Aggressive Outbursts among Adults with Major Depressive Disorder: Results from the Collaborative Psychiatric Epidemiological Study

Abstract Introduction Little is known about the epidemiology of aggressive outbursts, including physical assault, property destruction, and verbal aggression, among adults with unipolar major depression disorder (MDD). Methods We examined the prevalence and correlates of aggressive outbursts among adults with primary MDD (N=2539) from the Collaborative Psychiatric Epidemiological Study (N=20013) using generalized linear models. Results The prevalence estimate of any aggressive outbursts was 58.7% among adults with MDD. MDD was associated with aggressive outbursts independent of other psychiatric diagnoses. The prevalence of aggressive outbursts differed significantly by age, race/ethnicity, sex, education, marital status, and employment status, and psychiatric diagnoses. Aggressive outbursts were associated with greater severity and earlier age of onset for MDD. Positive associations were also found between the frequency of aggressive outbursts and depressive symptoms including weight/appetite change, fatigue, recurrent thoughts of death. Moreover, aggressive outbursts significantly multiplied the odds of experiencing higher levels of functional impairment, suicidal ideation, suicide plan, and suicide attempt. Conclusion Aggressive outbursts are much more common than previously recognized among adults with MDD. The significant association of aggressive outbursts with MDD characteristics, increased functional impairment, and suicidal thoughts and behaviors make them an important target for assessment and treatment for adults with MDD.