Characteristics And Correlation Of Suicidal Ideation-related Cognitive Impairment In Adolescents With Depressive Disorder

Objective: To explore the characteristics of attentional bias（AB）,emotional memory（EM）,executive function（EF）and their role in the early identification of suicidal ideation in adolescents with depressive disorder.MDD is a general term of disease mainly manifested by mood or depression,accompanied by varying degrees of cognitive and behavioral changes,accompanied by psychotic symptoms,some patients have self-injury,suicide behavior,and even death.The incidence of adolescent depressive disorder has been increasing in recent years,which is about4%-8% among adolescents,and the male to female ratio is about 1:2.Foreign studies have shown that the cumulative incidence of depression among adolescents under 18 years old in the community is up to 20%.Depressive disorder seriously affects the physical and mental health and social functions of adolescents,most patients have a tendency to relapse,and some adolescents’ depressive symptoms can last into adulthood.Severe adolescent depressive disorder patients are often accompanied by negative suicidal ideas and behaviors.The suicidal ideas of patients with depressive disorder are often stubborn and recurrent.Driven by suicide ideation（SI）,some adolescents will make suicide attempts（SA）.Many adult studies have shown that neurocognitive and social cognitive impairment exists in the acute phase of MDD,and cognitive impairment may be one of the important factors for depression,susceptibility to suicidal activities and long-term secondary effects.At present,there are few studies on cognitive function of adolescents with depression at different stages of suicide activity in China.This study used attentional bias,emotional memory task and stroop color words test（SCWT）to study adolescents with MDD with suicidal ideation.Methods: Adolescents aged 13-18 years with depressive disorder who met the Diagnostic criteria for depressive disorder in the diagnostic and statistical manual of mental disorders（DSM-5）were collected.Experiment 1 used E-prime programming to design attentional bias and emotional memory paradigm,according to the Beck scale for suicidal ideation-chinese version（BSI-CV）evaluation results,the adolescent depressive disorder patients were divided into the adolescent depressive disorder group with suicidal ideation（SI group,n =50）and adolescents with depressive disorder without suicidal ideation（NSI group,n =36）.Experiment 2 used the stroop color words test（SCWT）,and according to the BSI-CV assessment results,the adolescents with depression were divided into the adolescent depression group with suicidal ideation（SI group,n =47）and those without suicidal ideation（NSI group,n=38）.Healthy control group was recruited from healthy adolescent students from two ordinary middle schools in Hefei City who were matched with the MDD group in terms of age,gender,and education level during the same period（the adolescent depressive disorder patients to be included in the group below are called case group）.The 17-item Hamilton depression scale-17（HAMD-17）,the 14-item Hamilton anxiety scale-14（HAMA-14）,the Beck scale for suicidal ideation-chinese version,BSI-CV),Mini international neuropsychiatric interview chinese version（M.I.N.I）for symptom assessment,using attentional bias,emotional memory task test,and stroop color words test were used to evaluate the case group and healthy control group.Results: Experiment one:（1）In the attentional bias task test,the negative reaction time and neutral reaction time of the case group were significantly higher than those of the healthy adolescent group.There was no significant difference in the adolescent depression group,and there was no significant difference in the negative correct rate,neutral correct rate,and attentional bias among the three groups.（2）In the emotional memory test,the positive picture valence score of the case group was significantly lower than that of the healthy adolescent group,and the positive score of the group with suicidal ideation was lower than that of the group without suicidal ideation;the valence score of neutral pictures in the group with suicidal ideation was significantly higher lower than the no suicidal ideation group and the healthy group;the negative picture valence score of the case group was significantly higher than that of the healthy group;in the recognition stage,the recognition rate of positive pictures in the adolescent depression group was significantly lower than that in the healthy group,and the three groups of neutral pictures There was no significant difference in the recognition rate,and the recognition rate of negative pictures in the group with suicidal ideation was significantly lower than that in the healthy group;there was no significant difference in the number of misrecognition of pictures in each category among the three groups.（3）In the emotional memory task test,negative picture recognition accuracy was significantly negatively correlated with anxiety/somatization,cognitive impairment,mental anxiety,and suicidal ideation intensity（r=-0.352,-0.326,-0.309,-0.319,-0.302,-0.345,all P <0.01）Positive and neutral picture recognition rates were not significantly correlated with anxiety,depression,and suicidal ideation intensity.（4）Univariate analysis showed that neutral image valence score,HAMA-14 total score,mental anxiety,somatic anxiety,HAMD-17 total score,cognitive impairment and block would affect the presence OR absence of suicidal ideation（P <0.01）.Multivariate Logstic regression analysis showed that neutral image score of emotional memory task was lower（OR =-0.503,P <0.01）and high HAMD-17 factor cognitive impairment score（OR =-1.388,P <0.05）were risk factors for suicidal ideation in adolescents with depression.Experiment two: In stroop color word test,the healthy control group had significantly lower point time,word time,color word time and SIE time than the case group（P <0.01）.There were no significant differences in point time,word time,color word time and SIE time between the depressive disorder group with suicidal ideation and the depressive disorder group without suicidal ideation.Conclusion: Attentional bias,emotional memory and executive function of adolescents with depressive disorder are impaired,and the impairment of emotional memory is more obvious in adolescent depressive disorder patients with suicidal ideation.The valence scores of positive and neutral pictures in the suicidal ideation group were significantly lower than those of adolescent depressive disorder patients without suicidal ideation,and compared with the healthy control group,the negative picture recognition task was worse and correlated with the intensity of suicidal ideation.Negative bias in neutral pictures and the severity of cognitive impairment may be important risk factors for suicidal ideation in adolescents with depression.