The Inter-Relationships of Depressive and Anxiety Symptoms with Suicidality Among Asian Psychiatric Patients: Findings From the REAP-AD3
Li-Ya A, Yuan Feng, Qinge Zhang, Tian-Mei Si, Roy Abraham Kallivayalil, Andi J. Tanra, Amir Hossein Jalali Nadoushan, Kok Yoon Chee, Afzal Javed, Kang Sim, Pornjira Pariwatcharakul, Yukako Nakagami, Toshiya Inada, Kuan-Lun Huang, Shih-Ku Lin, Seon-Cheol Park, Norman Sartorius, Naotaka Shinfuku, Takahiro A. Kato, Chee H. Ng, Yu-Tao XiangBackground:
Depressive and anxiety symptoms (depression and anxiety hereafter), and suicidality are common among psychiatric patients. This study examined the network structure of depressive and anxiety symptoms and suicidality among psychiatric patients across Asia.
Methods:
Data were drawn from the Research on Asian Psychotropic Prescription Patterns for Antidepressants Phase 3 study (REAP-AD3), which included 2,455 psychiatric patients from 11 Asian countries and territories. Depression and anxiety were assessed using the 9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively, while suicidality (i.e., suicidal thoughts or acts) was assessed by a clinical interview. Expected Influence (EI) and Bridge EI were used as centrality indices in the symptom network to characterize the structure of the symptoms.
Results:
The point prevalence of suicidality was 30.1% (95% confidence interval [CI] = 28.2, 31.9) among the psychiatric patients. The network analysis identified PHQ2 (“Sad mood”) as the most central symptom, followed by GAD2 (“Uncontrollable worry”). Additionally, PHQ8 (“Motor disturbances”) and S (“Suicidality”) were identified as bridge nodes linking depression and anxiety with suicidality. The flow network indicated that PHQ6 (“Guilt”) and PHQ2 (“Sad mood”) had the strongest positive associations with suicidality.
Conclusions:
Suicidality was common among psychiatric patients across Asia. The central and bridge symptoms might represent potential clinical markers and generate hypotheses for longitudinal and interventional research on depression, anxiety, and suicidality in the future.