Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-31T23:16:33.931Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  11 January 2010

V. Lux  and
K. S. Kendler
V. Lux
Affiliation:
Department of Psychology, Free University Berlin, Germany
K. S. Kendler*
Affiliation:
Virginia Institute for Psychiatric and Behavioral Genetics and Departments of Psychiatry and Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA USA
*
*Address for correspondence: Dr K. S. Kendler, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Box 980126, Richmond, VA 23298–0126, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The DSM-IV symptomatic criteria for major depression (MD) derive primarily from clinical experience with modest empirical support.

Method

The sample studied included 1015 (518 males, 497 females) Caucasian twins from a population-based registry who met criteria for MD in the year prior to the interview. Logistic regression analyses were conducted to compare the associations of: (1) single symptomatic criterion, (2) two groups of criteria reflecting cognitive and neurovegetative symptoms, with a wide range of potential validators including demographic factors, risk for future episodes, risk of MD in the co-twin, characteristics of the depressive episode, the pattern of co-morbidity and personality traits.

Results

The individual symptomatic criteria showed widely varying associations with the pattern of co-morbidity, personality traits, features of the depressive episode and demographic characteristics. When examined separately, these two criteria groups showed robust differences in their patterns of association, with the validators with the cognitive criteria generally producing stronger associations than the neurovegetative.

Conclusions

Among depressed individuals, individual DSM-IV symptomatic criteria differ substantially in their predictive relationship with a range of clinical validators. These results challenge the equivalence assumption for the symptomatic criteria for MD and suggest a more than expected degree of ‘covert’ heterogeneity among these criteria. Part of this heterogeneity is captured by the distinction between cognitive versus neurovegetative symptoms, with cognitive symptoms being more strongly associated with most clinically relevant characteristics. Detailed psychometric evaluation of DSM-IV criteria is overdue.

Keywords

Criteria symptomsDSM-IVheterogeneitymajor depressionpsychiatric diagnosis
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 10 , October 2010 , pp. 1679 - 1690
Copyright
Copyright © Cambridge University Press 2010

