Major depressive disorder with suicidal ideation or behavior in Chinese population: A scoping review of current evidence on disease assessment, burden, treatment and risk factors

The Mediating Role of Hope in the Relationship Between Illness Uncertainty and Discharge Readiness Among Patients With Major Depressive Disorder

PURPOSE

To investigate the effects of illness uncertainty on discharge readiness and explore whether hope mediates this relationship in individuals with major depressive disorder (MDD).

METHOD

A cross-sectional survey was conducted with 218 patients with MDD at a hospital in China. Data were collected using self-reported questionnaires, including demographic and clinical information, the Mishel Uncertainty in Illness Scale, Herth Hope Index, and Readiness for Hospital Discharge Scale. Descriptive statistics, correlation analysis, and path analysis were used to analyze the data.

RESULTS

Illness uncertainty was negatively associated with hope (r = -0.14, p < 0.05) and discharge readiness (r = -0.207, p < 0.01). Conversely, hope was positively associated with discharge readiness (r = 0.445, p < 0.01). Hope partially mediated the relationship between illness uncertainty and discharge readiness, accounting for 28.5% of the total effect.

CONCLUSION

Illness uncertainty directly impacted discharge readiness in patients with MDD and exerted an indirect effect through the mediating role of hope. Findings highlight the importance of psychosocial interventions aimed at enhancing hope and reducing illness uncertainty to improve discharge readiness and support post-hospital recovery. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Association between living arrangement and psychological well-being among patients with major depressive disorder: the moderating role of body mass index

BACKGROUND

Major depressive disorder (MDD) is highly prevalent globally, significantly impacting psychological well-being (PWB). Herein, we aim to evaluate the impact of different living arrangements on PWB in individuals with MDD and explore the potential moderating role of BMI in this relationship.

METHODS

Participants with MDD were recruited from a specialist mental health hospital between December 2019 and April 2023. The diagnosis of MDD was assessed by trained psychiatrists using the Mini-International Neuropsychiatric Interview (M.I.N.I.). Psychological well-being was evaluated using the World Health Organization-Five Well-Being Index. Univariable and multivariable logistic regression models were used to examine the association between different living arrangements and PWB at the 12-month follow-up. The Participants were categorized into underweight, normal weight, and overweight groups based on BMI, followed by conducting stratified analysis.

RESULTS

After adjusting for covariates, living with family (AOR = 1.80, 95%CI = 1.14-2.87, P = 0.026) was associated with a higher PWB. There was significant moderating effect of BMI on the association of living arrangements with PWB (P = 0.049). The stratification analyses revealed significant associations between living arrangements and PWB in the normal weight group, while no significant associations were found in the underweight and overweight groups.

CONCLUSIONS

Living with family was significantly associated with higher levels of PWB in individuals with MDD, especially among those with a normal BMI. These findings highlight the synergistic effect of living with family and maintaining a healthy BMI on improving PWB in depressed individuals.

Haematological markers of inflammation in major depressive disorder (MDD) patients with suicidal behaviour: A systematic review and meta-analysis

INTRODUCTION

Suicide is a significant global health issue linked to neuroinflammation. This study assessed neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) as systemic inflammation indicators in suicidal behaviour of major depressive disorder (MDD) patients.

METHODS

The search included databases like Scopus, PubMed, PsycINFO, Web of Science, and CINAHL Complete, focusing on English-language observational studies up to March 2025. It examined the NLR, PLR, and MLR in individuals with MDD exhibiting suicidal behaviour, comparing them to MDD patients without such behaviors or healthy controls. Study quality was assessed using the Newcastle-Ottawa Scale (NOS), and data analysis utilized Stata software version 17.

