Study And Comparison Of Suicide Risk Factors In Patients With Unipolar Depressive Disorder Or Bipolar Disorder

Objective:To explore the related risk factors and differences of suicide attempt in patients with unipolar or bipolar depressive disorder,and to provide more accurate risk factors for the prevention and intervention of suicidal behavior in patients with different subtypes of depressive disorder.Methods:Patients with depressive disorder who were discharged from Shandong Daizhuang Hospital were selected between January 1,2016 and July 31,2020.A total of 665 cases were enrolled and divided into 192 cases in unipolar depressive disorder with suicide attempt group(referred to as unipolar suicide group),175 cases in bipolar depressive disorder with suicide attempt group(referred to as bi polar suicide group),166 cases in unipolar control group and 132 cases in bipolar control group according to whether suicide attempt was accompanied.Demographic data(including family history,bad habits,age,gender,marital status,work status,education level)and clinical characteristics(including age of onset,number of previous attacks,presence or absence of anxiety symptoms,presence or absence of atypical features,presence or absence of other symptoms,presence or absence of panic attacks)were investigated by self-made Demographic Data Questionnaire and Disease Clinical Characteristics Questionnaire.The first scores of Hamilton Depression Scale(HAMD-17)and Hamilton Anxiety Scale(HAMA)in medical records of patients were reviewed to assess the depression status and anxiety status of patients.SPSS20.0 software was used for statistical analysis of data,χ~2 test was adopted for enumeration data and t test was applied for measurement data.Logistic regression model was established to discuss the risk factors of suicide attempt in patients with unipolar or bipolar depressive disorder.Results:1.Comparison of demographic data and clinical characteristics between unipolar suicide group and unipolar control group:the number of previous attacks in unipolar suicide group was more than that in control group,and the family history of suicide,presence of physical discomfort,panic attack,obsessive-compulsive symptom and psychotic symptom were lower than those in control group(P<0.05).2.Comparison of demographic data and clinical characteristics between bipolar suicide group and bipolar control group:the bipolar suicide group was higher than control group in terms of family history of suicide,age at first onset,number of previous attacks and psychotic symptom,but was lower in terms of physical discomfort and obsessive-compulsive symptom(P<0.05).3.Comparison of demographic data and clinical characteristics between unipolar suicide group and bipolar suicide group:the proportions of females(61.9%),married patients(82.8%)and patients with anxiety(mental anxiety of 80.7%,physical discomfort of 50%)in unipolar suicide group were higher than those in bipolar suicide group(P<0.05).The proportions of aspects of bad habits(drinking history of 11.4%,smoking history of 16.5%),family history(24.5%),number of previous attacks(14.2%),panic attacks(8.5%),obsessive-compulsive symptom(8%)and psychotic symptom(46.2%)were lower than those in bipolar suicide group(P<0.05).4.Comparison of scores of HAMD-17 and HAMA between unipolar suicide group and unipolar control group:the total score and scores of anxiety somatization factor,sleep disturbance factor,retardation factor and cognitive impairment factor of HAMD-17 in unipolar suicide group were higher than those in control group while the score of weight factor was lower than that in control group(P<0.05).The total score of HAMA was higher while the score of somatic anxiety factor was lower in unipolar suicide group compared to control group(P<0.05).5.Comparison of scores of HAMD-17 and HAMA between bipolar suicide group and bipolar control group:the total score and scores of weight factor,sleep disturbance factor,retardation factor and cognitive impairment factor of HAMD-17were higher in bipolar suicide group than those in control group while the score of anxiety somatization factor was lower than that in control group(P<0.05).The total score and somatic anxiety factor score of HAMA in bipolar suicide group were lower than those in control group(P<0.05).6.Comparison of scores of HAMD-17 and HAMA between unipolar suicide group and bipolar suicide group:the scores of cognitive impairment factor,retardation factor,weight factor and sleep disturbance factor of HAMD-17 in unipolar suicide group were lower than those in bipolar suicide group while the score of anxiety somatization factor was higher than bipolar suicide group(P<0.05).The score of anxiety somatization factor of HAMA in unipolar suicide group was higher than that in bipolar suicide group,but the total anxiety score was lower than that in bipolar suicide group(P<0.05).7.With suicide attempt as the dependent variable and taking age at first onset,gender,education level,marital status,presence or absence of family history o f suicide,bad habits,atypical symptoms,psychotic symptom,panic attack symptom,obsessive-compulsive symptom,sleep disturbance and anxiety,the number of previous attacks and scores of HAMD-17 factors and HAMA factors as independent variables,multivariate Logistic regression analysis showed that positive family history of suicide(OR=1.811,P=0.042),panic attacks(OR=3.216,P=0.029),obsessive-compulsive symptom(OR=4.105,P=0.031),psychotic symptom(OR=2.633,P=0.000)and physical discomfort(OR=1.959,P=0.007)were risk factors for suicide in patients with unipolar depressive disorder,and the number of previous attacks(OR=0.239,P=0.000)was a protective factor for suicide in patients with unipolar depressive disorder.Positive family history of su icide(OR=3.27,P=0.002),number of previous attacks(OR=3.045,P=0.000)and presence of psychotic symptom(OR=4.656,P=0.000)were the risk factors for suicide in patients with bipolar depressive disorder,and obsessive-compulsive symptom(OR=0.184,P=0.000)and physical discomfort(OR=0.378,P=0.005)were protective factors for suicide in patients with bipolar depressive disorder.Conclusions:1.Patients in the unipolar suicide group had a higher proportion of female,married,and had more significant anxiety symptoms than patients in the bipolar suicide group.2.Patients in the bipolar suicide group manifested more compulsions,panic attacks,psychotic symptoms,maladaptive habits,previous episodes,and a more significant family history than those in the unipolar suicide group.3.Positive family history of suicide,panic attacks,compulsions,psychotic symptoms,and somatic discomfort may contribute to a higher risk of suicide in patients with unipolar depression.Positive family history of suicide,n umber of previous episodes,psychotic symptoms may lead to a higher risk of suicide in patients with bipolar depression.