Subtypes of major depression: latent class analysis in depressed Han Chinese women

Abstract

Background Despite substantial research, uncertainty remains about the clinical and etiological heterogeneity of major depression (MD). Can meaningful and valid subtypes be identified and would they be stable cross-culturally? Method Symptoms at their lifetime worst depressive episode were assessed at structured psychiatric interview in 6008 women of Han Chinese descent, age ≥30 years, with recurrent DSM-IV MD. Latent class analysis (LCA) was performed in Mplus. Results Using the nine DSM-IV MD symptomatic A criteria, the 14 disaggregated DSM-IV criteria and all independently assessed depressive symptoms (n=27), the best LCA model identified respectively three, four and six classes. A severe and non-suicidal class was seen in all solutions, as was a mild/moderate subtype. An atypical class emerged once bidirectional neurovegetative symptoms were included. The non-suicidal class demonstrated low levels of worthlessness/guilt and hopelessness. Patterns of co-morbidity, family history, personality, environmental precipitants, recurrence and body mass index (BMI) differed meaningfully across subtypes, with the atypical class standing out as particularly distinct. Conclusions MD is a clinically complex syndrome with several detectable subtypes with distinct clinical and demographic correlates. Three subtypes were most consistently identified in our analyses: severe, atypical and non-suicidal. Severe and atypical MD have been identified in multiple prior studies in samples of European ethnicity. Our non-suicidal subtype, with low levels of guilt and hopelessness, may represent a pathoplastic variant reflecting Chinese cultural influences.

Symptoms of major depression: Their stability, familiality, and prediction by genetic, temperamental, and childhood environmental risk factors

“…Our results for childhood sexual abuse-whose impact on risk for MD is likely to be largely causal (Kendler et al, 2000;Nelson et al, 2002)-are congruent with findings from a large clinically ascertained sample of depressed women in China (Li et al, 2014). In that sample, childhood sexual abuse was commonest among women with atypical depression that was characterized by many of the same symptoms predicted by sexual abuse in our twins: hypersomnia, weight gain, psychomotor retardation, suicidal ideation, and feelings of worthlessness.…”

Depression-Related Increases and Decreases in Appetite: Dissociable Patterns of Aberrant Activity in Reward and Interoceptive Neurocircuitry

“…Depression-related increases and decreases in appetite and weight have long been codified as antipodal diagnostic markers in the Diagnostic and Statistical Manual (e.g., DSM-5). Yet while appetite changes have long been recognized as common diagnostic features of depression, and more recently as some of the most discriminating depressive symptoms in latent class analyses of depressive subtypes (6-8), there exist no data on differential brain activity among depressed subjects exhibiting increased versus decreased appetites. The present study thus investigated whether depression-related increases and decreases in appetite are associated with differential neural activity in response to food stimuli.…”

“…Patients with major depressive disorder exhibit marked heterogeneity in appetite, with approximately 48% of adult depressed patients exhibiting depression-related decreases in appetite, while approximately 35% exhibit depression-related increases in appetite (5). In fact, across large depressed cohorts, appetite and weight changes are often some of the most discriminating symptoms in latent class analyses of depression subtypes (6-8). These changes in appetite and weight are 75-85% stable across depressive episodes (9, 10), suggesting that they may be trait markers of how depression is manifested within a particular individual.…”

Chronicity of Depression and Molecular Markers in a Large Sample of Han Chinese Women

“…Diagnoses were established with the CIDI (WHO lifetime version 2.1; Chinese version) as previously described. [18] Stressful life events were assessed as has been described previously. [19] Briefly, participants were asked whether they had ever experienced any of 16 traumatic life events (see Supporting Information), which have been previously assessed for their association with MDD in CONVERGE.…”