RESULTS

From an initial 131 articles, ten studies were included, analyzing 2017 participants. MDD patients with suicidal behaviour had significantly elevated NLR levels compared to non-suicidal MDD patients (SMD: 0.34 [0.12, 0.56]; I2: 67.68 %) and healthy controls (SMD: 1.02 [0.28, 1.76]; I2: 96.15 %). Additionally, no differences in PLR levels were found in suicidal MDD patients compared to their non-suicidal counterparts (SMD: 0.11 [-0.04, 0.27]; I2: 38.39 %), but PLR levels were higher in comparison to healthy controls (SMD: 0.38 [0.17, 0.59]; I2: 38.02 %). Four studies showed higher MLR levels in suicidal MDD patients compared to the non-suicidal group (SMD: 0.33 [0.04, 0.62]; I2: 71.60 %) and healthy controls (SMD: 0.32 [0.06, 0.59]; I2: 44.37 %).

CONCLUSION

Increased inflammatory biomarkers in MDD patients with suicidal tendencies highlight the need for further research on their potential as suicide vulnerability indicators and the utility of NLR, PLR and MLR in clinical practice.

The epidemiological burden of major depressive disorder in women of childbearing age and its relationship with the sociodemographic index: A systematic analysis based on the global burden of disease study from 1990 to 2021

BACKGROUND

The global burden and trends of Major depressive disorder (MDD) among women of childbearing age (WCBA) remain unclear.

METHODS

This study utilized data from the Global Burden of Disease database to extract information on the prevalence, incidence, and disability-adjusted life years (DALYs) related to major depression among WCBA from 1990 to 2021. The study estimated the annual percentage change to assess trends in disease burden and calculated point estimates using 95 % uncertainty intervals.

RESULTS

Between 1990 and 2021, there was a significant increase in the incidence, prevalence, and number of DALYs associated with MDD among WCBA, with increases of 73 %, 73 %, and 72 %, respectively. In low Sociodemographic Index (SDI) regions, WCBA exhibited the highest prevalence, incidence, and DALYs of MDD, whereas high SDI regions had the highest prevalence. East Asia was the only region that reported a decline in the prevalence, incidence, and DALYs associated with MDD. The Central America region experienced the most substantial increases in incidence and DALYs, while East Asia showed the most notable declines in prevalence and DALYs. At the country level, Singapore had the largest global declines in prevalence, incidence, and DALYs, whereas Mexico exhibited the most significant rise. Age group analysis revealed that the most pronounced increase in cases of major depression was observed among women aged 45-49 years.

CONCLUSION

Over the past 32 years, the burden of MDD among WCBA has significantly increased worldwide, particularly in low SDI and high SDI regions, as well as among the 45-49 age group.

Integrative analysis of signaling and metabolic pathways, immune infiltration patterns, and machine learning-based diagnostic model construction in major depressive disorder

Major depressive disorder (MDD) is a multifactorial disorder involving genetic and environmental factors, with unclear pathogenesis. This study aims to explore the pathogenic pathway of MDD and its relationship with immune responses and to discover its potential targets by bioinformatics methods. We first applied gene set variation analysis (GSVA) and seven different immune infiltration algorithms to the GSE98793 dataset to determine the differences in signaling pathways, metabolic pathways, and immune cell infiltration between MDD patients and healthy controls. Differentially expressed genes between MDD patients and controls were obtained from five datasets (GSE98793, GSE32280, GSE38206, GSE39653, and GSE52790), and 113 machine learning methods were employed to construct MDD diagnostic models. Based on the constructed MDD diagnostic models, MDD patients were divided into high-risk and low-risk groups. GSVA and immune microenvironment analyses were conducted to investigate the differences between the two groups. Furthermore, potential drugs and therapeutic targets for the high-risk MDD group were explored to provide new insights and directions for the precise treatment of MDD. GSVA and immune infiltration results indicate that patients with MDD exhibit differences from normal individuals in various aspects, including biological processes, signaling pathways, metabolic processes, and immune cells. To investigate the functions and biological significance of differentially expressed genes in MDD patients, we performed GO and KEGG enrichment analyses on the differentially expressed genes from five databases (GSE98793, GSE32280, GSE38206, GSE39653, and GSE52790). By comparing the enrichment results across the five datasets, we found that the cell-killing signaling pathway was consistently present in the enriched signaling pathways of all datasets, suggesting that this pathway may play a crucial role in the pathogenesis of MDD. The random forest algorithm (AUC = 0.788) was selected as the optimal algorithm from 113 machine learning algorithms, leading to the development of a robust and predictive MDD algorithm, highlighting the important role of NPL in MDD. By dividing MDD into high and low-risk subgroups based on diagnostic model scores, enrichment pathways, and immunological results further demonstrated that high-risk MDD is associated with increased levels of reactive oxygen species, inflammation, and numbers of T cells and B cells. Through GSEA scoring, five upregulated pathways in the high-risk MDD group were identified, and multiple potential drugs such as Mibefradil, LY364947, ZLN005, STA- 5326, and vemurafenib were screened. Patients with MDD show differences in signaling pathways, metabolic pathways, and immune mechanisms. By constructing an MDD diagnostic model, we predicted the key genes of MDD and the characteristic pathways associated with a higher risk of MDD. This provides new insights for risk stratification identification and offers new perspectives for the clinical application of precision immunotherapy and drug development.

