Article

Deconstructing major depression: A validation study of the DSM-IV symptomatic criteria

Department of Psychology, Free University Berlin, Germany.
Psychological Medicine (Impact Factor: 5.43). 10/2010; 40(10):1679-90. DOI: 10.1017/S0033291709992157
Source: PubMed

ABSTRACT The DSM-IV symptomatic criteria for major depression (MD) derive primarily from clinical experience with modest empirical support.
The sample studied included 1015 (518 males, 497 females) Caucasian twins from a population-based registry who met criteria for MD in the year prior to the interview. Logistic regression analyses were conducted to compare the associations of: (1) single symptomatic criterion, (2) two groups of criteria reflecting cognitive and neurovegetative symptoms, with a wide range of potential validators including demographic factors, risk for future episodes, risk of MD in the co-twin, characteristics of the depressive episode, the pattern of co-morbidity and personality traits.
The individual symptomatic criteria showed widely varying associations with the pattern of co-morbidity, personality traits, features of the depressive episode and demographic characteristics. When examined separately, these two criteria groups showed robust differences in their patterns of association, with the validators with the cognitive criteria generally producing stronger associations than the neurovegetative.
Among depressed individuals, individual DSM-IV symptomatic criteria differ substantially in their predictive relationship with a range of clinical validators. These results challenge the equivalence assumption for the symptomatic criteria for MD and suggest a more than expected degree of 'covert' heterogeneity among these criteria. Part of this heterogeneity is captured by the distinction between cognitive versus neurovegetative symptoms, with cognitive symptoms being more strongly associated with most clinically relevant characteristics. Detailed psychometric evaluation of DSM-IV criteria is overdue.

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    • "Major Depressive Disorder (MDD) is a burdensome disorder with heterogeneous symptomatology (Lux and Kendler, 2010; Widiger and Clark, 2000; Widiger and Samuel, 2005) and course trajectories (Penninx et al., 2011; Wardenaar et al., 2014). This heterogeneity is a likely reason for the persistent lack of comprehensive etiological models for depression (Luyten et al., 2006). "
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    • "The course of MC symptoms was expected to be specifically predicted by cognitive vulnerability and the tendency to experience negative emotions. The neuroticism and extraversion scales of the Neuroticism-Extraversion-Openness- Five-Factor-Inventory (NEO-FFI; Costa and McCrae, 1992) were included as these were previously shown to be associated with MC-type symptomatology (Lux and Kendler, 2010). In addition, cognitive vulnerability was assessed through the mastery scale (Pearlin and Schooler, 1978) (assessing locus-of-control) and the Rosenberg self-esteem scale (Rosenberg, 1965). "
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    Journal of Affective Disorders 03/2015; 179:38-46. DOI:10.1016/j.jad.2015.03.029 · 3.71 Impact Factor
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    • "In addition, the symptoms chosen as criteria for DSM depression are a small subset of possible depression symptoms (McGlinchey et al. 2006; Zimmerman et al. 2006a) and were determined largely by clinical consensus instead of empirical evidence (Zimmerman et al. 2006b; Kendler & Zachar, 2008; Lux & Kendler, 2010). For instance, helplessness and hopelessness as compound symptoms have been shown to perform more strongly than some of the DSM-IV criterion symptoms in distinguishing depressed from healthy individuals (McGlinchey et al. 2006). "
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