Patients With an MDE and History of Psychotic Symptoms Present With More Severe Clinical Profile

Patients with MDE-HPS+ vs those with MDE-HPS- more often presented with a higher probability of more severe profile, with increased rates of psychiatric comorbidities, particularly a history of a manic episode and a history of a suicide attempt.

Individuals from the general population who have a major depressive episode (MDE) and a history of psychotic symptoms (MDE-HPS+) present with more psychiatric comorbidities and an overall more severe clinical profile compared with patients with MDE but no history of psychotic symptoms (MDE-HPS-), according to a study published in the Journal of Affective Disorders.

Although psychotic depression has been widely studied, data remains limited about MDE-HPS+. The findings of this study were according to an analysis of responses from the Mental Health in the General Population survey, which interviewed 38,694 individuals from the general population in France between 1999 and 2003.

Participants in the survey were screened for psychiatric disorders with the Mini International Neuropsychiatric Interview (MINI). This study focused on MDE, alcohol use disorder (AUD) and abuse, history of a manic episode, panic disorder, social anxiety disorder, generalized anxiety disorder, and post-traumatic stress disorder (PTSD). Previous suicide attempts were also accessed. Additionally, psychotic symptoms were screened with the “psychotic disorders” section of the MINI. Delusional symptoms as well as auditory and visual hallucinations were assessed.

A diagnosis of a current MDE was reported in 11.2% (n=4229) of the entire sample and was included in this analysis. Approximately 39.3% (n=1578) of these participants had ≥1 lifetime psychotic symptoms and were included in the MDE-HPS+ group. This population yielded a 4% prevalence rate for MDE-HPS+ in the overall sample. Compared with the individuals with MDE-HPS-, those with MDE-HPS+ were significantly younger (18-29 years: odds ratio [OR], 2.42; 95% CI, 1.85-3.17; P <.001; 30-44 years: OR, 1.90; 95% CI, 1.49-2.42; P <.001; 45-59 years: OR, 1.65; 95% CI, 1.30-2.10; P <.001) and were less educated (OR, 1.34; 95% CI, 1.07-1.69; P =.011).

Patients with MDE-HPS+ more often reported that they were never married (OR, 1.35; 95% CI, 1.13-1.61; P <.001) and separated (OR, 1.26; 95% CI, 1.01-1.57; P =.038). Additionally, a significantly higher rate of migrants from the 3 generations was observed for participants with MDE-HPS+ (first-generation migrant: OR, 1.47; 95% CI, 1.13-1.91; P =.004; second-generation migrant: OR, 1.25; 95% CI, 1.02-1.51; P =.027; third-generation migrant: OR, 1.37; 95% CI, 1.10-1.69; P =.004).

The study also found that patients with MDE-HPS+ vs those with MDE-HPS- more often had a history of a manic episode (OR, 1.82; 95% CI, 1.21-2.75; P =.004), AUD (OR, 1.36; 95% CI, 1.02-1.80; P =.034), panic disorder (OR, 2.08; 95% CI, 1.68-2.57; P <.001), social anxiety disorder (OR, 1.65; 95% CI, 1.28-2.11; P <.001), generalized anxiety disorder (OR, 1.48; 95% CI, 1.23-1.77; P <.001), and a personal history of a suicide attempt (OR, 1.61; 95% CI, 1.33-1.95; P <.001).

Limitations of this study included its observational cross-sectional design, generalizability, as well as the lack of data on participants’ treatments or personality disorders.

Considering these findings, the investigators of this study suggest that “the history of psychotic symptoms should always be explored in patients with MDE, as well as the opportunity to prescribe a mood stabilizer, especially in treatment resistant depression.”


Benard V, Pignon B, Geoffroy PA, et al. Depression with and without a history of psychotic symptoms in the general population: sociodemographic and clinical characteristics [published online May 16, 2020]. J Affect Disord. doi: 10.1016/j.jad.2020.04.048