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Is Clinical Depression Distinct from Subthreshold Depressive Symptoms? A Review of the Continuity Issue in Depression Research
Abstract
Resolving whether subthreshold depressive symptoms exist on a continuum with unipolar clinical depression is important for progress on both theoretical and applied issues. To date, most studies have found that individuals with subthreshold depressive symptoms resemble cases of major depressive disorder along many important dimensions (e.g., in terms of patterns of functional impairment, psychiatric and physical comorbidity, familiality, sleeping EEG, and risk of future major depression). However, such manifest similarities do not rule out the possibility of a latent qualitative difference between subthreshold and diagnosable depression. Formal taxonomic analyses, intended to resolve the possibility of a latent qualitative distinction, have so far yielded contradictory findings. Several large-sample latent class analyses (LCA) have identified latent clinical and nonclinical classes of unipolar depression, but LCA is vulnerable to identification of spurious classes. Paul Meehl's taxometric methods provide a potentially conservative alternative way to identify latent classes. The one comprehensive taxometric analysis reported to date suggests that self-report depression symptoms occur along a latent continuum but exclusive reliance on self-report depression measures and incomplete information regarding sample base rates of depression makes it difficult to draw strong inferences from that report. We conclude that although most of the evidence at this time appears to favor both a manifest and latent continuum of unipolar depression symptomatology, several important issues remain unresolved. Complete resolution of the continuity question would be speeded by the application of both taxometric techniques and LCA to a single large sample with a known base rate of lifetime diagnosed depressives.
... Ainsi, il nous semble plus pertinent de toujours analyser les résultats à l'échelle de repérage des signes de l'EDC en axant, certes, sur un score global, mais surtout sur chaque signe de l'EDC repéré chez la personne évaluée (Faravelli et al., 1996;Fried & Nesse, 2014Gotlib, Lewinsohn, & Seeley, 1995;Solomon, Haaga, & Arnow, 2001 Les différents traits de personnalité forment un tout organisé dont les bases sont physiologiques (Allport, 1937;Byrne, 1966;Carver & Scheier, 2012;Cattell, 1950;Eysenck, 1953 Cet outil s'appuie sur le modèle de traitement de l'information sensorielle de Dunn. ...
... Bien que ces différentes manifestations soient liées entre elles (Annexe 5.2, tableau 28), les éléments liés à l'affect sont uniquement corrélés entre eux, mais pas aux autres manifestations dépressives. Or, pour poser un diagnostic de trouble dépressif récurrent, la présence d'une humeur dépressive tous les jours ou presque est nécessaire et les symptômes de l'épisode dépressif récurrent viennent s'y ajouter.Les recherches dans le domaine de la dépression mettent de plus en plus en évidence l'existence d'un syndrome sub-clinique, rejoignant la notion de spectre du normal au pathologique introduite dans l'autisme(Bertha & Balázs, 2013;Lee et al., 2019;Solomon et al., 2001). Un syndrome dépressif sub-clinique est défini par la présence de moins de cinq signes de l'EDC pendant une durée d'au minimum deux semaines(Lee et al., 2019;Rodríguez, Nuevo, Chatterji, & Ayuso-Mateos, 2012;Solomon et al., 2001), ce qui le différencie également des manifestations dépressives.Malgré les limites de notre étude, l'ensemble de ces éléments souligne la différence entre les manifestations dépressives, un trouble dépressif récurrent et un syndrome dépressif subclinique. ...
... Or, pour poser un diagnostic de trouble dépressif récurrent, la présence d'une humeur dépressive tous les jours ou presque est nécessaire et les symptômes de l'épisode dépressif récurrent viennent s'y ajouter.Les recherches dans le domaine de la dépression mettent de plus en plus en évidence l'existence d'un syndrome sub-clinique, rejoignant la notion de spectre du normal au pathologique introduite dans l'autisme(Bertha & Balázs, 2013;Lee et al., 2019;Solomon et al., 2001). Un syndrome dépressif sub-clinique est défini par la présence de moins de cinq signes de l'EDC pendant une durée d'au minimum deux semaines(Lee et al., 2019;Rodríguez, Nuevo, Chatterji, & Ayuso-Mateos, 2012;Solomon et al., 2001), ce qui le différencie également des manifestations dépressives.Malgré les limites de notre étude, l'ensemble de ces éléments souligne la différence entre les manifestations dépressives, un trouble dépressif récurrent et un syndrome dépressif subclinique. ...
Dès la première description du Trouble du Spectre de l'Autisme, Kanner (1943) a souligné la présence momentanée de manifestations dépressives chez un des cas. Aujourd'hui, l'Episode Dépressif Caractérisé (EDC) est considéré comme étant un des troubles psychiatriques les plus fréquemment associés au TSA, ayant des répercussions à court, moyen et long termes sur l'enfant ayant un TSA et sa famille. Pourtant, aujourd'hui, il n'existe pas de consensus concernant la façon d'évaluer la symptomatologie dépressive chez les enfants et les adolescents ayant un TSA. Les objectifs de cette recherche sont de créer et de valider une échelle de repérage des signes de l'EDC, d'identifier les facteurs associés aux signes de l'EDC chez les enfants et les adolescents ayant un TSA et d'étudier les manifestations dépressives dans leur fonctionnement habituel. Quatre études ont été réalisées. La première a permis de créer l'échelle de repérage des signes de l'EDC spécifique aux enfants et aux adolescents ayant un TSA. Elle est composée de 3 parties : une évaluation des douleurs et des médicaments pris par l'enfant, le listing des changements environnementaux et l'évaluation de la symptomatologie dépressive ; en deux étapes : une description du fonctionnement habituel de l'enfant puis une mesure de l'ampleur des changements de comportements. La seconde étude visait à valider cette échelle (N=153). La fidélité inter-juges est très satisfaisante mais devra être évaluée sur un échantillon plus important (ρfiabilité=0,98 ; ρfiabilité=0,02). L'échelle a de bonnes validités apparente, de contenu et de critère et une excellente consistance interne (αéchelleEDC=0,91). Elle est composée de deux facteurs : un de changements comportementaux et l'autre de changements émotionnels et cognitifs. La troisième étude visait à identifier les facteurs associés à l'EDC chez les enfants et les adolescents ayant un TSA (N=58). Des facteurs individuels, notamment liés au parcours de soin concernant le diagnostic de TSA mais aussi la santé somatique ; familiaux, notamment le vécu parental et le désir d'avoir des amis sont liés à la symptomatologie dépressive. La quatrième étude avait pour objectif d'identifier des manifestations dépressives dans le fonctionnement habituel des enfants et des adolescents ayant un TSA (N=133). Plus d'un tiers de l'échantillon exprime de la tristesse quasiment tous les jours et plus d'un quart n'exprime quasiment jamais de joie. Plus de la moitié des enfants et des adolescents de l'échantillon ne prend aucun plaisir au quotidien. Un jeune sur cinq a des comportements auto-agressifs et 28% ont des comportements hétéro-agressifs tous les jours. La moitié de l'échantillon a des difficultés de sommeil et 58% en a d'appétit tous les jours. Enfin, trois quarts des jeunes expriment de la culpabilité ou de la dévalorisation tous les jours.
... Moreover, several people may present symptoms of depression without meeting the criteria for a categorical diagnosis. In other words, symptoms may express a subsyndrome, early detection of which may aid prognosis and interventions (Solomon et al., 2001). For example, van Lang et al. (2006) investigated approximately 3,000 adolescents and concluded that, even in large samples, there are few individuals who present depression exactly as described in the nosography manuals. ...
... For example, sleeping problems can induce fatigue and lack of concentration, which, in turn, trigger symptoms of mood and anhedonia. Many individuals in this class, however, may be those referred to as underdiagnosed in a categorical or sub-syndrome perspective and should be evaluated in a more in-depth way (Pelletier et al., 2017;Solomon et al., 2001). ...
Response styles and non-linearity might reduce the validity of scores on depression inventories. To address both issues, we explored the latent class structure of the Baptista’s Depression Scale (EBADEP), and the influence of extreme response bias. In total, 1,137 Brazilian college students (M = 26 years, SD = 7.3) participated in this study. Taxometric analysis yielded ambiguous results, without clear support for either a dimensional or a categorical representation of the data. We found three latent classes: one comprising participants with a tendency to endorse items about sadness, angst, pessimism, and low self-efficacy; another with individuals scoring low on all symptoms; and a third with intermediate scores. We found no relationship between the composition of latent classes and extreme response. Participants who reported having received a diagnostic of depression were more likely to belong to the first latent class. These findings validate the clinical usefulness of a latent class structure for the EBADEP.
... A fundamental question in human genetics and medicine is whether clinical disorders represent extreme manifestations of continuously distributed traits or categorically distinct phenotypes with distinct etiologies. This question is especially relevant to psychiatric disorders such as major depressive disorder, where symptoms can vary considerably outside the clinical range 1 . Discerning between continuous and categorical models of psychiatric illness is critical to a wide variety of scientific and clinical applications, including the design of empirical research (e.g., determining whether data can be aggregated across continuous and case-control studies), the development of nosological and diagnostic frameworks, and the appropriate application of therapeutics developed and validated for clinical populations to those with subclinical symptoms and vice versa. ...
A core question in both human genetics and medicine is whether clinical disorders represent extreme manifestations of continuous traits or categorically distinct entities with unique genetic etiologies. To address this question, we introduce Genomic Taxometric Analysis of Continuous and Case-Control data (GTACCC), a novel method for systematically evaluating continuity and differentiation of traits across the severity spectrum. GTACCCs key innovation lies in binarizing continuous data at multiple severity thresholds, enabling the estimation of genetic continuity and differentiation within the trait and in its relation to other traits via multivariate models. We apply GTACCC to self-reported neuroticism data from UK Biobank (N= 414,448) and clinically ascertained major depressive disorder (MDD) data from the Psychiatric Genomics Consortium (Neff = 111,221). We find that while neuroticism shares a considerable portion of its genetic etiology with MDD across the nonclinical, and even very low, range of (rg ~ .50), genetic sharing increases monotonically across the severity spectrum, approaching unity only at the highest levels of severity (rg ~ 1.0). Genomic structural equation models indicate that a single liability threshold model of negative emotionality is less consistent with the data than a multifactor model, suggesting that a gradient of genetic differentiation emerges across the spectrum of negative emotionality. Thus, within continuous measures of negative emotionality, partly distinct genetic liabilities exist at varying severity levels, with only the most severe levels associated with liabilities that approach equivalence to MDD genetics.
... 6). Depressive symptoms that do not meet a diagnostic threshold may also cause substantial suffering and dysfunction (Angst & Merikangas, 1997;Pasacreta, 1997;Solomon et al., 2001). Therefore, this study does not define depressive symptoms as a clinical level of disorder (i.e., major depression). ...
Purpose: Existing research indicates a complex relationship between the racial/ethnic composition of neighborhoods, individuals' own race/ethnicity, and depressive symptoms. To fill this gap, this study aims to test whether race/ethnicity moderates the relationship between neighborhood racial/ethnic composition and depressive symptoms.
Materials and Methods: This study used merged data from the Health and Retirement Study 2016 and the American Community Survey 2014-2018 Data (N = 5,241). This study applied a mixed-effects negative binomial regression model.
Results: Non-Hispanic Black respondents tended to have higher counts of depressive symptoms, compared to non-Hispanic Whites. However, the moderation effect of individuals’ own race/ethnicity was significant for non-Hispanic Blacks. Specifically, non-Hispanic Blacks experienced lower predicted counts of depressive symptoms when living in neighborhoods with a higher proportion of Black residents, suggesting a protective effect of racial concordance.
Discussion: These findings highlight the importance of considering the dynamics of depressive symptomatology and race at both the individual and neighborhood levels. Interventions targeting vulnerable older adults can be more effectively designed by incorporating individual and neighborhood racial contexts.
... In fact, this does not even necessarily lead to a more incapacitating disorder (cf. Gotlib et al., 1995;Solomon et al., 2001;Fried and Nesse, 2015). ...
Researchers are increasingly acknowledging that psychopathological conditions usually grouped together under the generic label “depression” are highly diverse. However, no differential therapeutic approach currently exists that is sensitive to the varieties of depression afflicting young people. In fact, the discussion is missing something much more fundamental: a specification of the types of adolescent depression. Recent research that has aimed to classify different kinds of depression has mainly studied adult populations and predominantly used technically complicated measurements of biological markers. The neglect of the potential particularities of dysphoric disorders affecting youths is unfortunate, and the exclusive focus on biological parameters unnecessarily restrictive. Moreover, this one-sidedness obfuscates more directly available sources of clinically relevant data that could orient conceptualization efforts in child and adolescent psychiatry. Particularly, clues for discriminating different types of adolescent depression may be obtained by analyzing personally articulated accounts of how affected young people experience changes in their relation to the world and to themselves. Thus, here we present and discuss the findings of a study that explored the possibility of specifying types of adolescent depression in a phenomenological way. The study investigated the association between these types and the vicissitudes of personality development. In accounts given by youths diagnosed with depression during semi-structured interviews, we identified themes and examined their phenomenological centrality. Specifically, our qualitative analyses aimed to determine the relative importance of certain themes with respect to the overall intelligibility of the described changes to the relational space. Based on the findings of these analyses, we differentiate three specifiers of adolescent depression and suggest an association between particular types of experiences and the trajectory of affected adolescents’ personality development. To our knowledge, this is the first phenomenologically grounded specification of types of adolescent depression with potential therapeutic significance. Thus, based on this contribution, we propose that modes of scientific exploration that are close to phenomenological philosophy—which have been ignored in the context of developmental psychopathology—could offer a foundation to theories developed in the field of child and adolescent psychiatry.
