Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-27T22:52:18.058Z Has data issue: false hasContentIssue false
  • English
  • Français

Understanding the severity of depression: do nondepressive symptoms influence global ratings of depression severity?

Published online by Cambridge University Press:  12 November 2019

Mark Zimmerman Open the ORCID record for Mark Zimmerman [Opens in a new window] ,
Caroline Balling ,
Iwona Chelminski  and
Kristy Dalrymple
Mark Zimmerman*
Affiliation:
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, Rhode Island, USA.
Caroline Balling
Affiliation:
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, Rhode Island, USA.
Iwona Chelminski
Affiliation:
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, Rhode Island, USA.
Kristy Dalrymple
Affiliation:
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, Rhode Island, USA.
*
*Mark Zimmerman, MD, Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Almost all depression measures have been developed without discussing how to best conceptualize and assess the severity of depression. It is therefore not surprising that measures differ in both how items are rated and item content. The question that we address in the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project is whether a measure of depression severity should include symptoms that are frequent in depressed patients but are defining features of other disorders (eg, anxiety, irritability)

Methods.

Patients were evaluated with a semi-structured interview and severity ratings were made of each symptom of major depressive disorder (MDD) as well as anxiety, irritability, and somatization. Patients were also rated on the Clinical Global Index of severity (CGI).

Results.

Three of the 5 nondepressive symptoms (psychic anxiety, somatic anxiety, and subjective anger) were significantly correlated with the CGI. The correlation between the sum of all 5 nondepressive symptoms and the CGI was significantly lower than the correlation between the sum of the depressive symptom severity ratings (0.12 vs 0.52, z = 11.0, p < .001). The partial correlation between the CGI and the nondepressive symptom severity ratings (after controlling for the total depressive symptom ratings) was nonsignificant.

Discussion.

After accounting for the severity of depressive symptoms, the severity of the nondepressive symptoms was not associated with global ratings of depressive severity. These findings raise questions regarding the appropriateness of including ratings of anxiety, irritability, and somatization on a measure that purportedly assesses the severity of depression.

