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

Published online by Cambridge University Press:  09 April 2014

Y. Li ,
S. Aggen ,
S. Shi ,
J. Gao ,
Y. Li ,
M. Tao ,
K. Zhang ,
X. Wang ,
C. Gao  and
L. Yang
...Show all authors
Y. Li
Affiliation:
Wellcome Trust Centre for Human Genetics, Oxford, UK
S. Aggen
Affiliation:
Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
S. Shi
Affiliation:
Shanghai Mental Health Center, P.R.C. Huashan Hospital of Fudan University, Shanghai, P.R.C.
J. Gao
Affiliation:
Chinese Traditional Hospital of Zhejiang, Hangzhou, Zhejiang, P.R.C.
Y. Li
Affiliation:
No.1 Hospital of Zhengzhou University, Zhengzhou, Henan, P.R.C.
M. Tao
Affiliation:
Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang, P.R.C.
K. Zhang
Affiliation:
No. 1 Hospital of Shanxi Medical University, Taiyuan, Shanxi, P.R.C.
X. Wang
Affiliation:
ShengJing Hospital of China Medical University, Heping District, Shenyang, Liaoning, P.R.C.
C. Gao
Affiliation:
No. 1 Hospital of Medical College of Xian Jiaotong University, Xian, Shaanxi, P.R.C.
L. Yang
Affiliation:
Jilin Brain Hospital, Siping, Jilin, P.R.C.
Y. Liu
Affiliation:
The First Hospital of China Medical University, Heping District, Shenyang, Liaoning, P.R.C.
K. Li
Affiliation:
Mental Hospital of Jiangxi Province, Nanchang, Jiangxi, P.R.C.
J. Shi
Affiliation:
Xian Mental Health Center, New Qujiang District, Xian, Shaanxi, P.R.C.
G. Wang
Affiliation:
Beijing Anding Hospital of Capital University of Medical Sciences, Xicheng District, Beijing, P.R.C.
L. Liu
Affiliation:
Shandong Mental Health Center, Jinan, Shandong, P.R.C.
J. Zhang
Affiliation:
No. 3 Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, Guangdong, P.R.C.
B. Du
Affiliation:
Hebei Mental Health Center, Baoding, Hebei, P.R.C.
G. Jiang
Affiliation:
Chongqing Mental Health Center, Jiangbei District, Chongqing, P.R.C.
J. Shen
Affiliation:
Tianjin Anding Hospital, Hexi District, Tianjin, P.R.C.
Z. Zhang
Affiliation:
No. 4 Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R.C.
W. Liang
Affiliation:
Psychiatric Hospital of Henan Province, Xinxiang, Henan, P.R.C.
J. Sun
Affiliation:
Nanjing Brain Hospital, Nanjing, Jiangsu, P.R.C.
J. Hu
Affiliation:
Harbin Medical University, Nangang District, Haerbin, Heilongjiang, P.R.C.
T. Liu
Affiliation:
Shenzhen Kang Ning Hospital, Luohu District, Shenzhen, Guangdong, P.R.C.
X. Wang
Affiliation:
First Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R.C.
G. Miao
Affiliation:
Guangzhou Brain Hospital (Guangzhou Psychiatric Hospital), Liwan District, Guangzhou, Guangdong, P.R.C.
H. Meng
Affiliation:
No. 1 Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, P.R.C.
Y. Li
Affiliation:
Dalian No. 7 Hospital, Ganjingzi District, Dalian, Liaoning, P.R.C.
C. Hu
Affiliation:
No. 3 Hospital of Heilongjiang Province, Beian, Heilongjiang, P.R.C.
Y. Li
Affiliation:
Wuhan Mental Health Center, Wuhan, Hubei, P.R.C.
G. Huang
Affiliation:
Sichuan Mental Health Center, Mianyang, Sichuan, P.R.C.
