TY - JOUR
T1 - The identification of symptom-based subtypes of depression
T2 - A nationally representative cohort study
AU - ten Have, Margreet
AU - Lamers, Femke
AU - Wardenaar, Klaas
AU - Beekman, Aartjan
AU - de Jonge, Peter
AU - van Dorsselaer, Saskia
AU - Tuithof, Marlous
AU - Kleinjan, Marloes
AU - de Graaf, Ron
N1 - Copyright © 2015 Elsevier B.V. All rights reserved.
PY - 2016/1/15
Y1 - 2016/1/15
N2 - 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 respondents with a lifetime key symptom of depression at baseline and who participated in the first two waves (n=1388), symptom profiles at baseline were based on symptoms reported during their worst lifetime depressive episode. Depressive symptoms and DSM-IV diagnoses were assessed with the Composite International Diagnostic Interview 3.0. Three latent variable techniques (latent class analysis, factor analysis, factor mixture modelling) were used to identify the best subtyping model.Results: A latent class analysis, adjusted for local dependence between weight change and appetite change, described the data best and resulted in four distinct depressive subtypes: severe depression with anxiety (28.0%), moderate depression with anxiety (29.3%), moderate depression without anxiety (23.6%) and mild depression (19.0%). These classes showed corresponding clinical correlates at baseline and corresponding course and outcome indicators at follow-up (i.e., class severity was linked to lifetime mental disorders at baseline, and service use for mental health problems and current disability at followup).Limitations: Although the sample was representative of the population on most parameters, the findings are not generalisable to the most severely affected depressed patients.Conclusions: Depression could best be described in terms of both qualitative differences between symptom categories and quantitative differences in severity. In particular anxiety was a distinguishing feature within moderate depression. This study stresses the central position anxiety occupies in the concept of depression. (C) 2015 Elsevier BY. All rights reserved.
AB - 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 respondents with a lifetime key symptom of depression at baseline and who participated in the first two waves (n=1388), symptom profiles at baseline were based on symptoms reported during their worst lifetime depressive episode. Depressive symptoms and DSM-IV diagnoses were assessed with the Composite International Diagnostic Interview 3.0. Three latent variable techniques (latent class analysis, factor analysis, factor mixture modelling) were used to identify the best subtyping model.Results: A latent class analysis, adjusted for local dependence between weight change and appetite change, described the data best and resulted in four distinct depressive subtypes: severe depression with anxiety (28.0%), moderate depression with anxiety (29.3%), moderate depression without anxiety (23.6%) and mild depression (19.0%). These classes showed corresponding clinical correlates at baseline and corresponding course and outcome indicators at follow-up (i.e., class severity was linked to lifetime mental disorders at baseline, and service use for mental health problems and current disability at followup).Limitations: Although the sample was representative of the population on most parameters, the findings are not generalisable to the most severely affected depressed patients.Conclusions: Depression could best be described in terms of both qualitative differences between symptom categories and quantitative differences in severity. In particular anxiety was a distinguishing feature within moderate depression. This study stresses the central position anxiety occupies in the concept of depression. (C) 2015 Elsevier BY. All rights reserved.
KW - Major depressive disorder
KW - Depressive subtypes
KW - Depressive symptoms
KW - Population study
KW - Latent class analysis
KW - Factor mixture model
KW - LATENT CLASS ANALYSIS
KW - MENTAL-HEALTH SURVEY
KW - IV PERSONALITY-DISORDERS
KW - FACTOR MIXTURE ANALYSIS
KW - COMORBIDITY SURVEY
KW - MAJOR DEPRESSION
KW - UNIPOLAR DEPRESSION
KW - INCIDENCE STUDY-2
KW - ANXIETY NESDA
KW - POPULATION
U2 - 10.1016/j.jad.2015.10.040
DO - 10.1016/j.jad.2015.10.040
M3 - Article
C2 - 26546775
SN - 0165-0327
VL - 190
SP - 395
EP - 406
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -