Symptom Severity and Sociodemographic Correlates of the Suicide Crisis Syndrome in Major Depression: A Multicentric Investigation

Objective: The suicide crisis syndrome (SCS) is a suicide-specific acute cognitive-affective state that seeks to identify individuals at increased near-term risk of suicide. However, little is known about its correlates in psychiatric populations. We aimed to assess symptom severity and sociodemographic correlates of SCS in patients with major depressive disorder (MDD), compared to healthy controls. Methods: Between November 2021 and August 2022, we cross-sectionally administered the revised Suicide Crisis Inventory (SCI-2) to patients with MDD and matched healthy controls across 24 centers in India. We compared SCS total and domain scores between groups using independent samples t-tests. Linear regressions were used to determine the sociodemographic characteristics uniquely associated with SCS, over and above clinical diagnosis. Results: We obtained responses from 1196 patients with MDD (Mean age = 38.1 ± 12.2 years, 54.8% female) and 1067 controls (Mean age = 36.7 ± 11.4 years, 50.5% female). The MDD group had significantly greater severity of total SCS symptoms (t[2063]= −58.57, p < 0.001, Cohen’s d = 2.42) and each of its five domains. In multivariate analyses, age (B= −.37, SE=.11, p < 0.001), female sex (B = 3.61, SE = 1.62, p = 0.026), and living in a nuclear family (B= −3.97, SE = 1.73, p = 0.022) were significantly associated with SCS symptoms. The relationship between age and SCS symptoms was significantly stronger among MDD patients (B= −0.48, SE = 0.14, p < 0.001). Conclusion: Our findings are consistent with prior cross-national investigations of SCS correlates in community samples and overlap with correlates of suicidal behavior. These results point to the potential utility of the SCS construct in early identification of at-risk individuals and prevention of subsequent suicidal behavior.