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Background <p>This study aimed to investigate the differential clinical characteristics and distinct risk factors for suicide attempts between patients with psychotic major depression (PMD) and non-psychotic major depression (NPMD).</p> Methods <p>A cross-sectional analysis was conducted on a cohort of major depressive disorder patients. Comprehensive demographic and clinical data were collected. Assessments included the Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Positive and Negative Syndrome Scale (PANSS) positive subscale, and Clinical Global Impression-Severity scale (CGI-S). Fasting blood samples were analyzed for thyroid function (TSH, TgAb, TPOAb, FT3, FT4), metabolic parameters (fasting blood glucose, lipid profiles), and other biomarkers.</p> Results <p>Patients with PMD demonstrated a more severe clinical profile, including significantly higher HAMD, HAMA, and CGI-S scores, alongside elevated thyroid antibodies (TgAb, TPOAb) compared to the NPMD group. A critical finding was the divergent set of predictors for suicide attempts between the diagnostic subgroups. For the overall MDD cohort and the NPMD subgroup specifically, the severity of anxiety (HAMA) and depression (HAMD) were the primary risk factors. In stark contrast, for patients with PMD, positive psychotic symptoms (PANSS) and elevated TSH levels emerged as the dominant and unique predictors of suicide attempts. ROC analysis confirmed the high discriminatory power of TSH for suicide in PMD (AUC = 0.863).</p> Conclusions <p>The path to suicidal behavior differs significantly between PMD and NPMD. Suicide risk in NPMD is primarily driven by the severity of core mood and anxiety symptoms, whereas in PMD, it is predominantly associated with the presence of psychosis and significant HPT axis dysregulation.</p>

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Gender differences and risk factors for suicide attempts in first-episode drug-naïve psychotic versus non-psychotic major depression: a large cross-sectional study

  • 期刊论文

  • 发表日期：

    2025年12月2日

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  • Peng Cui,
  • Shutong Yang,
  • Jianan Zhou,
  • Zaimina Xuekelaiti,
  • Yuanyuan Liu,
  • Guoshuai Luo,
  • Xiangyang Zhang

摘要

Background

This study aimed to investigate the differential clinical characteristics and distinct risk factors for suicide attempts between patients with psychotic major depression (PMD) and non-psychotic major depression (NPMD).

Methods

A cross-sectional analysis was conducted on a cohort of major depressive disorder patients. Comprehensive demographic and clinical data were collected. Assessments included the Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Positive and Negative Syndrome Scale (PANSS) positive subscale, and Clinical Global Impression-Severity scale (CGI-S). Fasting blood samples were analyzed for thyroid function (TSH, TgAb, TPOAb, FT3, FT4), metabolic parameters (fasting blood glucose, lipid profiles), and other biomarkers.

Results

Patients with PMD demonstrated a more severe clinical profile, including significantly higher HAMD, HAMA, and CGI-S scores, alongside elevated thyroid antibodies (TgAb, TPOAb) compared to the NPMD group. A critical finding was the divergent set of predictors for suicide attempts between the diagnostic subgroups. For the overall MDD cohort and the NPMD subgroup specifically, the severity of anxiety (HAMA) and depression (HAMD) were the primary risk factors. In stark contrast, for patients with PMD, positive psychotic symptoms (PANSS) and elevated TSH levels emerged as the dominant and unique predictors of suicide attempts. ROC analysis confirmed the high discriminatory power of TSH for suicide in PMD (AUC = 0.863).

Conclusions

The path to suicidal behavior differs significantly between PMD and NPMD. Suicide risk in NPMD is primarily driven by the severity of core mood and anxiety symptoms, whereas in PMD, it is predominantly associated with the presence of psychosis and significant HPT axis dysregulation.