ASSOCIATION BETWEEN FASTING THYROID STIMULATING HORMONE AND SUICIDAL IDEATION IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER AT A TERTIARY CARE HOSPITAL- A CROSS-SECTIONAL STUDY
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Keywords
Hypothyroidism, Hyperthyroidism, Suicidality, Biological psychiatry, Major depressive disorder
Abstract
Introduction: Major Depressive Disorder (MDD) is a leading cause of disability worldwide and poses significant risks for suicidal ideation and attempts. Despite extensive research on the biological underpinnings of MDD, the complex interactions between endocrine function and mental health outcomes remain incompletely understood. Elevated serum Thyroid stimulating hormone (TSH) levels, indicative of hypothyroidism, have been associated with depressive symptoms and increased risk of suicidal ideation. Understanding the relationship between fasting TSH levels and suicidal ideation in patients with MDD could offer new insights into the pathophysiology of depression and inform more effective screening and intervention strategies.
Aim: To investigate the role of serum Thyroid Stimulating Hormone (TSH) in depressive disorder and suicidality.
Materials and Methods: The study was carried out in Department of Psychiatry, S.V. Medical College, Tirupati, Andhra Pradesh from February to July 2024 for a duration of 6 months. A cross-sectional comparative study design was employed where the patients were divided into two groups, i.e., 30 subjects with Major Depressive Disorder (MDD) with suicidal ideation (SI) and 30 subjects with Major Depressive Disorder without suicidal ideation. Sociodemographic characteristics were recorded on a structured pro forma. DSM-V was used to diagnose MDD in the patients. Beck Depression Inventory (BDI-I) and Columbia- Suicide Severity Rating Scale (C-SSRS) were used on subjects to determine the severity of depression and suicidal ideation respectively. ELISA method was used to measure serum values of fasting TSH in the collected samples.
Results: Most patients were between the ages of 31 and 40. Most of the participants received up to primary education and were married. 53.3% of the patients without suicidal ideation and 36.7% of patients with suicidal ideation had a past history of depressive illness with a chi-square value of 1.684. No significant association was found among the other sociodemographic parameters as p values were not significant. Compared with non-SI individuals, SI individuals had higher scores on BDI-I, 83.3% and 16.7% with severe and extreme depression respectively as well as higher TSH serum levels, 36.7% patients with TSH above 4.5 mIU/L. Elevated TSH levels (>4.5mIU/L) correlate with a higher incidence of severe depression, more severe ideation, and increased suicidal behavior with a p-value of 0.001. Extreme levels of depression are associated with higher severity of suicidal ideation and behavior, as well as greater intensity of suicidal ideation.
Conclusions: The study findings show that MDD patients with suicidal behavior had higher TSH levels compared to those without, though this difference wasn't statistically significant. The current study emphasizes the importance of regular assessment of thyroid function parameters for suicide prevention, along with possible treatment for impaired thyroid function for the suicide intervention in MDD patients. Such patients with abnormal TSH must undergo thorough screening for suicidal ideation.
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Raghav Kannappan
Postgraduate Resident, Psychiatry, S. V. Medical College, Tirupati, Andhra Pradesh, India
Mallikarjuna Rao
Associate Professor , Psychiatry, S. V. Medical College, Tirupati, Andhra Pradesh, India
Bharathi Sibbala
Assistant Professor, Psychiatry, S. V. Medical College, Tirupati, Andhra Pradesh, India
Chenchu Jahanavi Byrapogu
Assistant Professor, Psychiatry, S. V. Medical College, Tirupati, Andhra Pradesh, India
Nallapaneni Nageswara Rao
Professor, Psychiatry, Kurnool Medical College, Kurnool, Andhra Pradesh, India
Sanjay Venugopal
Senior Resident, ESIC Hospital, Ayanavaram, Chennai, Tamilnadu, India