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Understanding the heterogeneity of depression through the triad of symptoms, course and risk factors: a longitudinal, population-based study

Published on Jul 1, 2000in Journal of Affective Disorders 4.08
· DOI :10.1016/S0165-0327(99)00132-9
Li Shiun Chen8
Estimated H-index: 8
(Johns Hopkins University),
William W. Eaton82
Estimated H-index: 82
(Johns Hopkins University)
+ 1 AuthorsGerald Nestadt65
Estimated H-index: 65
(Johns Hopkins University)
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Abstract
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 Baltimore Epidemiologic Catchment Area (ECA) follow-up study (1981 to 1993 / 6) were examined. Data on diagnoses, symptoms, course and risk factors were collected using the Diagnostic Interview Schedule (DIS). Latent class analysis was applied to summarize symptom patterns. Course characteristics and risk factor profiles were compared among potential subtypes based on the number of symptom groups or symptom patterns. Logistic regression models were used to examine the etiologic heterogeneity among potential subtypes based on symptoms. Results: The number of symptom groups gave the most efficient insight into differential etiologic processes. Severe depression (7-9 symptom groups) was associated with female gender, family history of depression but not with stressful life events before the onset of the first episode. Moderate (5-6 symptom groups) and mild depression (3-4 symptom groups) were associated with family history of depression, stressful life events before the onset, but not with female gender. The latent class model generated patterns of depressive psychopathology as follows: anhedonia, suicidal, psychomotor, and severely depressed subtypes. The Anhedonia subtype showed a course and risk factor profile distinct from the others. Limitations: The measurement of psychopathology was based on self-reported DIS interviews instead of psychiatric assessments. Recall or report bias cannot be excluded in the ascertainment of family history and stressful life events. Conclusions: Depression is heterogeneous, even below the threshold of syndromal diagnosis. The severity of an episode appears to be more informative than the pattern of symptoms, with the possible exception of a putative anhedonic subtype. © 2000 Elsevier Science B.V. All rights reserved.
  • References (26)
  • Citations (112)
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References26
Newest
Published on Mar 1, 1999in Social Psychiatry and Psychiatric Epidemiology 3.15
M. A. Badawi1
Estimated H-index: 1
(Westat),
William W. Eaton1
Estimated H-index: 1
(Westat)
+ 2 AuthorsJ. Gallo1
Estimated H-index: 1
(Westat)
Predictors of non-response were investigated in a 15-year follow-up (1981–1996) of 3,481 individuals in a probability sample from the household population of East Baltimore. Demographics (age, sex, race, education, marital status, and unemployment), household factors (living arrangements, household income, household size, and number of children), cultural variables (ancestral ethnicity and foreign language), social variables (social support and networks, committing felony, carrying a weapon, usi...
129 Citations Source Cite
Published on Dec 1, 1998in British Journal of Psychiatry 7.23
William W. Eaton82
Estimated H-index: 82
(Johns Hopkins University),
James C. Anthony85
Estimated H-index: 85
(Johns Hopkins University)
+ 7 AuthorsLi Shiun Chen8
Estimated H-index: 8
(Johns Hopkins University)
BACKGROUND The objective is to estimate parameters of the natural history of panic disorder, including its prodrome, incidence, recovery and recurrence. METHOD In 1981 the Baltimore Epidemiologic Catchment Area Study interviewed 3481 individuals probabilistically selected from the household population. During 1993-1996, 1920 of these individuals (73% of survivors) were interviewed again. Baseline and follow-up interviews included the National Institute of Mental Health Diagnostic Interview Sched...
57 Citations Source Cite
Published on Nov 1, 1997in Archives of General Psychiatry
William W. Eaton82
Estimated H-index: 82
(Johns Hopkins University),
James C. Anthony85
Estimated H-index: 85
(Johns Hopkins University)
+ 5 AuthorsLi Shiun Chen8
Estimated H-index: 8
(Johns Hopkins University)
Background: Natural history can be characterized by incidence, recurrence, and duration of episodes. Research on the incidence of major depression is rare; studies of recurrence and duration are limited to clinical samples. Methods: The Baltimore, Md, site of the Epidemiologic Catchment Area Program followed up its 1981 baseline cohort of 3481 respondents with an additional assessment in 1993 to 1996. Interviews were obtained from 1920 respondents (73% of the survivors). The Diagnostic Interview...
339 Citations Source Cite
Published on Aug 1, 1997in Journal of Affective Disorders 4.08
Ronald C. Kessler229
Estimated H-index: 229
(UM: University of Michigan),
Shanyang Zhao24
Estimated H-index: 24
(UM: University of Michigan)
+ 1 AuthorsMarvin Swart74
Estimated H-index: 74
(Duke University)
Abstract Data from the National Comorbidity Survey are used to study the lifetime prevalences, correlates, course and impairments associated with minor depression (mD), major depression with 5–6 symptoms (MD 5–6), and major depression with seven or more symptoms (MD 7–9) in an effort to determine whether mD is on a continuum with MD. There is a monotonic increase in average number of episodes, average length of longest episode, impairment, comorbidity, and parental history of psychiatric disorde...
