The Association Between Suicide Risk and Affective Temperaments in First-Episode and Neuroleptic-Naïve Major Depressive Disorder

Abstract Background Suicide risk is associated with depression. Affective temperaments may play a role in this risk. We explored the relationship between affective temperaments and suicide and identified some traits that can predict suicide risk in depression. Methods We analyzed the results of Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) in 284 participants recruited from a psychiatric clinic and the community in Beijing and compared the subscale scores (cyclothymic, dysthymic, anxious, irritable and hyperthymic) among major depressive disorder (MDD) versus the general population as well as depressive patients with versus without suicide risk, using student’s test, Chi-square test, rank sum test, multivariable regression modeling and receiver operating characteristic (ROC) analysis. Results The incidence of suicidal risk in depressive subjects was 47.62% (80/168). Being unmarried (P<0.001), unemployment (P=0.007) and temperaments of dysthymic, cyclothymic, anxious, and irritable scores (all P<0.05) were significantly more prevalent in depressive patients than in the general population. A young age (P<0.001), female sex (P=0.037), being unmarried (P=0.001), more severe depression (P<0.001), and dysthymic, anxious and cyclothymic temperament (all P<0.05) were significantly more prevalent in depressive disorder patients with suicide risk than in those without suicide risk. The logistic regression analysis showed that younger age (OR=0.937, 95% CI 0.905~0.970), female sex (OR=2.606, 95% CI 1.142~5.948), more severe depression (OR=1.145, 95% CI 1.063~1.234), cyclothymic temperament (OR=1.275, 95% CI 1.102~1.475) and dysthymic temperament (OR=1.265, 95% CI 1.037~1.542) were all independently associated with high suicidal risk in first-episode major depressive patients (P<0.05). By ROC analysis, the area under the compound factor (age, sex, HAMD score without the 3rd item, cyclothymic and dysthymic temperament) was 0.853 (95% CI 0.790~0.903). Conclusion The suicide rate in first-episode neuroleptic-naïve major depressive disorder (MDD) subjects was higher than we thought. Temperament traits differ between the general population and those with major depressive disorder. Major depressive disorder subjects with much more severe depressive symptoms and cyclothymic or dysthymic temperament were at high risk of suicide. Compound factors (age, sex, HAMD score without the 3rd item, cyclothymic and dysthymic temperament score) could be predictors of suicide risk in the clinic.