... This symptom severity result raises the possibility of a parsimonious explanation of how untroubled pullers differ from the fully diagnosed, namely that their hair pulling problems are less severe. Extensive theorizing and research have considered the possibility that, for instance, major depression represents the severe end of a continuum with nonclinical sadness (e.g., Solomon et al., 2001), or that personality disorders represent maladaptive extremes of normal personality trait dimensions (e.g., Widiger & McCabe, 2020). By analogy, we consider in Study 2 whether any differences between fully diagnosed pullers and untroubled pullers might be accounted for by considering them as occupying different places on the same continuum, using analyses of group differences with statistical control of symptom severity. ...
Nonclinical hair-pulling is much more prevalent than hair pulling associated with a diagnosis of trichotillomania (TTM). However, little is known about nonclinical pulling. The purpose of this exploratory research was to begin characterizing a subset of nonclinical hair pullers we refer to as "untroubled pullers," people who engage in recurrent, noncosmetic hair-pulling without associated distress or impairment. In a secondary analysis of two studies conducted online, untroubled pullers reported significantly lower symptom severity than did those diagnosed with TTM. The Big Five personality dimensions did not differentiate the groups in Study 1, but untroubled pullers endorsed significantly less disability, focused and automatic pulling, social anxiety, perceived risk in intimacy, and perfectionism in Study 2. These findings remained significant after controlling for symptom severity. Age and race resulted in mixed findings between the two studies, but no differences arose in other demographics. These findings suggest that symptom severity may not sufficiently explain differences in associated distress and impairment. Future studies are needed on how other constructs related to distress and impairment interact with hair-pulling behavior to provide insight into when pulling is associated with clinically significant distress or impairment.
... Modelos experimentales confirman que la disminución de la concentración de 5HT en el cerebro puede causar insomnio (3). La obesidad y la disfunción de la tiroides también influyen en la calidad del sueño de las mujeres climatéricas (4)(5)(6)(7)(8). Por otra parte, no es fácil discriminar la influencia de factores como la ansiedad, el estrés y depresión con los trastornos del sueño, en general (9) así como tampoco con los cambios producidos por el avance de la edad. ...
... Grigoriadis et al. found evidence that the prevalence of anxiety disorders in the perinatal period may be higher than previously thought and that anxiety may be more prevalent than depression in certain populations (Grigoriadis et al. 2011). It also represents exactly what Salomon et al. argued for in their review (Salomon et al. 2001). Regarding the question if diagnosable unipolar depression and limited depressive symptoms are qualitatively distinct or only differ in degree they stated that analysis based on self-report measures are somewhat ambiguous in their implications, because elevated self-report scores may rather reflect various kinds of negative affect and psychological disorders than unipolar clinical depression. ...
There is a high prevalence of depression in Germany and all over the world. Maternal depressive symptoms during pregnancy have been shown in some studies to be associated with an increased risk of preterm birth and low birth weight. The influence of maternal depressive symptoms during pregnancy on preterm delivery and fetal birth weight was investigated in a prospective single-centre study.
... These microbial discrepancies across countries highlight a need for each country or geographic region to develop a unique microbiome database to guide future microbial research. [69] Furthermore, although the division of patients into clinical MDD and subthreshold depressive symptoms is rather crude, [70] analyzing the association between depression severity and gut microbiota proved impossible based on currently available data. Some alterations were found to be specific to MDD such as increased Flavonifractor and Holdemania. ...
The emergence of the coronavirus disease 2019 pandemic has dramatically increased the global prevalence of depression. Unfortunately, antidepressant drugs benefit only a small minority of patients. Thus, there is an urgent need to develop new interventions. Accumulating evidence supports a causal relationship between gut microbiota dysbiosis and depression. To advance microbiota-based diagnostics and therapeutics of depression, a comprehensive overview of microbial alterations in depression is presented to identify effector microbial biomarkers. This procedure generated 215 bacterial taxa from humans and 312 from animal models. Compared to controls, depression shows significant differences in β-diversity, but no changes in microbial richness and diversity. Additionally, species-specific microbial changes are identified like increased Eggerthella in humans and decreased Acetatifactor in rodent models. Moreover, a disrupted microbiome balance and functional changes, characterized by an enrichment of pro-inflammatory bacteria (e.g., Desulfovibrio and Escherichia/Shigella) and depletion of anti-inflammatory butyrate-producing bacteria (e.g., Bifidobacterium and Faecalibacterium) are consistently shared across species. Confounding effects of geographical region, depression type, and intestinal segments are also investigated. Ultimately, a total of 178 species and subspecies probiotics are identified to alleviate the depressive phenotypes. Current findings provide a foundation for developing microbiota-based diagnostics and therapeutics and advancing microbiota-oriented precision medicine for depression.
... As a subclinical depressive symptom, subthreshold depression (StD) refers to such a depressive state that does not meet the criteria of major depressive disorder (MDD; Cuijpers et al., 2021;Rodríguez et al., 2012) and exists on a continuum between no depressive symptoms and major depression (Angst et al., 2000;Solomon et al., 2001;Tuithof et al., 2018;Zhang et al., 2020). Although previous studies have found that depression is associated with deficits of visual functioning (for a review, Fitzgerald, 2013), most of these studies have focused on MDD patients. ...
Subthreshold depression (StD), as a subclinical state, is highly prevalent and increases the risk for developing major depressive disorder (MDD). Although several studies have reported deficits of contrast sensitivity in MDD patients, it is unclear whether individuals with StD could demonstrate deficits of contrast sensitivity and whether the deficits could remain stable over time. Here we used a contrast discrimination task (a suprathreshold task) and a contrast detection task (a near‐threshold task) to compare contrast sensitivity of the StD group with that of matched non‐depressed controls. For each task, a spatial four‐alternative forced‐choice method and a psychophysical QUEST procedure were used to measure contrast discrimination threshold or contrast detection threshold. Participants performed an initial assessment and a follow‐up assessment 4 months later. Compared to the non‐depressed controls, individuals with StD demonstrated reduced contrast discrimination sensitivity, not only at the initial assessment but also at the follow‐up assessment, indicating a stable abnormality. Contrast discrimination thresholds at the initial assessment did not predict changes of depression symptom severity over time. For contrast detection sensitivity, there was no significant difference between the StD group and non‐depressed controls. We concluded that contrast discrimination testing might provide a trait‐dependent biomarker for depression.
... In addition to the application of DCMs to educational and achievement tests, Templin and Henson (2006) proposed a disjunctive version of a DCM, the deterministic input noisy or gate (DINO) model, and applied this model to diagnose the degrees of a psychological gambling disorder. With the exception of their research, most studies have used traditional exploratory clustering methods to classify individuals into different classes in terms of different personality types (e.g., Fals-Stewart et al., 1994;Solomon et al., 2001), and a few studies have applied DCMs to personality assessment (e.g., Revuelta et al., 2018). ...
The forced-choice (FC) item formats used for noncognitive tests typically develop a set of response options that measure different traits and instruct respondents to make judgments among these options in terms of their preference to control the response biases that are commonly observed in normative tests. Diagnostic classification models (DCMs) can provide information regarding the mastery status of test takers on latent discrete variables and are more commonly used for cognitive tests employed in educational settings than for noncognitive tests. The purpose of this study is to develop a new class of DCM for FC items under the higher-order DCM framework to meet the practical demands of simultaneously controlling for response biases and providing diagnostic classification information. By conducting a series of simulations and calibrating the model parameters with a Bayesian estimation, the study shows that, in general, the model parameters can be recovered satisfactorily with the use of long tests and large samples. More attributes improve the precision of the second-order latent trait estimation in a long test, but decrease the classification accuracy and the estimation quality of the structural parameters. When statements are allowed to load on two distinct attributes in paired comparison items, the specific-attribute condition produces better a parameter estimation than the overlap-attribute condition. Finally, an empirical analysis related to work-motivation measures is presented to demonstrate the applications and implications of the new model.
... There is also growing recognition that subthreshold depression-i.e., depressive symptoms that do not meet the diagnostic criteria of major depressive disorder or dysthymia-is even more prevalent than depressive disorders [46,47] and associated with lower quality of life [48] and functional impairment [49]. Finally, there is strong evidence that subthreshold depressive symptoms are important risk factors for major depression [50], which suggests that symptoms below the threshold of diagnostic criteria should be considered in studies of depression in this population [51]. ...
Little is known about the association between acculturation and mental health among Dominican populations in the United States. Data came from a community survey of Dominican residents of New York City (n = 2744). Associations between two indicators of acculturation, proportion of life spent in the U.S. and interview language (English/Spanish), with lifetime depressive symptoms (Patient Health Questionnaire-9 score ≥ 5) were examined using logistic regression overall and by gender. In adjusted models, respondents with English-language interview and above-median proportion of life spent in the U.S. had 77% higher odds (95% CI 1.28, 2.44) of lifetime depressive symptoms than those with Spanish-language interview and below-median proportion of life spent in the U.S. There was some evidence of elevated odds of depressive symptoms among men with English-language interview and below-median proportion of life spent in the U.S. Additional research is needed to elucidate gender-specific impacts of acculturation on mental health in this population.
... Many people may have "subsyndromal" depressive symptoms, such as minor depression or brief recurrent depression (Kessler & Wang, 2008, p. 6). Depressive symptoms that do not meet a diagnostic threshold may also cause substantial suffering and dysfunction (Angst & Merikangas, 1997;Pasacreta, 1997;Solomon, Haaga, & Arnow, 2001). Therefore, this study does not define depressive symptoms as a clinical level of disorder. ...
Existing research indicates neighborhood is an important determinant of depressive symptoms. However, this research has several limitations. These include a lack of investigation of older adults’ experiences and of social support as a possible moderator. The current study aims to fill these gaps by increasing knowledge about the relationships between perceived neighborhood disorder and depressive symptoms among older adults. Applying stress process theory, this study investigated the relationships between two subjective indicators of neighborhood stressors – physical and social perceived neighborhood disorder and depressive symptoms. This study also tested whether social support moderated the effects of the neighborhood stressors on depressive symptoms. This study was based on secondary data analysis from the Health and Retirement Study 2016 (N = 3,684; age 50+). This study applied a negative binomial regression in that the outcome was a count variable. The results showed the stress buffering effects of social support were not significant for both perceived neighborhood social disorder and physical disorder. Not as a moderator but as the main effect, lower social support was significantly related to higher depressive symptoms. Having a depression history, lower self-rated health, female, and lower education were also related to higher depressive symptoms. This study contributes to social work practice by addressing older adults’ depressive symptomatology. Findings identified vulnerable older adults to target for interventions based on individual characteristics. Focusing on social support should be a vital component of interventions. Social workers can help older adults maintain and strengthen their social support, with beneficial effects on their depressive symptomatology.
... In addition, although literature (e.g., Bauer et al., 2012;Herzog et al., 2021;Rosen et al., 2020) thus far suggests that patients receiving treatment for PTSD or OCD profit similarly in the presence of pre-treatment depressive disorders, there are only a few studies that looked into this and most have insufficient power due to small sample sizes. Furthermore, comorbidity was mainly investigated dichotomously (yes/no diagnosis), whereas continuous self-report symptom-severity scales might better reflect the course of the depression (Hankin et al., 2005;Solomon et al., 2001). Moreover, continuous predictors have more statistical power to detect effects than dichotomized predictors (Royston et al., 20056). ...
Background
: Although anxiety and depression are highly comorbid disorders, it remains unclear whether and how a concurrent depression affects the outcome of anxiety treatment.
Method: Using anonymized routine outcome monitoring (ROM) data of 740 patients having received specialized treatment for an anxiety disorder, OCD, or PTSD, this study investigates whether a comorbid diagnosis of depression and/or self-reported depression severity levels relate to the patients’ improvement following anxiety treatment.
Results
: The results show that both the patients with and those without comorbid depression had profited similarly from the anxiety, OCD, or PTSD treatment, regardless of whether depression was merely diagnosed prior to treatment or based on self-reported severity (and assuming a smallest effect size of interest of d = 0.35/r = .2). Importantly, the post-treatment reductions in self-reported depressive symptoms were strongly and positively related to the reductions in self-reported anxiety symptoms and disorder-related disability.
Limitations
: Causal inferences cannot be made due to the retrospective cross-sectional design. Conclusions: The outcomes obtained in a naturalistic patient sample support current treatment guidelines recommending evidence-based treatment for anxiety disorders, OCD, and PTSD in patients with and without a comorbid depression. Future treatment studies are recommended for investigate the (bi)directionality of anxiety and depressive symptoms throughout treatment.
... Antidepressant medication has low acceptability in pregnant women and is only appropriate for moderatesevere depression [23,24]. However, levels of depressive symptoms that are associated with functional impairment, but that do not necessarily meet criteria for a diagnosis of major depressive disorder have been shown to have adverse effects on the mother and unborn child [25,26] and can be treated effectively with psychological treatments [27][28][29][30]. The World Health Organization mental health gap (mhGAP) intervention guide, designed for PHC workers in LMICs, recommends several brief, manualised psychological therapies for people with depression: interpersonal psychotherapy, cognitive behavioural therapy, behavioural activation therapy and problem solving therapy (PST) [31]. ...
Background
Despite a high prevalence of antenatal depression in low- and middle-income countries, there is very little evidence for contextually adapted psychological interventions delivered in rural African settings. The aims of this study are (1) to examine the feasibility of procedures for a future fully powered efficacy trial of contextually adapted brief problem solving therapy (PST) for antenatal depression in rural Ethiopia, and (2) to investigate the acceptability, fidelity and feasibility of delivery of PST in routine antenatal care.