574 Citations Source Cite
Published on Aug 1, 1997in Journal of Affective Disorders 4.08
Lewis L. Judd52
Estimated H-index: 52
(UCSD: University of California, San Diego)
Data presented during the 1996 CINP President's Workshop supported the conclusion that unipolar major depressive disorder (MDD) is a pleomorphic mood disorder consisting of a cluster of depressive subtypes existing in a relatively homogeneous symptomatic clinical continuum, extending from subsyndromal depressive symptomatology (SSD) through minor depressive episode, dysthymic disorder, major depressive episode and double depression. This indicates that common unipolar depressive subtypes can be ...
35 Citations Source Cite
Published on Apr 1, 1997in American Journal of Psychiatry 13.65
K. R R Krishnan7
Estimated H-index: 7
,
Judith C. Hays41
Estimated H-index: 41
,
Dan G. Blazer106
Estimated H-index: 106
Objective: The authors' goal was to characterize the clinical and demographic features of vascular depression. Method: They classified 89 depressed patients into two groups-those with vascular (N=32) and nonvascular (N=57) depression-on the basis of examination of brain magnetic resonance images. All of the patients were enrolled in the National Institute of Mental Health Clinical Research Center for the Study of Depression in Later Life, located at Duke University. The patients with vascular an...
609 Citations Source Cite
Published on Jan 1, 1997in American Journal of Psychiatry 13.65
Christina Sobin24
Estimated H-index: 24
,
Harold A. Sackeim85
Estimated H-index: 85
(Columbia University)
Objective: The authors summarize current knowledge regarding the psychomotor symptoms of depression. Method: Findings from the objective quantification of psychomotor symptoms are reviewed, and methodological issues are considered. The contemporary empirical literature regarding the diagnostic, prognostic, and potential pathophysiologic significance of psychomotor symptoms is summarized. Results: It has been repeatedly shown that depressed patients differ from normal and psychiatric comparison g...
397 Citations Source Cite
Published on Nov 1, 1996in Journal of Affective Disorders 4.08
Gwenolé Loas13
Estimated H-index: 13
The aim of the present study is to present a model of depressive vulnerability centered on anhedonia. After a review of the literature, we suggest a specific symptomatic profile associating anhedonia, introversion, low sensation-seeking, autonomy, dysfunctional attitudes, high displeasure capacity, obsessive-compulsive features, passitivity and pessimism. This symptomatic profile could constitute a mild chronic mood disorder which, following stress, might decompensate into unipolar endogenomorph...
126 Citations Source Cite
Published on May 1, 1996in Archives of General Psychiatry
Kenneth S. Kendler152
Estimated H-index: 152
(MCV: VCU Medical Center),
Lindon J. Eaves95
Estimated H-index: 95
+ 3 AuthorsRonald C. Kessler229
Estimated H-index: 229
Background: Depression, a clinically heterogeneous syndrome, may also be etiologically heterogeneous. Using a prospective, epidemiologic, and genetically informative sample of adult female twins, we identify and validate a typology of depressive syndromes. Methods: Latent class analysis was applied to 14 disaggregated DSM-III-R symptoms for major depression reported over the last year by members of 1029 female-female twin pairs. Results: Seven classes were identified, of which 3 represented clin...
269 Citations Source Cite
Published on Jan 1, 1996in International Review of Psychiatry 2.99
Paul Bebbington98
Estimated H-index: 98
(UCL: University College London)
The high prevalence of depressive disorder in women is well established. However, it has not been convincingly explained. This reflects a more general failure of research to provide a comprehensive aetiological account of depression. The examination of the sex difference can be used as a probe to evaluate how far we have gone in substantiating integrated models of depressive disorder. In this paper, I review several lines of investigation in order to assess the relative importance of social, psy...
182 Citations Source Cite
Cited By112
Newest
Published on Mar 1, 2019in Scientific Reports 4.01
Anne-Louise Gannon1
Estimated H-index: 1
(University of Newcastle),
Laura O’Hara5
Estimated H-index: 5
(Edin.: University of Edinburgh)
+ 9 AuthorsLaura Milne8
Estimated H-index: 8
(Edin.: University of Edinburgh)
The hypothalamic-pituitary-adrenal (HPA) axis regulates responses to internal and external stressors. Many patients diagnosed with conditions such as depression or anxiety also have hyperactivity of the HPA axis. Hyper-stimulation of the HPA axis results in sustained elevated levels of glucocorticoids which impair neuronal function and can ultimately result in a psychiatric disorder. Studies investigating Glucocorticoid Receptor (GR/NR3C1) in the brain have primarily focused on the forebrain, ho...
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Published on Feb 18, 2019in Australasian Psychiatry 0.94
Tamara May9
Estimated H-index: 9
(Deakin University),
Saxby Pridmore24
Estimated H-index: 24
(UTAS: University of Tasmania)
Objectives: This study aimed to explore the effects of a four-week course of transcranial magnetic stimulation (TMS) on the following symptoms of major depressive episode (MDE): mood, work activities, health concerns, guilt, anxiety and retardation. Method: Patients underwent 20 daily sessions of 10 Hz TMS (two sets of 10 daily treatments separated by two days of rest). The six-item Hamilton Depression Rating Scale (HAMD-6) was administered before and after treatment. Remission was operationalis...