A network analysis of alexithymia, empathy, and suicidal ideation in Chinese adolescents with major depressive disorders

Background

Suicidal ideation is prevalent in major depressive disorder (MDD) and is closely related to empathy and alexithymia. While traditional approaches (e.g., regression models) focus on linear associations, network analysis provides unique advantages by mapping dynamic symptom interactions and identifying pivotal nodes that may drive suicidal risk. This study investigates these relationships through a network lens to reveal actionable intervention targets.

Methods

The study included 329 adolescents with MDD (ages 12-18). The Alexithymia Scale (TAS-20), Interpersonal Reactivity Index (IRI), and the Positive and Negative Suicide Ideation scale (PNSI) were used to assess alexithymia, empathy, and suicidal ideation levels, respectively. Network analysis was conducted to model the relationships between symptoms and calculate centrality and stability indices.

Results

Network analysis revealed strong stability with Emotional Identification Difficulty (DIF) and Personal Distress (PD) identified as the most influential core symptoms, exhibiting the strongest bridging roles between emotional dysfunction and suicidal ideation. DIF showed particularly robust connections to both PD and suicidal ideation, while comparative subgroup analyses indicated no significant differences in network patterns between first-episode and recurrent MDD patients, suggesting consistent symptom dynamics across illness stages.

Conclusion

By revealing DIF and PD as central therapeutic targets, this study demonstrates how network analysis can uncover intervention opportunities missed by traditional approaches. Clinically, targeting these nodes through emotion recognition training and distress tolerance interventions may disrupt the pathway to suicidality in adolescents with MDD.

Transcriptional Patterns of Nodal Entropy Abnormalities in Major Depressive Disorder Patients with and without Suicidal Ideation

Previous studies have indicated that major depressive disorder (MDD) patients with suicidal ideation (SI) present abnormal functional connectivity (FC) and network organization in node-centric brain networks, ignoring the interactions among FCs. Whether the abnormalities of edge interactions affect the emergence of SI and are related to the gene expression remains largely unknown. In this study, resting-state functional magnetic resonance imaging (fMRI) data were collected from 90 first-episode, drug-naive MDD with suicidal ideation (MDDSI) patients, 60 first-episode, drug-naive MDD without suicidal ideation (MDDNSI) patients, and 98 healthy controls (HCs). We applied the methodology of edge-centric network analysis to construct the functional brain networks and calculate the nodal entropy. Furthermore, we examined the relationships between nodal entropy alterations and gene expression. The MDDSI group exhibited significantly lower subnetwork entropy in the dorsal attention network (DAN) and significantly greater subnetwork entropy in the default mode network than the MDDNSI group. The visual learning score of the measurement and treatment research to improve cognition in schizophrenia (MATRICS) consensus cognitive battery was negatively correlated with the subnetwork entropy of DAN in the MDDSI group. The support vector machine model based on nodal entropy achieved an accuracy of 81.87% when distinguishing the MDDNSI and MDDSI. Additionally, the changes in SI-related nodal entropy were associated with the expression of genes in cell signaling and interactions, as well as immune and inflammatory responses. These findings reveal the abnormalities in nodal entropy between the MDDSI and MDDNSI groups, demonstrated their association with molecular functions, and provided novel insights into the neurobiological underpinnings and potential markers for the prediction and prevention of suicide.

