Depression severity partially mediates the association between thyroid function and psychotic symptoms in first-episode, drug-naive major depressive disorder patients with comorbid anxiety at different ages of onset

Qi-Meng Sun; Sen Zhang; Ya-Hui Xu; Jun Ma; Yan-Ting Zhang; Xiang-Yang Zhang

doi:10.1016/j.jad.2023.07.015

Depression severity partially mediates the association between thyroid function and psychotic symptoms in first-episode, drug-naive major depressive disorder patients with comorbid anxiety at different ages of onset

J Affect Disord. 2023 Oct 15:339:342-347. doi: 10.1016/j.jad.2023.07.015. Epub 2023 Jul 10.

Authors

Qi-Meng Sun¹, Sen Zhang¹, Ya-Hui Xu¹, Jun Ma², Yan-Ting Zhang³, Xiang-Yang Zhang⁴

Affiliations

¹ The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, China.
² Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.
³ Suzhou Guangji Hospital, Suzhou, China.
⁴ CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China. Electronic address: zhangxy@psych.ac.cn.

PMID: 37437726
DOI: 10.1016/j.jad.2023.07.015

Abstract

Background: Anxiety and psychotic symptoms are common in patients with major depressive disorder (MDD), with a strong association with thyroid function. Age of onset contributes to the heterogeneity of MDD patients. This study aimed to assess the prevalence of psychotic symptoms in MDD patients with comorbid anxiety and to explore the relationship between thyroid function and psychotic symptoms by ages of onset.

Methods: A total of 894 first-episode, drug-naïve Chinese Han MDD patients with comorbid anxiety were recruited. Thyroid function and psychometric measures including Hamilton Anxiety Scale, Hamilton Depression Scale, and Positive and Negative Syndrome Scale were evaluated. Patients were divided into early adulthood onset (EAO, < 45 years old) and mid-adulthood onset (MAO, ≥ 45 years old) groups.

Results: The MAO subgroup had a higher prevalence of psychotic symptoms compared to EAO subgroup. TSH and TPOAb levels were positively correlated with psychotic symptoms severity, with a more pronounced effect in MAO subgroup. Furthermore, MDD severity partially mediated the effects of TPOAb and TSH levels on psychotic symptoms in both subgroups.

Limitations: A causal relationship could not be demonstrated with this cross-sectional study, and the results should be limited to first-episode, drug-naïve MDD patients without considering more potential confounders. Moreover, the male-to-female ratio imbalance is present.

Conclusions: Our results indicated that age of onset moderated the association between thyroid function and psychotic symptom, and depression severity partially mediated the effects of thyroid function on psychotic symptoms, suggesting thyroid function may serve as a biomarker of psychotic symptoms in MDD patients with anxiety.

Keywords: Age of onset; Anxiety; Major depressive disorder; Psychotic symptoms; Thyroid function.