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

Abdi, H (2007). Bonferroni and Sidak corrections for multiple comparisons. In Encyclopedia of Measurement and Statistics (ed. Salkind, N. J.), pp. 103–107. Sage: Thousand Oaks, CA.Google Scholar
Akiskal, HS, McKinney, WT Jr. (1975). Overview of recent research in depression. Integration of ten conceptual models into a comprehensive clinical frame. Archives of General Psychiatry 32, 285–305.CrossRefGoogle ScholarPubMed
Angst, J, Dobler-Mikola, A (1984). Do the diagnostic criteria determine the sex ratio in depression? Journal of Affective Disorders 7, 189–198.CrossRefGoogle ScholarPubMed
APA (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association: Washington, DC.Google Scholar
APA (1987). Diagnostic and Statistical Manual of Mental Disorders – Revised, 3rd edn. American Psychiatric Association: Washington, DC.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Balazs, J, Benazzi, F, Rihmer, Z, Rihmer, A, Akiskal, KK, Akiskal, HS (2006). The close link between suicide attempts and mixed (bipolar) depression: implications for suicide prevention. Journal of Affective Disorders 91, 133–138.CrossRefGoogle ScholarPubMed
Beck, AT, Alford, BA (2008). Depression: Causes and Treatment, 2nd edn. University of Pennsylvania Press: Pennsylvania.Google Scholar
Carragher, N, Adamson, G, Bunting, B, McCann, S (2009). Subtypes of depression in a nationally representative sample. Journal of Affective Disorders 113, 88–99.CrossRefGoogle Scholar
Cassidy, WL, Flanagan, NB, Spellman, M, Cohen, ME (1957). Clinical observations in manic-depressive disease: a quantitative study of one hundred manic-depressive patients and fifty medically sick controls. Journal of the American Medical Association 164, 1535–1546.CrossRefGoogle ScholarPubMed
Chen, LS, Eaton, WW, Gallo, JJ, Nestadt, G (2000). Understanding the heterogeneity of depression through the triad of symptoms, course and risk factors: a longitudinal, population-based study. Journal of Affective Disorders 59, 1–11.CrossRefGoogle ScholarPubMed
Eysenck, HJ (1970). Classification of depressive illnesses. British Journal of Psychiatry 117, 241–250.CrossRefGoogle ScholarPubMed
Eysenck, SBG, Eysenck, HJ, Barrett, P (1985). A revised version of the psychoticism scale. Personality and Individual Differences 6, 21–29.CrossRefGoogle Scholar
Fagerström, KO (1978). Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addictive Behaviors 3, 235–241.CrossRefGoogle ScholarPubMed
Faravelli, C, Servi, P, Arends, JA, Strik, WK (1996). Number of symptoms, quantification, and qualification of depression. Comprehensive Psychiatry 37, 307–315.CrossRefGoogle ScholarPubMed
Feighner, JP, Robins, E, Guze, SB, Woodruff, RA Jr., Winokur, G, Munoz, R (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 57–63.CrossRefGoogle ScholarPubMed
Feild, H, Armenakis, A (1974). On use of multiple tests of significance in psychological research. Psychological Reports 35, 427–431.CrossRefGoogle Scholar
Frances, A, Pincus, HA, Widiger, TA, Davis, WW, First, MB (1990). DSM-IV: work in progress. American Journal of Psychiatry 147, 1439–1448.Google ScholarPubMed
Gillespie, RD (1929). The clinical differentiation of types of depression. Guy's Hospital Report 9, 306–344.Google Scholar
Hybels, CF, Blazer, DG, Pieper, CF, Landerman, LR, Steffens, DC (2009). Profiles of depressive symptoms in older adults diagnosed with major depression: latent cluster analysis. American Journal of Geriatric Psychiatry 17, 387–396.CrossRefGoogle ScholarPubMed
Keller, MB, Klein, DN, Hirschfeld, RMA, Kocsis, JH, McCullough, JP, Miller, I, First, MB, Holzer, CP, Keitner, GI, Marin, DB, Shea, T (1995). Results of the DSM-IV mood disorders field trial. American Journal of Psychiatry 152, 843–849.Google ScholarPubMed
Keller, MC, Neale, MC, Kendler, KS (2007). Association of different adverse life events with distinct patterns of depressive symptoms. American Journal of Psychiatry 164, 1521–1529.CrossRefGoogle ScholarPubMed
Kendell, RE (1969). Continuum model of depressive illness. Proceedings of the Royal Society of Medicine – London 62, 335–339.Google ScholarPubMed
Kendler, KS, Eaves, LJ, Walters, EE, Neale, MC, Heath, AC, Kessler, RC (1996). The identification and validation of distinct depressive syndromes in a population-based sample of female twins. Archives of General Psychiatry 53, 391–399.CrossRefGoogle Scholar
Kendler, KS, Gardner, CO Jr. (1998). Boundaries of major depression: an evaluation of DSM-IV criteria. American Journal of Psychiatry 155, 172–177.CrossRefGoogle ScholarPubMed
