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 3.79
· DOI :10.1016/S0165-0327(99)00132-9
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 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 (25)
  • Citations (112)
Published on Jan 1, 1997in American Journal of Psychiatry 13.40
Christina Sobin24
Estimated H-index: 24
Harold A. Sackeim84
Estimated H-index: 84
(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...
394 Citations Source Cite
Published on Dec 1, 1990in British Journal of Psychiatry 5.87
Giulio Perugi15
Estimated H-index: 15
Laura Musetti17
Estimated H-index: 17
+ 3 AuthorsH.S. Akiskal33
Estimated H-index: 33
In a consecutive clinical series of 538 subjects with primary mood disorders the male:female differences were most skewed (1:4) in recurrent unipolars, 1:2 in single episode and bipolar I subtypes, and about even (1:1) in bipolar II. The sexes did not differ in age at onset of depression, stressors preceding index episodes, endogenous features, psychotic symptoms, suicide attempts, and rates of chronicity. Females had lower mean number of hypomanic, and higher mean number of depressive, episodes...
121 Citations Source Cite
Published on Apr 1, 1997in American Journal of Psychiatry 13.40
K. R. R. Krishnan9
Estimated H-index: 9
Judith C. Hays40
Estimated H-index: 40
Dan G. Blazer104
Estimated H-index: 104
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...
605 Citations Source Cite
Published on Jan 1, 1990
Susan Nolen-Hoeksema70
Estimated H-index: 70
Women are twice as likely as men to experience protracted sadness, apathy, low self-esteem, and other symptoms of depression. How can we account for this sex difference? Several explanations have been proposed, some dating back many years. This book critically examines the evidence for each explanation in an attempt to discover what we do and do not know about sex differences in depression. It is a landmark review of the historical, theoretical and empirical approaches to sex differences in depr...
729 Citations
Published on Aug 1, 1997in Journal of Affective Disorders 3.79
Lewis L. Judd52
Estimated H-index: 52
(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 Jan 1, 1985in Trends in Neurosciences 11.44
Myrna M. Weissman126
Estimated H-index: 126
(Yale University),
Gerald L. Klerman73
Estimated H-index: 73
(Harvard University)
Abstract The most common forms of affective disorder are ‘major depression' and ‘bipolar disorder' (i. e. major depression plus mania occurring at some time in the person's life). There is now consistent evidence from epidemiological, family and clinical studies that the rates of major depression are about twofold higher among women than men, and that the sex ratios of bipolar disorder are equal. Many explanations, including artifactual, psychosocial, genetic, endocrine, have been offered to acc...
179 Citations Source Cite
Published on Jan 1, 1994in Journal of Abnormal Psychology 4.64
Nick Haslam57
Estimated H-index: 57
(The New School),
Aaron T. Beck107
Estimated H-index: 107
(University of Pennsylvania)
Taxometric procedures were used to test claims for the content and latent structure of 5 proposed subtypes of major depression: an endogenous form, sociotropic and autonomous forms proposed by A. Beck (1983), a self-critical form proposed by S. J. Blatt (e.g., S. J. Blatt & E. Homann, 1992), and a hopelessness jorm proposed by L. Y. Abramson, G. I. Metalsky, and L. B. Alloy (1989). Analysis of self-reported symptom and personality profiles of 531 consecutively admitted outpatients with a primary...
131 Citations Source Cite
Published on Aug 1, 1997in Journal of Affective Disorders 3.79
Ronald C. Kessler222
Estimated H-index: 222
(University of Michigan),
Shanyang Zhao22
Estimated H-index: 22
(University of Michigan),
Dan G. Blazer104
Estimated H-index: 104
(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...
571 Citations Source Cite
Published on May 1, 1996in Archives of General Psychiatry
Kenneth S. Kendler153
Estimated H-index: 153
(VCU Medical Center),
Lindon J. Eaves91
Estimated H-index: 91
+ 3 AuthorsRonald C. Kessler222
Estimated H-index: 222
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...
266 Citations Source Cite
Published on Dec 1, 1988in Archives of General Psychiatry
Dan G. Blazer104
Estimated H-index: 104
Max A. Woodbury28
Estimated H-index: 28
+ 3 AuthorsLinda K. George79
Estimated H-index: 79
• A multivariate classification technique was used to examine whether depressive symptoms and symptoms frequently associated with depressive disorders would cluster into recognizable syndromes that parallel traditional DSM-III psychiatric diagnoses. An analysis was made of all respondents in the Epidemiologic Catchment Area (ECA) project of the Piedmont region of North Carolina who reported suffering from depressive symptoms (n = 406) at the second wave of the ECA study. The analysis identified ...
130 Citations Source Cite
Cited By112
Published on Jul 1, 2015in Cell Biochemistry and Biophysics 1.46
Wei Zhang2
Estimated H-index: 2
(China Medical University (PRC)),
Xin-an Zhang1
Estimated H-index: 1
Post-stroke depression (PSD) is the most common psychiatric complication in stroke survivors that has been associated with increased physical disability, distress, poor rehabilitation, and suicidal ideation. However, there are still no biomarkers available to support objective laboratory testing for this disorder. Here, a GC–MS-based urinary metabolomics approach was used to characterize the urinary metabolic profiling of PSD (stroke) subjects and non-PSD (health controls) subjects in order to i...
