Sex Differences in the Prevalence and Correlates of Suicide Attempts in Patients with First-Episode and Drug-Naïve Psychotic Major Depression

Abstract

Purpose: Sex differences play an important role in depression prevalence, symptom profile, treatment response, and disease course. However, sex differences in factors associated with suicide attempts (SAs) in first-episode and drug-naïve (FEDN) patients with psychotic major depression (PMD) remain unclear.

Methods: In this study, 171 patients with FEDN PMD were recruited. Patients' symptoms were assessed using the Hamilton Rating Scale for Depression (HAMD), Hamilton Anxiety Rating Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) positive subscale. In addition, metabolic parameters and thyroid hormone levels were measured.

Results: The prevalence of SA was remarkably high in both male and female PMD patients (53.19% vs. 50.81%), without significant differences between the two groups. In male PMD patients, the combination of marital status and thyroid-stimulating hormone (TSH) levels was found to effectively distinguish between SA and non-SA cases, with an AUC value of 0.87. In addition, the HAMD score and diastolic blood pressure (BP) were significantly associated with the frequency of SAs in this subgroup. For female PMD patients, the combination of positive score, diastolic BP, TSH, and antithyroglobulin was found to be an effective discriminator between SA and non-SA cases, with an AUC of 0.91. Furthermore, duration of illness, positive score, systolic BP, and thyroid peroxidase antibody were found to be significantly associated with the frequency of SAs in this subgroup.

Conclusions: Our results indicate a high incidence of SAs in both men and women with PMD. Several clinically relevant factors, metabolic parameters, and thyroid hormone function contribute to sex differences in SAs in FEDN PMD patients.

Keywords: Drug-naïve; First episode; Psychotic major depression; Sex difference; Suicide attempt.