Dimensional diagnosis of depression: Adding the dimension of course to severity, and comparison to the DSM

Published on Nov 1, 2002in Comprehensive Psychiatry 2.13
· DOI :10.1053/comp.2002.35902
Stewart A. Shankman23
Estimated H-index: 23
(Stony Brook University),
Daniel N. Klein71
Estimated H-index: 71
(Stony Brook University)
Abstract
Abstract It has long been debated whether depression is best classified with a categorical or dimensional diagnostic system. There has been surprisingly little discussion, however, of what the contents of a dimensional classification should include, with most studies employing a single dimension based on symptom severity. The present study explored whether a dimension based on prior course of depression increases the validity of a dimensional model based on symptom severity alone and whether the two dimensions combined improve upon the present categorical system (DSM). The sample consisted of 133 patients with a broad spectrum of depressive diagnoses. External validators included family history of mood disorder, assessed using the family history method, and course over a 6-month prospective follow-up period. Prior course contributed significant incremental validity over and above symptom severity in predicting subsequent course and family history of mood disorder. However, the linear combination of symptom severity and prior course provided only a minimal increase in predictive power over and above the DSM diagnoses of major depressive disorder (MDD) and dysthymia. Copyright 2002, Elsevier Science (USA). All rights reserved.
  • References (52)
  • Citations (17)
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References52
Published on Jun 1, 1983in American Journal of Psychiatry 13.40
Martin B. Keller113
Estimated H-index: 113
,
Phillip Lavori6
Estimated H-index: 6
+ 2 AuthorsGerald L. Klerman73
Estimated H-index: 73
Of 3 1 6 patients with a major depressive disorder who were followed for between 6 months and 2 years, 80 (25%) had a preexisting chronic minor depression of at least 2 years’ duration. The chronic minor depression reduced the apparent effect of the known predictors of recovery and relapse from the major depressive disorder and predicted a very pernicious course for the chronic depression. Furthermore, the longer the patient continued to suffer from a chronic minor depression after recovering fr...
200 Citations Source Cite
Published on Jan 1, 1952
A. C. Lloyd1
Estimated H-index: 1
,
R. Hackforth1
Estimated H-index: 1
The dialogue begins with a playful discussion of erotic passion, then extends the theme to consider the nature of inspiration, love and knowledge. The centerpiece is the myth of the charioteer - the famous and moving account of the vision, fall and incarnation of the soul. Professor Hackforth here translates the dialogue for the student and general reader. There is a running commentary on the course of the argument and the meaning of the key Greek terms, and a full intoduction to explain the phi...
82 Citations
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
Published on Jan 1, 1995in American Journal of Psychiatry 13.40
Martin B. Keller113
Estimated H-index: 113
(Butler Hospital),
Daniel N. Klein71
Estimated H-index: 71
(Butler Hospital)
+ 8 AuthorsD. B. Marin1
Estimated H-index: 1
(Butler Hospital)
Objective: The DSM-IV mood disorders field trial, a multisite collaborative study, was designed to explore the reliability of a course-based diagnostic classification system for major depression, evaluate the symptom criteria for dysthymia, and explore the need for additional diagnostic categories for milder forms of mood disorder (e.g., minor and recurrent brief depression). Method : Five hundred twenty-four depressed subjects were recruited from inpatient, outpatient, and community settings at...
196 Citations Source Cite
Published on Jan 1, 1971
Eliot Slater8
Estimated H-index: 8
,
Valerie Cowie8
Estimated H-index: 8
280 Citations
Published on Apr 1, 1999in British Journal of Psychiatry 5.87
Harold Alan Pincus61
Estimated H-index: 61
(American Psychological Association),
Wendy W. Davis18
Estimated H-index: 18
(American Psychological Association),
Laurie E. McQueen3
Estimated H-index: 3
(American Psychological Association)
BACKGROUND Subthreshold conditions (i.e. not meeting full diagnostic criteria for mental disorders in DSM-IV or ICD-10) are prevalent and associated with significant costs and disability. Observed more in primary care and community populations than in speciality settings, varying conceptualisations have been applied to define these conditions. AIMS To examine definitional issues for subthreshold forms of depression (e.g. minor depression) and to suggest future directions for research and nosolog...
