Suicide ideation and male-female differences in major depressive disorder

Abstract

Objective

This study aimed to explore male-female differences in suicide ideation (SI) and suicide risk factors in major depressive disorder (MDD).

Methods

We analysed 482 adults (sample 1) and 438 elderly outpatients (sample 2) with MDD. Sample 1 was treated with different antidepressant combinations (escitalopram; bupropion plus escitalopram; venlafaxine plus mirtazapine) and assessed by means of the Concise Health Risk Tracking (SI), Quick Inventory of Depressive Symptomatology, Altman Mania Rating Scale and Psychiatric Diagnostic Screening Questionnaire. Sample 2 was treated with venlafaxine and assessed using the Hamilton scale for depression, Anxiety Sensitivity Index and Penn State Worry Questionnaire for anxiety, Beck Scale for Suicide Ideation and Repeatable Battery for the Assessment of Neuropsychological Status.

Results

In sample 1, females had greater depression severity (O.R 0.961 99%CI: 0.929 − 0.995), males reported more alcohol abuse (O.R 1.299 99%CI: 1.118 − 1.509) and active SI (O.R 1.109 99%CI: 1.005 − 1.255). In sample 2 men showed more severe SI (O.R 1.067; 99%CI: 1.014 − 1.122) and weight loss (OR = 5.89 99%CI: 1.01 − 34.19), women more gastrointestinal symptoms.

Conclusions

In these selected samples, although women had more severe depression, men had more suicide risk factors. Such differences might contribute to men’s increased suicide risk.

KEY POINTS

• In major depressive disorder sex differences affect the clinical expression of depressive episodes. In comparison to men, women endorse higher levels of overall depression in adult MDD and more somatic anxiety and gastrointestinal symptoms in late-life MDD.

• After controlling for confounding variables, males have more severe SI and a larger number of suicide risk factors (eg. alcohol abuse; weight loss). The association between male sex and SI is detectable in both adults and elderly patients with MDD.

• Further studies are necessary to elucidate how sex differences in suicide ideation and suicide risk factors are related to men’s increased suicide risk.

Keywords:

• Male-female differences
• suicide ideation
• suicide risk
• cognitive impairment
• mixed depression
• major depressive disorder

Acknowledgments

We thank the NIMH for having had the possibility of analysing their data on the COMED sample. We also thank the authors of previous publications in this dataset, and foremost, we thank the patients and their families who accepted to be enrolled in the study. Data and biomaterials were obtained from the limited access datasets distributed from the NIH. The ClinicalTrials.gov identifier is NCT00590863.

Ethics statement

The CO-MED and IRL-GRey trials were conducted according to the Principles of Helsinki Declaration; their protocols were approved by ethical committees at local recruitment sites. All subjects who met selection criteria were included in both trials after obtaining their written informed consent. This research group certifies that data collected from the CO-MED and IRL-GRey trials were exclusively used for scientific investigation and, before obtaining access to them, the objectives of our investigation were clearly reported in the request form (Olgiati & Serretti, 2022).

Disclosure statement

The authors declare that this research work was conducted in the absence of any commercial or financial support that could be construed as a potential conflict of interest.

Data availability statement

Data are available from: https://www.nimhgenetics.org/.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.