Suicidality Trajectory, Hopelessness, Resilience, and Self-Efficacy Among Patients With Treatment-Resistant Depression in Vietnam.

Abstract

Background: Patients with treatment-resistant depression (TRD) have higher rates of suicidal ideation and a higher suicide attempt prevalence than patients with other types of depression.

Purpose: This study was designed to study the suicidality trajectory and relationships between hopelessness, resilient coping, and self-efficacy, respectively, and suicidal ideation and suicide attempts in patients with TRD during hospitalization and at 3 months after discharge.

Methods: A longitudinal survey of 53 psychiatric inpatients with TRD was conducted. Suicidality, hopelessness, resilient coping, self-reported medication adherence, and self-efficacy were assessed at Weeks 1 and 2 (T0 and T1) after hospitalization and Week 1 and Months 1 and 3 after discharge. Data were analyzed using a Cox regression model.

Results: Suicidality varied across the five time points, with a downward trend observed between T0 and T1 (reflecting the initial effects of inpatient treatment) and an upward trend observed across the 3-month follow-up. Antidepressant overdose was the most common method used for suicide. The risk of high suicidal ideation during follow-up was 1.63, 2.63, and 1.14 times higher, respectively, in participants with a high level of hopelessness, low level of resilient coping, and low self-efficacy. Also, having a higher level of hopelessness and being younger in age increased the risk of attempting suicide by 3.07 times and over 6 times, respectively, compared to older participants.

Conclusions/implication for practice: Suicidality was shown to fluctuate between the in-hospital treatment phase and the first 3 months following discharge in this sample of patients with TRD. Younger age, feelings of hopelessness, low resilience, and low self-efficacy were the top four factors contributing to postdischarge suicide risk. These findings highlight the need for regular patient monitoring and assessment to identify those with TRD who are at high risk of suicide as well as the importance of focusing on hopelessness, resilience, and self-efficacy as predictors of suicide ideation and attempts. Nurses should help patients with TRD, especially those who are younger, and improve and maintain their hope, resilience, and self-efficacy both during hospitalization and shortly after discharge.