214 Citations Source Cite
Published on Aug 1, 1997in Journal of Affective Disorders 3.79
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. Th...
235 Citations Source Cite
Published on Jul 1, 2000in Journal of Affective Disorders 3.79
Li Shiun Chen8
Estimated H-index: 8
(Johns Hopkins University),
William W. Eaton81
Estimated H-index: 81
(Johns Hopkins University)
+ 1 AuthorsGerald Nestadt65
Estimated H-index: 65
(Johns Hopkins University)
Background: There is an ongoing research effort to test if depression is a homogeneous clinical syndrome and to identify valid and useful subtypes based on the number and nature of depressive symptoms. This study summarizes the patterns of depressive symptoms evident in a prospective study of the general population and examines the validity of potential subtypes by studying their course and etiologic heterogeneity. Methods: A general population sample of 1920 adults (aged 18-96) from the Baltimo...
112 Citations Source Cite
Published on Aug 1, 1982in Archives of General Psychiatry
Martin B. Keller113
Estimated H-index: 113
,
Robert W. Shapiro13
Estimated H-index: 13
+ 1 AuthorsNicola Wolfe2
Estimated H-index: 2
• With the use of life tables to describe time while patients were well and subsequent rates of relapse for 75 patients after their recovery from an episode of major depressive disorder in a naturalistic study, a high risk of relapse was detected shortly after recovery. Twenty-four percent of patients relapsed within 12 weeks at risk, and 12% of patients relapsed within four weeks at risk. The presence of an underlying chronic depression and three or more previous affective episodes predicted a ...
209 Citations Source Cite
Published on Mar 1, 2000in Comprehensive Psychiatry 2.13
Jules Angst77
Estimated H-index: 77
,
Robert Sellar1
Estimated H-index: 1
,
Kathleen R. Merikangas100
Estimated H-index: 100
There has been widespread debate about the validity of the contemporary diagnostic classification system of depression. The major goal of this study is to examine the prognostic significance of each of the major subtypes of depression using data from 5 interviews of a 15-year prospective community-based cohort study. The stability of the following diagnostic subtypes across the duration of the study was examined: major depressive disorder (MDD), dysthymia, recurrent brief depression (RBD), and m...
119 Citations Source Cite
  • References (52)
  • Citations (17)
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Cited By17
Published on May 1, 2013in Annals of Clinical Psychiatry 1.47
Leonardo Zaninotto11
Estimated H-index: 11
,
Daniel Souery45
Estimated H-index: 45
+ 7 AuthorsAlessandro Serretti67
Estimated H-index: 67
BACKGROUND: Depressive subtypes generally have been neglected in research on treatment efficacy. We studied a sample of 699 severe unipolar depressed patients to detect any association between depressive features and treatment resistance. METHODS: Participants were divided into psychotic (PSY, n = 90), melancholic (MEL, n = 430) and non-melancholic (n = 179) subjects according to clinical features. Formal diagnostic criteria (Mini International Neuropsychiatric Interview items), and items from 1...
6 Citations
Daniel N. Klein71
Estimated H-index: 71
(Stony Brook University),
Lea R. Dougherty23
Estimated H-index: 23
,
Thomas M. Olino30
Estimated H-index: 30
We aim to provide a starting point toward the development of an evidence-based assessment of depression in children and adolescents. We begin by discussing issues relevant to the diagnosis and classification of child and adolescent depression. Next, we review the prevalence, selected clinical correlates, course, and treatment of juvenile depression. Along with some general considerations in assessment, we discuss specific approaches to assessing depression in youth (i.e., interviews, rating scal...
