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Suicidal thoughts/acts and clinical correlates in patients with depressive disorders in Asians: results from the REAP-AD study

  • Seon-Cheol Park (a1), Min-Soo Lee (a2), Sang Woo Hahn (a3), Tian-Mei Si (a4), Shigenobu Kanba (a5), Mian-Yoon Chong (a6), Chee Kok Yoon (a7), Pichet Udomratn (a8), Adarsh Tripathi (a9), Norman Sartorius (a10), Naotaka Shinfuku (a11), Margarita M. Maramis (a12) and Yong Chon Park (a13) (a14)...



Using data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) study, we aimed to present the rates and clinical correlates of suicidal thoughts/acts in patients recruited from a total of 40 centres in 10 Asian countries/areas: China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Singapore, Taiwan, and Thailand.


Data from 1122 patients with depressive disorders in the REAP-AD study were used. The ICD-10 was employed to diagnose depressive episodes and recurrent depressive disorder. The presence or absence of suicidal thoughts/acts and profile of other depressive symptoms was established using the National Institute for Health and Clinical Excellence guidelines for depression. Country/area differences in rates of suicidal thoughts/acts were evaluated with the χ2 test. In addition, depressive symptom profiles, other clinical characteristics, and patterns of psychotropic drug prescription in depressed patients with and without suicidal thoughts/acts were compared using analysis of covariance for continuous variables and logistic regression analysis for discrete variables to adjust the effects of covariates.


The rates of suicidal thoughts/acts in 10 countries/areas varied from 12.8% in Japan to 36.3% in China. Patients with suicidal thoughts/acts presented more persistent sadness (adjusted odds ratio [aOR]=2.64, p<0.001), loss of interest (aOR=2.33, p<0.001), fatigue (aOR=1.58, p<0.001), insomnia (aOR=1.74, p<0.001), poor concentration (aOR=1.88, p<0.001), low self-confidence (aOR=1.78, p<0.001), poor appetite (aOR=2.27, p<0.001), guilt/self-blame (aOR=3.03, p<0.001), and use of mood stabilisers (aOR=1.79, p<0.001) than those without suicidal thoughts/acts.


Suicidal thoughts/acts can indicate greater severity of depression, and are associated with a poorer response to antidepressants and increased burden of illness. Hence, suicidal thoughts/acts can provide a clinical index reflecting the clinical status of depressive disorders in Asians.


Corresponding author

Yong Chon Park, Department of Psychiatry, Hanyang University Guri Hospital, 249-1, Gyomun-dong, Guri 471-701, Republic of Korea. Tel: +82 31 560 2273; Fax: +82 31 554 2599; E-mail:


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1. Jeon, HJ. Epidemiologic studies on depression and suicide. J Korean Med Assoc 2012;55:322338.
2. Park, YM, Ko, YH, Lee, MS, Lee, HJ, Kim, L. Type-D personality can predict suicidality in patients with major depressive disorder. Psychiatr Investig 2014;11:232236.
3. Vijayakumar, L, Rajkumar, S. Are risk factors for suicide universal? A case-control study in India. Acta Psychiatr Scand 1999;99:407411.
4. Baek, JH, Park, JI, An, J et al. Review of suicide prevention programs: Massauchsetts, United States, in comparison with Seoul. Psychiatr Investig 2015;12:281287.
5. Carragher, N, Mewton, L, Slade, T, Teesson, M. An item response analysis of the DSM-IV criteria for major depression: findings from the Australian National Survey of Mental Health and Wellbeing. J Affect Disord 2011;130:9298.
6. Jeon, HJ, Walker, RS, Inamori, A et al. Differences in depressive symptoms between Korean and American outpatients with major depressive disorder. Int Clin Psychopharmacol 2014;29:150156.
7. Cantor, CH, Neulinger, K. The epidemiology of suicide and attempted suicide. Aust N Z Psychiatry 2000;34:370387.
8. Han, CS, Ogrozniczuk, JS, Oliffe, JL. Qualitative research on suicide in East Asia: a scoping review. J. Mental Health 2013;22:372383.
9. Shinfuku, N. Research on Asian Prescription Pattern (REAP): focusing on data from Japan. Taiwanese J Psychiatry 2014;28:7295.
10. Chee, KY, Tripathi, A, Avasthi, A et al. . Country variations in depressive symptoms profile in Asian countries: findings of the Research on Asia Psychotropic Prescription (REAP) studies. Asia Pac Psychiatry 2015;7:276285.
11. Chee, KY, Tripathi, A, Avasthi, A et al. International study on antidepressant prescription pattern at 40 major psychiatric institutions and hospitals in Asia: a 10-year comparison study. Asia Pac Psychiatry 2015;7:366374.
12. Chen, C, Si, TM, Xiang, YT et al. Prevalence and prescription of antidepressants in depression with somatic comorbidity in Asia: the Research on East Asian Psychotropic Prescription Patterns Study. Chin Med J 2015;127:853858.
13. Park, SC, Lee, MS, Shinfuku, N et al. Gender differences in depressive symptom profiles and patterns of psychotropic drug usage in Asian patients with depression: findings from the Research on Asian Psychotropic Prescription Patterns for Antidepressants study. Aust N Z J Psychiatry 2015;49:833841.
14. Park, SC, Shinfuku, N, Maramis, MM, Lee, MS, Park, YC. Adjunctive antipsychotic prescriptions for patients with depressive disorders in Asia: the Research on Asian Psychotrophic Prescription Patterns for Antidepressant (REAP-AD) study. Am J Psychiatry 2015;172:684685.
15. World Health Organization. The ICD-10 classification of mental and behavioral disorders, clinical descriptions and diagnostic guidelines. Geneva: World Health Organization, 1992.
16. National Institute for Health and Clinical Excellence. Depression in adults: the treatment and management of depression in adults. London: National Institute for Health and Clinical Excellence, 2009.
17. Park, SC, Lee, MS, Kang, SG, Lee, SH. Patterns of antipsychotic prescription to patients with schizophrenia in Korea: results from the health insurance review & assessment service-national patient sample. J Korean Med Sci 2014;29:719728.
18. Takei, N, Nakamura, K. Is inseki-jisatsu responsibility-driven suicide, culture-bound? Lancet 2004;363:1400.
19. Marcus, SM, Kerber, KB, Rush, AJ et al. Sex differences in depressive symptoms in treatment-seeking adults: confirmatory analysis form the sequenced treatment alternatives to relieve depression study. Compr Psychiatry 2008;49:238246.
20. Bagalkot, TR, Park, JI, Kim, HT et al. Lifetime prevalence of and risk factors for suicidal ideation and suicide attempts in a Korean community sample. Psychiatry 2014;77:360363.
21. Lim, AY, Lee, AR, Hatim, A et al. Clinical and sociodemographic correlates suicidality in patients with major depressive disorder from six Asian countries. BMC Psychiatry 2014;14:37.
22. Imai, H, Chen, W, Fujutomi, E et al. Depression and subjective economy among elderly people in Asian communities: Japan, Taiwan and Korea. Arch Gerontol Geriatr 2015;60:322327.
23. Pearson, V, Liu, M. Ling’s death: an ethnography of a Chinese woman’s suicide. Suicide Life Threat Behav 2002;32:347358.
24. Dong, XQ, Chang, ES, Zeng, P, Simon, MA. Suicide in the global Chinese aging population: a review of risk and protective factors, consequences and interventions. Aging Dis 2015;6:121130.
25. Morris, P, Maniam, T. Ethnicity and suicidal behaviour in Malaysia: a review of the literature. Transcul Psychiatry 2001;38:5161.
26. Aishvarya, S, Maniam, T, Sidi, H, Oei, TPS. Suicide ideation and intent in Malaysia: a review of the literature. Compr Psychiatry 2014;55(Suppl. 1):s95s100.
27. Tseng, WS. Culture and psychopathology: general view. In: Bhugra D, Bhui K editors Textbook of cultural psychiatry. Cambridge: Cambridge University Press, 2007; p. 95112.
28. O’Reilly, D, Rosato, M. Religion and the risk of suicide: longitudinal study of over 1 million people. Br J Psychiatry 2015;206:466470.
29. Seo, HJ, Jung, YE, Jeong, S et al. Persistence and resolution of suicidal ideation during treatment of depression in patients with significantly suicidality at the beginning of treatment: the CRESCEND study. J Affect Disord 2014;155:208215.
30. Zhu, Y, Zhang, H, Shi, S et al. Suicidal risk factors of recurrent major depression in Han Chinese women. PLoS One 2013;8:e80030.
31. Ando, S, Kasai, K, Matamura, M, Hasegawa, Y, Hirakawa, H, Asukai, N. Psychosocial factors associated with suicidal ideation in clinical patients with depression. J Affect Disord 2013;151:561565.
32. Jia, Z, Wang, Y, Huang, X, Kuang, W et al. Impaired frontothalamic circuitry in suicidal patients with depression revealed by diffusion tensor imaging at 3.0 T. J Psychiatry Neurosci 2014;39:170177.
33. Malhi, GS, Tanious, M, Das, P, Berk, M. The science and practice of lithium therapy. Aust N Z J Psychiatry 2012;46:192211.
34. Hantouche, EG, Akiskal, HS, Lancrenon, S et al. Mood stabilizer augmentation in apparently ‘unipolar’ MDD: predictors of response in the naturalistic French national EPIDEP study. J Affect Disord 2005;84:243249.
35. Mastumoto, T, Kobayashi, T, Kato, S. Predictors of length of hospital stay for patients with late-onset depression in Japan. Psychogeriatrics 2014;14:124131.
36. Weitz, E, Hollon, SD, Kerkhof, A, Cuijpers, P. Do depression treatments reduce suicidal ideation? The effects of CBT, IPT, pharmacotherapy, and placebo on suicidality. J Affect Disord 2014;167:98103.
37. Yu, SH, Liu, SK, Lin, KM. Psychopharmacology across cultures. In: Bhugra D, Bhui K editors Textbook of cultural psychiatry. Cambridge: Cambridge University Press, 2007; p. 402413.



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