Association between Perceived Stressfulness of Stressful Life Events and the Suicidal Risk in Chinese Patients with Major Depressive Disorder

Jing-Yu Lin, Yu Huang, Yun-Ai Su, Xin Yu, Xiao-Zhen Lyu, Qi Liu, Tian-Mei Si, Jing-Yu Lin, Yu Huang, Yun-Ai Su, Xin Yu, Xiao-Zhen Lyu, Qi Liu, Tian-Mei Si

Abstract

Background: Patients with major depressive disorder (MDD) usually have high risk of suicidality. Few studies have investigated the effects of stressful life events (SLEs) on the risk of suicide in Chinese patients who have developed MDD. This study aimed to investigate the impact of SLEs on suicidal risk in Chinese patients with MDD.

Methods: In total, 1029 patients with MDD were included from nine psychiatric hospitals to evaluate the impact of SLEs on suicidal risk. Patients fulfilling the Mini-International Neuropsychiatric Interview (MINI) criteria for MDD were included in the study. Patients were excluded if they had lifetime or current diagnoses of psychotic disorder, bipolar disorder, and alcohol or substance dependence. Depressive symptoms were assessed by the 17-item Hamilton Depression Scale (HAMD-17). The suicidal risk of MDD patients was determined by the suicide risk module of MINI. SLEs were assessed by the Life Events Scale.

Results: No gender difference was found for suicidal risk in MDD patients. Patients with suicidal risk had younger ages, lower education levels, more drinking behavior, and lower marriage rate, and fewer people had child and more severe depressive symptoms than nonsuicidal risk group. High-level perceived stressfulness (HPS) and number of SLEs that patients were exposed to were significantly greater in patients with suicidal risk than patients without. In multivariate logistic analysis, HPS of SLEs (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.16-2.05, P = 0.003) and depressive symptoms (OR = 1.08, 95% CI: 1.05-1.11, P < 0.001) were associated with suicidal risk even after adjustment of gender, age, marriage, drinking behavior, and childless.

Conclusions: HPS of SLEs is associated with suicide risk in Chinese patients with MDD. Further suicide prevention programs targeting this risk factor are needed.

Trial registration: ClinicalTrials.gov: NCT02023567; https://ichgcp.net/clinical-trials-registry/NCT02023567?term=NCT02023567&rank=1.

Keywords: Life Stresses; Major Depressive Disorder; Suicide.

Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1
Figure 1
Subscales of SLEs in two groups. *P < 0.001, †P=0.002, nonsuicidal risk group compared with suicidal risk group. SLEs: Stressful life events; LES: Life Events Scale.

