Higher Negative Self-Reference Level in Patients With Personality Disorders and Suicide Attempt(s) History During Biological Treatment for Major Depressive Disorder: Clinical Implications

Samuel Bulteau; Morgane Péré; Myriam Blanchin; Emmanuel Poulet; Jérôme Brunelin; Anne Sauvaget; Véronique Sébille

doi:10.3389/fpsyg.2021.631614

Higher Negative Self-Reference Level in Patients With Personality Disorders and Suicide Attempt(s) History During Biological Treatment for Major Depressive Disorder: Clinical Implications

Front Psychol. 2021 Mar 25:12:631614. doi: 10.3389/fpsyg.2021.631614. eCollection 2021.

Authors

Samuel Bulteau^{1

2}, Morgane Péré³, Myriam Blanchin¹, Emmanuel Poulet^{4

5}, Jérôme Brunelin⁴, Anne Sauvaget⁶, Véronique Sébille^{1

3}

Affiliations

¹ UMR INSERM 1246, SPHERE MethodS in Patient-Centered Outcomes and HEalth ResEarch, University of Nantes, University of Tours, Nantes, France.
² CHU Nantes, Department of Addictology and Psychiatry, Nantes, France.
³ CHU Nantes, Department of Methodology and Biostatistics, Nantes, France.
⁴ INSERM-U1028, CNRS-UMR5292, Lyon Neuroscience Research Center, PSYR2 Team, University of Lyon, CH Le Vinatier, Lyon, France.
⁵ Department of Emergency Psychiatry, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
⁶ Nantes Université, CHU Nantes, Movement, Interactions, Performance (MIP), EA 4334, University of Nantes, Nantes, France.

Abstract

Objective: The aim of the study was to identify clinical variables associated with changes in specific domains of self-reported depression during treatment by antidepressant and/or repetitive Transcranial Magnetic Stimulation (rTMS) in patients with Major Depressive Disorder (MDD). Methods: Data from a trial involving 170 patients with MDD receiving either venlafaxine, rTMS or both were re-analyzed. Depressive symptoms were assessed each week during the 2 to 6 weeks of treatment with the 13-item Beck Depression Inventory (BDI₁₃). Associations between depression changes on BDI₁₃ domains (Negative Self-Reference, Sad Mood, and Performance Impairment), treatment arm, time, and clinical variables were tested in a mixed linear model. Results: A significant decrease of self-reported depressive symptoms was observed over time. The main characteristics associated with persistent higher depressive symptomatology on Negative Self-Reference domain of the BDI₁₃ were personality disorders (+2.1 points), a past history of suicide attempt(s) (+1.7 points), age under 65 years old (+1.5 points), and female sex (+1.1 points). Conclusions: Early cognitive intervention targeting specifically negative self-referencing process could be considered during pharmacological or rTMS treatment for patients with personality disorders and past history of suicide attempt(s).

Keywords: BDI; major depressive disorder; patient-reported outcome; personality disorder; rTMS; suicide attempt; venlafaxine.