Methods
Design: A randomised, controlled, feasibility trial and mixed method process evaluation. Participants: Consecutive women attending antenatal clinics in two primary care facilities in rural Ethiopian districts. Eligibility criteria: (1) disabling levels of depressive symptoms (Patient Health Questionnaire (PHQ-9) score of five or more and positive for the 10 th disability item); (2) gestational age 12–34 weeks; (3) aged 16 years and above; (4) planning to live in the study area for at least 6 months; (5) no severe medical or psychiatric conditions. Intervention: Four sessions of adapted PST delivered by trained and supervised antenatal care staff over a maximum period of eight weeks. Control: enhanced usual care (EUC). Sample size: n = 50. Randomisation: individual randomisation stratified by intimate partner violence (IPV). Allocation: central phone allocation. Outcome assessors and statistician masked to allocation status. Primary feasibility trial outcome: dropout rate. Primary future efficacy trial outcome: change in PHQ-9 score, assessed 9 weeks after recruitment. Secondary outcomes: anxiety symptoms, trauma symptoms, intimate partner violence, disability, healthcare costs at 9 weeks; postnatal outcomes (perinatal and neonatal complications, onset of breast feeding, child health) assessed 4–6 weeks postnatal. Other trial feasibility indicators: recruitment, number and duration of sessions attended. Audio-recording of randomly selected sessions and in-depth interviews with purposively selected participants, healthcare providers and supervisors will be analysed thematically to explore the acceptability and feasibility of the trial procedures and fidelity of the delivery of PST.
Discussion
The findings of the study will be used to inform the design of a fully powered efficacy trial of brief PST for antenatal depression in routine care in rural Ethiopia.
Trial registration
The protocol was registered in the Pan-African clinical trials registry, (PACTR): registration number: PACTR202008712234907 on 18/08/2020; URL: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9578 .
... Antidepressant medication has low acceptability in pregnant women and is only appropriate for moderate-severe depression (23,24). However, levels of depressive symptoms that are associated with functional impairment, but that do not necessarily meet criteria for a diagnosis of major depressive disorder have been shown to have adverse effects on the mother and unborn child (25,26) and can be treated effectively with psychological treatments (27)(28)(29)(30). The World Health Organization mental health gap (mhGAP) intervention guide, designed for PHC workers in LMICs, recommends several brief, manualised psychological therapies for people with depression: interpersonal psychotherapy, cognitive behavioural therapy, behavioural activation therapy and problem solving therapy (PST) (31). ...
Background: Despite a high prevalence of antenatal depression in low- and middle-income countries, there is very little evidence for contextually adapted psychological interventions delivered in rural African settings.
The aims of this study are: (1) to examine the feasibility of procedures for a future fully powered efficacy trial of contextually adapted brief Problem Solving Therapy (PST) for antenatal depression in rural Ethiopia, and (2) to investigate the acceptability, fidelity and feasibility of delivery of PST in routine antenatal care.
Methods: Design: A randomized, controlled, feasibility trial and mixed method process evaluation. Participants: Consecutive women attending antenatal clinics in two primary care facilities in rural Ethiopian districts. Eligibility criteria: 1) Disabling levels of depressive symptoms (Patient Health Questionnaire (PHQ-9) score of five or more and positive for the 10th disability item); 2) gestational age 12-34 weeks; 3) aged 16 years and above, 4) planning to live in the study area for at least six months; 5) no severe medical or psychiatric conditions. Intervention: Four sessions of adapted PST delivered by trained and supervised antenatal care staff over a maximum period of eight weeks. Control: enhanced usual care (EUC). Sample size: n=50. Randomisation: individual randomisation stratified by intimate partner violence (IPV). Allocation: central phone allocation. Outcome assessors and statistician masked to allocation status.
Primary feasibility trial outcome: dropout rate. Primary future efficacy trial outcome: change in PHQ-9 score, assessed nine weeks after recruitment. Secondary outcomes: anxiety symptoms, trauma symptoms, intimate partner violence, disability, healthcare costs at 9 weeks; postnatal outcomes (perinatal and neonatal complications, onset of breast feeding, child health) assessed 4-6 weeks postnatal. Other trial feasibility indicators: recruitment, number and duration of sessions attended. Audio-recording of randomly selected sessions and in-depth interviews with purposively selected participants, healthcare providers and supervisors will be analysed thematically to explore the acceptability and feasibility of the trial procedures and fidelity of the delivery of PST.
Discussion: The findings of the study will be used to inform the design of a fully-powered efficacy trial of brief PST for antenatal depression in routine care in rural Ethiopia.
Trial registration: The protocol was registered in the Pan-African clinical trials registry, (PACTR): registration number: PACTR202008712234907 on 18/08/2020;
URL: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9578
Funding: This work is supported through the DELTAS Africa Initiative [DEL-15-01].
... Nevertheless, jogging is a significant contribution to either clinical or nonclinical level of mental health in adolescents. In comparison to our study with the reference [77], we learned that not only an identified clinical and nonclinical class of depressive symptoms but also non-identified depressive prodrome is vulnerable via the dimensional approach from the self-rated measure. However, we should be careful about the recognition between the subthreshold depression (SD) [78,79] and the depressive prodrome in adolescents. ...
The adolescent depressive prodrome has been conceptualized as an early integrated sign of depressive symptoms, which may develop to a first episode of depression or return to normal for the adolescents. In this study, depressive prodrome presented the early self-rated depressive symptoms for the sample participants. By referring to the Kutcher Adolescent Depression Scale and the psychometric characteristics of the Adolescent Depression Scale (ADR), we proposed a self-rated questionnaire to assess the severity of the depressive symptoms in adolescents before and after attending the jogging program on a high school campus in Taiwan. With the parental co-signature and self-signed informed consent form, 284 high school students under the average age of 15 years, participated in this study in March 2019. Through the software of IBMSPSS 25, we used a binary logistic model, principal component analysis (PCA), multiple-dimensional analysis, and receiver operating characteristic curve (ROC) to analyze the severity of the depressive prodrome via the threshold severity score (SC) and false positive rate (FPR). Findings revealed that attending the 15-week jogging program (3 times a week, 45 min each) on campus can change the severity status and reduce the prevalence of moderate-severe depressive prodrome by 26%. The two-dimensional approach identified three symptoms, which were the crying spell, loss of pleasure doing daily activities, and feeling the decline in memory. They kept being invariant symptoms during the course of depressive prodrome assessment for sample participants. In this study, the campus jogging program appeared to be able to affect the FPR of the measure of depressive prodrome. Compared with the subthreshold depression, the depressive prodrome emphasized the assessment from the view of the secondary prevention by representing the change from a person’s premorbid functioning up until the first onset of depression or returning to normal. However, the subthreshold depression is a form of minor depression according to DSM-5 criteria varying on the number of symptoms and duration required, highly prevalent in the concern of primary care.
... Depression is a common mental disorder with clinical symptoms ranging from low mood to severe phenotype, including suicidal behavior [1]. The most common symptoms include sadness, guilt, loss of interest, inability to feel pleasure, fatigue, problems with sleep and difficulty concentrating [2]. ...
Depressive disorders are common among young people and can decrease social competences and thus the quality of life. There is a relationship between the occurrence of depressive disorders and insomnia. The aim of the study was to determine the prevalence of insomnia and depressive behavior and assess the relationship between these among participants of the Pol’and’Rock Festival, Kostrzyn, Poland 2019. The study used the Athens Insomnia Scale (AIS) and the Beck Inventory II Scale (BDI-II). The study group consisted of 923 people, with the majority of women (n = 500; 54.2%). A total of 297 persons (32.2%) reported varying severity of depressive symptoms. Insomnia was observed in 261 (28.28%) respondents. Sleeping disturbances were observed more frequently in females. Persons with insomnia had a significantly higher BDI-II score. A strong positive correlation (r = 0.65) between the number of points obtained on the Beck and AIS scales was observed. Insomnia and depressive behavior are prevalent in the Polish population. Due to long-term social and economic consequences, special attention should be paid to the prevention, early detection and treatment of both disorders.
... In response to these issues with the categorical approach, many researchers have suggested that mental disorders, such as depression, should be seen as dimensional. From this perspective, people who suffer from 'severe depression' occupy a higher position on a continuous latent variable rather than being qualitatively different from the normal population (Brown & Barlow, 2005;Jablensky, 2012a;Solomon et al., 2001;Watson, 2005;Widiger & Samuel, 2005). For example, rather than a discrete category such as diabetes mellitus, a dimensional perspective in medicine would be a continuous factor that underlies certain problems, such as blood pressure. ...
Traditionally, psychiatric syndromes have formed the primary target of explanation in psychopathology research. However, these syndromes have been significantly criticised for their conceptual weakness and lack of validity. Ultimately, this limits our ability to create valid explanations of these categories; if the target is invalid then our explanations will suffer as a consequence. Using depression as extended example, this doctoral thesis explores the theoretical and methodological challenges associated with classifying and explaining mental disorders, and develops an alternative explanatory approach and associated methodology for advancing our understanding of mental disorders-the Phenomena Detection Method (PDM; Clack & Ward, 2020; Ward & Clack, 2019).
This theoretical thesis begins by evaluating the current approaches to defining, classifying, and explaining mental disorders like depression, and explores the methodological and theoretical challenges with building theories of them. Next, in moving forward, I argue that the explanatory target in psychopathology research should shift from arbitrary syndromes to the central symptoms and signs of mental disorders. By conceptualising the symptoms of a disorder as clinical phenomena, and by adopting epistemic model pluralism as an explanatory strategy, we can build multi-faceted explanations of the processes and factors that constitute a disorder's core symptoms. This core theoretical and methodological work is then followed by the development of the PDM. Unique in the field of psychopathology, the PDM links different phases of the inquiry process to provide a methodology for conceptualising the symptoms of psychopathology and for constructing multi-level models of the pathological processes that comprise them. Next, I apply the PDM to the two core symptoms of depression-anhedonia and depressed mood-as an illustrative example of the advantages of this approach. This includes providing a more secure relationship between the pathology of depression and its phenotypic presentation, as well as greater insight into the relationship between underlying biological and psychological processes, and behavioural dysfunction. Next, I evaluate the PDM in comparison to existing metatheoretical approaches in the field and make some suggestions for future development. Finally, I conclude with a summary of the main contributions of this thesis.
Considering the issues with current diagnostic categories, simply continuing to build explanations of syndromes is not a fruitful way forward. Rather, the complexity of mental disorders suggests we need to represent their key psychopathological phenomena or symptoms at different levels or aspects using multiple models. This thesis provides the metatheoretical and methodological foundations for this to successfully occur.
... The reduction of subthreshold depressive symptoms was found to be of upmost importance for preventing the establishment of a clinical diagnosis of major depression (Cuijpers et al., 2008). Moreover, taking into account the considerable empirical evidence suggesting that depression may be conceptualized as a continuum (Solomon, Haaga, & Arnow, 2001), the reduction of levels of depressive symptoms even in women who score below the cut-off score (i.e., who do not present early-onset symptoms) may exert a protective effect for the development of a clinical diagnosis of PPD. ...
Be a Mom is a self-guided web-based intervention, grounded in cognitive behavioral therapy, delivered to postpartum women to prevent persistent postpartum depression [PPD] symptoms. We aimed to evaluate Be a Mom in terms of its preliminary efficacy, feasibility, and acceptability. A pilot randomized, two-arm controlled trial was conducted. Eligible women (presenting PPD risk-factors and/or early-onset PPD symptoms) were enrolled in the study and were randomly assigned to the intervention (Be a Mom) or to the waiting-list control group. Participants in both groups completed baseline (T1) and postintervention (T2) assessments. The 194 women presenting risk factors/early-onset PPD symptoms were allocated to the intervention (n = 98) or to the control (n = 96) group. A significant Time × Group interaction effect was found for both depressive and anxiety symptoms, with women in the intervention group presenting a larger decrease in symptoms from T1 to T2 (p < .05). Less than half of the women (41.8%) completed Be a Mom. Most women (71.4%) would use Be a Mom again if needed. Results provide preliminary evidence of the Be a Mom’s efficacy, acceptability and feasibility, although further research is needed to establish Be a Mom as a selective/indicative preventive intervention for persistent PPD.
... Depression has been linked to lower quality of life, higher rates of several chronic diseases, greater functional and social impairment, and increased risk of mortality (Brody, Pratt, & Hughes, 2018). Symptoms that do not meet a diagnostic threshold may nevertheless cause substantial suffering and dysfunction (Angst & Merikangas, 1997;Solomon, Haaga, & Arnow, 2001). Depressive symptoms in later life are particularly relevant to many adverse outcomes due to a trajectory that is often chronic and recurring (Alexopoulos, 2005). ...
The current study examined whether perceived neighborhood social disorder predicted depressive symptoms among unmarried older women (N = 823) drawn from the 2016 Health and Retirement Study. This study also tested the stress-buffering effect of friends support. A negative binomial regression model showed that higher perceived neighborhood social disorder was associated with higher depressive symptoms. The number of close friends was a significant factor, but no stress-buffering effect of friends support was identified. This study highlights the adverse effect of negative perceptions of the neighborhood social environment on unmarried older women’s depressive symptoms.
... Relatedly, a symptomatic heterogeneity of depression can predict treatment responses; in fact, remission rates to antidepressant medications were lower in depressed patients with somatic symptomatology [9]. Furthermore, depression may be severe with only a few symptoms [10], warranting the need to analyze individual symptom pattern of depression beyond its overall severity. While prior studies have examined the temporal trajectory of depression based on its severity in breast cancer patients [11,12], studies profiling individual symptom patterns of depression, which would inform the development of tailored interventions, are scarce. ...
Purpose
The aim of this study was to examine profiles of depressive symptoms and the association with anxiety and quality of life (QOL) in breast cancer survivors.
Methods
A cross-sectional multicenter survey involving 5 hospitals in Korea was implemented between February 2015 and January 2017. A self-report survey included the Patient Health Questionnaire-9, Short Form 36, and State and Trait Anxiety Scale. Data from 347 patients were analyzed.