References

    1. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S, et al. Suicide and suicidal behavior. Epidemiol Rev. 2008;30:133–54. doi: 10.1093/epirev/mxn002.
    1. World Health Organization. Geneva: World Health Organization; 2018. [Last accessed on 2018 Jan 28]. Mental Health: suicide Prevention. Available from:
    1. Cao XL, Zhong BL, Xiang YT, Ungvari GS, Lai KY, Chiu HF, et al. Prevalence of suicidal ideation and suicide attempts in the general population of China: A meta-analysis. Int J Psychiatry Med. 2015;49:296–308. doi: 10.1177/0091217415589306.
    1. Turecki G, Brent DA. Suicide and suicidal behaviour. Lancet. 2016;387:1227–39. doi: 10.1016/S0140-6736(15)00234-2.
    1. Arsenault-Lapierre G, Kim C, Turecki G. Psychiatric diagnoses in 3275 suicides: A meta-analysis. BMC Psychiatry. 2004;4:37. doi: 10.1186/1471-244X-4
    1. Brådvik L, Mattisson C, Bogren M, Nettelbladt P. Mental disorders in suicide and undetermined death in the Lundby study. The contribution of severe depression and alcohol dependence. Arch Suicide Res. 2010;14:266–75. doi: 10.1080/13811118.2010.494146.
    1. Rihmer Z. Suicide risk in mood disorders. Curr Opin Psychiatry. 2007;20:17–22. doi: 10.1097/YCO.0b013e3280106868.
    1. Dong M, Wang SB, Li Y, Xu DD, Ungvari GS, Ng CH, et al. Prevalence of suicidal behaviors in patients with major depressive disorder in China: A comprehensive meta-analysis. J Affect Disord. 2018;225:32–9. doi: 10.1016/j.jad.2017.07.043.
    1. Hawton K, Casañas I Comabella C, Haw C, Saunders K. Risk factors for suicide in individuals with depression: A systematic review. J Affect Disord. 2013;147:17–28. doi: 10.1016/j.jad.2013.01.004.
    1. O'Connor RC, Nock MK. The psychology of suicidal behaviour. Lancet Psychiatry. 2014;1:73–85. doi: 10.1016/S2215-0366(14)70222-6.
    1. Liu RT, Miller I. Life events and suicidal ideation and behavior: A systematic review. Clin Psychol Rev. 2014;34:181–92. doi: 10.1016/j.cpr.2014.01.006.
    1. Aleman A, Denys D. Mental health: A road map for suicide research and prevention. Nature. 2014;509:421–3. doi: 10.1038/509421a.
    1. Liu RT, Cheek SM, Nestor BA. Non-suicidal self-injury and life stress: A systematic meta-analysis and theoretical elaboration. Clin Psychol Rev. 2016;47:1–4. doi: 10.1016/j.cpr.2016.05.005.
    1. Zhang J, Ma Z. Patterns of life events preceding the suicide in rural young Chinese: A case control study. J Affect Disord. 2012;140:161–7. doi: 10.1016/j.jad.2012.01.010.
    1. Phillips MR, Yang G, Zhang Y, Wang L, Ji H, Zhou M, et al. Risk factors for suicide in China: A national case-control psychological autopsy study. Lancet. 2002;360:1728–36. doi: 10.1016/S0140-6736(02)11681-3.
    1. Pompili M, Innamorati M, Szanto K, Di Vittorio C, Conwell Y, Lester D, et al. Life events as precipitants of suicide attempts among first-time suicide attempters, repeaters, and non-attempters. Psychiatry Res. 2011;186:300–5. doi: 10.1016/j.psychres.2010.09.003.
    1. Kessler RC. The effects of stressful life events on depression. Annu Rev Psychol. 1997;48:191–214. doi: 10.1146/annurev.psych.48.1.191.
    1. Monroe SM, Harkness KL. Life stress, the “kindling” hypothesis, and the recurrence of depression: Considerations from a life stress perspective. Psychol Rev. 2005;112:417–45. doi: 10.1037/0033-295X.112.2.417.
    1. Park S, Hatim Sulaiman A, Srisurapanont M, Chang SM, Liu CY, Bautista D, et al. The association of suicide risk with negative life events and social support according to gender in Asian patients with major depressive disorder. Psychiatry Res. 2015;228:277–82. doi: 10.1016/j.psychres.2015.06.032.
    1. Hardt J, Johnson JG. Suicidality, depression, major and minor negative life events: A mediator model. Psychosoc Med. 2010;7:Doc05. doi: 10.3205/psm000067.
    1. Lv X, Si T, Wang G, Wang H, Liu Q, Hu C, et al. The establishment of the objective diagnostic markers and personalized medical intervention in patients with major depressive disorder: Rationale and protocol. BMC Psychiatry. 2016;16:240. doi: 10.1186/s12888-016-0953-z.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22–33.
    1. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62. doi: 10.1136/jnnp.23.1.56.
    1. Chen L, Liu YH, Zheng QW, Xiang YT, Duan YP, Yang FD, et al. Suicide risk in major affective disorder: Results from a national survey in China. J Affect Disord. 2014;155:174–9. doi: 10.1016/j.jad.2013.10.046.
    1. Pompili M, Rihmer Z, Akiskal H, Amore M, Gonda X, Innamorati M, et al. Temperaments mediate suicide risk and psychopathology among patients with bipolar disorders. Compr Psychiatry. 2012;53:280–5. doi: 10.1016/j.comppsych.2011.04.004.
    1. Yang DS, YL Z. Life Event Scale (LES). Rating scales for mental health (in Chinese) Chin Ment Health J. 1999;12:101–6.
    1. Liu Y, Zhang J. The impact of negative life events on attempted suicide in rural China. J Nerv Ment Dis. 2017;206:187–194. doi: 10.1097/NMD.0000000000000727.
    1. Paykel ES. The interview for recent life events. Psychol Med. 1997;27:301–10. doi: 10.1017/S0033291796004424.
    1. Mandelli L, Nearchou FA, Vaiopoulos C, Stefanis CN, Vitoratou S, Serretti A, et al. Neuroticism, social network, stressful life events: Association with mood disorders, depressive symptoms and suicidal ideation in a community sample of women. Psychiatry Res. 2015;226:38–44. doi: 10.1016/j.psychres.2014.11.001.
    1. Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The columbia-suicide severity rating scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168:1266–77. doi: 10.1176/appi.ajp.2011.10111704.
    1. Brådvik L, Mattisson C, Bogren M, Nettelbladt P. Long-term suicide risk of depression in the Lundby cohort 1947-1997 – Severity and gender. Acta Psychiatr Scand. 2008;117:185–91. doi: 10.1111/j.1600-0447.2007.01136.x.
    1. Leskelä U, Rytsälä H, Komulainen E, Melartin T, Sokero P, Lestelä-Mielonen P, et al. The influence of adversity and perceived social support on the outcome of major depressive disorder in subjects with different levels of depressive symptoms. Psychol Med. 2006;36:779–88. doi: 10.1017/S0033291706007276.
    1. Johnson J, Gooding PA, Wood AM, Tarrier N. Resilience as positive coping appraisals: Testing the schematic appraisals model of suicide (SAMS) Behav Res Ther. 2010;48:179–86. doi: 10.1016/j.brat.2009.10.007.
    1. Weyrauch KF, Roy-Byrne P, Katon W, Wilson L. Stressful life events and impulsiveness in failed suicide. Suicide Life Threat Behav. 2001;31:311–9. doi: 10.1521/suli.31.3.311.24240.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever