Development of a Predictive Score for Suicide Attempts in Patients with Treatment-Resistant Depression and Implementation for Suicide Prevention in Thailand
Abstract
Material and Methods: This study involved patients aged 20–60 years who were diagnosed with TRD and attended psychiatric outpatient clinics in Bangkok, Thailand. Statistical analysis involved univariate logistic regression to identify potential predictors (p-value<0.05), followed by multivariable logistic regression with backward stepwise selection (p-value<0.01) to develop a predictive model; the model was implemented in a new patient cohort, and suicide attempt rates were compared pre- and post-implementation.
Results: Among 653 TRD patients, 221 had attempted suicide. Nine important predictors were found. The model was excellent at making predictions (area under the receiver operating characteristic (AuROC)=0.993, 95% confidence interval (CI): 0.989–0.997) and had strong internal validation (AuROC=0.98, 95% CI: 0.979–0.999). Risk scores categorized patients into low-, moderate-, and high-risk groups. After creating a predictive scoring system for assessing and preventing suicide risk, it was implemented in 185 new TRD patients. At 6 months and 1 year, there was a statistically significant reduction in suicide attempts (p-value<0.05).
Conclusion: The developed predictive score effectively stratifies suicide risk among TRD patients and informs tailored suicide prevention care plans. Its implementation resulted in a significant reduction in suicide attempts, underscoring its potential as a clinical tool for suicide prevention in TRD patients. Notably, protective factors identified in this study, such as good compliance and spiritual security, may also contribute to lowering suicide risk.
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Who.int. Monitoring and sharing suicide data and statistics [homepage on the Internet]. Geneva: World Health Organization [cited 2025 Mar 5]. Available from: https://www.who.int/ activities/monitoring-and-sharing-suicide-data-and-statistics
Who.int. Suicide prevention in Thailand: a whole-of-society approach [homepage on the Internet]. Geneva: World Health Organization [cited 2025 Mar 5]. Available from: https://www. who.int/news-room/feature-stories/detail/suicide-preventionin- thailand--a-whole-of-society-approach
Suicide.dmh.go.th. The national data suicide rates of Thailand [homepage on the Internet]. Nonthaburi: Department of Mental Health, Thailand [cited 2025 Mar 5]. Available from: https:// suicide.dmh.go.th/report/suicide/english/stat_prov.asp
Lundberg J, Cars T, Lampa E, Ekholm Selling K, Leval A, Gannedahl A, et al. Determinants and outcomes of suicidal behavior among patients with major depressive disorder. JAMA Psychiatry 2023;80:1218-25.
Cai H, Xie M, Zhang Q, Cui X, Lin X, Sim K, et al. Prevalence of suicidality in major depressive disorder: a systematic review and meta-analysis of comparative studies. Front Psychiatry 2021;12:690130.
Mahikul W, Srichan P, Narkkul U, Soontarawirat I, Kitro A, Pumipuntu N, et al. Mental health status and quality of life among Thai people after the COVID-19 outbreak: a crosssectional study. Sci Rep 2024;14:25896.
Tay WWY, Jesuthasan J, Wan KS, Ong T, Mustapha F. Eighteen months into the COVID-19 pandemic: The prevalence of depression, anxiety, and stress symptoms in Southeast Asia and the associated demographic factors. Front Public Health 2022;10:863323.
Prasartpornsirichoke J, Pityaratstian N, Poolvoralaks C, Sirinimnualkul N, Ormtavesub T, Hiranwattana N, et al. The prevalence and economic burden of treatment-resistant depression in Thailand. BMC Public Health 2023;23:1541.
Nice.org. Depression in adults: treatment and management [homepage on the Internet]. Manchester: National Institute for Health and Care Excellence [cited 2025 Jun 9]. Available from: https://www.nice.org.uk/guidance/ng222
McIntyre RS, Alsuwaidan M, Baune BT, Berk M, Demyttenaere K, Goldberg JF, et al. Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World Psychiatry 2023;22:394-412.
Bergfeld IO, Mantione M, Figee M, Schuurman PR, Lok A, Denys D. Treatment-resistant depression and suicidality. J Affect Disord 2018;235:362-7.
Braun C, Bschor T, Franklin J, Baethge C. Suicides and suicide attempts during long-term treatment with antidepressants: a meta-analysis of 29 placebo-controlled studies including 6,934 patients with major depressive disorder. Psychother Psychosom 2016;85:171-9.
Orsolini L, Latini R, Pompili M, Serafini G, Volpe U, Vellante F, et al. Understanding the complex of suicide in depression: from research to clinics. Psychiatry Investig 2020;17:207-21.