Results
Latent profile analysis identified five profiles of depressive symptoms: (1) “no depression” (63.98%); (2) “mild depression with sleep problems” (16.43%); (3) “mild depression” (8.65%); (4) “moderate depression with anhedonia” (7.78%); and (5) “moderately severe depression” (3.17%). Results from Fisher’s exact test and analysis of variance (ANOVA) to examine whether sociodemographic and clinical characteristics distinguish the classes indicated that marital status, income and education as well as C-reactive protein distinguished a few classes. Multivariate analysis of covariance and analysis of covariance results indicated that both types of anxiety as well as several dimensions of QOL differed between the identified classes.
Conclusions
The current results suggest that although identified classes were characterized overall by severity of depression, a few classes also reflected pronounced individual symptom patterns, warranting tailored interventions for these symptom patterns, along with overall severity of depression.
... A abordagem dimensional da depressão permite distinguir os indivíduos em termos de níveis de funcionamento depressivo, em vez de apenas separar entre "depressivos" e "não depressivos". Dessa forma, a EBADEP-ID permite captar variados graus de depressão, incluindo níveis subclínicos, considerados dignos de atenção em serviços de saúde (Solomon, Haaga, & Arnow, 2001). ...
Modelos bifator têm sido relatados na literatura como explicações plausíveis para a estrutura latente da depressão. O presente estudo busca expandir essa área de investigação, tendo como objetivo principal realizar uma análise exploratória bifator da Escala Baptista de Depressão - Versão Idosos (EBADEP-ID). Os participantes foram 311 idosos com idades variando de 60 a 90 anos, provenientes de cinco grupos populacionais de tipo clínico e não clínico. Os resultados mostraram um melhor ajuste aos dados para o modelo bifator com um fator geral e dois fatores específicos, quando comparado a uma simples solução unidimensional. Entretanto, todos os itens carregaram predominantemente no fator geral, ocorrendo poucas cargas significativas nos fatores específicos, o que sustenta a unidimensionalidade do instrumento. O escore geral da EBADEP-ID apresentou elevada consistência interna (0,95 pelo coeficiente alfa, e 0,98 pelo coeficiente ômega) e capacidade informativa, além de alta sensibilidade e especificidade. Implicações teóricas e práticas dos resultados, bem como limitações do estudo, são discutidas ao final.
... Analyses of depression have yielded mixed results but generally have found evidence of continuity rather than discontinuity (Haslam & Beck, 1994;J. Ruscio & Ruscio, 2000;Solomon, Haaga, & Arnow, 2001;Whisman & Pinto, 1997). ...
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) groups disorders into diagnostic classes on the basis of the subjective criterion of "shared phenomenological features." There are now sufficient data to eliminate this rational system and replace it with an empirically based structure that reflects the actual similarities among disorders. The existing structural evidence establishes that the mood and anxiety disorders should be collapsed together into an overarching class of emotional disorders, which can be decomposed into 3 subclasses: the bipolar disorders (bipolar I, bipolar II, cyclothymia), the distress disorders (major depression, dysthymic disorder, generalized anxiety disorder, posttraumatic stress disorder), and the fear disorders (panic disorder, agoraphobia, social phobia, specific phobia). The optimal placement of other syndromes (e.g., obsessive-compulsive disorder) needs to be clarified in future research.
... In contrast with such medical or categorical models of sexual functioning and dysfunction (for a discussion, see Pronier & Monk-Turner, 2014), the dimensional model of psychopathology (Anderson, Huppert, & Rose, 1993) postulates the existence of a continuum of psychopathology symptoms in the population, ranging from total absence in nonsymptomatic individuals to full-scale symptom constellations in persons suffering from severe mental disorders (Kessler, 2002). Evidence for the existence of a dimensional, continuous distribution of symptoms in the population has been found to vary among mental disorders (e.g., Fraley & Spieker, 2003;Haslam, 2003a;Haslam, 2003b;Solomon, Haaga, & Arnow, 2001;Thewissen, Bentall, Lecomte, van Os, & Myin-Germeys, 2008). Forbes, Baillie, and Schniering (2016) proposed a dimensional model of sexual dysfunction as part of an internalizing disorder dimension, together with depressive and anxiety disorders. ...
The present study aimed to investigate associations of automatic and controlled cognition with sexual functioning, and moderation of these associations by working memory capacity in a community sample of heterosexual women (N = 65) and men (N = 51). Participants performed two single-target Implicit Association Tests (ST-IATs) to assess implicit liking and wanting of erotic stimuli. The Sexual Opinion Survey (SOS) was used to assess explicit liking of sex. The International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) were used to assess sexual function. Working memory capacity was assessed using the Towers of Hanoi task and mood using the Hospital Anxiety and Depression Scale (HADS). In female participants, higher levels of sexual functioning co-occurred with stronger implicit associations of erotic stimuli with wanting, whereas implicit sex liking was unrelated to level of sexual functioning. In male participants, higher levels of sexual functioning co-occurred with lower implicit liking of erotic stimuli, whereas implicit sex wanting was unrelated to sexual functioning. Higher erotophilia scores were related to higher levels of sexual functioning in both women and men, but anxiety and depression symptoms were unrelated to sexual functioning. Working memory capacity did not moderate the associations between erotophilia and sexual functioning.
... Additionally, a person's score on a dimensional scale can still be compared to a population-specific cutoff score to enable the categorization into suffering versus not suffering from clinically relevant depressive symptoms. Furthermore, taking into account the existing literature on the courses, consequences, and comorbidities of depressive symptoms, it can be concluded that depressive symptoms vary along a unidimensional spectrum of unipolar depression and do not indicate qualitatively different and disparate categories (Rodríguez et al., 2012;Solomon, Haaga, & Arnow, 2001). Arguably, categorical diagnostics-by applying an all-or-none law-may underestimate the importance of SubD because clinically relevant depressive symptoms may impair a person in important areas of functioning even if the symptoms do not meet MDD criteria (Rodríguez et al., 2012). ...
Objectives. The present dissertation focused on nursing home (NH) residents’ depressive symptoms and the role of social activity, functional ability, and physical activity training in explaining these symptoms. First, the interplay of residents’ basic competence (BaCo), expanded everyday competence (ExCo), and depressive symptoms was considered (Study I). The mediating role of perceived control was also examined. Building on the importance of BaCo for residents’ depressive symptoms, the effect of a BaCo-enhancing physical activity program (LTCMo) on residents’ depressive symptoms development was investigated (Study II). Furthermore, to better understand the roles of BaCo and ExCo in residents’ depressive symptoms, ExCo-related activities were differentiated into contact with co-residents and staff, and participation in organized activities. Their respective enjoyabilities were also considered longitudinally (Study III). Finally, the role of depressive symptoms in predicting residents’ sensor-based life-space was explored (Study IV). Design. Data were drawn from the study Long-Term Care in Motion (LTCMo; Current Controlled Trials ISRCTN96090441), which was part of EU’s Social Innovations Promoting Active and Healthy Aging funding scheme [HEALTH.2012.3.2-3]. LTCMo installed a physical activity training in two NHs in Heidelberg. The intervention aimed at promoting both residents’ physical activity behavior and healthy aging at large. It offered multiple training components (BaCo-related group training and optionally serious games training, or individual training) and allowed residents to choose in which components they wished to participate. After the study intervention, the training was handed over to activity coordinators in the NHs, who implemented the training sustainably. Residents were followed for three (NH 1) and four (NH 2) measurement occasions each three months apart (waiting control group in NH 2). At each measurement occasion, new residents were allowed to enter the study. The presented studies were either based on cross-sectional (Studies I and IV) or on longitudinal data, which included the examination of the LTCMo training effect on residents’ depressive symptoms (Studies II and III). Participants. All permanent, non-palliative residents in the homes were approached and those who (or whose legal representative) gave written informed consent, participated. The number of participants considered in the various papers differed depending on the outcome and the study design. For the cross-sectional studies only referring to residents’ first measurements (Studies I and IV), the number of participants ranged between 65 and 196, with fewer residents particularly for the sensor-based life-space assessment in Study IV. In the longitudinal studies (Studies II and III), a maximum of 163 residents with 434 measurement points was considered. At pretest, 41% of the sample resided in NH 1 and 16% lived on dementia-care units; 70% were female. On average, residents were 84 years old (range 53–100), showed moderate cognitive impairment (M[Mini-Mental State Examination] = 20; range = 0–30), and depressive symptoms below the cut-off for clinical relevance (M[GDS-12R] = 3; range = 0–11). Across study time, 17% of pretest participants dropped out, 86% of which were death-related drop-outs. Methods. Measurements used in the present dissertation include resident interviews (e.g., depressive symptoms, activity enjoyability, cognitive performance), functional performance tests (e.g., BaCo-related gait speed), proxy ratings (e.g., ExCo-related activities), information from the obligatory care documentation in the NHs (e.g., demographic data), and sensor-based indoor tracking of residents (life-space). Depressive symptoms as measured with the Geriatric Depression Scale–Residential (GDS-12R) were the main outcome for Studies I to III. While they were modeled as latent variables using item response theory in Study I, they were modeled as gammadistributed scale scores in Studies II and III. Study IV considered several life-space dimensions as outcomes, namely the time away from the resident’s room and the number of life-space zone changes (transits). For the cross-sectional studies, structural equation models (Study I) and linear regressions (Study IV) with full information maximum likelihood estimations were used. For the longitudinal studies, generalized linear mixed models were used. Results. Less BaCo impairment and more ExCo-related activities were found to predict fewer depressive symptoms cross-sectionally (Study I). The paths between the latent factors were robust when cognitive impairment, home affiliation, sex, and age were controlled for. Perceived control mediated the effect of BaCo, but not ExCo, on residents’ depressive symptoms. Focusing on the effect of LTCMo’s BaCo-enhancing training program showed that residents not participating in the intervention experienced steadily increasing depressive symptomatology across study time, while residents receiving the training maintained their pretest level of depressive symptoms throughout (Study II). The training group suffered from significantly fewer depressive symptoms than the non-training group both at posttest and at follow-up. The effect was robust when controlling for home affiliation, sex, age, living on dementia-care unit, and perceived internal and external control which were significant predictors in Study I. When ExCo-related activities were investigated differentially as longitudinally-framed predictors of depressive symptoms (Study III), activity-specific patterns emerged. For self-initiated co-resident contact, the interaction of contact frequency and enjoyability predicted fewer depressive symptoms with fewest symptoms for those residents who frequently had enjoyable co-resident contact. For self-initiated staff contact, however, only marginal main effects of frequency and enjoyability emerged. And for participation in organized in-home activities, participation enjoyability rather than frequency predicted fewer depressive symptoms (Study III). Conforming to Study II, the training effects emerged and were robust to controlling ExCo-related activity frequency, enjoyability, and additional covariates (Study III). Finally, regarding life-space, residents with more depressive symptoms spent significantly less time away from their own room compared to residents with fewer depressive symptoms (Study IV). Depressive symptoms did not, however, affect the number of life-space transits. Conclusions. Findings support that BaCo impairment and ExCo-related activities, their respective enjoyabilities, and physical activity-enhancing training all are important for NH residents’ depressive symptoms. Given sufficient replication, these insights may guide future intervention research and, in the long run, help to create more effective interventions for maintaining low levels of depressive symptoms in NH residents. Beyond the present findings, future research may investigate the potential of combining enjoyable co-resident contact and a physical activity-enhancing training to reduce or maintain the level of residents’ depressive symptoms. Future research may also focus on assumed underlying processes to better identify residents at risk of developing depressive symptoms. As emerging in the present studies, perceived control may be a promising candidate process variable to consider.
... Keel et al. [7] used LCA for eating disorders phenotypes. Number of researches has been carried out in the field of general psychiatry using LC modeling; See [8][9][10][11][12][13][14][15][16]. Use of LCM in marketing research and medical diagnosis can be seen in [17,18]. ...
We believe that in last two decades perception regarding socio-religious values had been changed in our society. Survey has been carried out on “changes in social values and their acceptance” in year 2011. Respondents have asked 74 questions (marked on Likert-scale) regarding educational system, political and religious affiliations and their impact on social values. Among these we have selected only those questions related to socio-religious issues (based on of individual and collective perceptions about the prevailing standard of the society in comparison with Islamic standards). Similar surveys using the same questionnaire had had conducted in year 1994 and 2001. Respondents, at each time of survey, were young students (youth acquiring education) from different colleges (Karachi region) and Karachi University. Perception can be explained more appropriately through latent class model (LCM). Through LCM we can explore structures in the data in term of different opinion groups. The modeling is done on the selected set of similar questions from each year. Conditional probabilities for year 2011, 2001 and 1994 are then compared in search of presence of any difference of opinion between the respondents. It is observed that by the passage of time, due to the influence of the electronic media there is a change in the opinion about the values of the society among the youth. Although, there is a reduction in the proportion of “Dissatisfied group” within the society but negative perception is penetrating among our young generation specifically about Ulmah and Imam’s role and women’s due rights toward society.
... Fourth, although the PHQ-2 is a validated instrument to screen depressive symptoms, it is based on two cardinal symptoms only ("little interest" and "feeling down"). Therefore, it must be distinct from clinically diagnosed depression [30]. Nevertheless, these limitations are balanced by several strengths. ...
