Civardi Serena Chiara, Besana Filippo, Carnevale Miacca Giovanni, Mazzoni Filippo, Arienti Vincenzo, Politi Pierluigi, Brondino Natascia, Olivola Miriam
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.
Front Psychiatry. 2024 Mar 22;15:1371139. doi: 10.3389/fpsyt.2024.1371139. eCollection 2024.
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.
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.
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.
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.
难治性抑郁症（TRD）通常被定义为至少两次使用抗抑郁药物进行试验，且剂量合适、疗程恰当但仍治疗失败。与单纯重度抑郁发作的患者相比，TRD患者的死亡率更高。这种死亡率增加主要归因于外部原因导致的死亡，包括自杀和意外事故。我们研究的目的是在一组TRD门诊患者样本中识别与自杀未遂相关的社会人口统计学和精神病理学变量。
我们进行了一项单中心观察性研究，采用回顾性设计，纳入了63例转诊至意大利门诊心理健康中心的TRD患者样本。我们从访谈和临床记录中收集社会人口统计学和精神病理学数据。
样本中77.8%（N = 49）为女性，平均年龄为49.2岁（15.9）。33.3%（N = 21）的患者曾尝试自杀。54%（N = 34）的患者有精神科合并症。在收集的变量中，物质使用（p = 0.031）、精神科合并症（p = 0.049）和高汉密尔顿抑郁量表（HAM-D）评分（p = 0.011）与自杀未遂的发生相关。在回归模型中，物质使用（比值比[OR] 6.779）、精神科合并症（OR 3.788）和HAM-D评分（OR 1.057）可预测自杀未遂。在控制性别后，只有物质使用（OR 6.114）和HAM-D评分（OR 1.057）与自杀未遂保持关联。
合并症和物质滥用的综合治疗涉及不同的心理健康服务，这对实现这些患者的康复至关重要。我们的研究支持对TRD患者进行仔细临床评估以识别与自杀未遂风险增加相关因素的重要性。
