Sex differences and risk factors of self-reported suicide attempts in middle-aged Chinese Han patients with first-episode drug-naïve anxious depression: a large-scale cross-sectional study

This study aims to investigate sex differences and risk factors for self-reported suicide attempts among Chinese Han middle-aged patients with first-episode drug-naïve (FEDN) anxious depression (AD). A total of 1796 patients with FEDN major depressive disorder were enrolled in this study, including 341 middle-aged patients with AD. We compared the prevalence, demographics, and clinical characteristics of suicide attempts between male and female patients with FEDN middle-aged AD. We also explored the risk factors for self-reported suicide attempts in this population using binary logistic regression analysis. The male/female ratio was 91/250 and the age of onset was 51.50 ± 4.13. Our results showed that there were no significant sex differences in the prevalence of self-reported suicide attempts in middle-aged patients with FEDN AD. However, we did find significant differences in several demographic and clinical characteristics between self-reported suicide attempters and non-suicide attempters. Moreover, severe anxiety, measured by the Hamilton Anxiety Rating Scale score, was identified as a risk factor for self-reported suicide attempts in female middle-aged AD patients. Additionally, elevated thyroid peroxidase antibody (TPOAb) levels were linked to self-reported suicide attempts in male AD patients. Our findings suggest that there are no significant sex differences in the prevalence of self-reported suicide attempts in this population, but there may be sex-specific risk factors for self-reported suicide attempts in middle-aged AD. Clinical psychiatrists need to pay attention to thyroid hormone levels in middle-aged anxious depression. This study explores sex differences in self-reported suicide attempts among Chinese Han middle-aged patients with first-episode drug-naïve (FEDN) major depressive disorder (MDD) and anxious depression (AD). 1. No significant sex differences in the prevalence of self-reported suicide attempts were observed; however, important demographic and clinical differences between suicide attempters and non-suicide attempters were identified. 2. Middle-aged depression is associated with increased self-reported suicide attempts risk during ages 45–60 due to mood swings and hormonal changes. 3. Psychotic symptoms in MDD patients are linked to higher suicide risk, and severe anxiety, measured by the HAMA score, is a risk factor for self-reported suicide attempts in female middle-aged AD patients. 4. Elevated TPOAb levels are associated with self-reported suicide attempts in male AD patients. These findings emphasize the need for further research on sex-specific risk factors in middle-aged anxious depression to enhance suicide prevention strategies.