224 Citations Source Cite
Published on Jan 1, 2004in Psychological Bulletin 13.25
James C. Coyne74
Estimated H-index: 74
(University of Pennsylvania),
Richard Thompson29
Estimated H-index: 29
(Juvenile Protective Association),
Valerie E. Whiffen27
Estimated H-index: 27
(University of Ottawa)
16 Citations Source Cite
Published on Jun 1, 2014in Journal of Anxiety Disorders 3.48
Nicholas C. Jacobson7
Estimated H-index: 7
(Pennsylvania State University),
Michelle G. Newman37
Estimated H-index: 37
(Pennsylvania State University)
a b s t r a c t Anxiety and depression are often highly correlated with each other. To explain this connection, the present study examined the longitudinal relationship between earlier anxiety and later depression, using avoidance as a mediator and trauma as a moderator. Participants (N = 6504 adolescents) completed baseline measures of anxiety and depression, a measure of avoidance one year later, a measure of trauma six to eight years later, and a measure of depression 12–14 years later. Analy...
35 Citations Source Cite
Published on Sep 1, 2011in International Journal of Law and Psychiatry 1.28
Graham Mellsop16
Estimated H-index: 16
(University of Auckland),
Debra Fraser1
Estimated H-index: 1
(University of Auckland)
+ 1 AuthorsDavid B Menkes17
Estimated H-index: 17
(University of Auckland)
Abstract In considering psychiatric evidence, criminal justice systems make considerable use of labels from official psychiatric classificatory systems. There are legislated requirements for psychological and/or behavioural phenomena to be addressed in legal tests, however medico-legal use of the current categorical diagnostic frameworks which are increasingly complex is difficult to justify. The lack of validity in large domains of the present classificatory systems is now more openly acknowled...
3 Citations Source Cite
Published on Jul 1, 2010in Social Science & Medicine 3.01
Sarah Van de Velde11
Estimated H-index: 11
(Ghent University),
Piet Bracke25
Estimated H-index: 25
(Ghent University),
Katia Levecque16
Estimated H-index: 16
(Ghent University)
One of the most consistent findings in the social epidemiology of mental health is the gender gap in depression. Depression is approximately twice as prevalent among women as it is among men. However, the absence of comparable data hampers cross-national comparisons of the prevalence of depression in general populations. Using information about the frequency and severity of depressive symptoms from the third wave of the European Social Survey (ESS-3), we are able to fill the gap the absence of c...
282 Citations Source Cite
Published on Jan 1, 2008in Journal of Abnormal Psychology 4.64
Daniel N. Klein71
Estimated H-index: 71
(Stony Brook University)
The number of categories and specifiers for mood disorders has increased with each successive edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM). Many of these categories and specifiers can be viewed as an effort to map the various permutations of severity and chronicity that characterize the depressive disorders. However, this has resulted in a system that (a) is unnecessarily complex and unwieldy, (b) has created problems with artificial distinctions between categories...
69 Citations Source Cite
Published on Jul 1, 2012in Psychological Medicine 5.47
Didi Rhebergen12
Estimated H-index: 12
(VU University Medical Center),
Femke Lamers24
Estimated H-index: 24
(VU University Medical Center)
+ 3 AuthorsBrenda W. J. H. Penninx123
Estimated H-index: 123
(VU University Medical Center)
Background Current classification of unipolar depression reflects the idea that prognosis is essential. However, do DSM categories of major depressive disorder (MDD), dysthymic disorder (Dysth) and double depression (DD=MDD+Dysth) indeed adequately represent clinically relevant course trajectories of unipolar depression? Our aim was to test DSM categories (MDD, Dysth and DD) in comparison with empirically derived prognostic categories, using a prospectively followed cohort of depressed patients....
40 Citations Source Cite
Candice R Quinn7
Estimated H-index: 7
(University of Sydney),
Anthony Harris43
Estimated H-index: 43
(University of Sydney),
Andrew H. Kemp56
Estimated H-index: 56
(University of Sydney)
Major depressive disorder is often considered to be a homogenous disorder that changes in terms of severity; however, the presence of distinct subtypes and a variety of presenting symptoms suggests much heterogeneity. Aiming to better understand the relationship between heterogeneity and diagnosis we used an exploratory approach to identify subtypes of depression on the basis of clinical symptoms and neuropsychological performance. Cluster analysis identified two groups of patients distinguished...
20 Citations Source Cite