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Environmental Conditions and Biological Profile of Patients with Major Depressive Disorder with or without Suicidal Behavior

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  • Institut universitaire en santé mentale de Montréal
Presentation

Environmental Conditions and Biological Profile of Patients with Major Depressive Disorder with or without Suicidal Behavior

Abstract

This study characterized the environmental conditions and biological profile of patients with major depressive disorder (MDD) and suicidal behavior (SB) who are admitted in the psychiatric emergency room. The study is based on the Signature Bank, a biopsychosocial bank collected and stored from people with mental health problems. The bank is located in Canada and it is accessible to researchers around the world. The first 50 patients with MDD with or without SB were selected (28 men and 22 women). Their mean age was 43-y (SD, 13-y). Their education level and annual earnings were lower, while they reported more adverse childhood experiences in comparison with a matching control group of 50 non-hospitalized individuals from the 2012 Canadian Community Health Survey on Mental Health. Plasma levels of the inflammatory cytokine tumor necrosis factor-alpha (TNF-a) were positively and significantly correlated with suicidal ideations. These findings contribute to better characterize the poor socioeconomic conditions of life of MDD patients admitted in the psychiatric emergency room. Additionally, the data suggest that plasma TNF-a may serve as a susceptibility marker of suicidal risk in patients with MDD. Novel strategies are likely to emerge in order to predict and prevent suicidal risk in MDD patients.
EnvironmentalConditionsandBiologicalProfile
ofPatientswithMajorDepressiveDisorderwith
orwithoutSuicidalBehavior
06December2016
EdouardKouassi,RéalLabelle,Charles
EdouardGiguère,SoniaLupien,andthe
SignatureConsortium
Research Center,InstitutUniversitaireenSantéMentale
deMontréal;UniversitédeMontréal,Quebec,Canada
Introduction
MDD:aglobalpublichealth concern (WorldFederation forMental
Health)
Itaffects510%ofadolescentsand1015%ofadults
Itimposesasignificant burden notjust onindividuals with thedisorder,but
also ontheir families,communities,etc.
Depression is thefirstmentalillness most associated with suicidal
behaviors
Depression andsuicidearetheproduct ofmultipleandcomplex
interactionsbetween psychosocialandbiological factors
Recent findings indicate that proinflammatory cytokines(IL1beta,IL
6,TNFalpha)may play arole indepression andsuicide
Objectives
Tocharacterize thesocioeconomic status ofpatientswith MDDwith
orwithout suicidal behaviors inasettingofthepsychiatric emergency
room
Toexploretherelationship between inflammatory cytokinesand
suicidal behaviors inthese patients.
Methodology
TheSignatureBank(SIG)(N=1133)
Mood andAnxiety Disorders (N=262«0
FirstEpisode ofPsychosis (N=137)
LongTerm Psychosis (N=237)
Montreal/Urban cityofQuebec,Canada
InstitutuniversitaireensantémentaledeMontréal:largest psychiatric hospital
CanadianCommunity Health Survey(CCHS)(N=2449)
ProvinceofQuebec/Urban area
Subjects ofless than 20yearoldwere excluded
Thisstudy:
First50participantsofSIGw/osuicidal behavior versus50matching controls from CCHS
Methodology (Contd)
Childhood maltreatment:measured bytheChildhood Experiences of
ViolenceQuestionnaire(CEVQ)
Majordepression:PatientHealth Questionnaire(PHQ9)
Suicidal Behaviors (SuicideBehaviors QuestionnaireRevised (SBQR)
Inflammatory markers:Plasmalevels ofCRP,IL1beta,IL6,andTNF
alphameasured byhighly sensitiveimmunoassays
Statistical analyses:ANOVAandPearsoncorrelation test
1– Socioeconomic Conditions
CCHS:CanadianCommunity Health Survey(Statistics Canada)
Women
Men
% (Signature)
0 102030400 10203040
Asthma
Arthrosis
Back pain
Hypertension
Migraine
Pulmonary
disease
Diabetes
Cardiac
diseaseCancer
CVA
Intestinal
disease
Women
Men
% (CCHS)
0 10203040
Asthma
Arthrosis
Back pain
Hypertension
Migraine
Pulmonary
disease
Diabetes
Cardiac
diseaseCancer
CVA
Intestinal
disease
0 10203040
Signature
(N=1133)
CCHS
(N=2449)
ChronicHealthProblems
Demographics andclinical profileofMDD
patients
N=50
M=56%;F=44%
Age:43y(SD,13y)
FrenchCanadian=76%
Maritalstatus:22%married
71%livealone
34%suicidal ideation and30%suicideattempts
48%family history ofpsychiatric disorders
78%Physicalorsexual abuseinchildhood
AdverseChildhood Experiences (50SIGvs50CCHS)
Signature CCHS
Violence Witness (%)
020406080
Women - SIG
Men
Women - CCHS
Men
Signature CCHS
Physical Abuse (%)
020406080
Signature CCHS
Sexual Abuse (%)
020406080
Violence Witness (Frequency)
Signature CCHS
0 1-2 3-5 >10
Violence Witness (Frequency)
Signature CCHS
0 1-2 3-5 >10
Violence Witness (Frequency)
Signature CCHS
0 1-2 3-5 >10
Education Level (50SIGvs50CCHS)
No High School High School Post High School No High School High School Post High School
%
0 20406080
Women
Men Women
Men
Signature CCHS
Annual Earnings (50SIGvs50CCHS)
< 20 000 20 000-40 000 > 40 000 < 20 000 20 000-40 000 > 40 000
%
0 20406080
Women
Men Women
Men
Signature CCHS
Employment Status (50SIGvs50CCHS)
Unemployed Employed Unemployed Employed
%
0 20406080
Women
Men Women
Men
Signature CCHS
2‐ Inflammatory markers:
CRP,IL1beta,IL6etTNFalpha
0 2 4 6 8 10 12 14
Conc. (mg/L)
C-Reactive Protein
0123456
Conc. (pg/ml)
IL-1beta IL-6 TNF-alpha
02468101214
12345
C-Reactive Protein
Level of suicidal thoughts
r = -0.0694 (p = 0.6392)
0.00 0.05 0.10 0.15 0.20 0.25
12345
IL-1beta
Level of suicidal thoughts
r = 0.2363 (p = 0.4161)
01234
12345
IL-6
Level of suicidal thoughts
r = -0.0899 (p = 0.5346)
12345
12345
TNF-alpha
Level of suicidal thoughts
r = 0.3449 (p = 0.0142)
3‐ InflammationandSuicidal Behavior
Conclusion
MDDis associated with poor socioeconomic conditionsoflifeinthe
settingsofpatientsadmitted inthepsychiatric emergencyroom
Thedatasuggest that plasmaTNFalphamay serveasasusceptibility
markerofsuicidal risk inpatientswith MDD
Novel strategies arelikely toemerge inorder topredict andto
prevent suicidal risk inMDDpatients.
Acknowledgements
SignatureBank
CRIUSMM
CRHRDP
CRISE(Centrederechercheetd’interventionsurlesuicideetl’euthanasie)
AlexandraHoehne (PhDStudent)
LouisePouliot(Research Assistant)
IngridAgbato (Research Assistant)
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