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The depressive spectrum: diagnostic classification and course

Published on Aug 1, 1997in Journal of Affective Disorders 4.08
· DOI :10.1016/S0165-0327(97)00057-8
Jules Angst81
Estimated H-index: 81
(UZH: University of Zurich),
Kathleen R. Merikangas102
Estimated H-index: 102
(Yale University)
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Abstract
Abstract The spectrum of depression is much wider than that reflected in the current diagnostic nomenclature. A large proportion of subjects with depression both in treatment and in the community fail to meet diagnostic criteria for either major depressive disorder (MDD) or dysthymia. Inclusion of subthreshold categories of depression dramatically improves the coverage of treated depression, particularly in community samples, and better enables the characterization of its longitudinal course. This paper investigates the application of diagnostic criteria for both threshold and subthreshold categories of depression in a prospective longitudinal community study of young adults from Zurich, Switzerland. We present the prevalence and treatment rates of each of the depressive subtypes, the degree of diagnostic overlap and the longitudinal stability of subthreshold and threshold categories of depression. The findings indicate that the prevalence rates of subthreshold categories of depression are quite high in the community, and that a substantial proportion of subthreshold depressives, particularly those with recurrent depression, receive treatment. There is a strong tendency for individuals to meet multiple depressive subtypes over time, with little stability of individual categories among those who continue to manifest depression over a 15-year period. The prospective longitudinal data reveal that major depression is both an antecedent to and sequela of subthreshold categories, providing evidence for the validity of the spectrum concept of depression. However, the need for a threshold for the symptom criteria is suggested by the lack of predictive value of minor depression and depressive symptoms only. These results suggest that both the current symptom threshold for a depressive syndrome and recurrence, but not the minimum duration of depressive episodes, are important components of the classification of depression.
  • References (26)
  • Citations (236)
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References26
Newest
Wolfgang Maier101
Estimated H-index: 101
(University of Mainz),
R. Herr5
Estimated H-index: 5
(University of Mainz)
+ 3 AuthorsG. Faust2
Estimated H-index: 2
(University of Mainz)
Depression with substantial psychosocial impairment, but not qualifying as depressive disorder according to the standard diagnostic manuals, is frequent among primary care patients. Recurrent brief depression (RBD) is a diagnostic category intended to identify a major proportion of this group of patients. The WHO study on “Psychological Problems in Primary Health Care” was used as a vehicle to estimate the proportion of patients with this diagnosis and to evaluate the validity of this diagnosis ...
13 Citations Source Cite
Wolfgang Maier101
Estimated H-index: 101
,
R. Herr5
Estimated H-index: 5
+ 3 AuthorsG. Faust2
Estimated H-index: 2
20 Citations Source Cite
Published on Jan 1, 1994
Ronald C. Kessler229
Estimated H-index: 229
,
Katherine A. McGonagle18
Estimated H-index: 18
+ 5 AuthorsKenneth S. Kendler9
Estimated H-index: 9
3,465 Citations
Published on Jan 1, 1994in Archives of General Psychiatry
Ronald C. Kessler229
Estimated H-index: 229
(UM: University of Michigan),
Katherine A. McGonagle18
Estimated H-index: 18
(MPG: Max Planck Society)
+ 5 AuthorsKenneth S. Kendler9
Estimated H-index: 9
(MPG: Max Planck Society)
Background: This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States. Methods: The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version...
9,856 Citations Source Cite
Published on Oct 1, 1993in Archives of General Psychiatry
Johan Ormel105
Estimated H-index: 105
,
Tineke Oldehinkel4
Estimated H-index: 4
+ 1 AuthorsW. van den Brink74
Estimated H-index: 74
Background: We evaluated the long-term outcome of depression and anxiety and associated disability among primary-care attenders with common psychiatric disorders and symptoms (n=201) using binary and multicategorical, interview-based outcome measures of psychiatric illness and disability. Methods: A two-stage design was used. In the first stage, 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness with the General Health Questionnaire and by their physician...
183 Citations Source Cite
Jules Angst81
Estimated H-index: 81
,
A. Dobler-Mikola4
Estimated H-index: 4
A prospective study of depressive syndromes and diagnoses was performed among a young adult Swiss population with three interviews over 7 years. Different definitions of depressive states were used: on the one hand, depressive syndromes including mood disturbances of any severity, on the other, well-defined diagnoses of depression. Women were consistently overrepresented among subjects with depressive syndromes of some length and among those with DSM-III major depressive disorder. Both sexes app...
383 Citations Source Cite
Published on Jun 1, 1990in Journal of Affective Disorders 4.08
Jules Angst81
Estimated H-index: 81
,
Kathleen R. Merikangas102
Estimated H-index: 102
+ 1 AuthorsW. Wicki1
Estimated H-index: 1
(Yale University)
Abstract This paper presents the diagnostic criteria for a new subtype of affective disorder, recurrent brief depression (RBD). Data from a prospective longitudinal cohort of young adults from the general population of Zurich, Switzerland, showed that a substantial proportion, met all of the criteria for major depression in current diagnostic systems except duration. The validity of the subtype of RBD was examined according to clinical manifestations, severity, longitudinal course, and family hi...