Keywords

Severitydepressionmajor depressive disordersymptom severityanxietyirritability
Type
Original Research
Information
CNS Spectrums , Volume 25 , Issue 4 , August 2020 , pp. 557 - 560
Copyright
© Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hamilton, M.A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23(1): 56–62.Google Scholar
Montgomery, SA, Asberg, M.A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134(4): 382–389.Google Scholar
Rush, AJ, Gullion, CM, Basco, MR, Jarrett, RB, Trivedi, MHThe Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychol Med. 1996; 26(3): 477–486.Google Scholar
Zimmerman, M, Martin, J, McGonigal, P, et al.Validity of the DSM-5 anxious distress specifier for major depressive disorder. Depress Anxiety. 2019; 36: 31–38.Google Scholar
Ionescu, DF, Niciu, MJ, Henter, ID, Zarate, CADefining anxious depression: A review of the literature. CNS Spectr. 2013; 18(5): 252–260.Google Scholar
Judd, LL, Schettler, PJ, Coryell, W, Akiskal, HS, Fiedorowicz, JGOvert irritability/anger in unipolar major depressive episodes: past and current characteristics and implications for long-term course. JAMA Psychiatry. 2013; 70(11): 1171–1180.Google Scholar
Koh, K, Kim, C, Park, J.Predominance of anger in depressive disorders compared with anxiety disorders and somatoform disorders. J Clin Psychiatry. 2002; 63: 486–492.Google Scholar
Smith, GRThe epidemiology and treatment of depression when it coexists with somatoform disorders, somatization, or pain. Gen Hosp Psychiatry. 1992; 14(4): 265–272.Google Scholar
Vaccarino, AL, Sills, TL, Evans, KR, Kalali, AHPrevalence and association of somatic symptoms in patients with major depressive disorder. J Affect Disord. 2008; 110(3): 270–276.Google Scholar
Trivedi, MH, Rush, AJ, Ibrahim, HM, et al.The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychol Med. 2004; 34: 73–82.Google Scholar
Zimmerman, M, Balling, C, Chelminski, I, Dalrymple, K.Understanding the severity of depression: which symptoms of depression are the best indicators of depression severity? Compr Psychiatry. 2018; 87: 84–88.Google Scholar
Zimmerman, M.A review of 20 years of research on overdiagnosis and underdiagnosis in the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project. Can J Psychiatry. 2016; 61(2): 71–79.Google Scholar
Zimmerman, M, Mattia, JIPsychiatric diagnosis in clinical practice: Is comorbidity being missed? Compr Psychiatry. 1999; 40: 182–191.Google Scholar
First, MB, Spitzer, RL, Williams, JBW, Gibbon, M.Structured Clinical Interview for DSM-IV (SCID). Washington, D.C.: American Psychiatric Association; 1997.Google Scholar
Endicott, J, Spitzer, RLA diagnostic interview: The Schedule for Affective Disorders and Schizophrenia. Arch Gen Psychiatry. 1978; 35: 837–844.Google Scholar
Guy, W.NCDEU Assessment Manual for Psychopharmacology. 3rd ed. Rockville, MD: National Institute for Mental Health; 1976.Google Scholar
Fava, M, Rankin, MA, Wright, E, et al.Anxiety disorders in major depression. Compr Psychiatry. 2000; 41: 97–102.Google Scholar
Zimmerman, M, McDermut, W, Mattia, J.The frequency of anxiety disorders in psychiatric outpatients with major depressive disorder. Am J Psychiatry. 2000; 157: 1337–1400.Google Scholar
Coryell, W, Endicott, J, Andreasen, NC, et al.Depression and panic attacks: the significance of overlap as reflected in follow-up and family study data. Am J Psychiatry. 1988; 145: 293–300.Google Scholar
Gaynes, BN, Magruder, KM, Burns, BJ, Wagner, HR, Yarnall, KSH, Broadhead, WEDoes a coexisting anxiety disorder predict persistence of depressive illness in primary care patients with major depression? Gen Hosp Psychiatry. 1999; 21(3): 158–167.Google Scholar
Lin, CH, Wang, FC, Lin, SC, Chen, CC, Huang, CJA comparison of inpatients with anxious depression to those with nonanxious depression. Psychiatry Res. 2014; 220(3): 855–860.Google Scholar
Fichter, MM, Quadflieg, N, Fischer, UC, Kohlboeck, G.Twenty-five-year course and outcome in anxiety and depression in the Upper Bavarian Longitudinal Community Study. Acta Psychiatr Scand. 2010; 122: 75–85.Google Scholar
Pilkonis, PA, Choi, SW, Reise, SP, Stover, AM, Riley, WT, Cella, D.Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS(R)): depression, anxiety, and anger. Assessment. 2011; 18(3): 263–283.Google Scholar
Balsamo, M, Giampaglia, G, Saggino, A.Building a new Rasch-based self-report inventory of depression. Neuropsychiatr Dis Treat. 2014; 10: 153–165.Google Scholar
Vaccarino, AL, Evans, KR, Kalali, AH, et al.The Depression Inventory Development Workgroup: a collaborative, empirically driven initiative to develop a new assessment tool for major depressive disorder. Innov Clin Neurosci. 2016; 13(9-10): 20–31.Google Scholar
Zimmerman, M. Severity and treatment of depression: a review of 2 controversies. J Nerv Ment Dis, in press.Google Scholar
Zimmerman, M, Posternak, MA, Chelminski, I.Symptom severity and exclusion from antidepressant efficacy trials. J Clin Psychopharmacol. 2002; 22(6): 610–614.Google Scholar
Kotov, R, Krueger, RF, Watson, D, et al.The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. J Abnorm Psychol. 2017; 126(4): 454–477.Google Scholar
Insel, T, Cuthbert, B, Garvey, M, et al.Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010; 167: 748–751.Google Scholar