Depressive mixed state and anxious distress as risk factors for suicidal behavior during major depressive episodes.

Accurately assessing and predicting suicidal behavior in patients with depression are challenging for researchers and clinicians. We examined various risk factors for suicidal behavior during major depressive episodes (MDE), especially focusing on depressive mixed state (DMX) and anxious distress (AD). We recruited 187 patients with MDE and divided them into two groups-with and without suicidal behavior-defined as the cut-off score of 1 or more on the suicidal behavior sub-item in the quick inventory of depressive symptomatology-self report. The presence of DMX was defined as a total score of 13 or more on the self-administered 8-item questionnaire for DMX. We used multivariate logistic regression analysis with the presence or absence of suicidal behavior as a dependent variable for investigating factors associated with suicidal behavior. The with suicidal behavior group was younger and indicated a greater proportion of past suicide attempts, AD, and DMX than the without suicidal behavior group. Logistic regression analysis revealed that AD (P = 0.020) and DMX (P = 0.018) were significantly associated with suicidal behavior. AD and DMX may promote suicidal behavior during MDE. These two psychopathological features should be carefully monitored and intensively treated for the prevention of suicide-related events.