165 Citations Source Cite
Published on May 1, 1990in Journal of Affective Disorders 4.08
H.-J. Haug1
Estimated H-index: 1
,
E. Fähndrich1
Estimated H-index: 1
Abstract This study investigates the relationship between the severity of the depressive syndrome and the occurrence of diurnal mood variation. Several authors have proposed that diurnal variations of mood cease in the severest states of depression. By contrast, others suggest a rhythm-inducing effect of depression. We could not find any correlation between the severity of depression and various measures of diurnal mood variation in a group of 70 patients. These findings are discussed against th...
22 Citations Source Cite
Published on Aug 18, 1989in JAMA 51.27
Kenneth B. Wells86
Estimated H-index: 86
,
Anita L. Stewart71
Estimated H-index: 71
+ 6 AuthorsJohn E. Ware120
Estimated H-index: 120
We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11 242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditio...
2,512 Citations Source Cite
Cited By236
Newest
Published on Dec 1, 2019in BMC Psychiatry 2.67
Helle Østermark Sørensen4
Estimated H-index: 4
(AAU: Aalborg University),
Jan Brink Valentin5
Estimated H-index: 5
(AAU: Aalborg University)
+ 3 AuthorsØyvind Omland20
Estimated H-index: 20
(AAU: Aalborg University)
Depression and anxiety are prevalent mental disorders among the working population with potentially high personal and financial cost. The overall aim of this study was to test the applicability of an outreach collaborative model for early identification and treatment of clinical and sub-clinical mental disorders among Danish employees. This applicability was examined by I) investigating the fractions of identified and treated clinical and subclinical cases, II) describing the distribution and ch...
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Published on Mar 1, 2019in Pharmacopsychiatry 2.74
Michael Bauer70
Estimated H-index: 70
(TUD: Dresden University of Technology),
Rush Aj1
Estimated H-index: 1
(TTU: Texas Tech University)
+ 2 AuthorsMazda Adli31
Estimated H-index: 31
(Charité)
In spite of multiple new treatment options, chronic and treatment refractory courses still are a major challenge in the treatment of depression. Providing algorithm-guided antidepressant treatments is considered an important strategy to optimize treatment delivery and avoid or overcome treatment-resistant courses of major depressive disorder (MDD). The clinical benefits of algorithms in the treatment of inpatients with MDD have been investigated in large-scale, randomized controlled trials. Resu...
1 Citations Source Cite
Published on Jan 1, 2019in Journal of Affective Disorders 4.08
Hongguang Chen4
Estimated H-index: 4
(PKU: Peking University),
Xiao Wang1
Estimated H-index: 1
(PKU: Peking University)
+ 4 AuthorsHongchun Geng1
Estimated H-index: 1
Abstract Background Previous studies about comorbidity have primarily focused on disorders based on diagnostic criteria instead of symptoms. This study aimed to describe the prevalence and risk factors of anxiety comorbid depression based on a population-based sample in Chifeng City Inner Mongolia and explored the gender differences of depressive subtypes in anxiety patients. Methods This study was a cross-sectional study conducted among 6376 community residents. Logistics analysis and multiple-...
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Published on Nov 1, 2018in Depression and Anxiety 4.93
David S. Fink11
Estimated H-index: 11
(Columbia University),
Jaimie L. Gradus1
Estimated H-index: 1
(BU: Boston University)
+ 6 AuthorsSandro Galea85
Estimated H-index: 85
(BU: Boston University)
1 Citations Source Cite
Published on Aug 1, 2018in International Journal of Geriatric Psychiatry 3.14
Robert Sigström7
Estimated H-index: 7
(University of Gothenburg),
Margda Waern39
Estimated H-index: 39
(University of Gothenburg)
+ 2 AuthorsSvante Östling25
Estimated H-index: 25
(University of Gothenburg)
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Published on Mar 1, 2018in Biological Research For Nursing 1.51
Jennifer E. Sanner6
Estimated H-index: 6
(University of Texas Health Science Center at Houston),
Megan L. Grove26
Estimated H-index: 26
(University of Texas Health Science Center at Houston)
+ 5 AuthorsLorraine Frazier14
Estimated H-index: 14
(University of Texas Health Science Center at Houston)
Depressive symptoms independently contribute to major adverse coronary events (MACEs), with the biological immune response to depression being a likely mediator of this relationship. To determine whether genetic- and/or gender-specific phenotypic differences contribute to associations among depressive symptoms, inflammatory response, and risk of MACE in patients with acute coronary syndrome (ACS), we conducted a prospective study of 1,117 ACS patients to test a gender-specific model in which dep...
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Published on Dec 1, 2017in Korean journal of health psychology
Kim Jong-Nam2
Estimated H-index: 2
,
Soonmook Lee6
Estimated H-index: 6
+ 4 AuthorsChul-Hyun Cho1
Estimated H-index: 1
2 Citations Source Cite
Michael Bauer70
Estimated H-index: 70
(TUD: Dresden University of Technology),
Emanuel Severus18
Estimated H-index: 18
(TUD: Dresden University of Technology)
+ 1 AuthorsAllan H. Young69
Estimated H-index: 69
('KCL': King's College London)
AbstractObjective: Major depressive disorder (MDD) is a severe mood disorder affecting individuals of all ages and is characterised by single or recurrent major depressive episodes. Key elements of acute and maintenance treatment of MDD include pharmacotherapy, and psychological approaches such as psychoeducation and adherence monitoring.Methods: This summary of the ‘Practice guidelines for the biological treatment of unipolar depressive disorders’ comprises acute, continuation and maintenance t...
8 Citations Source Cite