Self-esteem and Suicide Probability in Melancholic and Non-melancholic Major Depressive Disorder

Melancholic features in major depressive disorder (MDD) are linked to greater clinical severity and increased suicide risk. This study compared self-esteem and suicide probability in melancholic and non-melancholic MDD and examined whether self-esteem is associated with suicide probability beyond depression severity.

A total of 157 adults with DSM-5 MDD (78 melancholic, 79 non-melancholic) and 162 age- and sex-matched healthy controls were included. Participants completed the Rosenberg Self-Esteem Scale (RSES), Suicide Probability Scale (SPS), Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale. Group comparisons, correlations, moderation analysis (RSES × subtype), and multiple linear regression models were conducted.

Compared with controls, patients with MDD had significantly lower self-esteem and higher suicide probability (p < 0.001). Melancholic patients showed lower self-esteem and higher SPS scores than non-melancholic patients (p < 0.001). In both subgroups, self-esteem was negatively correlated with suicide probability. Regression analyses demonstrated that self-esteem remained significantly associated with suicide probability after adjusting for depression severity, anxiety severity, and suicide attempt history. The RSES × subtype interaction was not significant, indicating comparable associations across subtypes. Findings were robust in sensitivity analyses.

Melancholic depression involves greater self-esteem impairment and suicide probability; however, the link between self-esteem and suicide probability is not subtype-specific. Lower self-esteem is a consistent correlate of suicide probability across depressive presentations. These findings should be interpreted cautiously given potential construct overlap with SPS components and the cross-sectional design.