suicidal ideation or depression. The pattern of findings was consistent across parent caregivers and spousal caregivers. Conclusions: Caregivers, rightly concerned about patients becoming suicidal or depressed, may try to care for the patient at the expense of their own health and well‐being. Treatments that focus on the health of caregivers must be developed and tested.     

Examining the relation between posttraumatic stress disorder and suicidal ideation in an OEF/OIF veteran sample

This study examined the relation between posttraumatic stress disorder (PTSD) and suicidal ideation among U.S. military veterans deployed during Operation Enduring Freedom and/or Operation Iraqi Freedom. Specific aims included investigation of (1) whether PTSD was associated with suicidal ideation after controlling for combat exposure and history of suicide attempt(s), (2) whether PTSD was associated with suicidal ideation absent a co-occurring depressive disorder (MDD) or alcohol use disorder (AUD), (3) whether co-occurring MDD or AUD increased risk of suicidal ideation among those with PTSD and (4) whether PTSD/MDD symptom clusters were differentially associated with suicidal ideation. Results pointed to unique effects associated with prior suicide attempt(s), PTSD and MDD. PTSD-diagnosed participants with co-occurring MDD or AUD were not significantly more likely to endorse suicidal ideation than PTSD-diagnosed participants without such comorbidity. The ‘emotional numbing’ cluster of PTSD symptoms and the ‘cognitive-affective’ cluster of MDD symptoms were uniquely associated with suicidal ideation.     

Suicidality in pediatric bipolar disorder: predictor or outcome of family processes and mixed mood presentation?

Algorta GP, Youngstrom EA, Frazier TW, Freeman AJ, Youngstrom JK, Findling RL. Suicidality in pediatric bipolar disorder: predictor or outcome of family processes and mixed mood presentation?
Bipolar Disord 2011: 13: 76–86. © 2011 The Authors.
Journal compilation © 2011 John Wiley & Sons A/S. Objective: Pediatric bipolar disorder (PBD) involves a potent combination of mood dysregulation and interpersonal processes, placing these youth at significantly greater risk of suicide. We examined the relationship between suicidal behavior, mood symptom presentation, family functioning, and quality of life (QoL) in youth with PBD. Methods: Participants were 138 youths aged 5–18 years presenting to outpatient clinics with DSM‐IV diagnoses of bipolar I disorder (n = 27), bipolar II disorder (n = 18), cyclothymic disorder (n = 48), and bipolar disorder not otherwise specified (n = 45). Results: Twenty PBD patients had lifetime suicide attempts, 63 had past or current suicide ideation, and 55 were free of suicide ideation and attempts. Attempters were older than nonattempters. Suicide ideation and attempts were linked to higher depressive symptoms, and rates were even higher in youths meeting criteria for the mixed specifier proposed for DSM‐5. Both suicide ideation and attempts were associated with lower youth QoL and poorer family functioning. Parent effects (with suicidality treated as outcome) and child effects (where suicide was the predictor of poor family functioning) showed equally strong evidence in regression models, even after adjusting for demographics. Conclusions: These findings underscore the strong association between mixed features and suicidality in PBD, as well as the association between QoL, family functioning, and suicidality. It is possible that youths are not just a passive recipient of family processes, and their illness may play an active role in disrupting family functioning. Replication with longitudinal data and qualitative methods should investigate both child and parent effect models.     

Indicators of pretreatment suicidal ideation in adults with major depressive disorder

Morris DW, Trivedi MH, Husain MM, Fava M, Budhwar N, Wisniewski SR, Miyahara S, Gollan JK, Davis LL, Daly EJ, Rush AJ. Indicators of pretreatment suicidal ideation in adults with major depressive disorder. Objective: In order to evaluate the presence of treatment emergent suicidal ideation (SI), it becomes necessary to identify those patients with SI at the onset of treatment. The purpose of this report is to identify sociodemographic and clinical features that are associated with SI in major depressive disorder (MDD) patients prior to treatment with a selective serotonin reuptake inhibitor. Method: This multisite study enrolled 265 out‐patients with non‐psychotic MDD. Sociodemographic and clinical features of participants with and without SI were compared post hoc. Results: Social phobia, bulimia nervosa, number of past depressive episodes, and race were independently associated with SI by one or more SI measure. Conclusion: Concurrent social phobia and bulimia nervosa may be potential risk factors for SI in patients with non‐psychotic MDD. Additionally, patients with more than one past depressive episode may also be at increased risk of SI.     

Clinical features of the patients with major depressive disorder co-occurring insomnia and hypersomnia symptoms: a report of NSSD study

BackgroundThe co-occurrence of insomnia and hypersomnia symptoms in patients with major depressive disorder (MDD) is associated with suicidal ideation and functional impairment. The relationship between sleep disturbances and clinical features and outcomes may not be adequately studied. In this study, we measured the functional impairments and clinical features of co-occurring insomnia and hypersomnia symptoms in Chinese patients with MDD.MethodsA post-hoc analysis was performed on data from the National Survey on Symptomatology of Depression (NSSD), which assessed the MDD patients in 32 hospitals by a clinician-rating questionnaire. The clinical features and outcomes were compared among the following four groups: insomnia symptom only, hypersomnia symptom only, both insomnia and hypersomnia symptoms, no sleep disturbance, respectively.ResultsTotally, 234 (7.15%) of 3275 participants with MDD co-occurred insomnia and hypersomnia symptoms. They had more depressive symptoms (27.41 ± 9.123), higher rate of suicide ideation (39.7%), more severe impairment in physical (58.1%), economic (32.9%), work (55.1%), and relationship with families (29.5%). Patients with both sleep disturbances were more likely to excessive worry about sleep, have suicidal ideation, the distress of social disharmony, more somatic symptoms, lack of energy, hyperphagia, loss of mood reactivity, and diurnal change, whereas less likely to have anxious mood.LimitationsSleep disorders were not diagnosed by current standard diagnostic criteria.ConclusionsPatients co-occurring with both sleep disturbances are associated with a higher rate of suicide risk and poorer social function. Our study could provide implications for suicidal risk evaluation and the development of therapeutic strategies for depression.     

社会支持对重性抑郁障碍患者自杀意念的影响

目的探讨社会支持对重性抑郁障碍(MDD)患者自杀意念的影响,为临床降低其自杀意念、减少自杀行为的发生提供参考。方法采用二阶段调查法,以在武汉市精神卫生中心门诊就诊的、符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)诊断标准的1135例MDD患者为研究对象。采用患者健康问卷抑郁量表(PHQ-9)、社会支持评定量表(SSRS)进行调查,采用二元Logistic回归分析探讨MDD患者自杀意念的影响因素。结果1135例MDD患者中,有688例(60.62%)存在自杀意念,有自杀意念者PHQ-9评分高于无自杀意念者,差异有统计学意义[(14.18±5.02)分vs.(11.07±4.61)分,t=10.497,P<0.01]。有自杀意念者的主观支持、对支持的利用度及SSRS总评分均低于无自杀意念者,差异均有统计学意义(P均<0.01)。以自杀意念为因变量,以客观支持、主观支持、对支持利用度及PHQ-9评分为自变量的二元Logistic回归模型为logit(P)=-0.286+0.026X1-0.035X2-0.063X3+0.128X4,其中主观支持和抑郁均对自杀意念有预测作用(B=-0.035、0.128,P<0.05或0.01)。结论存在抑郁症状及缺乏社会支持(尤其是主观支持)可能是MDD患者出现自杀意念的危险因素。