Major depressive disorder and suicide risk among adult outpatients at several general hospitals in a Chinese Han population

The association between somatic symptoms and suicidal ideation in Chinese first-episode major depressive disorder

BACKGROUND

Somatic symptoms are prevalent in patients with major depressive disorder (MDD) and often associated with a high risk of suicide. However, which somatic symptoms display as significant risk factors for suicidal ideation (SI) is still poorly understood in MDD.

METHODS

Two thousand and seventeen Chinese patients with first-episode MDD from the National Survey on Symptomatology of Depression were included in this study. A doctor-rating assessment questionnaire was constructed to evaluate depression related somatic symptoms, and stepwise logistic regression analysis was performed to explore the relationship between somatic symptoms and SI.

RESULTS

Our results showed a high prevalence of current SI in first-episode MDD (50.87%), while no significant gender differences (53.32% vs. 49.26%, P = 0.076) were observed. In addition, patients who have more somatic symptoms would be at the higher risk to elicit SI, and stepwise logistic regression analysis indicated that age (β = -0.020, P < 0.001), Pre-verbal physical complaints (β = 0.356, P = 0.001), Sensory system complaints (β = 0.707, P = 0.000), Other pain conditions (β = 0.434, P < 0.001), Late insomnia (β = 0.267, P = 0.008), Hypersomnia (β = 0.936, P < 0.001), Weight loss (β = 0.272, P = 0.006), Hyposexuality (β = 0.513, P = P < 0.001) were strongly associated with current SI in first-episode Chinese major depression.

CONCLUSIONS

Somatic symptoms are strongly associated with SI in first-episode MDD. It is suggestive for clinicians to show concerns for patients' somatic symptoms in practice.

Double screening for dual disorder, alcoholism and depression

Comorbidity of alcohol use disorder and major depressive disorder has been reported in samples. The aim of this study was to examine the relationship between alcoholism and depression in undiagnosed patients by simultaneously applying screening tests for both disorders. A total of 421 subjects were included in the study, of which 246 were female. Two screening tests, the Michigan Alcoholism Screening Test and the Beck Depression Inventory, were used. In the total sample, 28.03% of the respondents engaged in some type of harmful alcohol use and 55.82% experienced some level of depression; 24.70% of the respondents had both at the same time, some type of harmful alcohol use and some level of depression. Results of statistical analysis showed that a more problematic alcohol use type was associated with a more severe level of depression, with a greater positive association between problematic alcohol use and severity of depressive symptoms among females and more harmful alcohol consumption among males. This study points to the importance of screening for alcoholism and depression, because their timely detection and treatment improves the quality of life in newly diagnosed individuals and reduces the economic burden on society for health services due to greater use if a greater severity of dual disorder is reached.

Gender differences in the prevalence and clinical correlates of sleep disturbance in general hospital outpatients

This study investigated gender differences in the prevalence of sleep disturbance and related demographic and clinical characteristics, including quality of life (QOL), in Chinese outpatients. Up to 4399 adult outpatients (2896 females, 1503 males) who visited the neurological, cardiovascular, gastrointestinal, and gynaecological outpatient clinics in four general hospitals were recruited. Demographic and clinical data including QOL were collected by using self-report questionnaires. The prevalence of sleep disturbance in female outpatients (671/2896, 23.2%) was significantly higher than in male outpatients (302/1503, 20.1%) and remained significant after adjusting for significant confounders in the regression analysis. In the regression analysis, divorced/widowed and unemployed status were independently associated with a higher frequency of sleep disturbance in females, while educational level was independently associated with males only. Among these factors, depressive symptoms and older age were the most common risk factors for sleep disturbance in both genders. Sleep disturbance was not associated with the mental domains of the QOL assessments in both genders. This study suggests that sleep disturbance is more frequent in female outpatients and is associated with multiple factors in both genders. A longitudinal study is warranted to confirm the current findings.

Is suicide risk a predictor of diagnosis conversion to bipolar disorder?

To assess predictors of the diagnosis of bipolar disorder is important since it is known that the early diagnosis is associated with a better response to the treatment. Thus, the aim of this systematic review is to assess the role of the suicide risk in the diagnosis conversion to bipolar disorder. We searched Pubmed, Bireme, Scopus, and PsycINFO with no year restriction for articles containing the words (suicidal or suicide or suicide risk or suicide attempt) and (conversion or switch) and (bipolar disorder or mania or hypomania or bipolar disorders). The review included four studies, with only one confirming that subjects who converted to bipolar disorder had higher rates of suicide risk than subjects who did not convert to bipolar disorder. The main limitation of this review is that few longitudinal studies assessed the predictors of conversion to bipolar disorders. In conclusion, suicide risk appears to be a predictor of bipolar disorder; nevertheless, more studies are needed to confirm this association.

The Psycho-cardiac Coupling, Myocardial Remodeling, and Neuroendocrine Factor Levels: The Psychosomatics of Major Depressive Disorder

The association of major depressive disorder (MDD) with myocardial infarction (MI) and vice versa is not unknown. Depression, along with many other systemic factors like atherosclerosis, obesity, diabetes and vascular dysfunction, contributes to the development of adverse cardiac events in the future and, has always been a topic of interest in the fields of cardiology and psychosomatics. We wrote this review article to elaborate this relationship in detail. This article suggests that the individuals with type D personality who already had cardiovascular disease had undergone more serious myocardial damage. In addition, we elucidated the effects of depression on sympathetic activity and remodeling of myocardium after MI. The alterations in the neuroendocrine factors, which included the changes in levels of Serotonin (5-HT), Norepinephrine and Corticosterone, also geared towards the changes associated with depression-induced myocardial injury. However, we need more studies in the near future to further dig into this association process. Therefore, we recommend more research to explore the relationship of psychological factors and adverse cardiac outcomes.