Association between subclinical hypothyroidism and psychotic features in Chinese young adults with first-episode and untreated major depressive disorder

Wenyu Dai; Jieyu Liu; Haiqing Xie; Ziwei Teng; Wenbo Luo; Hui Yuan; Jindong Chen; Minghui Liu; Xiangyang Zhang

doi:10.1016/j.jad.2023.04.067

Association between subclinical hypothyroidism and psychotic features in Chinese young adults with first-episode and untreated major depressive disorder

J Affect Disord. 2023 Jul 15:333:209-215. doi: 10.1016/j.jad.2023.04.067. Epub 2023 Apr 21.

Authors

Wenyu Dai¹, Jieyu Liu², Haiqing Xie³, Ziwei Teng¹, Wenbo Luo¹, Hui Yuan⁴, Jindong Chen¹, Minghui Liu⁵, Xiangyang Zhang⁶

Affiliations

¹ National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
² National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; Department of Ultrasound Diagnostic, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
³ Department of Ultrasound Diagnostic, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
⁴ Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
⁵ Department of Ultrasound Diagnostic, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China. Electronic address: liuminghui03@aliyun.com.
⁶ CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China. Electronic address: zhangxy@psych.ac.cn.

PMID: 37086799
DOI: 10.1016/j.jad.2023.04.067

Abstract

Background: Thyroid dysfunction is often reported in patients with major depressive disorder (MDD) and may be associated with depression severity and psychotic symptoms. We included young adults with first-episode and untreated MDD to avoid the effect of age and disease duration on thyroid dysfunction and psychotic symptoms.

Methods: 481 young patients with MDD (aged 18-24 years) were recruited. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Positive and Negative Syndrome Scale (PANSS) positive subscale and Global Impression of Severity Scale (CGIS) were used to assess depression, anxiety, psychotic symptoms and disease severity, respectively.

Results: The prevalence rate of subclinical hypothyroidism (SCH) and thyroid antibody positivity was 56.76 % (273/481) and 26.61 % (128/481) in young MDD, respectively. A higher proportion of MDD patients with SCH displayed psychotic features (14.3 % vs. 5.3 %, OR = 2.985, p = 0.001). TSH was a risk factor for psychotic symptoms in MDD patient with SCH (B = 0.136, p = 0.017, OR = 1.384), with an AUC of 0.709, indicating acceptable discrimination. Multivariate regression analysis also showed that TSH was also independently associated with PANSS positive score (B = 0.339, t = 2.019, p = 0.045).

Limitation: This cross-sectional study design did not demonstrate a causal relationship. Relying solely on the PANSS positive subscale as psychotic symptoms may cause bias.

Conclusions: Our findings suggest that SCH is common in young patients with first-episode and untreated MDD. MDD patients with higher TSH levels may suffer from more psychotic symptoms. Regular screening of serum thyroid hormones is necessary in patients with MDD.

Keywords: Major depressive disorder; Psychotic features; Subclinical hypothyroidism; Young adult.

MeSH terms

Cross-Sectional Studies
Depressive Disorder, Major* / complications
Depressive Disorder, Major* / diagnosis
Depressive Disorder, Major* / epidemiology
East Asian People
Humans
Hypothyroidism* / complications
Hypothyroidism* / diagnosis
Hypothyroidism* / epidemiology
Thyrotropin
Young Adult

Substances

Thyrotropin