Cumulative effects of stress-sensitivity factors on depressive symptoms and suicide risk: A prospective study

doi:10.5498/wjp.v15.i2.99996

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Feb 19, 2025 (publication date) through Mar 13, 2025

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World Journal of Psychiatry

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Prospective Study

World J Psychiatry. Feb 19, 2025; 15(2): 99996
Published online Feb 19, 2025. doi: 10.5498/wjp.v15.i2.99996

Table 1 Demographic and clinical information of patients with major depressive disorders

Items	Overall MDD group (n = 206)	Subgroup based on follow-up data (n = 119)	*Sig.*
Age (years)	23 (10)	22 (9)	0.132
Years of education	14.52 ± 2.55	14.33 ± 2.66	0.530
BMI (kg/m²)	22.02 ± 4.34	22.43 ± 4.78	0.424
Gender (female), No. (%)	148 (71.8)	87 (73.1)	0.806
Marriage (unmarried), No. (%)	156 (75.7)	94 (79.0)	0.713
Ethnicity (Han), No. (%)	187 (90.8)	109 (91.6)	0.803
History of drinking, No. (%)	39 (18.9)	22 (18.5)	0.983
History of smoking, No. (%)	31 (15.0)	17 (14.3)	0.947
Depressive episodes	2 (1)	2 (1)	0.493
HAMD-17 score at baseline	21.24 ± 5.28	21.94 ± 5.05	0.557
HAMD-17 score at the end of follow-up¹	NA	10.88 ± 7.12	< 0.001^a
HAMA score at baseline	21.38 ± 7.54	21.51 ± 7.58	0.883
HAMA score at the end of follow-up¹	NA	11.69 ± 7.74	< 0.001^a
BSSI score at baseline	8.07 ± 7.68	7.57 ± 7.52	0.568
BSSI score at the end of follow-up¹ (n = 66)	NA	5.67 ± 7.10	0.004^a
SDS score at baseline	18.50 ± 5.96	19.01 ± 6.07	0.466
SDS score at the end of follow-up¹	NA	11.91 ± 7.57	< 0.001^a
PDQ-5 score at baseline	11.88 ± 3.54	11.69 ± 3.46	0.630
PDQ-5 score at the end of follow-up¹	NA	8.27 ± 4.58	< 0.001^a
Antidepressants at baseline
SSRIs, No. (%)	66 (32)	43 (36.1)	0.451
SNRIs, No. (%)	20 (9.7)	12 (10.1)	0.913
SARIs, No. (%)	98 (47.6)	62 (52.1)	0.432
Others², No. (%)	14 (6.8)	7 (5.9)	0.747
Antidepressants at the end of follow-up
SSRIs, No. (%)	NA	67 (32.5)	NA
SNRIs, No. (%)	NA	18 (8.7)	NA
SARIs, No. (%)	NA	86 (41.7)	NA
Others², No. (%)	NA	21 (17.6)	NA
Neuroticism score at baseline	44.92 ± 5.97	45.05 ± 5.70	0.919
T-AI score at baseline	59.98 ± 7.06	60.15 ± 6.80	0.824
PSS score at baseline	24.76 ± 4.96	24.83 ± 5.28	0.899
S-AI score at baseline	56.64 ± 8.67	56.47 ± 8.06	0.858

^aP < 0.05.

¹Comparison of clinical manifestations between baseline and the end of the 8-week follow-up.

²Others include Noradrenergic and Specific Serotonergic Antidepressants and Norepinephrine-Dopamine Reuptake Inhibitors.

BMI: Body mass index; HAMD-17: 17-item Hamilton Depression Scale; HAMA: Hamilton Anxiety Scale; BSSI: Beck Scale for Suicide Ideation; SDS: Sheehan Disability Scale; PDQ-5: Perceived Deficits Questionnaire five-item version; SSRIs: Selective Serotonin Reuptake Inhibitors; SNRIs: Serotonin-Norepinephrine Reuptake Inhibitors; SARIs: Serotonin Receptor Antagonists and Reuptake Inhibitors; T-AI: Trait Anxiety Inventory of State-Trait Anxiety Inventory; PSS: Perceived Stress Scale; S-AI: State Anxiety Inventory of State-Trait Anxiety Inventory; NA: Not available.

Table 2 Comparison of clinical manifestations at baseline and follow-up outcomes between major depressive disorders patients with high-level and low-level stress-sensitivity factors