Astrocytic pleiotrophin deficiency in the prefrontal cortex contributes to stress-induced depressive-like responses in male mice

Astrocytes are closely linked to depression, and the prefrontal cortex (PFC) is an important brain region involved in major depressive disorder (MDD). However, the underlying mechanism by which astrocytes within PFC contribute to MDD remains unclear. Using single-nucleus RNA sequencing analyses, we show a significant reduction in astrocytes and attenuated pleiotrophin-protein tyrosine phosphatase receptor type Z1 (PTN-PTPRZ1) signaling in astrocyte-to-excitatory neuron communication in the PFC of male MDD patients. We find reduced astrocytes and PTN in the dorsomedial PFC of male mice with depression induced by chronic restraint and social defeat stress. Knockdown of astrocytic PTN induces depression-related responses, which is reversed by exogenous PTN supplementation or overexpression of astrocytic PTN. The antidepressant effects exerted by astrocytic PTN require interaction with PTPRZ1 in excitatory neurons, and PTN-PTPRZ1 activates the AKT signaling pathway to regulate depression-related responses. Our findings indicate the PTN-PTPRZ1-AKT pathway may be a potential therapeutic target for MDD.

Association between overt aggression and suicidal ideation in patients with major depressive disorder: the mediational role of cognitive symptoms

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.

Effect of continuous esketamine infusion on brain white matter microstructure in patients with major depression: A diffusion tensor imaging study

INTRODUCTION

Esketamine has demonstrated acute antidepressant effects in patients with major depressive disorder (MDD). This study investigated whether these effects associate with reversible white matter fiber integrity recovery using diffusion imaging.

METHOD

Twenty patients with MDD and 20 healthy controls received 2-week esketamine treatment. Patients received 0.25 mg/kg intravenous esketamine. Emotional and cognitive recovery were assessed. Diffusion tensor imaging and tract-based spatial statistics evaluated white matter fiber integrity pre/post-treatment. Correlation analyses examined associations between white matter changes and clinical scales.

RESULTS

Compared to controls, patients with MDD exhibited decreased fractional anisotropy (FA) values of cerebral white matter fibers involving the association fibers, the commissural fibers and projection fibers. Esketamine effectively reduced depression, anxiety, and suicidal ideation scores while improving cognitive function. However, no reversible recovery of compromised white matter integrity was observed after 2 weeks of esketamine treatment. FA reductions in projection fibers correlated with anxiety and suicidal ideation severity.

LIMITATIONS

Concurrent sertraline use and lack of placebo control limited our ability to isolate esketamine's effects. The wide age range may have introduced response variability. We used minimal effective dosages based on previous research. The small sample size limited statistical power. Larger, more controlled studies are needed to validate these preliminary findings.

DISCUSSION

This study enhances MDD neuropathological understanding, with widespread white matter impairment and associations between projection fibers and symptom severity. While producing significant antidepressant effects, short-term esketamine did not recover compromised white matter microstructure.

