The relationship of lifetime suicide attempt with attachment, separation anxiety and chronotype in patients with unipolar major depressive disorder

Life-long suicidal behavior in depressed people stands out as a subject of interest. In this study, we aimed to examine the relationship between lifelong suicidal behavior and separation anxiety, attachment and chronotype in depressed patients. The hypothesis of the study; MDD (Major Depressive Disorder) patients with lifelong suicide attempts compared to those without suicide attempt and healthy controls; Separation anxiety, pathological attachment and eveningness chronotype characteristics are higher and the relationship between lifetime number of suicide attempts and eveningness chronotype characteristics is found to be mediated by separation anxiety and attachment. In this study, 70 patients aged 18-65 years with a diagnosis of MDD with a lifetime suicide attempt and 70 patients with a diagnosis of MDD without a lifetime suicide attempt and 70 healthy volunteers who applied to the Psychiatry Outpatient Clinic of Aydın Adnan Menderes University were included. Sociodemographic Data Form, Beck Suicidal Ideation Scale, Beck Depression Inventory (BDI), Morningness Eveningness Questionnaire (MEQ), Close Relationship Experiences Inventory, Separation Anxiety Symptom Inventory, Adult Separation Anxiety Questionnaire, State and Trait Anxiety Inventory 1 and 2 . (STAI) were applied to all participants. Type-1 error level was taken 5%. In the sociodemographic comparison of MDD patients with and without a lifetime suicide attempt; There was no significant difference other than total education period, employment status, place of residence and family history of psychiatric illness. In comparison of clinical variables; the age of onset of depression was earlier in the group with suicide attempt than in the group without suicide attempt (p=0.01). The number of depression episodes was higher in the group with suicide attempt (p<0.001). BDI (p<0.001), Beck Suicidal Ideation Scale (p<0.001), Close Relationship Experiences Inventory anxiety sub-dimension (p=0.013), Adult Separation Anxiety Questionnaire (p=0.023) scores were higher in the group with suicide attempt. In the patient group, a statistically significant positive correlation was found between the BDI score and the number of depression episodes (p<0.001) and the number of suicide attempts (p<0.001), and a negative correlation between the total education period (p<0.05). A statistically significant negative correlation was found between the Beck Suicidal Ideation Scale score and total education time (p<0.001) and the age of onset of depression (p<0.05), and a positive correlation between the number of depression episodes (p<0.001), suicide attempts (p<0.001) and BDI (p<0.001). In the patient group, there was a positive correlation between the avoidance sub-dimension score of Close Relationship Experiences Inventory and age (p<0.05) and BDI scores (p<0.05), and a statistically significant negative correlation was found between total education time (p<0.001). A positive statistically significant correlation was found between the anxiety sub-dimension score of Close Relationship Experiences Inventory and the number of suicide attempts (p<0.001), BDI (p<0.05) and Beck Suicidal Ideation Scale (p<0.001) scores. There was a positive correlation between MEQ and BDI score (p<0.001), age (p<0.001), age of onset of depression (p<0.001), total education time (p<0.001) and negative correlation between BDI (p<0.001), Close Relationship Experiences Inventory anxiety sub-measure (p<0.001) scores. While there was no statistically significant relationship between MEQ and the number of suicide attempt,Beck Suicidal Ideation Scale. A negative and statistically significant relationship was found between SASI, which examines childhood separation anxiety symptoms in adults, and age (p<0.001), depression onset age (p<0.001) and MEQ scores (p<0.001) and a statistically significant positive correlation between the scores of the ECR anxiety sub-dimension (p<0.001). Also, with the adult separation anxiety questionnaire, a negative correlation was found between age (p<0.05), depression onset age (p<0.001) and MEQ scores (p<0.001); a positive and statistically significant relationship and between depression episodes (p<0.001), number of suicide attempts (p<0.001), BDI (p<0.001), BSS (p<0.001), ECR anxiety sub-dimension (p<0.001) and SASI (p<0.001) scores. In our study, it was found that the age of onset of depression was earlier, the number of depression episodes was higher, and the BDI, BSS, ECR anxiety sub-dimension and ASA-27 scores were higher in MDD patients who had a lifetime suicide attempt. In addition, it was found that eveningness chronotype characteristics did not have a significant power in determining the differences between groups with and without suicide attempt. Contrary to our hypothesis, eveningness chronotype characteristics do not have a predictive effect on suicide attempt; eveningness chronotype characteristics were found to have a partial mediating effect on the relationship between Adult Separation Anxiety Questionnaire scores with depression onset age and depression severity. While some of these relationships are compatible with the literature, further studies are needed to confirm and support some of them with new data. In addition, social jetlag and sleep quality measurements were not made in our study, these assumptions should be confirmed in future studies accordingly.