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

Department of Psychology, Free University Berlin, Germany.
Psychological Medicine (Impact Factor: 5.94). 10/2010; 40(10):1679-90. DOI: 10.1017/S0033291709992157
Source: PubMed


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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    ABSTRACT: The course-heterogeneity of Major Depressive Disorder (MDD) hampers development of better prognostic models. Although latent class growth analyses (LCGA) have been used to explain course-heterogeneity, such analyses have failed to also account for symptom-heterogeneity of depressive symptoms. Therefore, the aim was to identify more specific data-driven subgroups based on patterns of course-trajectories on different depressive symptom domains. In primary care MDD patients (n=205), the presence of the MDD criterion symptoms was determined for each week during a year. Weekly 'mood/cognition' (MC) and 'somatic' (SOM) scores were computed and parallel processes-LCGA (PP-LCGA) was used to identify subgroups based on the course on these domains. The classes׳ associations with baseline predictors and 2-/3-year outcomes were investigated. PP-LCGA identified four classes: quick recovery, persisting SOM, persisting MC, and persisting SOM+MC (chronic). Persisting SOM was specifically predicted by higher baseline somatic symptomatology and somatization, and was associated with more somatic depressive symptomatology at long-term follow-up. Persisting MC was specifically predicted by higher depressive severity, thinking insufficiencies, neuroticism, loneliness and lower self-esteem, and was associated with lower mental health related quality of life and more mood/cognitive depressive symptomatology at follow-up. The sample was small and contained only primary care MDD patients. The weekly depression assessments were collected retrospectively at 3-month intervals. The results indicate that there are two specific prototypes of depression, characterized by either persisting MC or persisting SOM, which have different sets of associated prognostic factors and long-term outcomes, and could have different etiological mechanisms. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 03/2015; 179:38-46. DOI:10.1016/j.jad.2015.03.029 · 3.38 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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    ABSTRACT: For diagnostic purposes, the nine symptoms that compose the DSM-5 criteria for major depressive disorder (MDD) are assumed to be interchangeable indicators of one underlying disorder, implying that they should all have similar risk factors. The present study investigates this hypothesis, using a population cohort that shifts from low to elevated depression levels. We assessed the nine DSM-5 MDD criterion symptoms (using the Patient Health Questionnaire; PHQ-9) and seven depression risk factors (personal and family MDD history, sex, childhood stress, neuroticism, work hours, and stressful life events) in a longitudinal study of medical interns prior to and throughout internship (n = 1289). We tested whether risk factors varied across symptoms, and whether a latent disease model could account for heterogeneity between symptoms. All MDD symptoms increased significantly during residency training. Four risk factors predicted increases in unique subsets of PHQ-9 symptoms over time (depression history, childhood stress, sex, and stressful life events), whereas neuroticism and work hours predicted increases in all symptoms, albeit to varying magnitudes. MDD family history did not predict increases in any symptom. The strong heterogeneity of associations persisted after controlling for a latent depression factor. The influence of risk factors varies substantially across DSM depression criterion symptoms. As symptoms are etiologically heterogeneous, considering individual symptoms in addition to depression diagnosis might offer important insights obfuscated by symptom sum scores.
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