Comorbidity of Suicide Attempts and Psychotic Symptoms in First-Episode Major Depression

In a groundbreaking study published in BMC Psychiatry on July 29, 2025, researchers examined the prevalence of comorbid suicide attempts (SA) and psychotic symptoms (PS) among first-episode drug-naïve patients diagnosed with Major Depressive Disorder (MDD). This research, conducted by a team led by Dr. Aqiong Liu from the Department of Psychiatry at Nanjing Youan Hospital, involved 1,718 participants and revealed that approximately 4.4% of these patients exhibited both SA and PS, highlighting a significant risk factor for worsening mental health conditions.
The study underscores the critical nature of recognizing and addressing comorbid conditions in MDD patients, particularly as both SA and PS are linked to a poor prognosis and increased mortality risk. The research team categorized patients based on the presence of comorbid psychiatric symptoms (SAPS) and conducted extensive clinical evaluations, including sociodemographic data, clinical symptom assessments, and biochemical markers.
Key findings indicated that patients in the SAPS group were generally older, had an earlier onset of the disorder, and reported higher scores on depression (Hamilton Depression Rating Scale - HAMD), anxiety (Hamilton Anxiety Rating Scale - HAMA), and illness severity (Clinical Global Impression-Severity of Illness - CGI-SI). Moreover, biochemical analyses showed significant differences in thyroid hormone levels between those with and without SAPS, with higher thyroid-stimulating hormone (TSH) levels detected in the SAPS group.
The study's methodology involved a comprehensive cross-sectional design, allowing for the collection of multifaceted data, which was then analyzed using binary logistic regression to determine the factors most significantly associated with SAPS. The research team identified that higher HAMA scores (OR = 1.643, 95% CI: 1.439–1.878, p < 0.001) and CGI-SI scores (OR = 8.359, 95% CI: 2.651–26.352, p < 0.001) were strongly predictive of the comorbidity.
Dr. Huimin Yin, a co-author from Anhui Medical University, emphasized the importance of these findings in clinical settings, advocating for heightened awareness and proactive measures in treating FEDN MDD patients. The study not only contributes to the existing body of knowledge surrounding MDD but also establishes clinical markers that may aid in early identification and intervention strategies for those at risk of severe outcomes.
Overall, this research sheds light on the multifaceted nature of MDD and the pressing need for comprehensive treatment approaches that address both psychological and physiological aspects of the disorder. The authors recommend further longitudinal studies to explore causality and develop targeted interventions that could significantly improve the prognosis for patients suffering from this debilitating condition.
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