Subtypes of depression in a nationally representative sample

Psychology Research Institute, University of Ulster at Magee, Derry, Northern Ireland, United Kingdom.
Journal of Affective Disorders (Impact Factor: 3.38). 02/2009; 113(1-2):88-99. DOI: 10.1016/j.jad.2008.05.015
Source: PubMed


Continued research efforts aim to elucidate the heterogeneity in depression. The identification of meaningful and valid subtypes has implications for research and clinical practice. Based on patterns of depressive symptomatology, this study identified a typology of depressive syndromes using data from a large, nationally representative survey.
Analyses were based on a subsample of 12,180 respondents from the 2001-2002 Wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Latent class analysis was applied to the DSM-IV 'A' criteria for major depression to identify homogenous subtypes or classes of depressive syndromes. Associations between the emergent latent classes and demographic and clinical characteristics were assessed.
Three clinically relevant subtypes were identified, in addition to a class who reported few depressive symptoms: severely depressed (40.9%), psychosomatic (30.6%), cognitive-emotional (10.2%) and non-depressed (18.3%). The odds of experiencing negative life events, psychiatric disorders, and having a family background of major depression were significantly higher for the severely depressed, psychosomatic and cognitive-emotional classes, compared to the non-depressed class. Several unique differences between the latent classes also emerged.
Methodological shortcomings included: reliance on lay interviewer-administered structured interviews to determine diagnoses; basing sample selection on the endorsement of screener items; and, using measures of 'any anxiety disorder', 'any mood disorder', and 'any personality disorder' to determine psychiatric disorder prevalence rates.
Significant heterogeneity in depressive symptomatology exists in this U.S. sample. Profiling symptom patterns is potentially useful as a first step in developing tailored intervention and treatment programmes.

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Available from: Natacha Carragher, Oct 10, 2015
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    • "Odds ratios ( OR ) and 95% confidence intervals ( CI ) were used to evaluate these associations : ORs reflect the proportionate change in odds of membership of a given class , relative to the ref - erence class , associated with a one - unit change in the covariate ( Carragher et al . , 2009 ) ."
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    ABSTRACT: Aims:To develop a stability typology among opioid substitution therapy patients using a range of adherence indicators derived from clinical guidelines, and determine whether stable patients receive more unsupervised doses. Methods An interviewer-administered cross-sectional survey was used in opioid substitution therapy programs in three Australian jurisdictions, totalling 768 patients in their current treatment episode for ≥4 weeks. A structured questionnaire collated data from patients about their demographics, treatment characteristics, past 6-month drug use and medication adherence, psychosocial stability, comorbidity, child welfare concerns and levels of supervised dosing. Latent class analysis (LCA) was used to derive a stability typology. Linear regression models examined predictors of unsupervised dosing in the past month. Results LCA identified two classes: (i) a higher-adherence group (67%) who had low-moderate probabilities of endorsing the opioid substitution therapy stability indicators and (ii) a lower-adherence group (33%) who had moderate-high probabilities of endorsing the stability indicators. There was no association between adherence profile and the number of unsupervised doses. Significant predictors of receiving larger numbers of unsupervised doses included being older, living in New South Wales or South Australia (vs. Victoria), receiving methadone (vs. mono-buprenorphine), being prescribed in private clinic or general practice (vs. public clinic), reporting a longer current treatment episode, not receiving a urine drug screen in the past month, being currently employed and not having a prison history. Conclusions This study suggested that system-level factors and observable indicators of social functioning were more strongly associated with receipt of less supervised treatment. Future research should examine this using prospectively collected data.
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    • "The latent class model assumes that each class is internally homogeneous, i.e., the probability of engaging in a particular behavior is the same for all members belonging to a particular class (Lazarsfeld and Henry, 1968). In order to choose the final model of LCA, we used the Bayesian Information Criterion [BIC] (Nylund, 2007) to indicate the most parsimonious solution (Hagenaars and McCutcheon, 2002; Weich et al., 2011), and entropy, to express how well each class is classified (Carragher et al., 2009). We ran multiple-group LCA in the general sample to examine whether symptomatological profiles among classes were different across the male and female samples. "
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    • "Depression can be regarded as a heterogeneous condition, likely consisting of various subtypes associated with family psychiatric history, cognitive profiles and clinical features (Keller et al., 2007; Carragher et al., 2009). It has been estimated that 1 in 6 individuals with major depression also demonstrate psychotic features (psychotic major depression; PMD) (Johnson et al., 1991; Parker et al., 1992; Ohayon and Schatzberg, 2002). "
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