Prevalence and risk factors of psychotic symptoms in middle-aged patients with first-episode drug-naive major depressive disorder: A large-scale cross-sectional study

Background: Psychotic symptoms are common in patients with major depressive disorder (MDD). However, few studies have assessed the incidence of comorbid psychotic symptoms in first-episode drug naive (FEDN) MDD patients. The present study aimed to evaluate the prevalence and risk factors of psychotic symptoms in a large sample of middle-aged Chinese patients with FEDN MDD. Methods: 813 middle-aged (age range 35 to 65 years) outpatients with FEDN MDD were recruited. The 17-item Hamilton Rating Scale for Depression (HAMD), the 14-item Hamilton Anxiety Rating Scale (HAMA), and the positive subscales of the Positive and Negative Syndrome Scale (PANSS) were used to assess patient anxiety, depression and psychotic symptoms, respectively. Results: The prevalence of psychotic symptoms in middle-aged patients with FEND MDD was 10.95 %. Multi-variate logistic regression analysis showed that HAMA score, HAMD score, TSH, TC and BMI levels were sig-nificant predictors of psychotic symptoms in MDD middle-aged patients. The HAMA score and HAMD score predicted psychotic symptoms for both male and female middle-aged patients with MDD, while higher TSH, TC and BMI levels were correlated with psychotic symptoms only in female MDD patients. Furthermore, combining the HAMA score, HAMD score, and TSH could differentiate between psychotic major depression (PMD) and nonpsychotic major depression (NPMD) in middle-aged patients. Conclusions: Psychotic symptoms among middle-aged patients with MDD can be identified by integrating clinical and biological variables as early as possible during the first time see a doctor.