Noa Tsujii1, Hiroyuki Akashi2, Wakako Mikawa2, Emi Tsujimoto3, Atsushi Niwa2, Toru Adachi2, Osamu Shirakawa2. 1. Department of Neuropsychiatry, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan. Electronic address: tujiinoa@med.kindai.ac.jp. 2. Department of Neuropsychiatry, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan. 3. Department of Neuropsychiatry, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan; Department of Psychological Science, Graduate School of Humanities, Kwansei Gakuin University, 1-155 Uegahara-1bancho, Nishinomiya, Hyogo 662-8501, Japan.
Abstract
BACKGROUND: Discrepancies in depression severity between the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI) have been reported. However, whether these discrepancies impact vulnerability to suicide in patients with major depressive disorder (MDD) remains unclear. METHODS: Patients with mild MDD (n=161) were enrolled in the study and divided into the following 3 groups: (1) patients with MDD with the discrepancy (n=45), i.e., those with low HAMD17 scores (8-13) and high BDI-II scores (≥29), (2) patients with MDD without the discrepancy (n=46), i.e., those with low HAMD17 scores and low BDI-II scores (≤28), and (3) patients not currently depressed (n=70), i.e., those with HAMD17 scores ≤7 (affective controls). We examined the relationship of demographic, clinical, and neuropsychological variables with any discrepancy between self-rating and observer rating. RESULTS: Patients with MDD with the discrepancy had significantly higher hopelessness than those without the discrepancy and affective controls. Verbal fluency task performance of patients with MDD with the discrepancy was significantly impaired compared with that of those without the discrepancy and affective controls. Stepwise logistic regression analysis revealed that a history of suicide attempt [odds ratio (OR), 3.57; 95% confidence interval (CI), 1.12-11.37] and hopelessness (OR, 1.23; 95% CI, 1.09-1.38) increased odds of the discrepancy. LIMITATIONS: Results require replication. CONCLUSIONS: Clinicians should examine discrepancies between self- and observer-rated depression severities, which are associated with vulnerability to suicide in patients with MDD, even if objectively evaluated as mild.
BACKGROUND: Discrepancies in depression severity between the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI) have been reported. However, whether these discrepancies impact vulnerability to suicide in patients with major depressive disorder (MDD) remains unclear. METHODS:Patients with mild MDD (n=161) were enrolled in the study and divided into the following 3 groups: (1) patients with MDD with the discrepancy (n=45), i.e., those with low HAMD17 scores (8-13) and high BDI-II scores (≥29), (2) patients with MDD without the discrepancy (n=46), i.e., those with low HAMD17 scores and low BDI-II scores (≤28), and (3) patients not currently depressed (n=70), i.e., those with HAMD17 scores ≤7 (affective controls). We examined the relationship of demographic, clinical, and neuropsychological variables with any discrepancy between self-rating and observer rating. RESULTS:Patients with MDD with the discrepancy had significantly higher hopelessness than those without the discrepancy and affective controls. Verbal fluency task performance of patients with MDD with the discrepancy was significantly impaired compared with that of those without the discrepancy and affective controls. Stepwise logistic regression analysis revealed that a history of suicide attempt [odds ratio (OR), 3.57; 95% confidence interval (CI), 1.12-11.37] and hopelessness (OR, 1.23; 95% CI, 1.09-1.38) increased odds of the discrepancy. LIMITATIONS: Results require replication. CONCLUSIONS: Clinicians should examine discrepancies between self- and observer-rated depression severities, which are associated with vulnerability to suicide in patients with MDD, even if objectively evaluated as mild.