Background
The Demand Control Support Questionnaire (DCSQ) is an established self-reported tool to measure a stressful work environment. Validated German and English versions are however currently missing. The aim of this study was therefore to evaluate the psychometric properties of German and English versions of the DCSQ among white-collar employees in Switzerland and the US. Methods
This cross-sectional study was carried out on 499 employees in Switzerland and 411 in the US, respectively. The 17-item DCSQ with three scales assessed psychosocial stress at work (psychological demands, decision latitude, and social support at work). Depressive symptoms were measured by the 2-item Patient Health Questionnaire. Cronbach’s α and item-total correlations tested the scale reliability (internal consistency). Construct validity of the questionnaire was examined using exploratory factor analysis (EFA). Logistic regressions estimated associations of each scale and job strain with depressive symptoms (criterion validity). ResultsIn both samples, all DCSQ scales presented satisfactory internal consistency (Cronbach’s α ≥ 0.72; item-total correlations ≥ 0.33), and EFA showed the 17 items loading on three factors, which is in line with the theoretically assumed structure of the DCSQ construct. Moreover, all three scales as well as high job strain were significantly associated with depressive symptoms. The associations were stronger in the US sample. Conclusions
The German and the English versions of the DCSQ seem to be reliable and valid instruments to measure psychosocial stress based on the job demand-control-support model in the workplace of white-collar employees in Switzerland and the US.
... This family of statistical techniques is specifically designed to evaluate whether the latent structure of a construct is taxonic (i.e., categorical) or dimensional (i.e., continuous) in nature. That is, whereas traditional statistical methods (e.g., latent class analysis, cluster analysis) are more vulnerable to detecting spurious taxa (Solomon, Haaga, & Arnow, 2001), taxometric analysis is specifically appropriate for addressing this question because instead of assuming or imposing a specific latent structure on the data, it simultaneously compares the existing data to both categorical and continuous models to evaluate with which they better fit (Fraley & Waller, 1998). This statistical approach has been empirically validated (Ruscio, Ruscio, & Keane, 2004;Waller & Meehl, 1998), and has been increasingly applied to various forms of psychopathology, including negative symptoms of schizophrenia (Ahmed, Strauss, Buchanan, Kirkpatrick, & Carpenter, 2015), psychopathy (Murrie et al., 2007), attention-deficit/hyperactivity disorder (Marcus & Barry, 2011), and depression (Hankin, Fraley, Lahey, & Waldman, 2005;Liu, 2016;Richey et al., 2009), as well as cognitive vulnerability to depression (Gibb, Alloy, Abramson, Beevers, & Miller, 2004). ...
Behavioral Approach System (BAS) sensitivity has been implicated in the development of a variety of different psychiatric disorders. Prominent among these in the empirical literature are bipolar spectrum disorders (BSDs). Given that adolescence represents a critical developmental stage of risk for the onset of BSDs, it is important to clarify the latent structure of BAS sensitivity in this period of development. A statistical approach especially well-suited for delineating the latent structure of BAS sensitivity is taxometric analysis, which is designed to evaluate whether the latent structure of a construct is taxonic (i.e., categorical) or dimensional (i.e., continuous) in nature. The current study applied three mathematically non-redundant taxometric procedures (i.e., MAMBAC, MAXEIG, and L-Mode) to a large community sample of adolescents (n = 12,494) who completed two separate measures of BAS sensitivity: the BIS/BAS Scales Carver and White (Journal of Personality and Social Psychology, 67, 319–333. 1994) and the Sensitivity to Reward and Sensitivity to Punishment Questionnaire (Torrubia et al. Personality and Individual Differences, 31, 837–862. 2001). Given the significant developmental changes in reward sensitivity that occur across adolescence, the current investigation aimed to provide a fine-grained evaluation of the data by performing taxometric analyses at an age-by-age level (14–19 years; n for each age ≥ 883). Results derived from taxometric procedures, across all ages tested, were highly consistent, providing strong evidence that BAS sensitivity is best conceptualized as dimensional in nature. Thus, the findings suggest that BAS-related vulnerability to BSDs exists along a continuum of severity, with no natural cut-point qualitatively differentiating high- and low-risk adolescents. Clinical and research implications for the assessment of BSD-related vulnerability are discussed.
... The phenomenological approach to depression is not categorical [1,17] , dimensional [92][93][94] , or a combination of the two [16] . Rather, it is based on the notion of "ideal types" [49][50][51][52] . ...
This paper proposes a phenomenological approach to the diagnosis of depression, with the aim of overcoming the broadness and nonspecificity of the concept of major depressive disorder (MDD) in current systems of diagnostic classification of mental disorders. Firstly, we outline the methodological limitations of the current classification systems for the diagnosis of MDD. Secondly, we offer a conceptual differentiation between a "symptomatological" versus a "phenomenological" diagnosis of depression. Thirdly, we propose characteristic "disturbances of embodiment" as the fundamental phenomena of "core depression", which manifest themselves in 3 dimensions: embodied self, embodied intentionality, and embodied time. A more useful diagnosis of depression may be achieved by describing the phenomena that constitute a core depression, in order to avoid the overdiagnosis of MDD and its negative consequences in clinical practice.
... La prevención de cuadros de depresión menor y de otros subtipos depresivos parece una tarea más controvertida (Solomon, Haaga, y Arnow, 2001). Sin embargo, a nivel teórico y también práctico, existen razones que sugieren que la prevención de la depresión subclínica puede ser una meta tan relevante como las intervenciones (en este caso propiamente de tratamiento) de las depresiones ya instauradas. ...
Depression is one of the most common psychiatric disorders among adults and adolescents. Over the past 12 years, a significant progress in depression prevention research has taking place although many studies in this field still exhibit serious flaws. This paper discusses issues such as the choice of prevention objectives, theoretical considerations, the identification of high-risk groups, and the design of both preventive programs and their evaluation.
This article aimed to compare scales that evaluate depression regarding the content of their items. The BDI, BDI-II, CES-D, and EBADEP-A scales were used. Jaccard’s similarity index was used for the evaluation of item overlays. A total of 37 distinct symptoms were identified in the results and the overlapping of the items indicated a similarity variation between weak (0.39) and strong (0.73). It discusses the applicability of the scales and the most appropriate use according to this characteristic and the contributions of the study to the construction of new instruments. It concludes that the similarity of the items is important, since the instruments evaluate the same construct, however, dissimilarities must be considered when choosing the instrument from the context of application and objective of the evaluation.
Objectives
Previous research reports self-affirmation interventions to be efficacious in enhancing many life outcomes of normal individuals, but limited research has assessed its restorative and preserving capacities to enhance and maintain the self-esteem of individuals with subclinical depressive tendencies.
Methods
This study employed an experimental research design. Eighty participants (age range = 22–27 years) with subclinical depression were chosen using purposive sampling and were randomly assigned in equal numbers to the experimental and control conditions and their self-esteem was measured at pre-intervention, post-intervention and follow-up intervals.
Results
Results showed that the experimental group participants evoked significantly higher mean scores (F(1, 76) = 29.20, p < 0.001, η2 = 0.28) on self-esteem as compared to the control group at post-intervention (Control: Mean (SD) = 17.48 (2.73); Experimental: Mean (SD) = 51.43 (3.29)) and follow-up (Control: Mean (SD) = 18.28 (2.72); Experimental: Mean (SD) = 48.65 (3.74)). There was a significant difference in the mean scores of the self-esteem of the experimental group participants during post-intervention and follow-up (F(2, 152) = 6.50, p = 0.002, η2 = 0.08). These findings were evident in the conditions' (experimental, control) and intervals' (pre-intervention, post-intervention, follow-up) main and interaction effects: F(2, 152) = 6.54, p < 0.002, η2 = 0.08; and F(2, 152) = 3.87, p < 0.023, η2 = 0.05. The size of these effects ranged from very low, low, to medium (η2).
Conclusion
The findings revealed the restorative and preserving capacities of this self-affirmation intervention for self-esteem. The positive outcomes of the self-affirmation intervention may have been produced as result of the activation of meaning, positive cognitions and positive relationships.
Depression, as a common mental illness, has become a significant public health issue, and the recurrence rate for patients with depression who have been treated is relatively high. In this study, a mental health monitoring system based on wearable sensing wristbands with sensors for voice, activity, and heart rate has been developed. Using this system, we perform a therapeutic monitoring study for hospitalized patients with depression and healthy controls to investigate multimodal changes before, during, and after a course of treatment. The obtained results demonstrate there are significant changes in multimodal features such as audio short-time energy and angular velocity shape skewness with the remission of depressive symptoms. According to Mikels’ emotion wheel, a day’s data for subjects is defined as three types of emotional units and the emotional state of each emotional unit is recognized as positive or negative emotions. With this, emotion-sensing-graphs guided by Mikels’ emotion wheel theory are constructed. The analysis of emotion-sensing-graphs reveals that the same emotions are more closely linked to each other and the average degree and proportion of positive emotion nodes after a course of treatment have increased significantly. Finally, an emotion-sensing-graph graph convolutional network model fused three types of emotion-sensing-graphs with emotion labels has been developed to assess the levels of depression, thereby monitoring the changes in depressive symptoms. Compared with classical machine learning models, the accuracy, F1 score, and recall rate of the model perform best and the model achieves a verification accuracy of 0.83.
Background:
Information on major depressive disorder (MDD) and subthreshold depressive symptoms (SDS) is rarely reported in south China. This study examines the prevalence rates and patterns of MDD and SDS of a large representative sample of adult residents in south China.
Methods:
The Guangdong Mental Health Survey was conducted on adults (over 18 years) from September to December 2021. Multistage stratified cluster sampling was used and face-to-face interviews were done with a two-stage design by trained lay interviewers and psychiatrists. A total of 16,377 inhabitants were interviewed using standardized assessment tools. Data were weighted to adjust for differential probabilities of selection and differential response.
Results:
The weighted prevalence rates of MDD and SDS were 2.5 % (95%CI: 2.2 %-2.9 %) and 14.7 % (95%CI: 14.0 %-15.5 %), respectively. Multinomial logistic regression analysis revealed that female, younger age, living in urban area, higher education, unmarried, irregular meal pattern, lack of physical exercise, chronic diseases, irregular napping pattern and short sleep were positively associated with SDS. Besides, female, younger age, unmarried, irregular meal pattern, lack of physical exercise, chronic diseases, short sleep and poor mental health were positively associated with MDD.
Limitations:
The cross-sectional nature of the study limited causal inferences.
Conclusions:
The prevalence of MDD in Guangdong province in 2021 is higher than in mainland China in 2013. Given the higher prevalence of SDS, and high burden of depression, it also offers valuable opportunities for policymakers and health-care professionals to explore the factors affecting mental health in Guangdong province, especially during the COVID-19 epidemic.
Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years.
Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12 th , 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups.
Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis ( n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges’ g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges’ g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges’ g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges’ g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment.
Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults.
Registration: PROSPERO CRD42018115866 (23/11/2018).
Background: Despite a high prevalence of antenatal depression in low- and middle-income countries, there is very little evidence for contextually adapted psychological interventions delivered in rural African settings.
The aims of this study are: (1) to examine the feasibility of procedures for a future fully powered efficacy trial of contextually adapted brief Problem Solving Therapy (PST) for antenatal depression in rural Ethiopia, and (2) to investigate the acceptability, fidelity and feasibility of delivery of PST in routine antenatal care.
Methods: Design: A randomized, controlled, feasibility trial and mixed method process evaluation. Participants: Consecutive women attending antenatal clinics in two primary care facilities in rural Ethiopian districts. Eligibility criteria: 1) Disabling levels of depressive symptoms (Patient Health Questionnaire (PHQ-9) score of five or more and positive for the 10th disability item); 2) gestational age 12-34 weeks; 3) aged 16 years and above, 4) planning to live in the study area for at least six months; 5) no severe medical or psychiatric conditions. Intervention: Four sessions of adapted PST delivered by trained and supervised antenatal care staff over a maximum period of eight weeks. Control: enhanced usual care (EUC). Sample size: n=50. Randomisation: individual randomisation stratified by intimate partner violence (IPV). Allocation: central phone allocation. Outcome assessors and statistician masked to allocation status.
Primary feasibility trial outcome: dropout rate. Primary future efficacy trial outcome: change in PHQ-9 score, assessed nine weeks after recruitment. Secondary outcomes: anxiety symptoms, trauma symptoms, intimate partner violence, disability, healthcare costs at 9 weeks; postnatal outcomes (perinatal and neonatal complications, onset of breast feeding, child health) assessed 4-6 weeks postnatal. Other trial feasibility indicators: recruitment, number and duration of sessions attended. Audio-recording of randomly selected sessions and in-depth interviews with purposively selected participants, healthcare providers and supervisors will be analysed thematically to explore the acceptability and feasibility of the trial procedures and fidelity of the delivery of PST.
Discussion: The findings of the study will be used to inform the design of a fully-powered efficacy trial of brief PST for antenatal depression in routine care in rural Ethiopia.
Trial registration: The protocol was registered in the Pan-African clinical trials registry, (PACTR): registration number: PACTR202008712234907 on 18/08/2020;
URL: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9578
Funding: This work is supported through the DELTAS Africa Initiative [DEL-15-01].
Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years.
Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12 th , 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups.
Results: The systematic review included 81 RCTs, with 69 meeting eligibility for the network meta-analysis ( n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges’ g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges’ g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges’ g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges’ g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment.
Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults, irrespective of severity.
Registration: PROSPERO CRD42018115866 (23/11/2018).
Background:
Major depression (MD) is often characterised as a categorical disorder; however, observational studies comparing sub-threshold and clinical depression suggest MD is continuous. Many of these studies do not explore the full continuum and are yet to consider genetics as a risk factor. This study sought to understand if polygenic risk for MD could provide insight into the continuous nature of depression.
Methods:
Factor analysis on symptom-level data from the UK Biobank (N = 148 957) was used to derive continuous depression phenotypes which were tested for association with polygenic risk scores (PRS) for a categorical definition of MD (N = 119 692).
