Sex differences in the prevalence and correlates of suicide attempts in patients with first-episode and drug-naïve psychotic major depression.

Purpose: Sex differences play an important role in depression prevalence, symptom profile, treatment response, and disease course. However, sex differences in factors associated with suicide attempts (SAs) in first-episode and drug-naïve (FEDN) patients with psychotic major depression (PMD) remain unclear.

Methods: In this study, 171 patients with FEDN PMD were recruited. Patients' symptoms were assessed using the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) positive subscale. In addition, metabolic parameters and thyroid hormone levels were measured.

Results: The prevalence of SA was remarkably high in both male and female PMD patients (53.19% vs. 50.81%), without significant differences between the two groups. In male PMD patients, the combination of marital status and TSH levels was found to effectively distinguish between SA and non-SA cases, with an AUC value of 0.87. In addition, the HAMD score and diastolic blood pressure (BP) were significantly associated with the frequency of SAs in this subgroup. For female PMD patients, the combination of positive score, diastolic BP, TSH, and TgAb was found to be a very effective discriminator between SA and non-SA cases, with an AUC of 0.91. Furthermore, duration of illness, positive score, systolic BP, and TPOAb were found to be significantly associated with the frequency of SAs in this subgroup.

Conclusions: Our results indicate a high incidence of suicide attempts in both men and women with PMD. Several clinically relevant factors, metabolic parameters, and thyroid hormone function contribute to sex differences in suicide attempts in FEDN PMD patients.