Clinical correlates of new-onset and persistent suicidal ideation in adolescents with major depressive disorder

Yun Zhang¹Lewei Liu²Haojie Fan²Xi Zhang²Lei Xia^1,2Huanzhong Liu^1,2*

• ¹Anhui Medical University, Hefei, China
• ²The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China

Background: Suicidal ideation (SI) is common in adolescents with major depressive disorder (MDD). SI not only poses a serious threat to the patient's life safety, but also significantly hinders the process of psychological recovery and the restoration of social functioning. However, there is still a relative lack of longitudinal studies on the factors influencing SI in adolescents with MDD. Therefore, this study aimed to explore the longitudinal trajectory of SI in adolescents with MDD and to identify the relevant influencing factors. Methods: This study included 122 adolescents with MDD. At baseline and one-year follow-up, patients were assessed for SI. Based on the assessment results, patients were divided into SI group and non-SI group. In addition, the standardized questions and the Center for Epidemiological Studies Depression scale (CES-D), the Childhood Trauma Questionnaire (CTQ), and the Toronto Alexithymia Scale (TAS-20) were used to evaluate non-suicidal self-injury (NSSI), depressive symptoms, childhood maltreatment (CM), and alexithymia. Logistic stepwise regression analyses were employed to identify factors independently associated with SI in adolescents with MDD. Results: In adolescents with MDD, the prevalence of SI was 68.0%. At the follow-up period, the prevalence of persistent suicidal ideation (PSI) was 19.7%, and the prevalence of new-onset SI was 20.5%. Regression analyses showed that single-child family (OR = 3.969, 95%CI: 1.227 - 12.839, P = 0.021), TAS-20 score (OR = 1.091, 95%CI: 1.006 - 1.184, P = 0.035), and difficulties identifying feelings (OR = 1.134, 95%CI: 1.000 - 1.287, P = 0.050) were risk factors for PSI. NSSI (OR = 4.552, 95%CI: 1.488 - 13.921, P = 0.008) and positive affect (OR = 1.424, 95%CI: 1.125-1.804, P = 0.003) were risk factors for new-onset SI. Conclusion: Adolescents with MDD have a high risk of PSI, and new-onset SI should not be ignored. Factors such as single-child family, alexithymia, NSSI, and reduction of positive affect significantly affect the occurrence and persistence of SI. Therefore, early intervention targeting these factors is important to reduce the risk of adolescent suicide and improve mental health outcomes.