Chen Ningning, Wang Meiti, Chen Yiming, Wang Fan, Huang Qinte, Lyu Dongbin, Wu Chenglin, Yang Vivien, He Shuang, Liu Xirui, Xie Yixia, Zhang Qinting, Hong Wu
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wan Ping Road, Shanghai, 200030, China.
Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 201108, China.
Eur Arch Psychiatry Clin Neurosci. 2025 Mar 4. doi: 10.1007/s00406-025-01979-0.
Suicidal ideation, under the dominion of suicidal behavior, represents the most severe consequence of depressive disorders. Overt aggressive behaviors leading to agitated symptoms, coupled with cognitive symptoms during a depressive episode, both impact suicidal ideation and behavior. However, the precise mechanisms by which cognitive symptoms and overt aggressive behaviors influence suicidal ideation in patients with depressive disorders remain unclear. This cross-sectional study analyzed 301 MDD patients from the Shanghai Mental Health Centre between May 2017 and July 2020. Depression severity and cognitive symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17), overt aggression with the Modified Overt Aggression Scale (MOAS), and suicidal ideation with the Beck Scale for Suicide Ideation (BSSI). A multivariate logistic regression was conducted to identify risk factors for suicidal ideation. Patients with suicidal ideation had higher levels of cognitive impairment and overt aggression (Z = - 5.527, P < 0.01; Z = - 3.482, P < 0.01). Overt aggressive symptoms positively correlated with suicide ideation (r = 0.177, P = 0.006) and cognitive performance scores (r = 0.173, P = 0.035). And cognitive performance scores also positively correlated with suicide ideation (r = 0.308, P < 0.001). Logistic regression identified cognitive symptoms (OR 1.47) and overt aggression (OR 1.40) as predictors of suicidal ideation in MDD patients (P < 0.05). Mediation analysis revealed that cognitive symptoms mediated the relationship between overt aggression and suicidal ideation (indirect effect: 0.1903). In MDD, cognitive symptoms and overt aggression are significant predictors of suicidal ideation, with cognitive symptoms playing a mediating role. These findings suggest potential targets for therapeutic intervention.
自杀观念在自杀行为的支配下，是抑郁症最严重的后果。导致激越症状的明显攻击行为，与抑郁发作期间的认知症状一起，都会影响自杀观念和行为。然而，认知症状和明显攻击行为影响抑郁症患者自杀观念的确切机制仍不清楚。这项横断面研究分析了2017年5月至2020年7月期间来自上海精神卫生中心的301名重度抑郁症（MDD）患者。使用17项汉密尔顿抑郁量表（HAMD - 17）评估抑郁严重程度和认知症状，使用改良的明显攻击量表（MOAS）评估明显攻击行为，使用贝克自杀观念量表（BSSI）评估自杀观念。进行多因素逻辑回归以确定自杀观念的危险因素。有自杀观念的患者认知损害和明显攻击行为水平更高（Z = - 5.527，P < 0.01；Z = - 3.482，P < 0.01）。明显攻击症状与自杀观念呈正相关（r = 0.177，P = 0.006），与认知表现得分呈正相关（r = 0.173，P = 0.035）。并且认知表现得分也与自杀观念呈正相关（r = 0.308，P < 0.001）。逻辑回归确定认知症状（OR 1.47）和明显攻击行为（OR 1.40）是MDD患者自杀观念的预测因素（P < 0.05）。中介分析表明，认知症状介导了明显攻击行为与自杀观念之间的关系（间接效应：0.1903）。在MDD中，认知症状和明显攻击行为是自杀观念的重要预测因素，认知症状起中介作用。这些发现提示了治疗干预的潜在靶点。