Results:
Confirmatory factor analysis showed a five-factor hierarchical model, incorporating 15 of the original 18 items taken from the PHQ-9, GAD-7 and subjective well-being questionnaires, produced good fit to the observed covariance matrix (CFI = 0.992, TLI = 0.99, RMSEA = 0.038, SRMR = 0.031). MD PRS associated with each factor score (standardised β range: 0.057-0.064) and the association remained when the sample was stratified into case- and control-only subsets. The case-only subset had an increased association compared to controls for all factors, shown via a significant interaction between lifetime MD diagnosis and MD PRS (p value range: 2.23 × 10-3-3.94 × 10-7).
Conclusions:
An association between MD PRS and a continuous phenotype of depressive symptoms in case- and control-only subsets provides support against a purely categorical phenotype; indicating further insights into MD can be obtained when this within-group variation is considered. The stronger association within cases suggests this variation may be of particular importance.
Background
: This study aimed to investigate the association between psychosocial variables and depression severity among Chinese patients with first-episode major depressive disorder (MDD).
Methods
: This multicenter case-control study enrolled patients with first-episode MDD and healthy controls (HCs) from nine sites in China. Depressive symptoms, clinical features, and psychosocial variables were evaluated. Based on the total score of the Hamilton Rating Scale of Depression (HRSD-17), patients with MDD were classified into three subgroups of severity (mild, moderate and severe). The logistic regression analyses were conducted to investigate the independent risk factors of MDD and different severities of depression.
Results
: Overall, 598 MDD patients and 467 HCs were included. The proportions of patients with mild, moderate, and severe depression were 260 (29.5%), 443 (50.2%), and 179 (20.3%), respectively. The logistic regression model revealed that the demographic and psychosocial factors could explain 50.6% of the total variance of occurrence of MDD in the whole sample with HCs. However, in the subsample of MDD patients, only older age [OR=1.03 (95%CI: 1.02-1.05)], stressful social events [OR=1.04 (95%CI: 1.02-1.06)], and melancholic feature [OR=2.68 (95%CI: 1.91-3.74)] were independent risk factors for moderate and severe depression; these factors combined to explain only 10.2% of the total variance.
Limitations
: Only patients with first-episode MDD were included in this study, leaving the associated factors for the severity of recurrent depression uninvestigated.
Conclusion
: Demographic and psychosocial variables had satisfactory performance in predicting the occurrence of MDD, but showed inadequate value in predicting the depression severity of MDD patients.
Background:
Subthreshold depression (StD) is a prevalent condition that may increase the risk of incident major depressive disorder (MDD). However, the relationship between StD and MDD remains unclear.
Methods:
A total of 153 adult subjects, including 53 drug-naive MDD, 50 StD and 50 healthy control (HC) subjects, underwent a T1-weighted magnetic resonance imaging scan, and the gray matter volume (GMV) alterations among the three groups were quantitatively analyzed using voxel-based morphometry (VBM). Then, to capture the whole-brain connectivity characteristics, we constructed morphological brain networks (MBN) based on the similarity among brain regions of individual VBM images and compared the network connection strengths among the three groups.
Results:
The StD and MDD subjects had similar patterns of GMV reductions in the orbitofrontal cortex and left temporal gyrus, although the magnitude of the reductions was smaller in StD subjects. Moreover, a total of 21 morphological connections were significantly different among the three groups. For the majority of the different connections (15/21), the connection strength of the StD group took an intermediate position between that of the MDD and HC groups.
Limitations:
There is still a lack of a consistent definition of StD, and the age range of the subjects in this study was wide. Meanwhile the mechanisms and biological significance of the MBN remains to be clarified.
Conclusions:
These results may support the hypothesis that depression is better expressed as a spectrum and that StD exists on a spectrum with MDD.
In a two-wave, 4-month longitudinal study of 308 adults, two hypotheses were tested regarding the relation of Twitter-based measures of online social media use and in-person social support with depressive thoughts and symptoms. For four of five measures, Twitter use by in-person social support interactions predicted residualized change in depression-related outcomes over time; these results supported a corollary of the social compensation hypothesis that social media use is associated with greater benefits for people with lower in-person social support. In particular, having a larger Twitter social network (i.e., following and being followed by more people) and being more active in that network (i.e., sending and receiving more tweets) are especially helpful to people who have lower levels of in-person social support. For the fifth measure (the sentiment of Tweets), no interaction emerged; however, a beneficial main effect offset the adverse main effect of low in-person social support.
Background:
Many studies have investigated the existence of discrete groups comprising the clinical concept of depression. Nevertheless, identifying true latent depression groups might require the inclusion of indicators of severe manifestations of depression, such as suicidal thoughts, in the analysis. Another issue is that relatively few studies have addressed the latent structure of depression in children and adolescents from Latin American cultures.
Methods:
In the present study, we combined latent profile and taxometric analysis to investigate the latent structure underlying depression symptoms (negative emotionality and low positive emotionality indicators) and suicidal thoughts in four aggregated Brazilian youth samples (total N = 2587; mean age = 12.86 years; SD = 2.60; 50.8% females).
Results:
Latent profile analysis indicated five classes that clearly represented distinct levels on a continuum of depression. However, taxometric results were ambiguous with regard to highlighting depression as a purely dimensional or categorical latent entity (mean CCFI = 0.497).
Limitations:
The use of few indicators from a single instrument, the potential heterogeneity in the clinical group, and the non-random nature of the samples included in the study.
Conclusion:
The mixed findings support the existence of a dimension of depression, as well as latent classes of individuals. Factor mixture models are discussed as a strategy for further exploring the nature of depression among young people.
Is there a clear line between normal and abnormal mood? Studies of manifest and latent structure provide strong support for a continuum that extends from asymptomatic to subsyndromal to syndromal cases of increasing severity. Subsyndromal symptoms are impairing, predict syndrome onset and relapse, and account for more doctor's visits and suicide attempts than the full syndromes, yet they are not recognized in the current classification. For most research and some clinical activities, dimensional diagnoses are recommended, and examples are offered for how such diagnoses could be made. For clinical activities requiring decisions, a multithreshold model is proposed in which both lower (e.g., mild depression, capturing subsyndromal cases) and upper (e.g., major depression, capturing clinically significant cases) diagnostic categories are used to inform clinical care. Beyond its implications for diagnosis, the dimensionality of depression and anxiety has implications for etiology and for research aimed at understanding how emotions become disrupted in psychopathology.
The term "depression" can be used to refer to a fairly wide range of diagnoses and expressions of symptoms, so that two people may have completely different symptoms from each other, and yet both may have a similar diagnosis. Therefore, scales can be fundamental in the screening process, aiding in diagnosis and intervention with patients presenting clinically significant symptoms of depression. This article aims to discuss two current issues in psychological assessment. The first refers to different notes (description, importance, criticism) regarding the criteria in psychiatric manuals related to depressive disorders. The second theme discusses characteristics of the scales that evaluate depressive symptomatology and their specificities are discussed, since they may differ from each other, in several aspects such as basic theories, dimensionality, number of items, response type, life cycle specificities, application forms, among others.
Aims: To establish if HIV+ pregnant women present more psychiatric symptoms and illnesses than pregnant women without sexually transmitted infections (STI's). Material and methods: A psychiatric diagnostic assessment was performed, based on the Structured Clinical Interviews (SCID-I and II) for the DSM-IV, as well as the Personality Questionnaire for axis II (PQ-II), complemented by the Inventory of Personality Organization (IPO), the General Health Questionnaire (GHQ), the Edinburgh Perinatal Depression Scale (EPDS) and the Test of nonverbal intelligence BETA-IIR. The HIV group was conformed by 37 HIV+ women and the control group by 115 pregnant women without an STI. The tests used were the Kolmogorov-Smirnov test or the chi-square, as well as odds ratio with a 95% CI. Results: The HIV group was conformed by women in a lower range of age (p
Dysthymia was introduced in DSM-III as a form of chronic depression, while DSM-III-R added a second diagnostic category for chronic depression and labeled it chronic MD. Persistent depression disorder (PDD) is maintained by two pathological core problems the patient has not been able to resolve. First core problem is a pervasive fear avoidance state which stems from a history of early developmental maltreatment. Second core problem is the perceptual disconnection from the interpersonal environment patients brings to treatment, which suggests that others do not have any informing influence on the patient's behavior. One distinctive feature in the role of therapist of the cognitive behavioral analysis system of psychotherapy (CBASP) is disciplined personal involvement (DPI), a therapist role grounded in Kieslerian interpersonal theory. CBASP assumes that chronic depression is a lifetime disorder similar to diabetes and hypertension. In a manner similar to diabetes and hypertension, PDD can be managed as patients learn to control their chronic mood state.
There is active debate regarding whether diagnosable depression exists on a continuum with subthreshold depressive symptoms or represents a categorically distinct phenomenon. To address this question, multiple indexes of dysfunction (psychosocial difficulties, mental health treatment history, and future incidence of major depression and substance abuse/dependence) were examined as a function of the extent of depressive symptoms in 3 large community samples (adolescent, adult, and older adult; N = 3,003). Increasing levels of depressive symptoms were associated with increasing levels of psychosocial dysfunction and incidence of major depression and substance use disorders. These findings suggest that (a) the clinical significance of depressive symptoms does not depend on crossing the major depressive diagnostic threshold and (b) depression may best be conceptualized as a continuum. Limitations of the present study are discussed.
Researchers and practitioners have long debated the structural nature of mental disorders. Until recently, arguments favoring categorical or dimensional conceptualizations have been based primarily on theoretical speculation and indirect empirical evidence. Within the depression literature, methodological limitations of past studies have hindered their capacity to inform this important controversy. Two studies were conducted using MAXCOV and MAMBAC, taxometric procedures expressly designed to assess the underlying structure of a psychological construct. Analyses were performed in large clinical samples with high base rates of major depression and a broad range of depressive symptom severity. Results of both studies, drawing on 3 widely used measures of depression, corroborated the dimensionality of depression. Implications for the conceptualization, investigation, and assessment of depression are discussed.
Historically, depression researchers have examined continuity in terms of whether the symptoms and characteristics of mild, moderate, and severe depression differ in degree along a continuum (i.e., a quantitative difference) or in kind (i.e., qualitative difference). The authors propose a differentiated framework that distinguishes 4 direct tests of continuity (i.e., phenomenological, typological, etiological, and psychometric continuity). They use this framework to suggest that most evidence is consistent with the continuity hypothesis. Moreover, they maintain that the findings of future research can be incorporated into a 2-factor model of depression that allows for both continuities and discontinuities.
Taxometric procedures were used to test claims for the content and latent structure of 5 proposed subtypes of major depression: an endogenous form, sociotropic and autonomous forms proposed by A. Beck (1983), a self-critical form proposed by S. J. Blatt (e.g., S. J. Blatt & E. Homann, 1992), and a hopelessness form proposed by L. Y. Abramson, G. I. Metalsky, and L. B. Alloy (1989). Analysis of self-reported symptom and personality profiles of 531 consecutively admitted outpatients with a primary major depressive diagnosis sought to determine whether the clinical features proposed by the respective accounts systematically covary; which features are central to the respective latent structures; and whether these structures are discrete or continuous. Clear evidence for discreteness was found only for the endogenous subtype. The other proposed forms lacked internal coherence or were more consistent with a continuous or dimensional account.
The Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM–III–R) operationally defines disorder essentially as “statistically unexpectable distress or disability.” This definition is an attempt to operationalize 2 basic principles: that a disorder is harmful and that a disorder is a dysfunction (i.e., an inability of some internal mechanism to perform its natural function). However, the definition fails to capture the idea of “dysfunction” and so fails to validly distinguish disorders from nondisorders, leading to invalidities in many of DSM–III–R's specific diagnostic criteria. These problems with validity are traced to DSM–III–R's strategies for increasing reliability.
Discusses 2 types of depression based on disruptions of (1) interpersonal relatedness or (2) self-esteem, and considers the nature, etiology, and treatment of depression based on the phenomenology of the issues that cause individuals to become depressed. The interpersonal perspective of S. Arieti and J. Bemporad (1980), the object relations perspective of J. Bowlby (see record
1988-16459-001), and the psychoanalytic ego psychology and cognitive developmental theory perspective of S. J. Blatt (1992) are compared and contrasted with each other and with the cognitive-behavioral perspective of A. T. Beck (1983). Areas of agreement and differences among these 4 theoretical positions are discussed in terms of their implications for treatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
"I hypothesize that the statistical relation between schizotaxia, schizotypy, and schizophrenia is class inclusion: All schizotaxics become on all actually existing social learning regimes, schizotypic in personality organization; but most of these remain compensated. A minority, disadvantaged by other… constitutional weaknesses, and put on a bad regime by schizophrenogenic mothers… are thereby potentiated into clinical schizophrenia. What makes schizotaxia etiologically specific is its role as a necessary condition… . It is my strong personal conviction that… schizophrenia, while its content is learned, is fundamentally a neurological disease of genetic origin." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Describes the Maximum Covariance (MAXCOV) taxometric procedure within the coherent cut kinetics method. Using MAXCOV, when given 3 quantitative indicators of a conjectured latent taxon, a statistical function defined as the covariance of 2 indicators (designated for the procedure as the "output" indicators) computed within successive intervals along the third (designated as "input") indicator reveals whether the latent structure of the data is taxonic or not. If it is taxonic, latent parameters (base rate, hit rates, complement and taxon means) can be estimated, the latent distributions drawn, and subjects assigned to the taxon or the complement group. Several consistency tests are presented, using Monte Carlo configurations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The article, Issues and Recommendations Regarding Use of the Beck Depression Inventory (Kendall, Hollon, Beck, Hammen, & Ingram, 1987), has had a major impact on depression research. A majority of studies using only the BDI in nonclinical samples now refer to the construct measured as dysphoria rather than depression. This word change, however, is not always accompanied by other changes in research design and interpretation that would seem warranted by the concerns that initially prompted the dysphoria recommendation, such as the nonspecificity of high BDI scores to major depression. Researchers typically continue to derive hypotheses from depression theory, use only the BDI to measure dysphoria rather than purer markers of negative affectivity, cite as a limitation of their findings the danger of assuming continuity between subclinical and clinical depression, and sometimes lapse into depression terminology. Alternative suggestions are made for considering how the particular goals of a study might lead to various ways of handling the continuity issue.