Decoding Alzheimer's Disease With Depression: Molecular Insights and Therapeutic Target

The purpose of this study was to recognise predictive biomarkers and explore the promising therapeutic targets of AD with depression. We confirmed a positive correlation between AD and depression through MR Analysis. Through WGCNA analysis, we identified 1569 genes containing two modules, which were most related to AD. In addition, 1629 depressive DEGs were also identified. In these genes, 84 genes were shared by both AD and depression, which were screened by the Degree algorithm, MCC algorithm, and four machine learning algorithms. Two genes (ITGB5 and SPCS1) were confirmed as predictive biomarkers with AUC > 0.7. Furthermore, the nomogram indicated that ITGB5 and SPCS1 are good biomarkers in diagnosing AD with depression. Four drugs targeted at ITGB5 were determined by the DGIdb website. In conclusion, we identified two predictive biomarkers for AD with depression, thus providing promising therapeutic targets for AD with depression.

Chronic treatment of mixture of two iridoids proportional to prescriptional dose of Yueju improves hippocampal PACAP-related neuroinflammation and neuroplasticity signaling in the LPS-induced depression model

ETHNOPHARMACOLOGICAL RELEVANCE

Geniposide (GP) and shanzhiside methyl ester (SM) are the two important bioactive compounds in the classical traditional Chinese herbal medicine Yueju Pill, which is currently used as an over-the-counter (OTC) medicine in China. Yueju has been demonstrated with antidepressant-like effects with the prescriptional dose. As GP and SM both have antidepressant potential, the synergism of them could be crucial to the function of Yueju.

OBJECTIVES

The neuropeptide pituitary adenylyl cyclase-activating polypeptide (PACAP) has been implicated in the onset of antidepressant-like response. Here we investigated the synergism of the chronic treatment with GP and SM, at proportional doses to Yueju, on antidepressant-like effects, and underlying mechanism of PACAP-related signaling in a neuroinflammation-based depression model.

MATERIALS AND METHODS

Depression-related behaviors were tested in the lipopolysaccharide (LPS)-induced depression model. The molecular signaling of neuroinflammation and neuroplasticity was investigated using Western blot analysis, immunofluorescence and pharmacological inhibition of mTOR signaling.

RESULTS

Chronic treatment of GP and SM (GS) at the dose which is proportional to the prescriptional dose of Yueju synergistically elicited antidepressant-like effects. Chronic treatment of the GS or the conventional antidepressant fluoxetine (FLX) showed antidepressant-like effects in LPS-injected mice. In vitro analysis indicated the synergism of GS on PACAP expression. In the hippocampus of LPS-injected mice, both GS and FLX enhanced PACAP expression, downregulated the inflammatory signaling of Iba-1/NF-кB/IL-1β and NLRP3, and upregulated the neuroplasticity signaling of mTOR-BDNF/PSD95. Additionally, both treatments reduced microglia activation indicated by Iba-1 immunofluorescent staining. Rapamycin, an mTOR inhibitor, blunted the antidepressant-like effects and the upregulation of BDNF expression induced by chronic GS.

CONCLUSION

The antidepressant-like effects elicited by chronic fluoxetine or by synergistic doses of GS were involved in the upregulation of hippocampal PACAP levels, in association with ameliorated neuroinflammation and neuroplasticity signaling in LPS-injected mice. GS synergism may play a key part in the antidepressant-like effects of the prescriptional dose of Yueju.

The incidence and influencing factors of recent suicide attempts in major depressive disorder patients comorbid with moderate-to-severe anxiety: a large-scale cross-sectional study

BACKGROUND

Major depressive disorder (MDD) is a recurrent and persistent mental illness. However, there is a lack of research that distinguishes the severity of comorbid anxiety disorders in MDD, and insufficient evidence exists regarding the prevalence of MDD patients with comorbid moderate-to-severe anxiety in the Chinese population.

METHODS

The study included 1718 MDD patients (894 with moderate-to-severe anxiety symptoms and 824 without moderate-to-severe anxiety symptoms). Clinical symptoms and development were assessed using the Hamilton Depression Rating Scale-17 (HAMD-17), Hamilton Anxiety Rating Scale-14 (HAMA-14), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression (CGI). The blood pressure and thyroid hormone levels were measured.

