Associations between metabolic features and psychotic symptoms in anxious depression across different ages of onset: the mediating role of symptom severity.

BACKGROUND

Anxiety and psychotic symptoms frequently occur in major depressive disorder (MDD) and are associated with metabolic features. Age of onset plays a crucial role in the variability of MDD patients.

AIMS: To investigate associations between metabolic features and psychotic symptoms in anxious MDD patients categorized by age of onset.

METHODS

We conducted a cross-sectional analysis involving 894 anxious MDD patients, utilizing standardized assessments for depression (Hamilton Depression Scale, HAMD), anxiety (Hamilton Anxiety Scale, HAMA), and psychotic symptoms (Positive and Negative Syndrome Scale, PANSS), alongside metabolic features. Patients were categorized into the early adulthood onset (EAO, <45 years old) group and the mid-adulthood onset (MAO, ≥45 years old) group.

RESULTS

Our findings revealed that MAO patients exhibited higher prevalence of psychotic symptoms compared to EAO group. In the EAO group, fasting blood glucose (FBG) was independently associated with a higher risk of psychotic symptoms, while in the MAO group, triglyceride (TG) levels and systolic blood pressure (SBP) showed independent associations with increased risk. Exploratory serial mediation analyses indicated that depression/anxiety severity fully statistically mediated the relationship between FBG and psychotic symptoms in EAO patients. Additionally, symptom severity fully statistically mediated the SBP-psychotic symptoms link in MAO patients but only partially statistically mediated the TG-psychotic symptoms relationship.

CONCLUSIONS

These results underscore the complex interplay between psychological and physiological factors in anxious MDD, indicating that age of onset group statistically moderated the associations between metabolic features and psychotic symptoms, and depression/anxiety severity showed exploratory indirect associations consistent with statistical mediation between metabolic features and psychotic symptoms.