Items	Groups	HAMD-17 at baseline	HAMD-17 at the end of follow-up	HAMA at baseline	HAMA at the end of follow-up	BSSI at baseline	BSSI at the end of follow-up (n = 66)	SDS at baseline	SDS at the end of follow-up	PDQ-5 at baseline	PDQ-5 at the end of follow-up
Neuroticism	Low-level	20.88 ± 5.42	9.54 ± 6.56	20.75 ± 7.65	10.31 ± 7.31	6.92 ± 7.04	4.23 ± 5.77	17.28 ± 6.01	10.90 ± 7.34	11.35 ± 3.47	7.34 ± 4.20
	High-level	22.10 ± 4.86	14.11 ± 7.46	22.83 ± 7.12	14.97 ± 7.87	10.74 ± 8.46	8.55 ± 8.64	21.35 ± 4.74	14.31 ± 7.68	13.11 ± 3.40	10.49 ± 4.75
	Sig.	0.070	0.002^a	0.024^a	0.003^a	0.003^a	0.044^a	< 0.001^a	0.035^a	0.001^a	0.001^a
Trait anxiety	Low-level	20.08 ± 5.05	9.17 ± 6.38	20.00 ± 6.94	9.95 ± 6.46	6.44 ± 6.21	4.19 ± 5.13	17.52 ± 6.18	10.79 ± 7.12	11.51 ± 3.61	7.38 ± 4.17
	High-level	24.76 ± 4.33	15.97 ± 6.88	25.55 ± 7.84	16.83 ± 8.98	13.04 ± 9.46	9.61 ± 9.86	21.49 ± 3.97	15.23 ± 7.99	13.02 ± 3.06	10.91 ± 4.79
	Sig.	< 0.001^a	< 0.001^a	< 0.001^a	< 0.001^a	< 0.001^a	0.038^a	< 0.001^a	0.005^a	0.008^a	< 0.001^a
Perceived stress	Low-level	20.08 ± 5.13	10.26 ± 7.05	20.00 ± 7.01	10.67 ± 7.45	6.76 ± 7.15	4.84 ± 5.80	17.48 ± 5.97	11.28 ± 7.35	11.36 ± 3.50	7.78 ± 4.59
	High-level	24.07 ± 4.54	12.44 ± 7.17	24.72 ± 7.80	14.23 ± 7.99	11.27 ± 8.04	7.32 ± 9.09	21.00 ± 5.16	13.47 ± 8.00	13.15 ± 3.31	9.50 ± 4.40
	Sig.	< 0.001^a	0.132	< 0.001^a	0.023	< 0.001^a	0.253	< 0.001^a	0.155	0.001^a	0.063
State anxiety	Low-level	20.41 ± 5.13	10.23 ± 6.91	20.33 ± 7.44	10.59 ± 6.93	6.82 ± 6.89	5.20 ± 6.08	17.59 ± 6.04	11.38 ± 7.39	11.52 ± 3.59	7.80 ± 4.48
	High-level	23.98 ± 4.87	13.11 ± 7.50	24.81 ± 6.89	15.42 ± 9.23	12.19 ± 8.71	6.75 ± 9.11	21.50 ± 4.58	13.70 ± 8.04	13.08 ± 3.09	9.87 ± 4.66
	Sig.	< 0.001^a	0.064	< 0.001^a	0.017	< 0.001^a	0.418	< 0.001^a	0.162	0.007^a	0.038

^aP values that survived false discovery rate correction for multiple testing.

HAMD-17: 17-item Hamilton Depression Scale; HAMA: Hamilton Anxiety Scale; BSSI: Beck Scale for Suicide Ideation; SDS: Sheehan Disability Scale; PDQ-5: Perceived Deficits Questionnaire five-item version.

Table 3 Association of the number of high-level stress-sensitivity factors with clinical manifestations and follow-up outcomes in major depressive disorders

Items	Time	All factors Partial eta-squared (η²)	Sig.	PSS + S-AI Partial eta-squared (η²)	Sig.	Neuroticism + T-AI partial eta-squared (η²)	Sig.
HAMD-17	Baseline	0.158	< 0.001^a	0.153	< 0.001^a	0.085	< 0.001^a
HAMD-17	At the end of follow-up	NA	NA	NA	NA	0.204	< 0.001^a
HAMA	Baseline	0.145	< 0.001^a	0.129	< 0.001^a	0.072	< 0.001^a
HAMA	At the end of follow-up	NA	NA	NA	NA	0.155	< 0.001^a
BSSI	Baseline	0.160	< 0.001^a	0.117	< 0.001^a	0.135	< 0.001^a
BSSI	At the end of follow-up (n = 66)	NA	NA	NA	NA	0.156	0.002^a
SDS	Baseline	0.240	< 0.001^a	0.132	< 0.001^a	0.145	< 0.001^a
SDS	At the end of follow-up	NA	NA	NA	NA	0.072	0.003^a
PDQ-5	Baseline	0.138	< 0.001^a	0.065	< 0.001^a	0.066	< 0.001^a
PDQ-5	At the end of follow-up	NA	NA	NA	NA	0.143	< 0.001^a

^aP < 0.05.

The effect size is classified as small (0.01-0.05), medium (0.06-0.13), and large (≥ 0.14) based on Partial η². HAMD-17: 17-item Hamilton Depression Scale; HAMA: Hamilton Anxiety Scale; BSSI: Beck Scale for Suicide Ideation; SDS: Sheehan Disability Scale; PDQ-5: Perceived Deficits Questionnaire five-item version; NA: Not available.

Table 4 Multivariable regression analysis of depressive symptoms and suicide risk

Variables	HAMD-17 at baseline	HAMD-17 at the end of follow-up	BSSI at baseline	BSSI at the end of follow-up
Neuroticism	–0.089	0.179	0.117	0.392^a
Trait anxiety	0.284^a	0.247^a	0.219^a	0.077
Perceived stress	0.195^a	NA	0.056	NA
State anxiety	0.145	NA	0.057	NA
R²	0.261^a	0.129^b	0.139^b	0.186^a

^aP < 0.05.

^bP < 0.001.

Data are presented as standardized β.

HAMD-17: 17-item Hamilton Depression Scale; BSSI: Beck Scale for Suicide Ideation; NA: Not available.

Citation: Qin XM, Xu MQ, Qin YQ, Shao FZ, Ma MH, Ou WW, Lv GY, Zhang QQ, Chen WT, Zhao XT, Deng AQ, Xiong JT, Zeng LS, Peng YL, Huang M, Xu SY, Liao M, Zhang L, Li LJ, Ju YM, Liu J, Liu BS, Zhang Y. Cumulative effects of stress-sensitivity factors on depressive symptoms and suicide risk: A prospective study. World J Psychiatry 2025; 15(2): 99996
URL: https://www.wjgnet.com/2220-3206/full/v15/i2/99996.htm
DOI: https://dx.doi.org/10.5498/wjp.v15.i2.99996