Skip to main content

Advertisement

SpringerLink
Log in

Metabolic parameters and thyroid hormones in relation to suicide attempts in patients with first-episode and drug-naive major depressive disorder with comorbid glucose disturbances: a large cross-sectional study

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

The factors associated with suicide attempts in major depressive disorder (MDD) patients with comorbid glucose disturbances remain unclear. To the best of our knowledge, this is the first study with a large sample size to examine risk factors of suicide attempts in first-episode drug-naïve (FEDN) MDD patients with comorbid glucose disturbances, including clinically relevant factors, metabolic parameters, and thyroid hormone levels. A total of 1718 FEDN MDD patients were enrolled. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) were used to assess the clinical symptoms of patients. Fasting blood glucose, metabolic parameters, and thyroid hormone levels were measured. After controlling for HAMA and HAMD scores, the suicide attempt rate was 1.88 times higher in MDD patients with glucose disturbances than in MDD patients without glucose disturbances. Compared to non-suicide attempters, suicide attempters among the MDD patients with glucose disturbances had higher scores on HAMD and HAMA, PANSS positive symptoms, as well as higher levels of systolic and diastolic blood pressure, TC, LDL-C, thyroid stimulating hormone (TSH), TgAb, and thyroid peroxidases antibody (TPOAb). The combination of positive symptom score, HDL-C, systolic blood pressure, and marital status distinguished suicide attempters from non-suicide attempters. In addition, HAMA score, HAMD score, and TPOAb were associated with the number of suicide attempts in MDD patients with comorbid glucose disturbances. Our results suggest a high incidence of suicide attempts in MDD patients with comorbid glucose disturbances. Several clinically relevant factors, metabolic parameters, and thyroid hormone function have an impact on suicide attempts in MDD patients with comorbid glucose disturbances.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mendis S (2013) Stroke disability and rehabilitation of stroke: World Health Organization perspective. Int J Stroke 8:3–4

    Article  PubMed  Google Scholar 

  2. Battle DE (2013) Diagnostic and statistical manual of mental disorders (DSM). Codas 25:191–192

    PubMed  Google Scholar 

  3. Fava M et al (2004) Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D. Psychol Med 34:1299–1308

    Article  PubMed  Google Scholar 

  4. Ferrari AJ et al (2013) The epidemiological modelling of major depressive disorder: application for the global burden of disease study 2010. PLoS ONE 8:e69637

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Whiteford HA et al (2013) Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet 382:1575–1586

    Article  PubMed  Google Scholar 

  6. Li H et al (2017) Major depressive disorder and suicide risk among adult outpatients at several general hospitals in a Chinese Han population. PLoS ONE 12:e0186143

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sudol K, Mann JJ (2017) Biomarkers of suicide attempt behavior: towards a biological model of risk. Curr Psychiatry Rep 19:31

    Article  PubMed  Google Scholar 

  8. Fleischmann A et al (2016) Overview evidence on interventions for population suicide with an eye to identifying best supported strategies for LMICs. Glob Ment Health. https://doi.org/10.1017/gmh.2015.27

    Article  Google Scholar 

  9. Azorin JM et al (2010) Suicidal behaviour in a French cohort of major depressive patients: characteristics of attempters and nonattempters. J Affect Disord 123:87–94

    Article  PubMed  Google Scholar 

  10. Kim SW et al (2011) Relationship between a history of a suicide attempt and treatment outcomes in patients with depression. J Clin Psychopharmacol 31:449–456

    Article  PubMed  Google Scholar 

  11. Ma YJ et al (2020) Association of lipid profile and suicide attempts in a large sample of first episode drug-naive patients with major depressive disorder. Front Psychiatry 11:543632

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hawton K, Casañas ICC, Haw C, Saunders K (2013) Risk factors for suicide in individuals with depression: a systematic review. J Affect Disord 147:17–28

    Article  PubMed  Google Scholar 

  13. Dong R et al (2021) Sex differences in the association between suicide attempts and glucose disturbances in first-episode and drug naive patients with major depressive disorder. J Affect Disord 292:559–564

