The classification of depressive disorders

MacFadyen, Heather Wood

doi:10.1002/1097-4679(197507)31:3<380::aid-jclp2270310302>3.0.co;2-1

Cited by 9 publications

(5 citation statements)

References 63 publications

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“…A rich clinical literature has long debated the unity vs heterogeneity of the depressive syndrome, 37,38 several themes of which are echoed in our findings. First, Beck and Alford 39 suggested etiological primacy for the cognitive changes in depression.…”

Section: Commentmentioning

confidence: 60%

Evidence for Multiple Genetic Factors Underlying DSM-IV Criteria for Major Depression

Kendler¹,

Aggen²,

Neale³

2013

JAMA Psychiatry

131

110

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Section: Commentmentioning

confidence: 60%

Evidence for Multiple Genetic Factors Underlying DSM-IV Criteria for Major Depression

Kendler¹,

Aggen²,

Neale³

2013

JAMA Psychiatry

131

110

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“…Despite over half a century of research, many issues about the clinical and etiological heterogeneity of major depression (MD) are still unresolved (MacFadyen, 1975; Kendell, 1976; Cole et al 2008). Is depression a homogeneous clinical syndrome?…”

Section: Introductionmentioning

confidence: 99%

Subtypes of major depression: latent class analysis in depressed Han Chinese women

Aggen

Shi

et al. 2014

Psychol. Med.

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Background Despite substantial research, uncertainty remains about the clinical and etiological heterogeneity of major depression (MD). Can meaningful and valid subtypes be identified and would they be stable cross-culturally? Method Symptoms at their lifetime worst depressive episode were assessed at structured psychiatric interview in 6008 women of Han Chinese descent, age ≥30 years, with recurrent DSM-IV MD. Latent class analysis (LCA) was performed in Mplus. Results Using the nine DSM-IV MD symptomatic A criteria, the 14 disaggregated DSM-IV criteria and all independently assessed depressive symptoms (n=27), the best LCA model identified respectively three, four and six classes. A severe and non-suicidal class was seen in all solutions, as was a mild/moderate subtype. An atypical class emerged once bidirectional neurovegetative symptoms were included. The non-suicidal class demonstrated low levels of worthlessness/guilt and hopelessness. Patterns of co-morbidity, family history, personality, environmental precipitants, recurrence and body mass index (BMI) differed meaningfully across subtypes, with the atypical class standing out as particularly distinct. Conclusions MD is a clinically complex syndrome with several detectable subtypes with distinct clinical and demographic correlates. Three subtypes were most consistently identified in our analyses: severe, atypical and non-suicidal. Severe and atypical MD have been identified in multiple prior studies in samples of European ethnicity. Our non-suicidal subtype, with low levels of guilt and hopelessness, may represent a pathoplastic variant reflecting Chinese cultural influences.

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“…Whether the symptoms of MD can be well captured with one psychopathological dimension or require multiple dimensions has been long debated (Lewis, 1934; Grinker et al 1961; MacFadyen, 1975). Recent analyses suggest that multiple factors are required to explain the co-occurrence of current depressive symptoms (e.g.…”

Section: Introductionmentioning

confidence: 99%

The structure of the symptoms of major depression: exploratory and confirmatory factor analysis in depressed Han Chinese women

Li¹,

Aggen²,

Shi³

et al. 2013

Psychol. Med.

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BackgroundThe symptoms of major depression (MD) are clinically diverse. Do they form coherent factors that might clarify the underlying nature of this important psychiatric syndrome?MethodSymptoms at lifetime worst depressive episode were assessed at structured psychiatric interview in 6008 women of Han Chinese descent, age ⩾30 years with recurrent DSM-IV MD. Exploratory factor analysis (EFA) and confirmatoryfactor analysis (CFA) were performed in Mplus in random split-half samples.ResultsThe preliminary EFA results were consistently supported by the findings from CFA. Analyses of the nine DSM-IV MD symptomatic A criteria revealed two factors loading on: (i) general depressive symptoms; and (ii) guilt/suicidal ideation. Examining 14 disaggregated DSM-IV criteria revealed three factors reflecting: (i) weight/appetite disturbance; (ii) general depressive symptoms; and (iii) sleep disturbance. Using all symptoms (n = 27), we identified five factors that reflected: (i) weight/appetite symptoms; (ii) general retarded depressive symptoms; (iii) atypical vegetative symptoms; (iv) suicidality/hopelessness; and (v) symptoms of agitation and anxiety.ConclusionsMD is a clinically complex syndrome with several underlying correlated symptom dimensions. In addition to a general depressive symptom factor, a complete picture must include factors reflecting typical/atypical vegetative symptoms, cognitive symptoms (hopelessness/suicidal ideation), and an agitated symptom factor characterized by anxiety, guilt, helplessness and irritability. Prior cross-cultural studies, factor analyses of MD in Western populations and empirical findings in this sample showing risk factor profiles similar to those seen in Western populations suggest that our results are likely to be broadly representative of the human depressive syndrome.

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The classification of depressive disorders

Cited by 9 publications

References 63 publications

Evidence for Multiple Genetic Factors Underlying DSM-IV Criteria for Major Depression

Evidence for Multiple Genetic Factors Underlying DSM-IV Criteria for Major Depression

Subtypes of major depression: latent class analysis in depressed Han Chinese women

The structure of the symptoms of major depression: exploratory and confirmatory factor analysis in depressed Han Chinese women

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