Predictors of psychotic symptoms in first-episode and drug-naïve major depressive disorder patients with a history of suicide attempts: A large cross-sectional study

Abstract

Background: Psychotic symptoms (PS) are common in patients with major depressive disorder (MDD); however, few studies have examined risk factors for PS in first-episode and drug-naïve (FEDN) MDD patients with a history of suicide attempts. The purpose of this study was to investigate the incidence and risk factors for PS in FEDN MDD patients with a history of suicide attempts, with the aim of providing implications for early intervention. Methods: A total of 1718 FEDN MDD patients were recruited through a cross-sectional study. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) were used to assess patients’ symptoms. In addition, demographic data and clinical indicators were collected. Results: We found that FEDN MDD patients with a history of suicide attempts were 5.06 times more likely to have PS than those without a history of suicide attempts. HAMD score, HAMA score, and thyroid-stimulating hormone (TSH) were significant predictors of PS in FEDN MDD patients with a history of suicide attempts. The combined area under the curve (AUC) value of 0.94 distinguished patients with PS from those without PS. Conclusions: This study shows a high prevalence of PS in FEDN MDD patients with a history of suicide attempts. Anxiety symptoms, depressive symptoms, and TSH levels appear to predict PS in FEDN MDD patients with a history of suicide attempts.