Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Feb 19, 2025; 15(2): 99996
Published online Feb 19, 2025. doi: 10.5498/wjp.v15.i2.99996
Cumulative effects of stress-sensitivity factors on depressive symptoms and suicide risk: A prospective study
Xue-Mei Qin, Meng-Qi Xu, Ya-Qi Qin, Fang-Zhou Shao, Mo-Han Ma, Wen-Wen Ou, Guan-Yi Lv, Qian-Qian Zhang, Wen-Tao Chen, Xiao-Tian Zhao, Ao-Qian Deng, Jin-Tao Xiong, Ling-Si Zeng, Yi-Lin Peng, Mei Huang, Shu-Yin Xu, Mei Liao, Li Zhang, Ling-Jiang Li, Yu-Meng Ju, Jin Liu, Bang-Shan Liu, Yan Zhang
Xue-Mei Qin, Meng-Qi Xu, Ya-Qi Qin, Fang-Zhou Shao, Mo-Han Ma, Wen-Wen Ou, Guan-Yi Lv, Qian-Qian Zhang, Wen-Tao Chen, Xiao-Tian Zhao, Ao-Qian Deng, Jin-Tao Xiong, Ling-Si Zeng, Yi-Lin Peng, Mei Huang, Shu-Yin Xu, Mei Liao, Li Zhang, Ling-Jiang Li, Yu-Meng Ju, Jin Liu, Bang-Shan Liu, Yan Zhang, Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Co-corresponding authors: Bang-Shan Liu and Yan Zhang.
Author contributions: Liu BS and Zhang Y contributed equally to the conceptualization, project administration, supervision, and writing, review and editing of this manuscript; Li LJ facilitated the project administration, resources, and supervision; Liu BS, Zhang Y, and Qin XM are responsible for funding acquisition; Qin XM, Qin YQ, Shao FZ, Ma MM, Ou WW, Lv GY, Zhang QQ, Chen WT, Zhao XT, Deng AQ, Xiong JT, Zeng LS, Peng YL, Huang M, Xu SY, Liao M, Zhang L, Ju YM, and Liu J are responsible for the recruitment of participants, investigation, and data collection and curation; Qin XM and Xu MQ contributed to the data analyses and wrote the original draft; Liu BS and Qin XM contributed substantial revisions to the manuscript. All authors read and approved the final manuscript. The principal leader in charge of this project was Professor Zhang Y. Under the direction of Professor Zhang Y, Dr. Liu BS was in charge of this project's promotion and execution. They contributed equally to the conceptualization, project administration, supervision, funding acquisition, and writing-review & editing of this manuscript. Their contributions to the research and publication of the paper are equally significant. It is impossible to determine who provided more because their contributions are equal in size. Therefore, with the discussion of all the authors, it was agreed that Professor Zhang Y and Dr. Liu BS would be designated as co-corresponding authors.
Supported by Science and Technology Innovation 2030-Major Projects, No. 2021ZD0202000; National Key Research and Development Program of China, No. 2019YFA0706200; National Natural Science Foundation of China, No. 82371535; Science and Technology Innovation Program of Hunan Province, No. 2023RC3083; and Fundamental Research Funds for the Central Universities of Central South University, No. 2023ZZTS0838.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the National Clinical Medical Research Center, the Second Xiangya Hospital of Central South University, Approval No. MDD202011.
Informed consent statement: All participants in this study signed written informed consent prior to study inclusion.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bang-Shan Liu, MD, Associate Research Scientist, Attending Doctor, Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, Changsha 410011, Hunan Province, China. bangshan.liu@csu.edu.cn
Received: August 5, 2024
Revised: December 4, 2024
Accepted: December 25, 2024
Published online: February 19, 2025
Processing time: 161 Days and 18.8 Hours
Abstract
BACKGROUND

Sensitivity to stress is essential in the onset, clinical symptoms, course, and prognosis of major depressive disorder (MDD). Meanwhile, it was unclear how variously classified but connected stress-sensitivity variables affect MDD. We hypothesize that high-level trait- and state-related stress-sensitivity factors may have different cumulative effects on the clinical symptoms and follow-up outcomes of MDD.

AIM

To investigate how stress-sensitivity factors added up and affected MDD clinical symptoms and follow-up results.

METHODS

In this prospective study, 281 MDD patients were enrolled from a tertiary care setting. High-level stress-sensitivity factors were classified as trait anxiety, state anxiety, perceived stress, and neuroticism, with a total score in the top quartile of the research cohort. The cumulative effects of stress-sensitivity factors on cognitive dysfunction, disability and functional impairment, suicide risk, and depressive and anxiety symptoms were examined using an analysis of variance with linear trend analysis. Correlations were investigated further using multiple regression analysis.

RESULTS

Regarding high-level stress-sensitivity factors, 53.40% of patients had at least one at baseline, and 29.61% had two or more. Four high-level stress-sensitivity components had significant cumulative impacts on MDD symptoms at baseline (all P < 0.001). Perceived stress predicted the greatest effect sizes of state-related factors on depressive symptoms (partial η2 = 0.153; standardized β = 0.195; P < 0.05). The follow-up outcomes were significantly impacted only by the high-level trait-related components, mainly when it came to depressive symptoms and suicide risk, which were predicted by trait anxiety and neuroticism, respectively (partial η2 = 0.204 and 0.156; standardized β = 0.247 and 0.392; P < 0.05).

CONCLUSION

To enhance outcomes of MDD and lower the suicide risk, screening for stress-sensitivity factors and considering multifaceted measures, mainly focusing on trait-related ones, should be addressed clinically.

Keywords: Major depressive disorder; Stress sensitivity; Depressive symptoms; Suicide risk; Cumulative effect

Core Tip: How variously classified but related stress-sensitivity factors affected major depressive disorder (MDD) was unknown. This prospective study looked at the relationship between stress-sensitivity variables and MDD in a novel way. We found that in MDD patients with high-level stress-sensitivity components, baseline symptoms were worse; state factors, especially perceived stress, had a greater influence on depressive symptoms. Patients with high trait factors at follow-up performed worse, especially in trait anxiety- and neuroticism-influenced depressive symptoms and suicide risk, respectively. Screening for stress-sensitivity factors-especially trait ones-should be prioritized to improve disease prognosis.