    Article  PubMed  Google Scholar 

  14. Koponen H, Kautiainen H, Leppänen E, Mäntyselkä P, Vanhala M (2015) Association between suicidal behaviour and impaired glucose metabolism in depressive disorders. BMC Psychiatry 15:163

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sublette ME et al (2013) Regional brain glucose uptake distinguishes suicide attempters from non-attempters in major depression. Arch Suicide Res 17:434–447

    Article  PubMed  Google Scholar 

  16. Ma YJ et al (2019) The prevalence, metabolic disturbances and clinical correlates of recent suicide attempts in Chinese inpatients with major depressive disorder. BMC Psychiatry 19:144

    Article  PubMed  PubMed Central  Google Scholar 

  17. Shen Y et al (2019) Association of thyroid dysfunction with suicide attempts in first-episode and drug naïve patients with major depressive disorder. J Affect Disord 259:180–185

    Article  CAS  PubMed  Google Scholar 

  18. Pompili M et al (2012) Prolactin and thyroid hormone levels are associated with suicide attempts in psychiatric patients. Psychiatry Res 200:389–394

    Article  CAS  PubMed  Google Scholar 

  19. Duval F et al (2010) Thyroid axis activity and suicidal behavior in depressed patients. Psychoneuroendocrinology 35:1045–1054

    Article  CAS  PubMed  Google Scholar 

  20. Muldoon MF, Manuck SB, Matthews KA (1990) Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. BMJ 301:309–314

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Ellison LF, Morrison HI (2001) Low serum cholesterol concentration and risk of suicide. Epidemiology 12:168–172

    Article  CAS  PubMed  Google Scholar 

  22. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32:50–55

    Article  CAS  PubMed  Google Scholar 

  24. Yang W et al (2019) Prevalence and clinical profiles of comorbid anxiety in first episode and drug naïve patients with major depressive disorder. J Affect Disord 257:200–206

    Article  PubMed  Google Scholar 

  25. Zhou Y et al (2021) The association of clinical correlates, metabolic parameters, and thyroid hormones with suicide attempts in first-episode and drug-naïve patients with major depressive disorder comorbid with anxiety: a large-scale cross-sectional study. Transl Psychiatry 11:97

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Chung JH et al (2014) Suicidal ideation and suicide attempts among diabetes mellitus: the Korea national health and nutrition examination survey (KNHANES IV, V) from 2007 to 2012. J Psychosom Res 77:457–461

    Article  PubMed  Google Scholar 

  27. Li H, Huang Y, Wu F, Lang X, Zhang XY (2020) Prevalence and related factors of suicide attempts in first-episode and untreated Chinese Han outpatients with psychotic major depression. J Affect Disord 270:108–113

    Article  CAS  PubMed  Google Scholar 

  28. Handley TE et al (2016) Suicidal ideation reported by adults with type 1 or type 2 diabetes: results from diabetes MILES-Australia. Diabet Med 33:1582–1589

    Article  CAS  PubMed  Google Scholar 

  29. Roy A, Roy M, Janal M (2010) Suicide attempts and ideation in African-American type 1 diabetic patients. Psychiatry Res 179:53–56

    Article  PubMed  Google Scholar 

  30. Ceretta LB et al (2012) Increased prevalence of mood disorders and suicidal ideation in type 2 diabetic patients. Acta Diabetol 49(Suppl 1):S227-234

    Article  PubMed  Google Scholar 

  31. Batty GD, Kivimaki M, Park IS, Jee SH (2012) Diabetes and raised blood glucose as risk factors for future suicide: cohort study of 1 234 927 Korean men and women. J Epidemiol Community Health 66:650–652

    Article  PubMed  Google Scholar 

  32. Matlock KA, Yayah Jones NH, Corathers SD, Kichler JC (2017) Clinical and psychosocial factors associated with suicidal ideation in adolescents with type 1 diabetes. J Adolesc Health 61:471–477

    Article  PubMed  Google Scholar 

  33. Koponen H, Kautiainen H, Leppänen E, Mäntyselkä P, Vanhala M (2015) Cardiometabolic risk factors in patients referred to depression nurse case managers. Nord J Psychiatry 69:262–267

    Article  PubMed  Google Scholar 

  34. Pompili M et al (2009) Preventing suicide in jails and prisons: suggestions from experience with psychiatric inpatients. J Forensic Sci 54:1155–1162