Reutfors J, Andersson TM, Brenner P, Brandt L, DiBernardo A, Li G, et al. Mortality in treatment-resistant unipolar depression: a register-based cohort study in Sweden. J Affect Disord 2018; 238:674-9.
Civardi SC, Besana F, Carnevale Miacca G, Mazzoni F, Arienti V, Politi P, et al. Risk factors for suicidal attempts in a sample of outpatients with treatment-resistant depression: an observational study. Front Psychiatry 2024;15:1371139.
Iasp.info. Global suicide statistics [homepage on the Internet]. Washington DC: International Association for Suicide Prevention [cited 2025 Mar 5]. Available from: https://www.iasp.info/ wp-content/uploads/World-Suicide-Prevention-Day-Facts- Figures-2024.pdf
Tor PC, Amir N, Fam J, Ho R, Ittasakul P, Maramis MM, et al. A Southeast Asia consensus on the definition and management of treatment-resistant depression. Neuropsychiatr Dis Treat 2022;18:2747-57.
Paljärvi T, Tiihonen J, Lähteenvuo M, Tanskanen A, Fazel S, Taipale H. Psychotic depression and deaths due to suicide. J Affect Disord 2023;321:28-32.
Riera-Serra P, Navarra-Ventura G, Castro A, Gili M, Salazar- Cedillo A, Ricci-Cabello I, et al. Clinical predictors of suicidal ideation, suicide attempts and suicide death in depressive disorder: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2024;274:1543-63.
Gronemann FH, Jørgensen MB, Nordentoft M, Andersen PK, Osler M. Treatment-resistant depression and risk of all-cause mortality and suicidality in Danish patients with major depression. J Psychiatr Res 2021;135:197-202.
Reutfors J, Andersson TM, Tanskanen A, DiBernardo A, Li G, Brandt L, et al. Risk factors for suicide and suicide attempts among patients with treatment-resistant depression: nested case-control study. Arch Suicide Res 2021;25:424-38.
O’Connor SJ, Hewitt N, Kuc J, Orsini LS. Predictors and risk factors of treatment-resistant depression: a systematic review. J Clin Psychiatry 2023;85:23r14885.
Shi Y, Peng D, Zhang C, Mellor D, Wang H, Fang Y, et al. Characteristics and symptomatology of major depressive disorder with atypical features from symptom to syndromal level. J Affect Disord 2023;333:249-56.
Rost F, Booker T, Gonsard A, de Felice G, Asseburg L, Malda-Castillo J, et al. The complexity of treatment-resistant depression: a data-driven approach. J Affect Disord 2024; 358:292-301.
Rufino NC, Fidalgo TM, Dos Santos JP, Tardelli VS, Lima MG, Frick LP, et al. Treatment compliance and risk and protective factors for suicide ideation to completed suicide in adolescents: a systematic review. Braz J Psychiatry 2021;43:550-8.
Armbrecht E, Shah R, Poorman GW, Luo L, Stephens JM, Li B, et al. Economic and Humanistic Burden Associated with Depression and Anxiety Among Adults with Non-Communicable Chronic Diseases (NCCDs) in the United States. J Multidiscip Healthc 2021;14:887-96.
Wang YX, Sun Y, Missmer SA, Rexrode KM, Roberts AL, Chavarro JE, et al. Association of early life physical and sexual abuse with premature mortality among female nurses: prospective cohort study. BMJ 2023;381:e073613.
LeMoult J, Humphreys KL, Tracy A, Hoffmeister JA, Ip E, Gotlib IH. Meta-analysis: Exposure to early life stress and risk for depression in childhood and adolescence. J Am Acad Child Adolesc Psychiatry 2020;59:842-55.
Vidal C, Lhaksampa T, Miller L, Platt R. Social media use and depression in adolescents: A scoping review. Int Rev Psychiatry 2020;32:235-53.
Scherr S. Social media, self-harm, and suicide. Curr Opin Psychol 2022;46:101311.
Marmarosh C. Spirituality, security, compassion, and play: innovative ways group psychotherapy addresses human suffering. Int J Group Psychother 2024;74:85-97.
Ullah I, Jatchavala C, Waheed S, Shoib S, Ori D. Suicide in low- and middle-income countries: perspectives form overview of studies in South Asia. Asian J Psychiatr 2021;61:102715.
Menon V, Cherian AV, Ahmed F, Chongtham V, Dorji C, Gautam K, et al. Challenges and priorities for suicide prevention in Southeast Asia: insights from the Partnerships for Life regional workshop on suicide prevention. Asian J Psychiatr 2024;98:104126.
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