Purpose We aimed to explore the relationship between thyroid peroxidase antibody (TPO-Ab) and suicidal and aggressive behaviors in patients with major mental disorders. Methods We enrolled 812 inpatients with major mental disorders (schizophrenia, bipolar disorder, and major depressive disorder) in this retrospective study. Baseline interviews were conducted by two psychiatrists. The patients’ suicidal and aggressive behaviors were recorded in the electronic medical record system and these patients were evaluated in terms of violence and suicide behaviors according to the risk assessment form formulated in the Work Code for the Management and Treatment of Severe Mental Illness by the Ministry of Health of China. We calculated the incidence rates of positive TPO-Ab, the suicidal and aggressive behaviors. Furthermore, we explored the relationships among risk factors for suicidal and aggressive behaviors using logistics regression analysis. Results Among the 812 patients, 42.6% (n = 346) had TPO-Abs and were defined as the positive group. Rates of suicide and aggression among the enrolled patients were 12.7% (n = 103) and 10.2% (n = 83) respectively. The percentage of patients with aggressive behaviors (13%, n = 45) was higher than that in the negative group (8.2%, n = 38). In contrast, the incidence (9.5%) of suicidal behaviors in the positive group was lower than that (15.0%) in the negative group. TPO-Ab was found to increase the risk of aggressive behavior (odd ratio (OR) = 1.64, 95%CI (1.04, 2.59), P = 0.03) and this effect was still evident after we adjusted for thyroid function (OR = 1.65, 95%CI (1.03, 2.64), P = 0.04). Furthermore, subclinical hypothyroidism (OR = 2.64, 95%CI (1.19, 5.85), P = 0.02) and subclinical hyperthyroidism (OR = 7.03, 95%CI (2.23, 22.20), P = 0.001) were found to be risk factors of aggressive behavior but not for suicide behaviors. Conclusion TPO-Abs can affect aggressive behavior but do not affect suicidal behaviors, in patients with major mental disorders. Thus, antibody testing is necessary for psychiatric patients with aggressive behavior. The TPO-Ab test helped the psychiatric staff to determine aggressive behavior in advance.
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