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Published on Apr 4, 2019in Aging & Mental Health 2.96
Ruth T. Morin3
Estimated H-index: 3
(SFVAMC: San Francisco VA Medical Center),
Craig Nelson4
Estimated H-index: 4
(UCSF: University of California, San Francisco)
+ 2 AuthorsScott Mackin20
Estimated H-index: 20
(UCSF: University of California, San Francisco)
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Published on Apr 1, 2019in Journal of Affective Disorders 4.08
Myrthe G.B.M. Boekhorst (Tilburg University), Annemerle Beerthuizen4
Estimated H-index: 4
(EUR: Erasmus University Rotterdam)
+ 4 AuthorsVictor J. M. Pop42
Estimated H-index: 42
(Tilburg University)
Background Up to 10–15% of women experience high levels of depressive symptoms during pregnancy. Since these levels of symptoms can vary greatly over time, the current study investigated the existence of possible longitudinal trajectories of depressive symptoms during pregnancy, and aimed to identify factors associated with these trajectories. Methods Depressive symptoms were assessed prospectively at each trimester in 1832 women, using the Edinburgh (Postnatal) Depression Scale (E(P)DS). Growth...
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Published on Dec 1, 2018in Translational Psychiatry 5.18
Jianjun Chen15
Estimated H-index: 15
,
Shunjie Bai6
Estimated H-index: 6
(CQMU: Chongqing Medical University)
+ 6 AuthorsPeng Xie25
Estimated H-index: 25
(CQMU: Chongqing Medical University)
Available data indicate that patients with depression and anxiety disorders are likely to be at greater risk for suicide. Therefore, it is important to correctly diagnose patients with depression and anxiety disorders. However, there are still no empirical laboratory methods to objectively diagnose these patients. In this study, the multiple metabolomics platforms were used to profile the urine samples from 32 healthy controls and 32 patients with depression and anxiety disorders for identifying...
1 Citations Source Cite
Published on Nov 1, 2018in Journal of Biomedical Informatics 2.95
Min-hyung Kim1
Estimated H-index: 1
(Cornell University),
Samprit Banerjee19
Estimated H-index: 19
(Cornell University)
+ 7 AuthorsJyotishman Pathak32
Estimated H-index: 32
(Cornell University)
Abstract Objective We present a method for comparing association networks in a matched case-control design, which provides a high-level comparison of co-occurrence patterns of features after adjusting for confounding factors. We demonstrate this approach by examining the differential distribution of chronic medical conditions in patients with major depressive disorder (MDD) compared to the distribution of these conditions in their matched controls. Materials and methods Newly diagnosed MDD patie...
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Published on Apr 1, 2018in Journal of Child Psychology and Psychiatry 6.13
Christine B. Cha11
Estimated H-index: 11
(Columbia University),
Peter J. Franz4
Estimated H-index: 4
(Harvard University)
+ 3 AuthorsMatthew K. Nock70
Estimated H-index: 70
(Harvard University)
Background Suicide is a leading cause of death and a complex clinical outcome. Here, we summarize the current state of research pertaining to suicidal thoughts and behaviors in youth. We review their definitions/measurement and phenomenology, epidemiology, potential etiological mechanisms, and psychological treatment and prevention efforts. Results We identify key patterns and gaps in knowledge that should guide future work. Regarding epidemiology, the prevalence of suicidal thoughts and behavio...
10 Citations Source Cite
Published on Dec 1, 2017in Current Behavioral Neuroscience Reports
Thalia K. Robakis8
Estimated H-index: 8
(Stanford University),
Linn Aasly2
Estimated H-index: 2
(Stanford University)
+ 2 AuthorsNatalie L. Rasgon35
Estimated H-index: 35
(Stanford University)
Objective The purpose of this review was to critically assess the available data regarding associations between inflammation and symptoms of depression among perinatal women, and to explore whether there is support for the hypothesis that inflammation associated with depression can represent a precipitating insult for the development of gestational diabetes, a known inflammatory morbidity of pregnancy.
1 Citations Source Cite
Published on Dec 1, 2017in Journal of Consulting and Clinical Psychology 4.36
Karmel W. Choi8
Estimated H-index: 8
(Harvard University),
Abigail W. Batchelder10
Estimated H-index: 10
(Harvard University)
+ 2 AuthorsConall O’Cleirigh30
Estimated H-index: 30
(Harvard University)
3 Citations Source Cite
Published on Oct 3, 2017in Issues in Mental Health Nursing 0.98
Krystal Hays1
Estimated H-index: 1
(California Baptist University)
ABSTRACTStudies report that African Americans are likely to experience severe, chronic, and disabling depressive symptoms leading to poor depression outcomes. There are several psychosocial and sociocultural factors that individually contribute to depression in African Americans (i.e. chronic stress, negative life events, negative social interaction, social support, and religiosity). However, African Americans are a heterogeneous population and the identification of subpopulations with distinct ...
1 Citations Source Cite