Changes in Depression Subtypes Among Men in STAR*D: A Latent Transition Analysis

Abstract

The burden of depression in men is high. Current diagnostic criteria may not fully capture men's experience with depression. Descriptions of the heterogeneity in depression among men are lacking. The purpose of the study was to characterize latent subtypes of major depression and changes in these subtypes among men receiving citalopram in Level 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Latent transition analysis was applied to data from 387 men who completed baseline and Week 12 study visits in Level 1 of STAR*D. Items from the self-report version of the Quick Inventory of Depressive Symptomatology were used as indicators of latent depression subtypes. Four statuses were identified at baseline and Week 12. Baseline statuses were Mild (10% of men), Moderate (53%), Severe with Psychomotor Slowing (20%), and Severe with Psychomotor Agitation (17%). At Week 12, the statuses were Symptom Resolution (41%), Mild (36%), Moderate (18%), and Severe with Psychomotor Slowing (5%). Men in the Mild status were most likely to transition to Symptom Resolution (probability = 69%). Men in the Severe with Agitation status were least likely to transition to Symptom Resolution (probability = 0%). This work highlights the need to not focus solely on summary rating scores but to also consider patterns of symptoms when treating depression.

Change in suicidal ideation and associated factors among young adults in Hong Kong from 2018 to 2019: a latent transition analysis

“…This approach is useful for modeling the transition among the latent classes while allowing for likely misclassification errors and associated factors [ 19 ]. Although LTA has been applied in research on substance use and depression [ 20 , 21 ], previous studies [ 6 , 22 ] have not applied LTA to investigate transition in suicidal ideation across time. In view of this research gap, the first objective of the present study was to apply LTA to evaluate the latent classes of suicidal ideation and examine the stability and transition among young adults in Hong Kong over one year.…”

The utility of an RDoC motor domain to understand psychomotor symptoms in depression

“…Clinicians’ ratings of retardation or agitation are as frequent as 60–70% in acute depressive episodes, as indicated by the STAR*D trial (Novick et al ., 2005). These disturbances are particularly frequent in episodes of severe depression (Parker, 2000) and have been linked to poor outcome in treatment trials of depression (Ulbricht et al ., 2016, 2018; Sakurai et al ., 2017). Furthermore, clinician-rated psychomotor disturbances are suggested to distinguish the melancholic subtype of unipolar depression (Sobin and Sackeim, 1997; Parker, 2000) and also distinguish major depressive disorder from bipolar disorder, with stronger effects for retardation than agitation (Leonpacher et al ., 2015).…”

“…The proposed RDoC motor domain has the potential to inform tests clarifying whether motor behavior has unique predictive value in the course and treatment response of depression. Current post-hoc analyses suggest that motor disturbances would indicate poor treatment response (Ulbricht et al ., 2016, 2018; Sakurai et al ., 2017). Again, instrumental measures are very likely to outperform self-rated motor disturbances and predictions could become even more precise (Caligiuri and Ellwanger, 2000).…”

Heterogeneity in major depression and its melancholic and atypical specifiers: a secondary analysis of STAR*D

“…The IDS encompasses 30 depression symptoms, both DSM and non-DSM symptoms, rated on a 4-point (0-3) scale with a higher score indicating greater severity. Consistent with prior work [ 42 ], we considered a symptom to be present when an individual endorsed a severity level ≥2. The IDS covers most DSM-5 criterion symptoms in disaggregated form.…”