RESULTS

We found that the incidence of MDD patients with moderate-to-severe anxiety symptoms was 52.04%. The prevalence of recent suicide attempts in MDD comorbid moderate-to-severe anxiety patients was 31.8%, which was 4.24 times higher than that in patients without moderate-to-severe anxiety. Additionally, suicide attempters had elevated levels of thyroid stimulating hormone (TSH), anti-thyroglobulin (TgAb), thyroid peroxidases antibody (TPOAb), systolic blood pressure (SBP), and diastolic blood pressure (DBP) compared to non-suicide attempters. We further identified CGI score, TSH, TPOAb, and DBP as influential factors for recent suicide attempts in MDD individuals who had moderate-to-severe anxiety symptoms. These indexes could distinguish between suicide attempts and non-suicide attempts in MDD patients with moderate-to-severe anxiety symptoms.

CONCLUSIONS

Our findings mainly indicated a high prevalence of recent suicide attempts in MDD patients with moderate-to-severe anxiety. Several clinical correlates, thyroid hormones, and blood pressure might contribute to recent suicide attempts in MDD patients with moderate-to-severe anxiety symptoms.

The role of gender factors influencing multiple dimensions of somatic symptoms in major depressive disorder patients with suicidal ideation: insights from the Chinese NSSD study

BACKGROUND

The study aimed to explore the influence of gender on the prevalence of various somatic symptoms and their associations with suicidal ideation (SI) among patients with major depressive disorder (MDD).

METHODS

We recruited 3,275 patients with MDD from the National Survey on Symptomatology of Depression (NSSD), among whom 1,745 patients had SI. The clinical characteristics and the prevalence of somatic symptoms across 20 dimensions in MDD patients with SI were compared between male and female patients. Spearman correlation analysis and logistic regression analysis were used to explore the relationship between somatic symptoms and SI.

RESULTS

In patients with SI, 32.2% of female participants attributed the onset of MDD to physical concerns, whereas 27% of male patients held a similar perspective (P = 0.032). Female patients exhibited a higher prevalence of early insomnia (64.6% vs. 70.2%) and a lower prevalence of hypersomnia (17.2% vs. 12.9%) and urinary system symptoms (25.0% vs. 17.8%). Logistic regression analysis indicated that female patients displayed a broader range of somatic symptoms identified as risk factors for SI, including increased appetite, respiratory symptoms, circulatory system symptoms, limb pain, and various others.

CONCLUSION

This study unveils gender-specific patterns in somatic symptoms among MDD patients with SI, highlighting the clinical significance of these symptoms in diagnosis and intervention. Understanding how physical concerns contribute to MDD, especially among females, underscores the need for tailored clinical approaches. Recognizing and addressing these symptoms could guide more effective suicide prevention strategies and enhance MDD management in clinical practice.

Exploring the neurocognitive correlates of suicidal ideation in major depressive disorder: The role of frontoparietal and default mode networks

Suicidal ideation (SI) is a common symptom of major depressive disorder (MDD), often accompanied by cognitive alterations and emotional dysregulation. However, it is unclear whether cognitive dysfunction in patients with MDD is related to the presence or absence of SI and impaired connectivity within or between large-scale neurocognitive networks. Previous studies have shown that the frontoparietal network (FPN) and default mode network (DMN) are critical for cognitive control and emotional regulation. Participants were 51 MDD patients with suicidal ideation (MDDSI), 52 MDD patients without suicidal ideation (MDDNSI), and 55 healthy controls (HC). Using areas located within FPN and DMN networks as regions of interest (ROIs), we compared the cognitive performance of the three groups and the strength of the resting state functional connections (RSFC) within and between the FPN and DMN networks. Additionally, we examined the correlation between the strength of FC within the FPN and cognitive function in the SI group. Furthermore, network-based statistics (NBS) were used to correct for the strength of FPN and DMN functional connections. The study identified significant cognitive deficits in MDD patients. Reduced strength of FC was observed within the FPN and DMN networks in the SI group compared to the NSI group. In the SI group, the strength of FC within the FPN network was positively correlated with attention/vigilance. These insights underscore the critical roles of the FPN and DMN in the suicidal ideation, shedding light on the cognitively relevant neurobiological characteristics of MDDSI, providing new insights into the neural mechanisms of MDDSI. URL: https://www.chictr.org.cn/bin/project/edit?pid=131537. Registration number: ChiCTR2100049646.