    Article  PubMed  Google Scholar 

  35. Forsman J et al (2017) Glucose metabolism in completed suicide: a forensic-pathological pilot study. Croat Med J 58:34–39

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Mauvais-Jarvis F (2016) Role of sex steroids in β cell function, growth, and survival. Trends Endocrinol Metab 27:844–855

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Coupland C et al (2015) Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: cohort study using a primary care database. BMJ 350:h517

    Article  PubMed  PubMed Central  Google Scholar 

  38. Snowdon J (2018) Differences between patterns of suicide in East Asia and the West the importance of sociocultural factors. Asian J Psychiatr 37:106–111

    Article  PubMed  Google Scholar 

  39. Giupponi G et al (2016) Differences among South tyrolean suicides: a psychological autopsy study. Wien Klin Wochenschr 128:125–130

    Article  PubMed  Google Scholar 

  40. Dong M et al (2018) Prevalence of suicidal behaviors in patients with major depressive disorder in China: a comprehensive meta-analysis. J Affect Disord 225:32–39

    Article  PubMed  Google Scholar 

  41. Coentre R, Talina MC, Góis C, Figueira ML (2017) Depressive symptoms and suicidal behavior after first-episode psychosis: a comprehensive systematic review. Psychiatry Res 253:240–248

    Article  PubMed  Google Scholar 

  42. Thompson E et al (2020) Suicidal thoughts and behavior (STB) and psychosis-risk symptoms among psychiatrically hospitalized adolescents. Schizophr Res 218:240–246

    Article  PubMed  PubMed Central  Google Scholar 

  43. Baldessarini RJ, Tondo L (2020) Suicidal risks in 12 DSM-5 psychiatric disorders. J Affect Disord 271:66–73

    Article  CAS  PubMed  Google Scholar 

  44. Yin Y et al (2021) (2021) Auditory hallucinations, depressive symptoms and current suicidal ideation or behavior among patients with acute episode schizophrenia. Arch Suicide Res 10(1080/13811118):1993399

    Google Scholar 

  45. de Cates AN et al (2021) Self-harm, suicidal ideation, and the positive symptoms of psychosis: cross-sectional and prospective data from a national household survey. Schizophr Res 233:80–88

    Article  PubMed  PubMed Central  Google Scholar 

  46. Nordentoft M (2007) Prevention of suicide and attempted suicide in Denmark Epidemiological studies of suicide and intervention studies in selected risk groups. Dan Med Bull 54(306):369

    Google Scholar 

  47. Zhao K et al (2020) Potential metabolic monitoring indicators of suicide attempts in first episode and drug naive young patients with major depressive disorder: a cross-sectional study. BMC Psychiatry 20:387

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Zhang J et al (2005) Low HDL cholesterol is associated with suicide attempt among young healthy women: the third national health and nutrition examination survey. J Affect Disord 89:25–33

    Article  CAS  PubMed  Google Scholar 

  49. Maes M et al (1997) Lower serum high-density lipoprotein cholesterol (HDL-C) in major depression and in depressed men with serious suicidal attempts: relationship with immune-inflammatory markers. Acta Psychiatr Scand 95:212–221

    Article  CAS  PubMed  Google Scholar 

  50. Baek JH et al (2014) Serum lipids, recent suicide attempt and recent suicide status in patients with major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 51:113–118

    Article  CAS  PubMed  Google Scholar 

  51. Fiedorowicz JG, Coryell WH (2007) Cholesterol and suicide attempts: a prospective study of depressed inpatients. Psychiatry Res 152:11–20

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Brunner J et al (2006) High cholesterol, triglycerides, and body-mass index in suicide attempters. Arch Suicide Res 10:1–9

    Article  PubMed  Google Scholar 

  53. Tanskanen A et al (2000) High serum cholesterol and risk of suicide. Am J Psychiatry 157:648–650

    Article  CAS  PubMed  Google Scholar 

  54. Bartoli F et al (2017) Association between total serum cholesterol and suicide attempts in subjects with major depressive disorder: exploring the role of clinical and biochemical confounding factors. Clin Biochem 50:274–278

