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Research Article | Open Access

Relationship between TPO-Ab with aggressive behavior in major mental disorders

Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen 518118, China
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Abstract

Purpose

We aimed to explore the relationship between thyroid peroxidase antibody (TPO-Ab) and suicidal and aggressive behaviors in patients with major mental disorders.

Methods

We enrolled 812 inpatients with major mental disorders (schizophrenia, bipolar disorder, and major depressive disorder) in this retrospective study. Baseline interviews were conducted by two psychiatrists. The patients’ suicidal and aggressive behaviors were recorded in the electronic medical record system and these patients were evaluated in terms of violence and suicide behaviors according to the risk assessment form formulated in the Work Code for the Management and Treatment of Severe Mental Illness by the Ministry of Health of China. We calculated the incidence rates of positive TPO-Ab, the suicidal and aggressive behaviors. Furthermore, we explored the relationships among risk factors for suicidal and aggressive behaviors using logistics regression analysis.

Results

Among the 812 patients, 42.6% (n = 346) had TPO-Abs and were defined as the positive group. Rates of suicide and aggression among the enrolled patients were 12.7% (n = 103) and 10.2% (n = 83) respectively. The percentage of patients with aggressive behaviors (13%, n = 45) was higher than that in the negative group (8.2%, n = 38). In contrast, the incidence (9.5%) of suicidal behaviors in the positive group was lower than that (15.0%) in the negative group. TPO-Ab was found to increase the risk of aggressive behavior (odd ratio (OR) = 1.64, 95%CI (1.04, 2.59), P = 0.03) and this effect was still evident after we adjusted for thyroid function (OR = 1.65, 95%CI (1.03, 2.64), P = 0.04). Furthermore, subclinical hypothyroidism (OR = 2.64, 95%CI (1.19, 5.85), P = 0.02) and subclinical hyperthyroidism (OR = 7.03, 95%CI (2.23, 22.20), P = 0.001) were found to be risk factors of aggressive behavior but not for suicide behaviors.

Conclusion

TPO-Abs can affect aggressive behavior but do not affect suicidal behaviors, in patients with major mental disorders. Thus, antibody testing is necessary for psychiatric patients with aggressive behavior. The TPO-Ab test helped the psychiatric staff to determine aggressive behavior in advance.

Keywords

thyroidthyroid peroxidase antibody (TPO-Ab)autoantibodysuicideaggression

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Stress and Brain
Volume 3 Issue 1,
March 2023
Pages 47-61
DOI: 10.26599/SAB.2023.9060006
Cite this article:
Ren L, Wang Y. Relationship between TPO-Ab with aggressive behavior in major mental disorders. Stress and Brain, 2023, 3(1): 47-61. https://doi.org/10.26599/SAB.2023.9060006
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Characteristics of patients with and without TPO-Ab

Patients (n = 812)P
Variablepositive TPO-Ab group (n = 346, 42.6%)negative TPO-Ab group (n = 466, 57.4%)
Age, mean ± SD40.11 ± 0.7637.84 ± 0.690.03
Sex, n (%)0.10
Male180 (52.0)215 (46.1)
Female166 (48.0)251 (53.9)
PH, n (%)0.01
Yes206 (59.5)233 (50.0)
No140 (40.5)233 (50.0)
Length of Hospitalization66.48 ± 5.5938.81 ± 2.980.02
Hospitalization number4.91 ± 0.43.67 ± 0.290.01
Hospitalization expenses35,213 ± 227325,163 ± 1134< 0.001
Thyroid function, n (%)0.04
Hyperthyroidism26 (7.5)18 (3.9)
Subclinical hyperthyroidism4 (1.2)10 (2.1)
Euthyroidism285 (82.4)410 (88.0)
Subclinical hypothyroidism23 (6.6)18 (3.9)
Overt hypothyroidism8 (2.3)10 (2.1)
Diagnosis, n (%)< 0.001
Schizophrenia213 (61.6)207 (44.4)
Bipolar97 (28.0)116 (24.9)
Depression36 (10.4)143 (30.7)
Suicide, n (%)0.02
Yes33 (9.5)70 (15.0)
No313 (90.5)396 (85.0)
Aggression, n (%)0.02
No301(87.0)428 (91.8)
Yes45 (13.0)38 (8.2)