G. Li
Affiliation:
Mental Health Institute of Jining Medical College, Dai Zhuang, Bei Jiao, Jining, Shandong, P.R.C.
B. Ha
Affiliation:
Liaocheng No. 4 Hospital, Liaocheng, Shandong, P.R.C.
H. Deng
Affiliation:
Mental Health Center of West China Hospital of Sichuan University, Wuhou District, Chengdu, Sichuan, P.R.C.
Q. Mei
Affiliation:
Suzhou Guangji Hospital, Suzhou, Jiangsu, P.R.C.
H. Zhong
Affiliation:
Anhui Mental Health Center, Hefei, Anhui, P.R.C.
S. Gao
Affiliation:
Ningbo Kang Ning Hospital, Zhenhai District, Ningbo, Zhejiang, P.R.C.
H. Sang
Affiliation:
Changchun Mental Hospital, Changchun, Jilin, P.R.C.
Y. Zhang
Affiliation:
No. 2 Hospital of Lanzhou University, Lanzhou, Gansu, P.R.C.
X. Fang
Affiliation:
Fuzhou Psychiatric Hospital, Cangshan District, Fuzhou, Fujian, P.R.C.
F. Yu
Affiliation:
Harbin No. 1 Special Hospital, Haerbin, Heilongjiang, P.R.C.
D. Yang
Affiliation:
Jining Psychiatric Hospital, North Dai Zhuang, Rencheng District, Jining, Shandong, P.R.C.
T. Liu
Affiliation:
No. 2 Xiangya Hospital of Zhongnan University, Furong District, Changsha, Hunan, P.R.C.
Y. Chen
Affiliation:
Xijing Hospital of No. 4 Military Medical University, Xian, Shaanxi, P.R.C.
X. Hong
Affiliation:
Mental Health Center of Shantou University, Shantou, Guangdong, P.R.C.
W. Wu
Affiliation:
Tongji University Hospital, Shanghai, P.R.C.
G. Chen
Affiliation:
Huaian No. 3 Hospital, Huaian, Jiangsu, P.R.C.
M. Cai
Affiliation:
Huzhou No. 3 Hospital, Huzhou, Zhejiang, P.R.C.
Y. Song
Affiliation:
Mudanjiang Psychiatric Hospital of Heilongjiang Province, Xinglong, Mudanjiang, Heilongjiang, P.R.C.
J. Pan
Affiliation:
No. 1 Hospital of Jinan University, Guangzhou, Guangdong, P.R.C.
J. Dong
Affiliation:
Qingdao Mental Health Center, Shibei District, Qingdao, Shandong, P.R.C.
R. Pan
Affiliation:
Guangxi Longquanshan Hospital, Yufeng District, Liuzhou, P.R.C.
W. Zhang
Affiliation:
Daqing No. 3 Hospital of Heilongjiang Province, Ranghulu district, Daqing, Heilongjiang, P.R.C.
Z. Shen
Affiliation:
Tangshan No. 5 Hospital, Lunan District, Tangshan, Hebei, P.R.C.
Z. Liu
Affiliation:
Anshan Psychiatric Rehabilitation Hospital, Lishan District, Anshan, Liaoning, P.R.C.
D. Gu
Affiliation:
Weihai Mental Health Center, ETDZ, Weihai, Shandong, P.R.C.
X. Wang
Affiliation:
Renmin Hospital of Wuhan University, Wuchang District, Wuhan, Hubei, P.R.C.
X. Liu
Affiliation:
Tianjin First Center Hospital, Xinkai Road, Hedong District, Tianjin, P.R.C.
Q. Zhang
Affiliation:
Hainan Anning Hospital, Haikou, Hainan, P.R.C.
J. Flint
Affiliation:
Wellcome Trust Centre for Human Genetics, Oxford, UK
K. S. Kendler*
Affiliation:
Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
*
*Address for correspondence: K. S. Kendler, M.D., Virginia Institute for Psychiatric and Behavioral Genetics of VCU, Box 980126, Richmond, VA 23298-0126, USA. (Email: kendler@vcu.edu)
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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.

