The influence of gender-specific factors influencing severe anxiety in psychotic major depression: role of thyroid hormones and depression severity

Guoshuai Luo; Yifan Jing; Jie Yang; Shuo Wang; Zaimina Xuekelaiti; Cong Yao; Ying Gao; Hongli Chen; Daliang Sun; Jie Li; Xiangyang Zhang

doi:10.1007/s00702-024-02781-3

The influence of gender-specific factors influencing severe anxiety in psychotic major depression: role of thyroid hormones and depression severity

J Neural Transm (Vienna). 2024 May 2. doi: 10.1007/s00702-024-02781-3. Online ahead of print.

Authors

Guoshuai Luo^#¹, Yifan Jing^#¹, Jie Yang^#^{2

3

4

5}, Shuo Wang¹, Zaimina Xuekelaiti¹, Cong Yao¹, Ying Gao¹, Hongli Chen⁶, Daliang Sun⁷, Jie Li⁸, Xiangyang Zhang⁹

Affiliations

¹ Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China.
² The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin, 300170, China.
³ Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China.
⁴ Artificial Cell Engineering Technology Research Center, Tianjin, China.
⁵ Tianjin Institute of Hepatobiliary Disease, Tianjin, China.
⁶ State Key Laboratory of Separation Membrane and Membrane Process, Tiangong University, Tianjin, 300387, China.
⁷ Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China. sundaliang@tmu.edu.cn.
⁸ Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China. jieli@tmu.edu.cn.
⁹ CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing, 100101, China. zhangxy@psych.ac.cn.

^# Contributed equally.

PMID: 38693463
DOI: 10.1007/s00702-024-02781-3

Abstract

Background: Psychotic major depression (PMD) is characterized by major depressive disorder (MDD) accompanied by delusions or hallucinations. While the prevalence of PMD and its association with anxiety have been studied, gender-specific differences and the role of thyroid hormones in PMD-related anxiety remain less explored.

Methods: A total of 1718 first-episode and drug-naïve MDD patients was assessed for the presence of PMD and severe anxiety. Clinical assessments, including Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impressions-Severity (CGI-S) scale, were conducted to assess depression, anxiety, psychotic symptoms, and clinical severity, respectively. Blood samples were collected to measure thyroid function parameters.

Results: The prevalence of severe anxiety was higher in PMD patients compared to non-psychotic MDD patients (71.3% vs. 5.3%). No significant gender differences were observed in the prevalence of severe anxiety among PMD patients. However, elevated thyroid-stimulating hormone (TSH) levels and increased depression severity (HAMD scores) were identified as independent risk factors for severe anxiety in female PMD patients. In contrast, no significant risk factors were found in male PMD patients. The area under the receiver operating characteristic (AUCROC) analysis revealed that the HAMD score and TSH level showed acceptable discriminatory capacity for distinguishing between female PMD patients with and without severe anxiety.

Conclusion: This study highlights the heightened prevalence of severe anxiety in PMD patients, with TSH levels and depression severity emerging as gender-specific risk factors for anxiety in females. These findings suggest the importance of thyroid hormone assessment and tailored interventions for managing anxiety in female PMD patients.

Keywords: Depression severity; Gender differences; Psychotic major depression; Severe anxiety; Thyroid hormones.

Abstract

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