9 Citations Source Cite
Published on Oct 1, 2010in The Canadian Journal of Psychiatry
Safa Elgamal2
Estimated H-index: 2
(University of Waterloo),
Susan D. Denburg25
Estimated H-index: 25
(McMaster University)
+ 1 AuthorsGlenda MacQueen56
Estimated H-index: 56
(University of Calgary)
Objectives: To compare the performance of depressed patients to healthy control subjects on discrete cognitive domains derived from factor analysis and to examine the factors that may influence the performance of depressed patients on cognitive domains in a large sample. Methods: We compared the cognitive performance of 149 patients with major depression to 104 healthy control subjects using multivariate ANCOVA. We used principal component factor analysis to group the cognitive variables into co...
15 Citations Source Cite
Published on Jan 1, 2016in Journal of Affective Disorders 3.79
M. ten Have48
Estimated H-index: 48
Femke Lamers24
Estimated H-index: 24
(VU University Amsterdam)
+ 6 AuthorsR. de Graaf82
Estimated H-index: 82
Abstract Background In recent years, researchers have used various techniques to elucidate the heterogeneity in depressive symptoms. This study seeks to resolve the extent to which variations in depression reflect qualitative differences between symptom categories and/or quantitative differences in severity. Methods Data were used from the Netherlands Mental Health Survey and Incidence Study-2, a nationally representative face-to-face survey of the adult general population. In a subsample of res...
19 Citations Source Cite
Published on Dec 6, 2007in Social Psychiatry and Psychiatric Epidemiology 2.92
Ottar Bjerkeset16
Estimated H-index: 16
(Norwegian University of Science and Technology),
Hans M. Nordahl18
Estimated H-index: 18
(Norwegian University of Science and Technology)
+ 2 AuthorsOlav M. Linaker19
Estimated H-index: 19
(Norwegian University of Science and Technology)
Background Our aims were to examine the stability of self-rated anxiety and depression symptoms and the predictors for change in case-level status after 4 years in a general population sample.
20 Citations Source Cite
Published on Sep 1, 2015in Journal of Psychiatric Research 4.00
Ateka A. Contractor13
Estimated H-index: 13
(Brown University),
Jon D. Elhai37
Estimated H-index: 37
(University of Toledo)
+ 7 AuthorsJoseph R. Calabrese77
Estimated H-index: 77
(Case Western Reserve University)
Posttraumatic stress disorder (PTSD) is comorbid with major depressive disorder (MDD; Kessler et al., 1995) and generalized anxiety disorder (GAD; Brown et al., 2001). We aimed to (1) assess discrete patterns of post-trauma PTSD-depression-GAD symptoms using latent profile analyses (LPAs), and (2) assess covariates (gender, income, education, age) in defining the best fitting class solution. The PTSD Checklist (assessing PTSD symptoms), GAD-7 scale (assessing GAD symptoms), and Patient Health Qu...
28 Citations Source Cite
Published on Nov 1, 2002in Comprehensive Psychiatry 2.13
Stewart A. Shankman23
Estimated H-index: 23
(Stony Brook University),
Daniel N. Klein71
Estimated H-index: 71
(Stony Brook University)
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...
17 Citations Source Cite
Published on Aug 1, 2005in Journal of Abnormal Psychology 4.64
Mike Stoolmiller47
Estimated H-index: 47
Hyoun Kyoung Kim25
Estimated H-index: 25
Deborah M. Capaldi44
Estimated H-index: 44
Heterogeneity in the longitudinal course of depressive symptoms was studied through the use of general growth mixture modeling for young men in the Oregon Youth Study (N = 206), who ranged in age from 15 to 24 years. Four trajectory classes were identified: the very-low, the moderate-decreasing, the high-decreasing, and the high-persistent classes. The 3 lowest classes differed primarily quantitatively with the initial level or mean level across time being the major determinant of class differen...
115 Citations Source Cite
Published on Oct 1, 2012in Archives of General Psychiatry
Amy L. Byers25
Estimated H-index: 25
(University of California, San Francisco),
Eric Vittinghoff100
Estimated H-index: 100
(University of California, San Francisco)
+ 8 AuthorsLisa Fredman24
Estimated H-index: 24
(Boston University)
Context: Despite the frequent occurrence of depressive symptoms among older adults, especially women, little is known about the long-term course of late-life depressive symptoms. Objective: To characterize the natural course of depressive symptoms among older women (from the young old to the oldest old) followed up for almost 20 years. Design: Using latent-class growth-curve analysis, we analyzed women enrolled in an ongoing prospective cohort study (1988 through 2009). Setting: Clinic sites in ...
66 Citations Source Cite
Published on Mar 1, 2006in Behaviour Research and Therapy 4.13
Todd B. Kashdan59
Estimated H-index: 59
(George Mason University),
Jon D. Elhai11
Estimated H-index: 11
(University of South Dakota),
B. Christopher Frueh53
Estimated H-index: 53
(Medical University of South Carolina)
Abstract We explored relationships between anhedonia and posttraumatic stress disorder (PTSD) symptom clusters, including their role in predicting psychiatric comorbidity. Our measure of anhedonia was derived from an examination of the latent structure of the Beck Depression Inventory. We found evidence for a two-factor solution, leading to anhedonia and undifferentiated, global depressive symptoms scales. In primary analyses, anhedonia had a unique positive relationship with PTSD's emotional nu...
96 Citations Source Cite
Published on Dec 1, 2013in Journal of General Internal Medicine 4.00
Kara Zivin31
Estimated H-index: 31
Paul A. Pirraglia21
Estimated H-index: 21
(Brown University)
+ 2 AuthorsSandeep Vijan48
Estimated H-index: 48
(University of Michigan)
CONTEXT Diagnosis and treatment of depression has increased over the past decade in the United States. Whether self-reported depressive symptoms among older adults have concomitantly declined is unknown.
20 Citations Source Cite