Anxiety symptom trajectories and subsequent suicidal ideation among patients with major depressive disorder: A longitudinal study in China.

BACKGROUND

To examine the longitudinal associations between different anxiety symptom trajectories and subsequent suicidal ideation (SI) among patients with major depressive disorder (MDD).

METHODS

We used data from patients with MDD in the Depression Cohort in China. At baseline, 4, 8, and 12 weeks, anxiety symptoms were assessed using the Generalized Anxiety Disorder 7-item Scale, and trajectories were identified using latent class trajectory models. At 12, 24, and 48 weeks, SI was assessed using the Beck Scale for Suicide Ideation.

RESULTS

We included 718 participants with a median (IQR) age of 26.0 (22.3, 31.0) years, among whom 489 (68.1 %) were female. Five trajectories of anxiety symptoms were identified: persistent mild (25.1 %), rapidly decreasing (30.1 %), persistent moderate (21.7 %), slowly decreasing (10.3 %), and persistent severe (12.8 %). Compared to the persistent mild anxiety symptom trajectory, the rapidly decreasing anxiety symptom trajectory was significantly associated with lower levels of SI (β coefficient, -0.186; 95 % confidence interval [CI], -0.296 to -0.075). Conversely, the persistent moderate anxiety symptom trajectory (β coefficient, 0.126; 95 % CI, 0.03 to 0.249) and persistent severe anxiety symptom trajectory (β coefficient, 0.334; 95 % CI, 0.185 to 0.482) were associated with higher levels of SI. No statistically significant association was found for the slowly decreasing anxiety symptom trajectory (β coefficient, 0.051; 95 % CI, -0.101 to 0.202).

LIMITATIONS: Reporting bias; Selection bias; Observational design; Generalizability.

CONCLUSIONS

Among patients with MDD, achieving reductions in anxiety symptoms may mitigate suicidal risk, and attention should be paid to the suicidal risk associated with anxiety symptoms, particularly when symptoms remain severe in the longitudinal follow-up.