Characteristics of patients with suicidal and aggressive behaviors or not

VariableSuicide (n = 103)No-suicide (n = 709)PAggression (n = 83)No-aggression (n = 729)P
Age, mean ± SD33.78 ± 15.4939.54 ± 14.37< 0.00137.30 ± 12.8938.98 ± 14.820.27
Sex, n (%)0.05
Male26 (25.2)396 (52.0)49 (59.0)346 (47.5)
Female77 (74.8)340 (48.0)< 0.00134 (41.0)383 (52.5)
History, n (%)0.0020.15
Yes41 (39.8)398 (56.1)51 (61.4)388 (53.2)
No62 (60.2)311 (43.9)32 (38.6)341 (46.8)
TPO-Ab, n (%)0.020.02
Yes33 (32.0)313 (44.1)45 (54.2)301 (41.3)
No70 (68.0)396 (55.9)38 (45.8)428 (58.7)
Length of hospitalization28.06 ± 36.6653.87 ± 88.98< 0.00151.07 ± 83.0950.55 ± 84.810.96
Hospitalization number2.03 ± 2.404.52 ± 7.26< 0.0013.93 ± 5.814.23 ± 7.000.66
Hospitalization expenses21866 ± 1613030547 ± 35314< 0.00129295 ± 3379729463 ± 336150.97
Diagnosis, n (%)<0.001
Schizophrenia12 (11.7)408 (57.5)53 (63.9)367 (50.3)
Bipolar26 (25.2)187 (26.4)30 (36.1)183 (25.1)
Depression65 (63.1)114 (16.1)0 (0.0)179 (24.6)
Thyroid function0.130.002
Hyperthyroidism2(1.9%)42 (5.9%)5 (6.0%)39 (5.3%)
Subclinical hyperthyroidism1(1.0%)13 (1.8%)5 (6.0%)9 (1.2%)
Euthyroidism94 (91.3%)601 (84.8%)63 (75.9%)632 (86.7%)
Subclinical hypothyroidism2 (1.9%)39 (5.5%)9 (10.8%)32 (4.4%)
Hypothyroidism4 (3.9%)14 (2.0%)1 (1.2%)17 (2.3%)

Risks for suicide or aggression

SuicideR2HL-testPAggressionR2HL-testP
0.0730.940.0230.89
TPO-positive
NoRefRef
Yes0.63 (0.40, 0.98)0.041.64 (1.04, 2.59)0.03
Sex
MaleRefRef
Female3.11 (1.95, 4.98)<0.0010.65 (0.41, 1.04)0.65
Diagnosis
SchizophreniaRefRef
Bipolar disorder1.15 (0.71, 1.87)0.570.89 (0.50, 1.57)0.68
Depression0.85 (0.48, 1.49)0.571.07 (0.61, 1.88)0.82
Model200.0920.990.0460.86
TPO-Ab
NoRefRef
Yes0.66 (0.42, 1.04)0.071.65 (1.03, 2.64)0.04
Sex
MaleRefRef
Female3.18 (1.99, 5.12)< 0.0010.63 (0.39, 1.01)0.05
Diagnosis
SchizophreniaRefRef
Bipolar disorder1.16 (0.71, 1.89)0.550.87 (0.49, 1.55)0.63
Depression0.81 (0.46, 1.44)0.481.16 (0.65, 2.07)0.61
Thyroid functions
EuthyroidismRefRef
Sub-hypothyroidism0.35 (0.08, 1.49)0.162.64 (1.19, 5.85)0.02
hypothyroidism1.89 (0.58, 6.10)0.290.59 (0.08, 4.58)0.62
Sub-hyperthyroidism0.39 (0.05, 3.05)0.377.03 (2.23, 22.20)0.001
Hyperthyroidism0.29 (0.07, 1.24)0.101.25 (0.47, 3.34)0.65