The depressive spectrum: diagnostic classification and course

Published on Aug 1, 1997in Journal of Affective Disorders 3.79
· DOI :10.1016/S0165-0327(97)00057-8
Jules Angst77
Estimated H-index: 77
(University of Zurich),
Kathleen R. Merikangas100
Estimated H-index: 100
(Yale University)
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.
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  • Citations (235)
Published on Apr 1, 1982in American Journal of Psychiatry 13.40
Martin B. Keller113
Estimated H-index: 113
Robert W. Shapiro13
Estimated H-index: 13
Although ‘ ‘double depression ‘ ‘-major depressive disorder superimposed on an underlying chronic depression-is a f requent phenomenon, the concept has not been well formulated clinically and has rarely been described in the research literature. The authors found that 1) 26% of 101 patients who met the criteria for major depressive disorder had an underlying chronic depressive disorder of at least 2 years’ duration, 2) “recovery” ratesfor patients with superimposed depression differed greatly de...
275 Citations Source Cite
D. R. Cox98
Estimated H-index: 98
(Imperial College London)
The analysis of censored failure times is considered. It is assumed that on each individual arc available values of one or more explanatory variables. The hazard function (age-specific failure rate) is taken to be a function of the explanatory variables and unknown regression coefficients multiplied by an arbitrary and unknown function of time. A conditional likelihood is obtained, leading to inferences about the unknown regression coefficients. Some generalizations are outlined.
24.4k Citations Source Cite
Jules Angst77
Estimated H-index: 77
(University of Zurich),
A. Dobler-Mikola2
Estimated H-index: 2
(University of Zurich)
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...
379 Citations Source Cite
Published on Oct 1, 1993in Archives of General Psychiatry
Johan Ormel103
Estimated H-index: 103
Tineke Oldehinkel4
Estimated H-index: 4
+ 1 AuthorsW. van den Brink73
Estimated H-index: 73
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...
180 Citations Source Cite
Published on May 1, 1990in Journal of Affective Disorders 3.79
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 47.66
Kenneth B. Wells83
Estimated H-index: 83
Anita L. Stewart65
Estimated H-index: 65
+ 6 AuthorsJohn E. Ware107
Estimated H-index: 107
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...
2,488 Citations Source Cite
Published on Jun 1, 1978in Archives of General Psychiatry
Robert L. Spitzer82
Estimated H-index: 82
Jean Endicott94
Estimated H-index: 94
Eli Robins48
Estimated H-index: 48
• A crucial problem in psychiatry, affecting clinical work as well as research, is the generally low reliability of current psychiatric diagnostic procedures. This article describes the development and initial reliability studies of a set of specific diagnostic criteria for a selected group of functional psychiatric disorders, the Research Diagnostic Criteria (RDC). The RDC are being widely used to study a variety of research issues, particularly those related to genetics, psychobiology of selec...
5,455 Citations Source Cite
Published on Jun 1, 1990in Journal of Affective Disorders 3.79
Jules Angst77
Estimated H-index: 77
Kathleen R. Merikangas100
Estimated H-index: 100
+ 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...
166 Citations Source Cite
Cited By235
Published on Nov 1, 2007in The Canadian Journal of Psychiatry
Jennifer Bethell13
Estimated H-index: 13
Anne E. Rhodes21
Estimated H-index: 21
Objective: To determine whether, and to what extent, those who reported suicidal ideation and (or) attempts in the previous year, without meeting the criteria for major depressive episode (MDE), might still have experienced subthreshold depression. Method: Data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) were examined to estimate and compare the prevalence of depressed mood, a core symptom of MDE and subthreshold depression, within the previous month for th...
6 Citations Source Cite
Published on Sep 1, 1998in Journal of Affective Disorders 3.79
E. Szádóczky3
Estimated H-index: 3
Zs Papp2
Estimated H-index: 2
+ 2 AuthorsJ. Füredi2
Estimated H-index: 2
In order to estimate the prevalence of affective disorders in Hungary a sample of the Hungarian adult population (18–64 years) selected at random was interviewed using the Diagnostic Interview Schedule (DIS) which generated DSM-III-R diagnoses. The lifetime rate for Major Depressive Disorder (MDD) was 15.1%, and for Bipolar Disorders (BD) 5.1%. The female-to-male ratio was 2.7 for MDD and nearly equal for BD. The 1-year and 1-month period prevalence rates were 7.1% and 2.6% for MDD and 0.9% and ...