Changes in suicidal ideation during treatment among patients with major depressive disorder: A 6-month naturalistic follow-up study

AIM

There is limited evidence regarding predictors of changes in suicidal ideation (SI) in patients with major depressive disorder (MDD). The objective of this study was to describe changes in SI over a 6-month period and identify their predictors from naturalistic observations of MDD patients.

METHODS

In the cross-sectional analysis, we examined 257 patients with MDD at the first-visit assessment. Among the patients, 119 who completed the 6-month assessment (completers) were included in the longitudinal analysis. For the evaluation of depressive symptoms, including SI, the Quick Inventory of Depressive Symptomatology-Japanese version was administered at both the first-visit and follow-up assessments. At baseline, we also administered the Japanese version of the Ten Item Personality Inventory to assess personality traits and the PRIME Screen-Revised to assess psychotic symptoms.

RESULTS

In the cross-sectional analysis of first-visit patients, 36.2% (93/257) exhibited SI. Among completers, 14.3% (17/119) had prolonged SI. Among the completers with SI at the first-visit assessment, 38.6% (17/44) had SI at the follow-up assessment (prolonged SI). In linear regression models including all completers, prolonged SI was positively associated with endorsement of suspiciousness/persecutory ideas and negatively associated with higher age.

CONCLUSION

More than one-third of completers who had SI at the first-visit assessment experienced prolonged SI (SI at follow-up). Our findings can help clinicians predict the course of MDD by identifying associated demographic and clinical characteristics.

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

Background

This study aimed to identify socio-demographic, physiologic, and psychologic related factors of the first-time suicide attempt (FSA) in the past 14 days in Chinese adult patients with first-episode drug-naïve (FEDN) major depressive disorder (MDD).

Methods

A total of 1718 adult patients with FEDN MDD were enrolled in this cross-sectional survey. Depression, anxiety symptoms, and suicide attempts were assessed. Additionally, biological samples were collected and measured, while Logistic regression analysis was employed to explore the risk factors for FSA in the past 14 days among FEDN MDD patients.

Results

Among suicide attempters, 12.11% (208 out of 1718) reported experiencing FSA in the past 14 days. Logistic regression analysis showed that the risk factors for FSA included more severe anxiety symptoms (OR=1.37, 95%CI: 1.28-1.48, p<0.001), higher levels of total cholesterol (TC) (OR=1.42, 95%CI: 1.13-1.77, p=0.003), and elevated thyroid-stimulating hormone (TSH) (OR=1.13, 95%CI: 1.03-1.25, p=0.01). The regression model exhibited good discriminatory power for FSA with an area under the curve (AUC) of 0.82.

Conclusion

FEDN MDD patients with more severe anxiety and higher levels of TSH and TC are more likely to develop FSA in the past 14 days. These factors are risk factors for short-term (in the past 14 days) FSA and may serve as indicators for early intervention.

Analysis of risk factors of suicidal ideation in adolescent patients with depression and construction of prediction model

BACKGROUND

Major depressive disorder is a common mental illness among adolescents and is the largest disease burden in this age group. Most adolescent patients with depression have suicidal ideation (SI); however, few studies have focused on the factors related to SI, and effective predictive models are lacking.

AIM

To construct a risk prediction model for SI in adolescent depression and provide a reference assessment tool for prevention.