    Article  CAS  PubMed  Google Scholar 

  55. Park S, Yi KK, Na R, Lim A, Hong JP (2013) No association between serum cholesterol and death by suicide in patients with schizophrenia, bipolar affective disorder, or major depressive disorder. Behav Brain Funct 9:45

    Article  PubMed  PubMed Central  Google Scholar 

  56. Nam EJ, Lee JE (2019) Mediating effects of social support on depression and suicidal ideation in older korean adults with hypertension who live alone. J Nurs Res 27:e20

    Article  PubMed  PubMed Central  Google Scholar 

  57. Collazos-Perdomo D et al (2020) Association between major depression and arterial hypertension in a colombian population. Hipertens Riesgo Vasc 37:162–168

    Article  CAS  PubMed  Google Scholar 

  58. Cheung YB, Law CK, Chan B, Liu KY, Yip PS (2006) Suicidal ideation and suicidal attempts in a population-based study of Chinese people: risk attributable to hopelessness, depression, and social factors. J Affect Disord 90:193–199

    Article  PubMed  Google Scholar 

  59. Bernal M et al (2007) Risk factors for suicidality in Europe: results from the ESEMED study. J Affect Disord 101:27–34

    Article  CAS  PubMed  Google Scholar 

  60. Omary A (2021) Predictors and confounders of suicidal ideation and suicide attempts among adults with and without depression. Psychiatr Q 92:331–345

    Article  PubMed  Google Scholar 

  61. Nicoli M et al (2012) Prevalence and risk factors for suicide ideation, plans and attempts in the French general population: results from the ESEMeD study. Encephale 38:296–303

    Article  CAS  PubMed  Google Scholar 

  62. Howland RH (1993) Thyroid dysfunction in refractory depression: implications for pathophysiology and treatment. J Clin Psychiatry 54(2):47–54

    CAS  PubMed  Google Scholar 

  63. Carta MG et al (2004) The link between thyroid autoimmunity (antithyroid peroxidase autoantibodies) with anxiety and mood disorders in the community: a field of interest for public health in the future. BMC Psychiatry 4:25

    Article  PubMed  PubMed Central  Google Scholar 

  64. Degner D, Haust M, Meller J, Rüther E, Reulbach U (2015) Association between autoimmune thyroiditis and depressive disorder in psychiatric outpatients. Eur Arch Psychiatry Clin Neurosci 265:67–72

    Article  PubMed  Google Scholar 

  65. Ferløv-Schwensen C, Brix TH, Hegedüs L (2017) Death by suicide in graves’ disease and graves’ orbitopathy: a nationwide danish register study. Thyroid 27:1475–1480

    Article  PubMed  Google Scholar 

  66. Brandt F et al (2013) Graves disease and toxic nodular goiter are both associated with increased mortality but differ with respect to the cause of death: a Danish population-based register study. Thyroid 23:408–413

    Article  PubMed  Google Scholar 

  67. Wray NR et al (2018) Genome-wide association analyses identify 44 risk variants and refine the genetic architecture of major depression. Nat Genet 50:668–681

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank all the clinical psychiatrists and nurses in department of a general hospital in Taiyuan, Shanxi Province, for all of their hard work and significant contributions toward the study.

Funding

This study was supported by grants from the CAS International Cooperation Research Program (153111KYSB20190004) and funded by Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-033A).

Author information

Author notes

  1. Shi wang Chen and Xue Li have contributed equally to this work.

Authors and Affiliations

  1. Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China

    Shi wang Chen, Xue Li & Jie Li

  2. Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China

    XiaoE Lang

  3. Institute of Psychology, Chinese Academy of Science, Department of Psychology, University of Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China

    Xiang-yang Zhang

Authors
  1. Shi wang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xue Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. XiaoE Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jie Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiang-yang Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiang-yang Zhang.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, S.w., Li, X., Lang, X. et al. Metabolic parameters and thyroid hormones in relation to suicide attempts in patients with first-episode and drug-naive major depressive disorder with comorbid glucose disturbances: a large cross-sectional study. Eur Arch Psychiatry Clin Neurosci 273, 199–207 (2023). https://doi.org/10.1007/s00406-022-01490-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-022-01490-w

Keywords

Search

Navigation