Clinical symptoms, thyroid dysfunction, and metabolic disturbances in first-episode drug-naïve major depressive disorder patients with suicide attempts: A network perspective

Abstract

BackgroundsCo-occurrence of thyroid dysfunction, metabolic disturbances, and worsening clinical symptoms in major depressive disorder (MDD) patients with suicidal attempts (SA) are common. However, their relationship in SA patients remains unexplored. We aimed to (1) determine the independent association of thyroid dysfunction, clinical symptoms, and metabolic disturbances with SA; and (2) identify their interactions in SA patients via the network approach.Methods1718 FEDN MDD patients were recruited. Depressive, anxiety, and psychotic symptoms were assessed by the Hamilton Rating Scale for Depression (HAMD), the Hamilton Rating Scale for Anxiety (HAMA), and the Positive and Negative Syndrome Subscale positive subscale, respectively. The serum levels of thyroid hormones and other metabolic parameters were assessed. Logistic regression model was applied to determine the correlates of SA. Network analysis was applied to determine the interaction between thyroid dysfunction, clinical symptoms, and metabolic disturbances.ResultsSA patients had significant worse metabolic disturbances, thyroid dysfunction, and clinical symptoms than non-SA patients. Thyroid peroxidases antibody, thyroid stimulating hormone (TSH), HAMD scores, HAMA scores, and systolic blood pressure was independently associated with SA. Network analysis suggested that TSH was the hub of the network, exhibiting substantial associations with metabolic disturbances, anxiety, and psychotic symptoms in SA patients.ConclusionsOur work highlights the predominant role of serum TSH levels in the pathophysiology of SA. Regular thyroid function tests might help early detect SA. Targeting increased TSH levels may help reduce metabolic disturbances and clinical symptoms in SA patients.

Prevalence and related factors of first-time suicide attempts in the past 14 days in Chinese adult patients with first-episode drug-naïve major depressive disorder

“…This study showed that elevated TSH levels in patients with MDD were associated with an increased prevalence of FSA in the past 14 days, consistent with many previous studies (75)(76)(77)(78). A China-based study involving FEDN MDD patients found that the levels of serum TSH and TC are statistically higher in suicide attempters than in non-suicide attempters (76).…”

Association between childhood maltreatment and suicidal ideation among Chinese patients with chronic schizophrenia: the mediating role of insomnia

“…A single question (‘Have you ever attempted to kill yourself in your lifetime?’) was delivered to all participants. 41 Those who responded ‘Yes’ were further questioned about the method, time and frequency of suicidal attempts. We contacted their family members when necessary.…”

Sex-differential association of suicide attempts with thyroid dysfunction in first-episode and drug-naïve young major depressive disorder patients with comorbid anxiety

“…According to this rule, subjects with scores ≥ 21 were classified as MDD with comorbid anxiety (MDA) group, and other subjects were classified as MDD without anxiety (MDNA) group. To our knowledge, many previous studies also adopted these scoring rules to assess anxiety symptoms 17 – 19 .…”