| Objective:This study was divided into two parts,Study 1 and Study 2.1.Study 1:To validate and screen the physiological,psychological,and sociological factors associated with suicidal ideation in patients with first-episode childhood adolescent depressive disorder,and to explore the target group’s clinical characteristics and disease correlation factors.To provide a basis for interventions for suicidal ideation in target groups.2.Study 2:To investigate the effect of low-frequency and high-frequency repetitive Transcranial Magnetic Stimulation(rTMS)adjunctive medication on the acute treatment of first-episode childhood adolescent depressive disorder and suicidal ideation,and to provide a clinical reference for rapid relief of childhood adolescent depressive disorder and suicidal ideation.Methods:1.Study 1:This study was a cross-sectional survey,and a total of 150 study subjects were included.The study population was first-episode childhood adolescent depressive disorder patients admitted to Dai Zhuang Hospital in Shandong Province from January 2022 to October 2022.The study used a general information questionnaire,the 24-item Hamilton Depression Rating Scale(HAMD-24),the Hamilton Anxiety Scale(HAMA),the Simplified Coping Style Questionnaire(SCSQ),as well as laboratory and auxiliary examinations to collect general and psychological and physiological data of the patients.According to the 24-item Hamilton Depression Rating Scale suicidal ideation(HAMD-SI),all study subjects were divided into 96 cases with suicidal ideation(HAMD-SI≥1)and 54 cases without suicidal ideation(HAMD-SI<1).2.Study 2:In this study,a clinical case-control study method was used,96 patients with first-episode childhood adolescent depressive disorder with suicidal ideation(HAMD-SI≥1)were randomly divided into two groups using a clinical case-control study method,and were treated with rTMS in addition to pharmacotherapy,including 48 patients in the left high-frequency rTMS treatment group(10Hz)and 48 patients in the right low-frequency rTMS treatment group(1Hz),with stimulation sites located in the left and right dorsolateral prefrontal cortex(DLPFC),respectively.Two groups of study subjects were treated with a selective Serotonin Reuptake Inhibitor(SSRI).The treatment was continued for two weeks,and rTMS was administered five times a week for a total of 10 sessions.At the end of the two weeks of treatment,the HAMD-24 score reduction rate,suicidal ideation treatment efficiency rate differences between groups were used to assess the treatment effect.According to the references,in this study,the HAMD-24 reduction rate>25%was defined as treatment response,and the HAMD-24 reduction rate between 20%-25%was defined as an early improvement;a decrease in HAMD-SI score was defined as suicidal ideation treatment effectiveness.Results:1.Study 1:(1)Assessment of general information:the differences between the two groups of study subjects in terms of gender,age,family residence,years of education,age of onset,and duration of illness were not statistically significant(P>0.05).(2)Assessment of coping style:the subjects in the group with suicidal ideation had lower scores on the positive coping factor in the SCSQ than those in the group without suicidal ideation(Z=-6.202,P<0.001),and higher scores on the negative coping factor than in the group without suicidal ideation(Z=-7.801,P<0.001).(3)Assessment of anxiety and depressive severity:the subjects in the group with suicidal ideation had higher HAMD-24(Z=-5.277,P<0.001)and HAMA total score(Z=-7.089,P<0.05)than the group without suicidal ideation,and the difference was statistically significant.(4)Assessment of neuroendocrine levels:the differences between the two groups of study subjects in terms of thyroid-stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4),and cortisol(Cor)levels were not statistically significant(P>0.05).(5)Assessment of lipid metabolism levels:the total cholesterol(TC)of the study subjects with suicidal ideation,low-density lipoprotein(LDL)and triglyceride(TG)levels were higher in the study subjects with suicidal ideation than in the study subjects without suicidal ideation,and the differences were statistically significant(Z1=-3.532,t=-2.623,Z2=-2.992,P<0.05).(6)Assessment of cognitive function-related auditory-evoked potentials:compared to the group without suicidal ideation,the P3b latency of the auditory-evoked event-related potentials P300(ERP-P300)was prolonged(Z=-6.966,P<0.001)and the N2 amplitude was decreased(t=-3.154,P<0.05)in the study subjects with suicidal ideation,and the median P3 latency was above the normal threshold.(7)Analysis of influencing factors associated with suicidal ideation:severity of depression(OR=1.283,95%CI=1.039-1.513,P<0.05)and anxiety(OR=1.901,95%CI=1.218-2.966,P<0.05),negative coping style factor score(OR=1.759,95%CI=1.142-2.708,P<0.05),TC level(OR=34.599,95%CI=1.684-710.888,P<0.05),and P3b latency of auditory-evoked ERP-P300(OR=1.172,95%CI=1.043-1.317,P<0.05)were positively associated with suicidal ideation;positive coping style factor score(OR=0.777,95%CI=0.632-0.956,P<0.05)was negatively associated with suicidal ideation.2.Study 2:(1)Assessment of general information:the differences between the two groups of study subjects in terms of gender,age,family residence,years of education,age of onset,and duration of illness were not statistically significant(P>0.05).(2)Assessment of depression,and suicidal ideation severity at baseline:before receiving rTMS and medication,the differences in the HAMD-24 total score,and HAMD-SI score between the two groups of study subjects were not statistically significant(P>0.05).(3)Assessment of depressive disorder treatment effect:the high-frequency rTMS treatment group was more effective in early improvement of depressive disorder(χ2=8.167,P<0.01),and the difference between the two groups of study subjects in treatment response of depressive disorder was not statistically significant(χ2=0.445,P>0.05).(4)Assessment of the treatment effect of suicidal ideation:more people in the high-frequency rTMS treatment group had a decrease in HAMD-SI scores than in the low-frequency rTMS group,and the difference in the treatment efficiency rate of suicidal ideation between the two groups of study subjects was statistically significant(χ2=2.787,P>0.05).Conclusion:1.Study 1:(1)Patients with first-episode childhood adolescent depressive disorder with suicidal ideation had more pronounced anxiety and depression and were more inclined to adopt negative coping styles when they encounter frustration or suffer a blow.(2)Among patients with first-episode childhood adolescent depressive disorder,there were differences in lipid metabolism levels between those with and without suicidal ideation,with higher TC,LDL,and TG levels in those with suicidal ideation;(3)There were differences in cognitive function-related auditory-evoked potentials between patients with and without suicidal ideation in first-episode childhood adolescent depressive disorder,there may be differences in cognitive functioning in patients with or without suicidal ideation;(4)Anxiety,depression,negative coping styles,high levels of TC,and increased P3b latency of auditory-evoked ERP-P300 were risk factors for suicidal ideation in first-episode childhood adolescent depressive disorder,with positive coping styles as protective factors.Clinical interventions should assess these associated factors and develop appropriate interventions for that population.2.Study 2:For first-episode childhood adolescent depressive disorder,the early improvement effect of high-frequency rTMS combination drugs was superior to low-frequency rTMS combination drugs.In the acute treatment of suicidal ideation in depressive disorders,high-frequency rTMS combination drugs are advantageous and their effect of reducing suicidal ideation was superior to that of low-frequency rTMS combination drugs. |
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