Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands.
Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands.
J Psychiatr Res. 2022 Jul;151:65-72. doi: 10.1016/j.jpsychires.2022.04.005. Epub 2022 Apr 11.
Each year almost 800.000 people die from suicide, of which up to 87% are affected by major depressive disorder (MDD). Despite the strong association between suicidality and MDD, it remains unknown if suicidal symptoms during remission put remitted recurrent MDD patients (rrMDD) at risk for recurrence.
At baseline we compared sociodemographic characteristics and suicidal symptoms in un-medicated rrMDD participants to matched never-depressed controls. We used the HDRS and IDS-SR to assess suicidal symptoms and depressive symptomatology. Next, we studied the longitudinal association between baseline suicidal symptoms and time to recurrence(s) in rrMDD during a 2.5-year follow-up period using cox regression analyses. Further, we studied with longitudinal data whether suicidal symptoms and depressive symptomatology were cross-sectionally associated using mixed model analysis.
At baseline, rrMDD participants (N = 73) had higher self-reported suicidal symptoms than matched never-depressed controls (N = 45) (χ = 12.09 p < .002). Self-reported suicidal symptoms were almost four times higher (27.9% versus 6.9%) compared to clinician-rated suicidal symptoms in rrMDD at baseline. Self-reported baseline suicidal symptoms, but not clinician-rated symptoms, predicted earlier MDD-recurrence during follow-up, independent of other residual depressive symptoms (χ = 7.26, p < .026). Higher suicidal symptoms were longitudinally related to higher depressive symptoms (HDRS; F = 49.87, p < .001), IDS-SR; (F = 22.36, p < .001).
This study showed that self-reported - but not clinician-rated - suicidal symptoms persist during remission in rrMDD and predict recurrence, independent from residual symptoms. We recommend to monitor both suicidal and depressive symptomatology during remission in rrMDD, preferably also including self-reported questionnaires apart from clinician-rated. It would be beneficial for future research to assess suicidality using questionnaires primarily designed for measuring suicidal ideation.
每年有近 80 万人死于自杀，其中高达 87%的人患有重性抑郁障碍（MDD）。尽管自杀倾向与 MDD 之间存在强烈关联，但尚不清楚缓解期的自杀症状是否会使缓解期复发性 MDD 患者（rrMDD）面临复发风险。
在基线时，我们将未经治疗的 rrMDD 参与者与匹配的从未抑郁的对照组进行比较，比较了社会人口统计学特征和自杀症状。我们使用 HDRS 和 IDS-SR 来评估自杀症状和抑郁症状。接下来，我们使用 Cox 回归分析研究了基线时自杀症状与 rrMDD 在 2.5 年随访期间复发时间之间的纵向关联。此外，我们使用纵向数据研究了在 rrMDD 中，自杀症状和抑郁症状是否通过混合模型分析在横断面相关。
基线时，rrMDD 参与者（N=73）报告的自杀症状高于匹配的从未抑郁的对照组（N=45）（χ=12.09，p<.002）。rrMDD 患者的自我报告自杀症状比基线时临床医生评估的自杀症状高出近四倍（27.9%对 6.9%）。基线时自我报告的自杀症状，而不是临床医生评定的症状，可预测随访期间 MDD 的早期复发，独立于其他残留的抑郁症状（χ=7.26，p<.026）。较高的自杀症状与较高的抑郁症状（HDRS；F=49.87，p<.001）、IDS-SR（F=22.36，p<.001）呈纵向相关。
本研究表明，rrMDD 缓解期自我报告的自杀症状持续存在，并预测复发，独立于残留症状。我们建议在 rrMDD 缓解期监测自杀和抑郁症状，最好除了临床医生评估外，还包括自我报告的问卷。使用主要用于测量自杀意念的问卷评估自杀倾向将对未来的研究有益。
