Anxiety symptoms are linked to new-onset suicidal ideation after six months of follow-up in outpatients with major depressive disorder.
BACKGROUND
Suicide risk evaluation is one of the most challenging assessments of patients with major depressive disorder (MDD). Initial risk evaluation might be insufficient in predicting emergence of suicidal ideation during the maintenance period. We aimed to elucidate factors associated with emergence or persistence of suicidal ideation 6 months after initiation of outpatient treatment in patients with MDD.


METHODS
A total of 300 participants with MDD defined by DSM-IV-TR criteria underwent face-to-face interview at baseline and follow-up phone interview at 6 months later. Severity of depression, suicidal ideation, and anxiety were evaluated.


RESULTS
Among participants who did not report any suicidal idea at baseline, 10.9% reported suicidal ideation during the 6-month phone interview, while 28.4% of participants who reported suicidal ideation at baseline reported suicidal ideation during the phone interview. No significant difference in remission rate of depression was observed between the groups, but subjects without suicidal ideation at baseline had a higher rate of symptom improvement at the 6-month phone interview. After controlling for age, sex, baseline severity of suicide risk and depression and lifetime history of suicide attempts, emergence of suicidal ideation was significantly associated with anxiety level at baseline (t=2.127, p=0.039) and severity of depression symptoms at 6 month (t=-3.028, p=0.004); persistence of suicidal ideation was associated with severity of depression symptoms at 6 month (t=-4.962, p<0.001).


CONCLUSIONS
Follow-up evaluation was done by phone interview.


CONCLUSIONS
Anxiety at baseline needs to be carefully evaluated in assessing suicide risk of patients with MDD.
Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Bipolar Clinic and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Ji Hyun
JH
Baek
Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Jung Yoon
JY
Heo
Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Maurizio
M
Fava
Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
David
D
Mischoulon
Bipolar Clinic and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Andrew
A
Nierenberg
Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Jin Pyo
JP
Hong
Seoul National Hospital, Seoul, South Korea.
Sungwon
S
Roh
Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences & Technology, Department of Clinical Research Design and Evaluation, and Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, South Korea; Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: jeonhj@skku.edu.
Hong Jin
HJ
Jeon
D000328:Adult; D001007:Anxiety / Q000209:etiology* / Q000523:psychology* / Q000628:therapy; D003865:Major Depressive Disorder / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D010552:Personality Assessment; D012307:Risk Factors; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology; D013406:Suicide, Attempted
Depression; Phone interview; Suicide; anxiety