Structure of major depressive disorder in adolescents and adults in the US general population

Abstract

BackgroundAlthough techniques such as latent class analysis have been used to derive empirically based subtypes of depression in adult samples, there is limited information on subtypes of depression in youth.AimsTo identify empirically based subtypes of depression in a nationally representative sample of US adolescents, and to test the comparability of subtypes of depression in adolescents with those derived from a nationally representative sample of adults.MethodRespondents included 912 adolescents and 805 adults with a 12-month major depressive disorder, selected from the National Comorbidity Survey Adolescent Supplement and the National Comorbidity Survey Replication samples respectively. Latent class analysis was used to identify subtypes of depression across samples. Sociodemographic and clinical correlates of derived subtypes were also examined to establish their validity.ResultsThree subtypes of depression were identified among adolescents, whereas four subtypes were identified among adults. Two of these subtypes displayed similar diagnostic profiles across adolescent and adult samples (P=0.43); these subtypes were labelled ‘severe typical’ (adults 45%, adolescents 35%) and ‘atypical’ (adults 16%, adolescents 26%). The latter subtype was characterised by increased appetite and weight gain.ConclusionsThe structure of depression observed in adolescents is highly similar to the structure observed in adults. Longitudinal research is necessary to evaluate the stability of these subtypes of depression across development.

The performance of the K6 scale in a large adolescent sample.

“…In particular, the typical subtype was characterized by more loss of appetite and weight loss, psychomotor change and feelings of guilt, while the atypical tended to be defined by increased appetite and weight gain along with increased rates of binge eating disorder and higher body mass index (BMI). 70 Collectively, the findings from these studies suggest both symptom type and severity are sources of heterogeneity in adolescent depression and anxiety. Compared to adults, behavioral and somatic symptoms may be more common, and psychomotor symptoms less.…”

“…57 Because LCA identifies subclasses that share common characteristics, this method provides different information than variable-level techniques and may be more relevant to mental health treatment, prevention, practice, and policy. 69,70 While the preponderance of studies using LCA to examine subtypes of depression three anxiety problem classes and four affective problem classes. 68 Similarly, in a sample of 2,539 13-18 year olds from the NCS-A, Burstein et al also identified seven classes of adolescents with lifetime anxiety disorders that were characterized by disorder type rather than the degree or number of disorders.…”

“…71 Lamers et al, however, found three subtypes of 12-month major depressive disorder among 912 adolescents from the NCS-A that differed by both symptom type and severity. 70 Compared with the moderate subtype, the severe subtype was characterized by a greater number of depressive symptoms, number of depressive episodes, symptom severity, and role impairments. 70 Furthermore, the two severe subtypes (atypical and typical) possessed differential symptom profiles.…”

“…70 Compared with the moderate subtype, the severe subtype was characterized by a greater number of depressive symptoms, number of depressive episodes, symptom severity, and role impairments. 70 Furthermore, the two severe subtypes (atypical and typical) possessed differential symptom profiles. In particular, the typical subtype was characterized by more loss of appetite and weight loss, psychomotor change and feelings of guilt, while the atypical tended to be defined by increased appetite and weight gain along with increased rates of binge eating disorder and higher body mass index (BMI).…”

“…Compared to adults, behavioral and somatic symptoms may be more common, and psychomotor symptoms less. 70 Considering the somatic nature of classifying disorders subtypes has implications for understanding pathophysiologic differences and how these differences may influence prevention and treatment. 70 The application of the K6 therefore becomes particularly relevant to explore psychiatric comorbidity as it possesses a heterogeneous set of items spanning cognitive, behavioral, emotional, and pathophysiologic symptoms that comprise non-specific SPD.…”