204 Citations Source Cite
Published on May 1, 2009in The Canadian Journal of Psychiatry
Kun Yang3
Estimated H-index: 3
Guang-Rong Xie2
Estimated H-index: 2
+ 2 AuthorsLin-Yan Su2
Estimated H-index: 2
Objective:Astroglial-derived protein S100B is known to play important roles in axonal growth, neural plasticity, and energy regulation. Disturbance of these neurodevelopmental processes is proposed as one possible etiology for mood disorder. Therefore, we performed a genetic analysis of S100B in patients with major depressive disorder (MDD).Method:The polymorphisms of S100B were determined by polymerase chain reaction–restriction fragment length polymorphism in patients (n = 152) with MDD and he...
10 Citations Source Cite
Published on Aug 1, 2015in Journal of Adolescence 1.86
Allison Frost2
Estimated H-index: 2
(Stony Brook University),
Lindsay T. Hoyt9
Estimated H-index: 9
(University of California, San Francisco)
+ 1 AuthorsEmma K. Adam35
Estimated H-index: 35
(Northwestern University)
Abstract Depression is a prevalent and debilitating illness facing many adolescents, especially adolescent girls, whose risk for this disorder is approximately twice that of boys. Many studies have identified mechanisms that place girls at higher risk for depression during adolescence. Few, however, have examined differences in the everyday emotional experiences of boys and girls with varying levels of depressive symptoms. Using the Experience Sampling Method, this study investigated the roles o...
8 Citations Source Cite
Published on Jan 1, 2000in Women & Health 1.31
Ronald C. Kessler222
Estimated H-index: 222
(Harvard University)
Mood disorders are psychiatric disorders in which mood disturbance is the predominant clinical feature. These are among the most commonly occurring and seriously impairing diseases that affect women. Major depression, the most prevalent of the mood disorders, is arguably the number one disease among women in the world in terms of total disease burden. Ascertainment of mood disorders is typically based on patient self-reports, although information obtained from clinical observations and from info...
2 Citations Source Cite
Published on May 1, 2008in Social Psychiatry and Psychiatric Epidemiology 2.92
Takeaki Takeuchi13
Estimated H-index: 13
(Teikyo University),
Mutsuhiro Nakao24
Estimated H-index: 24
(Teikyo University),
Eiji Yano31
Estimated H-index: 31
(Teikyo University)
Authors investigated symptomatology of depressive state among workers in a 20-year study. A cohort of 167 men of a company in Japan, aged 18–40 years old at baseline in 1985 was researched as a study sample. Depressive symptoms were assessed by the Zung’s self-rating depression scale (SDS) consisting of 6 somatic- and 14 psychological-symptom items. In a logistic regression analysis, sleep disturbance and fatigue, and total somatic-symptom scores were related to both future and long-term depress...
7 Citations Source Cite
Published on Jan 1, 2004in Universitas Psychologica 0.34
Marcela Arrivillaga-Quintero10
Estimated H-index: 10
Carolina Cortés García1
Estimated H-index: 1
+ 1 AuthorsTatiana María Lozano Ortíz1
Estimated H-index: 1
The purpose of this research was to describe the characteristics of depression among young university students. Beginning with clinical and psycho-education...
42 Citations
Published on Mar 1, 2004in Journal of the American Geriatrics Society 4.16
Donald R. Royall37
Estimated H-index: 37
(University of Texas Health Science Center at San Antonio)
5 Citations Source Cite
Manfred M. Fichter55
Estimated H-index: 55
(Ludwig Maximilian University of Munich),
Gabriele Kohlboeck7
Estimated H-index: 7
(Ludwig Maximilian University of Munich),
Norbert Quadflieg22
Estimated H-index: 22
(Ludwig Maximilian University of Munich)
Objective The study describes course and outcome over 25 years in depressed and non-depressed men and women from a large community study. Outcome measures covered psychopathology, disability, and impaired functioning.
15 Citations Source Cite
Published on Mar 1, 2012in Clinical Psychology & Psychotherapy 2.51
Myrna M. Weissman126
Estimated H-index: 126
(Columbia University),
Helen Verdeli22
Estimated H-index: 22
Depression is highly prevalent and debilitating among medically ill patients. As high as one third of the primary practise patients screen positive for depression symptoms and over half of the patients diagnosed with major depressive disorder are treated in primary care. However, current primary care service arrangements do not efficiently triage patients who screen positive for depression into appropriate treatments that reflect their individual needs and preferences. In this paper, we describe...
5 Citations Source Cite