Authors (including presenting author) :
Cheng S
Affiliation :
Department of Psychiatry, Kowloon Hospital
Introduction :
There have been robust and consistent findings of rumination as a cognitive vulnerability factor of depression. The relationship between rumination and suicide has been a topic of interest and theoretically rumination has a role in the psychological models of suicide. However, the two subsets of rumination, namely brooding and reflection, were not found to be consistently related to suicidal ideation and suicide attempts especially in depressed subjects.
Objectives :
The primary objective was to investigate the correlation between rumination and suicidality in Chinese depressed patients, controlling for depressive severity. The secondary objective sought to compare the degree of rumination between depressed subjects and healthy controls.
Methodology :
This was a cross-sectional observational study conducted in Hong Kong. A total of 56 out-patients with major depressive disorder (MDD) and 60 age-and-sex-matched healthy control subjects were recruited and studied. Rumination was measured by Rumination Response Scale and suicidal ideation by Beck Scale of Suicidal Ideation. Pearson correlation and linear regression analysis were employed to examine the relationship between rumination and suicidal ideation. Binary logistic regression analysis was done to evaluate factors conferring odds to past suicide attempt. Depressive score was included as a covariate in both regression models.
Result & Outcome :
In MDD patients, rumination and suicidal ideation were positively and significantly correlated (r=0.53, p<0.01 for global rumination, r=0.40, p<0.01 for brooding, and r=0.29, p=0.03 for reflection). After controlling for covariates including depressive severity, there remained a positive and significant association (B=0.18, p=0.04) between global rumination and suicidal ideation, but the associations between each subtype of rumination, brooding and reflection, and suicidal ideation, were no longer significant. MDD patients with past suicide attempt endorsed a significantly higher level of reflection, even after accounting for confounding clinical factors. The degree of rumination was significantly higher in MDD patients than healthy controls.
The significant relationship between rumination and suicidal ideation was confirmed in Chinese MDD patients. The association of the two subtypes of rumination and suicidal ideation was not observed after accounting for confounding factors including depressive symptomology. The association of rumination with suicidality could be exerted through depression and/or other factors. Ethnocultural difference in rumination was brought to light and addressed. The adaptiveness of the reflective rumination was questioned. Clinicians are recommended to employ psychotherapy techniques in reducing rumination in patients.