Kendler, KS, Munoz, RA, Murphy, G(2009). The development of the Feighner criteria: an historical perspective. American Journal of Psychiatry. Published online: 15 December 2009. doi:10.1176/appi.ajp.2009.09081155.Google ScholarPubMed
Kendler, KS, Prescott, CA (1999). A population-based twin study of lifetime major depression in men and women. Archives of General Psychiatry 56, 39–44.CrossRefGoogle ScholarPubMed
Kendler, KS, Prescott, CA (2006). Genes, Environment, and Psychopathology: Understanding the Causes of Psychiatric and Substance Use Disorders. Guilford Press: New York.Google Scholar
Kendler, KS, Zachar, P (2008). The incredible insecurity of psychiatric nosology. In Philosophical Issues in Psychiatry (ed. Kendler, K. S. and Parnas, J.), pp. 368–383. The Johns Hopkins University Press: Baltimore, MD.CrossRefGoogle Scholar
Khan, AA, Gardner, CO, Prescott, CA, Kendler, KS (2002). Gender differences in the symptoms of major depression in opposite-sex dizygotic twin pairs. American Journal of Psychiatry 159, 1427–1429.CrossRefGoogle ScholarPubMed
Kiloh, LG, Garside, RF (1963). The independence of neurotic depression and endogenous depression. British Journal of Psychiatry 109, 451–463.CrossRefGoogle ScholarPubMed
Koenig, HG, Cohen, HJ, Blazer, DG, Krishnan, KR, Sibert, TE (1993). Profile of depressive symptoms in younger and older medical inpatients with major depression. Journal of the American Geriatric Society 41, 1169–1176.CrossRefGoogle ScholarPubMed
Leventhal, AM, Francione, WC, Zimmerman, M (2008). Associations between depression subtypes and substance use disorders. Psychiatry Research 161, 43–50.CrossRefGoogle ScholarPubMed
Lewis, AJ (1934). Melancholia: a clinical survey of depressive states. Journal of Mental Science 80, 277–378.CrossRefGoogle Scholar
McGlinchey, JB, Zimmerman, M, Young, D, Chelminski, I (2006). Diagnosing major depressive disorder VIII: are some symptoms better than others? Journal of Nervous and Mental Disease 194, 785–790.CrossRefGoogle ScholarPubMed
Mapother, E (1926). Discussion on manic-depressive psychosis. British Medical Journal 2, 872–885.Google Scholar
Merikangas, KR, Wicki, W, Angst, J (1994). Heterogeneity of depression. Classification of depressive subtypes by longitudinal course. British Journal of Psychiatry 164, 342–348.CrossRefGoogle ScholarPubMed
Middeldorp, CM, Wray, NR, Andrews, G, Martin, NG, Boomsma, DI (2006). Sex differences in symptoms of depression in unrelated individuals and opposite-sex twin and sibling pairs. Twin Research and Human Genetics 9, 632–636.CrossRefGoogle ScholarPubMed
Parker, G (2000). Classifying depression: Should paradigms lost be regained? American Journal of Psychiatry 157, 1195–1203.CrossRefGoogle ScholarPubMed
Parker, G (2005). Beyond major depression. Psychological Medicine 35, 467–474.CrossRefGoogle ScholarPubMed
Parker, G, Wilhelm, K, Asghari, A (1998). Depressed mood states and their inter-relationship with clinical depression. Social Psychiatry and Psychiatric Epidemiology 33, 10–15.CrossRefGoogle ScholarPubMed
SAS Institute (2005). SAS OnlineDoc Version 9.1.3. SAS Institute Inc.: Cary, NC.Google Scholar
Schotte, CK, Maes, M, Cluydts, R, Cosyns, P (1997). Cluster analytic validation of the DSM melancholic depression. The threshold model: integration of quantitative and qualitative distinctions between unipolar depressive subtypes. Psychiatric Research 71, 181–195.CrossRefGoogle ScholarPubMed
Spitzer, RL, Endicott, J, Robins, E (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Spitzer, RL, Fleiss, JL (1974). A re-analysis of the reliability of psychiatric diagnosis. British Journal of Psychiatry 125, 341–347.CrossRefGoogle ScholarPubMed
Stone, TT, Burris, BC (1950). Melancholia; clinical study of 50 selected cases. Journal of the American Medical Association 142, 165–168.CrossRefGoogle ScholarPubMed
Sullivan, PF, Prescott, CA, Kendler, KS (2002). The subtypes of major depression in a twin registry. Journal of Affective Disorders 68, 273–284.CrossRefGoogle Scholar
van Praag, HM (2000). Nosologomania: a disorder of psychiatry. World Journal of Biological Psychiatry 1, 151–158.CrossRefGoogle ScholarPubMed
Zimmerman, M, McGlinchey, JB, Young, D, Chelminski, I (2006 a). Diagnosing major depressive disorder III: can some symptoms be eliminated from the diagnostic criteria? Journal of Nervous and Mental Disease 194, 313–317.CrossRefGoogle ScholarPubMed
Zimmerman, M, McGlinchey, JB, Young, D, Chelminski, I (2006 b). Diagnosing major depressive disorder introduction: an examination of the DSM-IV diagnostic criteria. Journal of Nervous and Mental Disease 194, 151–154.CrossRefGoogle ScholarPubMed