METHODS

The data of 150 adolescent patients with depression at the First People's Hospital of Lianyungang from June 2020 to December 2022 were retrospectively analyzed. Based on whether or not they had SI, they were divided into a SI group (n = 91) and a non-SI group (n = 59). The general data and laboratory indices of the two groups were compared. Logistic regression was used to analyze the factors influencing SI in adolescent patients with depression, a nomogram prediction model was constructed based on the analysis results, and internal evaluation was performed. Receiver operating characteristic and calibration curves were used to evaluate the model's efficacy, and the clinical application value was evaluated using decision curve analysis (DCA).

RESULTS

There were differences in trauma history, triggers, serum ferritin levels (SF), high-sensitivity C-reactive protein levels (hs-CRP), and high-density lipoprotein (HDL-C) levels between the two groups (P < 0.05). Logistic regression analysis showed that trauma history, predisposing factors, SF, hs-CRP, and HDL-C were factors influencing SI in adolescent patients with depression. The area under the curve of the nomogram prediction model was 0.831 (95%CI: 0.763-0.899), sensitivity was 0.912, and specificity was 0.678. The higher net benefit of the DCA and the average absolute error of the calibration curve were 0.043, indicating that the model had a good fit.

CONCLUSION

The nomogram prediction model based on trauma history, triggers, ferritin, serum hs-CRP, and HDL-C levels can effectively predict the risk of SI in adolescent patients with depression.

Major depressive disease research in BRICS: A bibliometric analysis of publications from 2003 to 2022

Major depressive disorder (MDD) seriously threatens human health. BRICS, known as an acronym for "Brazil, Russia, India, China, and South Africa," were also actively carrying out researches on MDD. This study aimed to conduct a bibliometric study of research on MDD conducted by the BRICS. By searching in the Web of Science and using the software Vosviewer and Citespace as analysis tools, this study analyzed the cooperation network at the country, institution, author-specific levels, the research hotspots and trends from BRICS between 2003-2022. A total of 10,911 articles were finally included. Our findings showed that researches on MDD from BRICS rapidly increased during the past two decades. China and India have shown explosive growth, while South Africa has the largest average "Usage Count" and "Time Cited". The current cooperation partners of the BRICS were mainly high-income countries and other developing countries with similar cultures, languages, and geographical locations. Institutions in high-income countries served as the main bridges for BRICS cooperation, while at the author level, some core authors in the BRICS countries serve as centers. China showed a flexible model in domestic partnership, but institutions and authors in the other four countries have gathered to cooperate within the group. BRICS research on MDD mainly focused on cognitive science, brain science, epidemiology, and disease mechanisms. The keywords"gut microbiota", "network analysis," "machine learning" and "sleep quality" showed explosive growth and might become research hotspots in the near future. This bibliometric analysis provided a science knowledge graph and references for other researchers.

Multiphasic Personality Assessment in a Case Series of Adolescent Patients with Suicidal Ideation and/or Attempts

Suicide is an important public health issue. To examine the differences in personality characteristics between a group of adolescents with suicidal ideation (SI) and a group with a history of suicidal attempts (SA), we conducted a cross-sectional study. We enrolled 55 adolescents (51 females; 12-18 y.o.) who presented SI and/or SA. Using the Columbia Suicide Severity Rating Scale, we divided the sample into two groups: adolescents with SI and adolescents with SA. All participants filled in the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A). Adolescents in the SA group had greater difficulties in social relations, risky behaviors, and more intense suicidal ideation compared to those in the SI group. Adolescents in the SA group scored higher in Omission, in the Lie Scale, the Conduct Problem Scale, the Less Aspirations Scale, the Repression Scale in the MMPI-A, and item 283 of the MAST compared to the other group. The results suggest that using the MMPI-A to assess certain features (e.g., tendency to lie, repression) may be helpful in identifying young people who are at high risk of suicide. However, further research is required to determine the effectiveness of using this instrument.