We tested the attributional vulnerability hypothesis of the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989) with a retrospective behavioral high-risk paradigm. Currently nondepressed individuals who possessed either a depressogenic or a nondepressogenic attributional style were compared on their probability of exhibiting major depressive disorder and the hypothesized subtype of hopelessness depression, as well as on the number, duration, and severity of episodes of major depression in the past 2 years. Consistent with the predictions of the hopelessness theory of depression, attributionally vulnerable subjects were more likely to exhibit past major depressive disorder and hopelessness depression and experienced more episodes of these disorders than attributionally invulnerable subjects. In addition, high-risk subjects had more severe episodes of past major depression than did low-risk subjects. The two groups did not differ on duration of past major depressive episodes, although there was a trend for high-risk subjects' episodes to be of longer duration.
We describe the relationship of depression and depressive symptoms to disability days and days lost from work in 2980 participants in the Epidemiologic Catchment Area Study in North Carolina after 1 year of follow-up. Compared with asymptomatic individuals, persons with major depression had a 4.78 times greater risk of disability (95% confidence interval, 1.64 to 13.88), and persons with minor depression with mood disturbance, but not major depression, had a 1.55 times greater risk (95% confidence interval, 1.00 to 2.40). Because of its prevalence, individuals with minor depression were associated with 51% more disability days in the community than persons with major depression. This group was also at increased risk of having a concomitant anxiety disorder or developing major depression within 1 year. We conclude that the threshold for identifying clinically significant depression may need to be reevaluated to include persons with fewer symptoms but measurable morbidity. Only by changing our nosology can the societal impact of depression be adequately addressed.
One of the many controversies concerning the borderline personality disorder (BPD) diagnosis is whether the construct refers to a categorical or dimensional variable. The current study used Meehl's (1973) maximum covariance analysis to investigate this issue. The charts of 409 psychiatric inpatients were systematically reviewed for the presence of BPD and dysthymic symptoms. Charts of 244 inpatients were also reviewed to assess the presence of indicators of male sex, a categorical variable. The results for BPD and dysthymia were consistent with a dimensional model, whereas those for male sex were consistent with a categorical model. A dimensional model of classification of BPD is recommended, and suggestions for future research are provided.
The internal construct validity of the endogenous sub-type of major depression was investigated by statistically modelling the RDC endogenous and DSM-III melancholia diagnostic criteria. Data consisted of symptom ratings on 788 patients with major depression from NIMH Collaborative Depression Study. Results indicated that the symptoms in the criteria do not specify a dichotomous classification, melancholic-non-melancholic or endogenous-nonendogenous. Results did support the existence of two sub-typings, one related to anhedonia, and one related to vegetative symptoms. The vegetative sub-type rarely occurred in non-anhedonic patients. Previous studies may have found support for a simple endogenous sub-type because of this hierarchical relationship and as a result of methodological differences.
Classification in psychopathology is a problem in applied mathematics; it answers the empirical question "Is the latent structure of these phenotypic indicator correlations taxonic (categories) or nontaxonic (dimensions, factors)?" It is not a matter of convention or preference. Two taxometric procedures, MAMBAC and MAXCOV-HITMAX, provide independent tests of the taxonic conjecture and satisfactorily accurate estimates of the taxon base rate, the latent means, and the valid and false-positive rates achievable by various cuts. The method requires no gold standard criterion, applying crude fallible diagnostic "criteria" only in the phase of discovery to identify plausible candidate indicators. Confidence in the inference to taxonic structure and numerical accuracy of latent values is provided by multiple consistency tests, hence the term coherent cut kinetics for the general approach. Further revision of diagnostic systems should be based on taxometric analysis rather than on committee decisions based on clinical impressions and nontaxometric research.
The relationship between self-reported depression and a clinical diagnosis of depression was investigated. Within 2 weeks of completing the Center for Epidemiologic Studies Depression Scale (CES-D), a stratified sample of 425 primary medical care patients received the structured interview for the DSM-III-R. In the weighted data set, the CES-D was significantly related to a diagnosis of depression but also to other Axis I disorders. Most distressed subjects were not depressed, a fifth of the patients with major depressive disorder (MDD) had low distress, and the CES-D performed as well in detecting anxiety as in detecting depression. MDD, other depression diagnoses, and anxiety and substance use disorders were all significant predictors of CES-D score. Differences in demographic variables, treatment history, and impairment highlight the nonequivalence of the self-report scale and diagnosable depression. The use of a self-report in place of an interview-based diagnostic measure in the study of depression, as well as the use of such a report as a screening device, is discussed.
Secondary analyses in a subsample (N = 9160) of the National Institute of Mental Health Epidemiologic Catchment Area Program data base revealed that 19.6% of the general population reported one or more depressive symptoms in the previous month. One-year prevalence of two or more depressive symptoms in the general population was 11.8%, a prevalence figure exceeding the 9.5% 1-year prevalence for all the DSM-III mood disorders combined. We have labeled this potential clinical condition as subsyndromal symptomatic depression (SSD), defining it as any two or more simultaneous symptoms of depression, present for most or all of the time, at least 2 weeks in duration, associated with evidence of social dysfunction, occurring in individuals who do not meet criteria for diagnoses of minor depression, major depression, and/or dysthymia. SSD has a 1-year prevalence in the general population of 8.4%, two thirds of whom are women (63.4%). The most common SSD symptoms reported are insomnia (44.7%), feeling tired out all the time (42.1%), recurrent thoughts of death (31.0%), trouble concentrating (22.7%), significant weight gain (18.5%), slowed thinking (15.1%), and hypersomnia (15.1%). Increased prevalence of disability and welfare benefits was found in SSD as compared with respondents with no depressive symptoms. SSD represents a significant clinical population not covered by any DSM-III, DSM-III-R, or DSM-IV mood disorder diagnosis. Since SSD is also associated with significant increases in social dysfunction and disability, we feel there is good evidence to conclude that SSD is an unrecognized clinical condition of considerable public health importance that is deserving of further characterization and study.
Vredenburg, Flett, and Krames's (1993) conclusion that self-reported distress in college students is an appropriate analog for diagnosable depression is examined in light of a broader literature. Self-reported distress is conceptually and empirically distinct from depression and depressive symptoms. Distress has stronger correlates with common psychological and social factors. Distress in college students tends to be mild and transient, and most distressed college students are not depressed. Some other features of college life also make generalizations to clinical and community samples of adults problematic. Overall, ubiquitous misunderstandings in the literature have limited recognition of the pitfalls of studying distress as an analog for diagnosable depression. It is undesirable for reasons of science, social responsibility, and the credibility of psychological models of depression.
Depression, a clinically heterogeneous syndrome, may also be etiologically heterogeneous. Using a prospective, epidemiologic, and genetically informative sample of adult female twins, we identify and validate a typology of depressive syndromes.
Latent class analysis was applied to 14 disaggregated DSM-III-R symptoms for major depression reported over the last year by members of 1029 female-female twin pairs.
Seven classes were identified, of which 3 represented clinically significant depressive syndromes: (1) mild typical depression, (2) atypical depression, and (3) severe typical depression. Severe typical depression was characterized by comorbid anxiety and panic, long episodes, impairment, and help seeking. Atypical depression was similar in severity to mild typical depression, but was characterized by increased eating, hypersomnia, frequent, relatively short episodes, and a proclivity to obesity. Individuals with recurrent episodes tended to have the same syndrome on each occasion. The members of twin pairs concordant for depression had the same depressive syndrome more often than expected by chance and this resemblance was greater in monozygotic than in dizygotic pairs.
In an epidemiologic sample of female twins, depression is not etiologically homogeneous, but is instead made up of several syndromes that are at least partially distinct from a clinical, longitudinal, and familial/genetic perspective.
• Using longitudinal data from a community study of 9900 adults drawn from four sites in the United States and interviewed twice, 1 year apart, we investigated the predictors of first-onset major depression. Using odds ratios to estimate relative risk, we found that persons with depressive symptoms, compared with those without such symptoms, were 4.4 times more likely and persons with dysthymia were 5.5 times more likely to develop a first-onset major depression during a 1-year period. The lifetime prevalence rate for depressive symptoms was 24%. The attributable risk is a compound epidemiologic measure that reflects both the relative risk associated with depressive symptoms (4.4) and the prevalence of exposure to that risk (24%). It is a useful measure to document the burden of a risk to the community, and it was determined to be greater than 50%. Thus, more than 50% of cases of first-onset major depression are associated with prior depressive symptoms. The high prevalence of depressive symptoms in the community and their strong association with first-onset major depression make them important from a public health perspective. Because depressive symptoms are often unrecognized and untreated in clinical practice, we conclude that their identification and the development of effective treatments could have implications for the prevention of major depression.
The relationship between self-reported depression and a clinical diagnosis of depression was investigated. Within 2 weeks of completing the Center for Epidemiologic Studies Depression Scale (CES-D), a stratified sample of 425 primary medical care patients received the structured interview for the DSM-III-R. In the weighted data set, the CES-D was significantly related to a diagnosis of depression but also to other Axis I disorders. Most distressed subjects were not depressed, a fifth of the patients with major depressive disorder (MDD) had low distress, and the CES-D performed as well in detecting anxiety as in detecting depression. MDD, other depression diagnoses, and anxiety and substance use disorders were all significant predictors of CES-D score. Differences in demographic variables, treatment history, and impairment highlight the nonequivalence of the self-report scale and diagnosable depression. The use of a self-report in place of an interview-based diagnostic measure in the study of depression, as well as the use of such a report as a screening device, is discussed.
• Early-onset characterological depressions are distinguished from late-onset chronic depressions that complicate the longterm course of unipolar and nonaffective illnesses. In turn, characterological depressions are divisible into at least two subtypes: (1) "Subaffective dysthymias" have even sex distribution, are often complicated by superimposed depressive episodes, rapid eye movement latency is shortened, and they tend to respond to tricyclics or lithium carbonate. In brief, they share many features of primary affective illness. (2) "Character spectrum disorders," by contrast, represent a heterogeneous mixture of personality disorders with inconstant depressive features, are more common in women, are often complicated by alcohol and drug abuse, and outcome tends to be unfavorable.
This article presents methods for analyzing the relationships among a set of qualitative variables when some of these variables are specified manifest (i.e., observed) variables and others are latent (i.e., unobserved or unobservable) variables. We shall show how to estimate the magnitude of the various effects represented in pathdiagram models that include both the manifestand latent variables, and also how to test whether this kind of path-diagram model is congruent with the observed data. These methods can be applied in order to analyze data obtained in various kinds of surveys (including panel studies), and also in order to construct tests and indices for purposes of measurement and prediction. To illustrate their wide applicability and flexibility, we shall use these methods to reanalyze several different sets of data which were analyzed earlier by Coleman (1964), Lazarsfeld (1948, 1970), Goodman (1973a), and others. Except for some related conclusions in Goodman (1973a), the methods introduced herei...
Flexible methods that relax restrictive conditional independence assumptions of latent classanalysis (LCA) are described. Dichotomous and ordered category manifest variables are viewed asdiscretized latent continuous variables. The latent continuous variables are assumed to have a mixtureofmultivariate-normals distribution. Within a latent class, conditional dependence is modeled as the mutual association of all or some latent continuous variables with a continuous latent trait (or in special cases, multiple latent traits). The relaxation of conditional independence assumptions allows LCA to better model natural taxa. Comparisons of specific restricted and unrestricted models permit statistical tests of specific aspects of latent taxonic structure. Latent class, latent trait, and latent distribution analysis can be viewed as special cases of the mixed latent trait model. The relationship between the multivariate probit mixture model proposed here and Rost’s mixed Rasch (1990, 1991) model is discussed. Two studies illustrate different uses of the proposed model.
outline what we regard as the major conceptual issues related to the boundaries and overlap between psychiatric disorders, and discuss available approaches to studying these problems / draw on this literature to illustrate particular conceptual and methodological issues
conceptual issues [discreteness, categorical vs dimensional models] / discovering and confirming boundaries between disorders [multimodality, cluster analysis, mixture analysis, latent class analysis, nonlinearity, disordinal interactions] / relationship between nosological conventions and comorbidity / models of comorbidity / distinguishing between models of comorbidity [epidemiological studies, longitudinal studies, family studies] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This book discusses the MAXCOV-HITMAX procedure to reveal the underlying rationale of MAXCOV in simple terms and show how this technique can be used in a variety of disciplines by researchers in their taxonomic work. The misconceptions concerning the psychometric and philosophical status of taxonic constructs are discussed, and several meanings of the term "taxon" and the philosophy of science that has guided the authors' work in this area are reviewed. The authors describe MAXCOV-HITMAX and demonstrate how MAXCOV uses the General Covariance Mixture Theorem to test taxonic hypotheses (using utility programs written in S-Plus to do the taxometric procedures). Two new taxometric procedures are introduced, MAXEIG-HITMAX and L-Mode, for the simultaneous analysis of multiple taxon indicators. These techniques are contrasted with other data clustering and classification methods, such as latent profile analysis and Q-technique factor analysis. Guidelines are provided for corroborating taxonic models and the role of taxometrics in scientific methodology is described. The book is intended for professionals and practitioners in statistics, evaluation, survey research, sociology, psychology, education and communication research, policy studies, management, public health, and nursing. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Recurrent brief depression (RBD) is not a new artificial group of depression syndromes, but an important, frequently overlooked and clearly identified subcategory of depressive disorders. The symptoms do not differ from major depression; however, the duration of the brief episodes usually lasts 1 - 3 days. The patient can suffer from both brief and longer manifestations of depression and therefore qualify for both diagnoses: major depression on the one hand/or RBD on the other. If the patient suffers from both conditions the case is more severe, with higher social impairment and higher suicidal risk. Epidemiological studies carried out in different parts of the world indicated a prevalence rate of RBD of between 5% and 10% of patients seeking help in general practice. Unfortunately there is no clear treatment as yet established for RBD, although about 50% of these patients are given psychotropic drugs by practitioners. Controlled trials with antidepressants did not show a beneficial effect and there is no hint in the literature as to whether psychological therapies might be helpful. There is a need for further treatment studies in this important form of depression, which is categorizable within the depressive spectrum. ( Int J Psych Clin Pract 2000; 4: 195-199)
ABSTRACT A taxon is a nonarbitrary class whose existence is conjectured as an empirical question, not a mere semantic convenience. Numerous taxa are known to exist in nature and society (chemical elements, biological species, organic diseases, geological strata, kinds of stars, elementary particles, races, cultures, Mendelizing mental deficiencies, major psychoses, vocations, ideologies, religions). What personality types, if any, occur in the nonpathological population remains to be researched by sophisticated methods, and cannot be settled by fiat or “dimensional” preference. The intuitive concept of taxonicity is to be explicated by a combination of formal-numerical and causal criteria. Taxometric methods should include consistency tests that provide Popperian risk of strong discorroboration. In social science, latent class methods are probably more useful than cluster algorithms.
