Suicidal thoughts/acts and clinical correlates in patients with depressive disorders in Asians: results from the REAP-AD study.
OBJECTIVE
Using data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) study, we aimed to present the rates and clinical correlates of suicidal thoughts/acts in patients recruited from a total of 40 centres in 10 Asian countries/areas: China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Singapore, Taiwan, and Thailand.


METHODS
Data from 1122 patients with depressive disorders in the REAP-AD study were used. The ICD-10 was employed to diagnose depressive episodes and recurrent depressive disorder. The presence or absence of suicidal thoughts/acts and profile of other depressive symptoms was established using the National Institute for Health and Clinical Excellence guidelines for depression. Country/area differences in rates of suicidal thoughts/acts were evaluated with the χ2 test. In addition, depressive symptom profiles, other clinical characteristics, and patterns of psychotropic drug prescription in depressed patients with and without suicidal thoughts/acts were compared using analysis of covariance for continuous variables and logistic regression analysis for discrete variables to adjust the effects of covariates.


RESULTS
The rates of suicidal thoughts/acts in 10 countries/areas varied from 12.8% in Japan to 36.3% in China. Patients with suicidal thoughts/acts presented more persistent sadness (adjusted odds ratio [aOR]=2.64, p<0.001), loss of interest (aOR=2.33, p<0.001), fatigue (aOR=1.58, p<0.001), insomnia (aOR=1.74, p<0.001), poor concentration (aOR=1.88, p<0.001), low self-confidence (aOR=1.78, p<0.001), poor appetite (aOR=2.27, p<0.001), guilt/self-blame (aOR=3.03, p<0.001), and use of mood stabilisers (aOR=1.79, p<0.001) than those without suicidal thoughts/acts.


CONCLUSIONS
Suicidal thoughts/acts can indicate greater severity of depression, and are associated with a poorer response to antidepressants and increased burden of illness. Hence, suicidal thoughts/acts can provide a clinical index reflecting the clinical status of depressive disorders in Asians.
1Department of Psychiatry,Inje University Haeundae Paik Hospital,Busan,Korea.
Seon-Cheol
SC
Park
2Department of Psychiatry,Korea University College of Medicine,Seoul,Korea.
Min-Soo
MS
Lee
3Department of Psychiatry,Soonchunhyang University Seoul Hospital,Seoul,Korea.
Sang Woo
SW
Hahn
4Peking University Institute of Mental Health,Beijing,China.
Tian-Mei
TM
Si
5Department of Neuropsychiatry,Graduate School of Medical Sciences,Kyushu University,Fukuoka,Japan.
Shigenobu
S
Kanba
6School of Medicine,Kaohsiung Chang Gung Memorial Hospital,Chang Gung University,Kaohsiung,Taiwan.
Mian-Yoon
MY
Chong
7Department of Psychiatry and Mental Health,Tunku Abdul Rahman Institute of Neuroscience,Kuala Lumpur Hospital,Kuala Lumpur,Malaysia.
Chee Kok
CK
Yoon
8Department of Psychiatry, Faculty of Medicine,Prince of Songkla University,Songkhla,Thailand.
Pichet
P
Udomratn
9King George's Medical University,Chowk,Lucknow,India.
Adarsh
A
Tripathi
10Association for the Improvement of Mental Health Programs,Geneva,Switzerland.
Norman
N
Sartorius
11Department of Social Welfare,School of Human Sciences,Seinan Gakuin University,Fukuoka,Japan.
Naotaka
N
Shinfuku
12Department of Psychiatry, Faculty of Medicine,University of Airlangga/Dr. Soetomo General Hospital,Surabaya,Indonesia.
Margarita M
MM
Maramis
13Department of Psychiatry,Hanyang University Guri Hospital,Guri,Korea.
Yong Chon
YC
Park
D000328:Adult; D001208:Asia / Q000453:epidemiology; D044466:Asian People / Q000523:psychology*; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000627:therapeutic use; D059020:Suicidal Ideation
D011619:Psychotropic Drugs
Asians; depressive disorders; mood stabilisers; suicidal thoughts/acts