Issues concerning use of the Beck Depression Inventory (BDI) for the self-report of depressive symptomatology are raised and considered. Discussion includes the stability of depression and the need for multiple assessment periods, specificity and the need for multiple assessment measures, and selection cut scores and the need for terminological accuracy. Recommendations for the continued use of the BDI, designed to facilitate the integration of diverse studies and improve research on self-reported depression, are provided.
Taxometrics is a statistical procedure for determining whether relationships among observables reflect the existence of a latent taxon (type, species, category, disease entity). A formal-numerical definition is needed because intuitive, commonsense notions of “carving nature at its joints” or “identifying natural kinds” cannot resolve disagreements as to taxonic reality for hard cases. Specific etiology (e.g., major gene, germ, traumatic event) is often unknown and is not appropriate in nonmedical domains. Lacking an infallible criterion, the taxonic inference relies on the internal configural relations among the conjectural fallible indicators. An essential feature is multiple consistency tests that will not be satisfied if the latent structure is not taxonic or the parameters are badly estimated. Common misconceptions are that the taxon must be “sharply” distinguished, quantitative indicators must be bimodal, the causal origin must be biological, emergence of a large dimensional factor refutes taxonicity, and adopting a taxon is a mere matter of convention or preference.
The subtypes of major depression are reviewed, and a decision tree for the acute somatic treatment of major depression, including delusional and nondelusional depression, is presented. Considerations in clinicians' decisions about initiation and selection of acute somatic treatment for patients with major depression are then discussed. Current somatic therapies for nondelusional depression are described, with emphasis on the mechanisms of action of the drugs employed, the relationship between mechanism of action and side effect profile, and the selection of a drug on the basis of its side effect profile. The three current strategies for the treatment of delusional depression--electroconvulsive therapy, the combination of an antidepressant and an antipsychotic agent, and amoxapine alone--are then reviewed.
Using longitudinal data from a community study of 9900 adults drawn from four sites in the United States and interviewed twice, 1 year apart, we investigated the predictors of first-onset major depression. Using odds ratios to estimate relative risk, we found that persons with depressive symptoms, compared with those without such symptoms, were 4.4 times more likely and persons with dysthymia were 5.5 times more likely to develop a first-onset major depression during a 1-year period. The lifetime prevalence rate for depressive symptoms was 24%. The attributable risk is a compound epidemiologic measure that reflects both the relative risk associated with depressive symptoms (4.4) and the prevalence of exposure to that risk (24%). It is a useful measure to document the burden of a risk to the community, and it was determined to be greater than 50%. Thus, more than 50% of cases of first-onset major depression are associated with prior depressive symptoms. The high prevalence of depressive symptoms in the community and their strong association with first-onset major depression make them important from a public health perspective. Because depressive symptoms are often unrecognized and untreated in clinical practice, we conclude that their identification and the development of effective treatments could have implications for the prevention of major depression.
To estimate service utilization and social morbidity in the community associated with depressive symptoms. Estimates were made using an epidemiologic measure, population attributable risk. Population attributable risk is a compound measure reflecting both the morbid risk to an individual with a disorder and the prevalence of the disorder in the community.
Epidemiologic survey.
Eighteen thousand five hundred seventy-one adults in the Epidemiologic Catchment Area Study interviewed from a complex random sample in five US communities.
Suicide attempts, use of psychoactive medications, self-reported physical and emotional health, time lost from work, and general medical services or use of emergency departments for emotional problems.
Major depression-dysthymia (lifetime prevalence, 6.1%) and depressive symptoms (lifetime prevalence, 23.1%) were associated with increased service utilization and social morbidity as measured by the outcome variables. On a population basis, however, as much or more service burden and impairment was associated with depressive symptoms as with the clinical conditions of depression or dysthymia. The equal association results from the greater prevalence of depressive symptoms. Population attributable risk percentages associated with depressive symptoms (not disorder) were as follows: emergency department use (11.8%) or medical consultations for emotional problems (21.5%); use of tranquilizers (14.6%), sleeping pills (21.0%), or antidepressants (22.2%); fair or poor self-reported emotional health (15.3%); days lost from work (17.8%); and suicide attempts (25.0%).
Estimates of population attributable risk indicated that physicians actually provided services to more persons with depressive symptoms than to persons with formally defined conditions of depressive disorders. Subclinical depression, as a consequence of high prevalence, is a clinical and public health problem. Attention to diagnostic and treatment issues is indicated.
The Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) operationally defines disorder essentially as "statistically unexpectable distress or disability." This definition is an attempt to operationalize 2 basic principles: that a disorder is harmful and that a disorder is a dysfunction (i.e., an inability of some internal mechanism to perform its natural function). However, the definition fails to capture the idea of "dysfunction" and so fails to validly distinguish disorders from nondisorders, leading to invalidities in many of DSM-III-R's specific diagnostic criteria. These problems with validity are traced to DSM-III-R's strategies for increasing reliability.
The author examined the relationship between symptom criteria for major depression and family history of mood disorders in 82 outpatients with major depression and 27 outpatients with nonaffective disorders. The family members of depressed patients with six or more groups of DSM-III symptoms of major depression exhibited substantially higher rates of mood disorders than the family members of depressed patients with fewer than six groups of symptoms and the family members of patients with nonaffective disorders. These data suggest that stricter symptom criteria for major depression may define a more homogeneous phenotype, at least from the standpoint of familial aggregation.
The possibility that separation of a categorical depressive disease ('melancholia') from remaining depressive disorders can be improved by assessment of mental state signs was examined in patients treated by representative Sydney psychiatrists and patients referred to a specialised mood disorders unit. A set of signs, principally assessing retardation, was derived within the two samples by principal-components and latent-class analyses. Scores were significantly correlated with clinical, DSM-III, and RDC diagnoses, and appeared independent of severity, suggesting that melancholia can be defined phenomenologically. Scores were also associated with several 'validating' factors. Comparative analyses of a refined list of melancholia symptoms suggested that ratings of defined signs are likely to have greater capacity than symptom ratings to differentiate melancholia from residual depressive disorders.
The fit of the structure of DSM-III major depressive disorder to data from two large epidemiological surveys is assessed by latent class analysis. The surveys were conducted at the Baltimore and Raleigh-Durham sites of the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area Program. Three classes are required to fit the data, and the third class bears a strong resemblance to major depressive disorder, although it requires slightly more symptoms to be present than DSM-III. The derived structure replicates successfully for Baltimore and Raleigh-Durham, with a prevalence of the major depression category of 0.9% for both sites.
We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11,242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions. The poor functioning uniquely associated with depressive symptoms, with or without depressive disorder, was comparable with or worse than that uniquely associated with eight major chronic medical conditions. For example, the unique association of days in bed with depressive symptoms was significantly greater than the comparable association with hypertension, diabetes, and arthritis. Depression and chronic medical conditions had unique and additive effects on patient functioning.
Bimodality in a distribution of symptoms is often claimed to be convincing evidence that a disorder is categorical, a discrete disease entity, rather than the extreme on a continuous dimension. However, using concepts from contemporary psychometric theory it is shown that bimodality can arise from the dimensional viewpoint. In fact, contrary to the usual belief, bimodality would be expected to occur in many research contexts if the dimensional alternative were correct.
Early-onset characterological depressions are distinguished from late-onset chronic depressions that complicate the long-term course of unipolar and nonaffective illnesses. In turn, characterological depressions are divisible into at least two subtypes: (1) "Subaffective dysthymias" have even sex distribution, are often complicated by superimposed depressive episodes, rapid eye movement latency is shortened, and they tend to respond to tricyclics of lithium carbonate. In brief, they share many features of primary affective illness. (2) "Character spectrum disorders," by contrast, represent a heterogeneous mixture of personality disorders with inconstant depressive features, are more common in women, are often complicated by alcohol and drug abuse, and outcome tends to be unfavorable.
Taxometric procedures were used to test claims for the content and latent structure of 5 proposed subtypes of major depression: an endogenous form, sociotropic and autonomous forms proposed by A. Beck (1983), a self-critical form proposed by S. J. Blatt (e.g., S. J. Blatt & E. Homann, 1992), and a hopelessness form proposed by L. Y. Abramson, G. I. Metalsky, and L. B. Alloy (1989). Analysis of self-reported symptom and personality profiles of 531 consecutively admitted outpatients with a primary major depressive diagnosis sought to determine whether the clinical features proposed by the respective accounts systematically covary; which features are central to the respective latent structures; and whether these structures are discrete or continuous. Clear evidence for discreteness was found only for the endogenous subtype. The other proposed forms lacked internal coherence or were more consistent with a continuous or dimensional account.
The authors examined the clinical significance of depressive symptoms below the threshold for depressive disorder in outpatient samples.
The subjects were 775 adult patients with current depressive disorder, 1,420 patients with subthreshold depression, and 1,767 hypertensive patients with and without depression, all of whom were visiting the offices of mental health specialists and general medical care providers in three U.S. cities. Data on demographic characteristics, severity of depression, extent of psychiatric and medical comorbidity, family psychiatric history, and treatment history for the patients with depressive disorder and those with subthreshold depression were compared.
The percentage of patients with subthreshold depression who had a family history of depression (41%) was nearly as high as that of the patients with depressive disorder (59%). The two groups of patients had similar levels of medical and psychiatric comorbidity except for anxiety disorders, which were greater among the patients with depressive disorder. Among the hypertensive patients in the general medical sector, those with subthreshold depression were more similar to those with depressive disorder than to the nondepressed hypertensive patients. Treatment rates were considerably lower for patients with subthreshold depression than for patients with depressive disorder in the general medical sector, but they were similar in the mental health specialty sector.
In these outpatients, subthreshold depression appeared to be a variant of affective disorder and was treated as such in the mental health specialty sector but not in the general medical sector. The findings emphasize the importance of treatment outcome studies of patients with subthreshold depression.
The initial conception of manic depressive illness by Kraepelin included short and mild depressive and hypomanic states in the nosologic category of affective illnesses. A longitudinal epidemiologic study in Switzerland (the Zurich Study) identified brief, but recurrent, episodes of depression with severity of symptoms, impairment, and distress equivalent to major depression. The concept of recurrent brief depression was further confirmed in recent community and general practice studies. The diagnostic criteria for recurrent brief depression require the presence of at least five of nine depressive symptoms analogous to the symptoms of major depression, yet a duration of less than 2 weeks (in general 1 to 3 days), a recurrence of at least 12 times a year, and the evidence of work impairment. The 1-year prevalence in the general population is about 5% and the lifetime prevalence 16%. Recurrent brief depression may develop into major depression and vice versa in about the same percentage of cases. It is associated with considerable suicidality and treatment-seeking and is comorbid with anxiety disorders. Patients with combined major and recurrent brief depression are more severely affected, have a higher suicide attempt rate, and have an increased frequency of treatment-seeking than patients with only one condition. Further studies are needed to establish appropriate treatment strategies.
To test the hypothesis that depressed patients with selected neurobiologic disturbances are less responsive to psychotherapy, we examined responses to cognitive behavior therapy in relation to electroencephalographic sleep profiles.
Under a prospective, case-control design, 90 outpatients with probable or definite endogenous major depression (Schedule for Affective Disorders and Schizophrenia and Research Diagnostic Criteria) were stratified into abnormal and normal sleep subgroups (on the basis of an empirically validated electroencephalographic sleep profile) and more severe and less severe depression subgroups (on the basis of pretreatment Hamilton scores). Response to 16 weeks of treatment was analyzed for both intention-to-treat and completers (n = 82) samples. Outcomes during a 36-month prospective follow-up were assessed with survival analyses.
Abnormal sleep profiles and higher pretreatment depression severity were independently associated with poorer outcomes on several analyses. The association between sleep abnormality and cognitive behavior therapy response was not significant in the completers analyses, however, largely because of differential attrition. During follow-up, pretreatment depression severity was predictive of relapse and a lower recovery rate, whereas sleep abnormality was predictive of a lower recovery rate and a higher risk of recurrence.
Depressed patients characterized by higher severity and/or an abnormal electroencephalographic sleep profile were relatively less responsive to cognitive behavior therapy. These associations are hypothesized to result from a constellation of neurophysiologic disturbances that interfere with the acquisition, application, and implementation of the skills emphasized in cognitive behavior therapy.