Keywords

Atypical depressionChinadepressionlatent class analysismelancholiasuicidal ideation
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 15 , November 2014 , pp. 3275 - 3288
Copyright
Copyright © Cambridge University Press 2014 

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References

Akaike, H (1987). Factor analysis and AIC. Psychometrika 52, 317–332.CrossRefGoogle Scholar
Andreasen, NC, Grove, WM (1982). The classification of depression: traditional versus mathematical approaches. American Journal of Psychiatry 139, 45–52.Google ScholarPubMed
Beck, AT (1963). Thinking and depression. I. Idiosyncratic content and cognitive distortions. Archives of General Psychiatry 9, 324–333.CrossRefGoogle ScholarPubMed
Beck, AT (1967). Depression: Clinical, Experimental and Theoretical Aspects. Hoeber: New York.Google Scholar
Beck, AT, Alford, BA (2008). Depression: Causes and Treatment, 2nd edn. University of Pennsylvania Press: Philadelphia, PA. 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
Cole, J, McGuffin, P, Farmer, AE (2008). The classification of depression: are we still confused? British Journal of Psychiatry 192, 83–85.CrossRefGoogle Scholar
Davidson, JR, Woodbury, MA, Zisook, S, Giller, EL Jr. (1989). Classification of depression by grade of membership: a confirmation study. Psychological Medicine 19, 987–998.CrossRefGoogle ScholarPubMed
Eaton, WW, Dryman, A, Sorenson, A, McCutcheon, A (1989). DSM-III major depressive disorder in the community. A latent class analysis of data from the NIMH epidemiologic catchment area programme. British Journal of Psychiatry 155, 48–54.CrossRefGoogle ScholarPubMed
Grove, WM, Andreasen, NC, Winokur, G, Clayton, PJ, Endicott, J, Coryell, WH (1987). Primary and secondary affective disorders: unipolar patients compared on familial aggregation. Comprehensive Psychiatry 28, 113–126.CrossRefGoogle ScholarPubMed
Haslam, N, Beck, AT (1993). Categorization of major depression in an outpatient sample. Journal of Nervous and Mental Disease 181, 725–731.CrossRefGoogle 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
Ji, J, Kleinman, A, Becker, AE (2001). Suicide in contemporary China: a review of China's distinctive suicide demographics in their sociocultural context. Harvard Review of Psychiatry 9, 1–12.CrossRefGoogle ScholarPubMed
Kendell, RE (1976). The classification of depressions: a review of contemporary confusion. British Journal of Psychiatry 129, 15–28.CrossRefGoogle 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, Neale, MC, Prescott, CA (2001). Genetic risk factors for major depression in men and women: similar or different heritabilities and same or partly distinct genes? Psychological Medicine 31, 605–616.CrossRefGoogle ScholarPubMed
Kendler, KS, Prescott, CA (2006). Genes, Environment, and Psychopathology: Understanding the Causes of Psychiatric and Substance Use Disorders, 1st edn. Guilford Press: New York.Google Scholar
Lamers, F, Burstein, M, He, JP, Avenevoli, S, Angst, J, Merikangas, KR (2012). Structure of major depressive disorder in adolescents and adults in the US general population. British Journal of Psychiatry 201, 143–150.CrossRefGoogle ScholarPubMed
Lamers, F, de Jonge, P, Nolen, WA, Smit, JH, Zitman, FG, Beekman, AT, Penninx, BW (2010). Identifying depressive subtypes in a large cohort study: results from the Netherlands Study of Depression and Anxiety (NESDA). Journal of Clinical Psychiatry 71, 1582– 1589.CrossRefGoogle Scholar
Law, S, Liu, P (2008). Suicide in China: unique demographic patterns and relationship to depressive disorder. Current Psychiatry Reports 10, 80–86.CrossRefGoogle ScholarPubMed
Li, Y, Aggen, S, Shi, S, Gao, J, Li, Y, Tao, M, Zhang, K, Wang, X, Gao, C, Yang, L, Liu, Y, Li, K, Shi, J, Wang, G, Liu, L, Zhang, J, Du, B, Jiang, G, Shen, J, Zhang, Z, Liang, W, Sun, J, Hu, J, Liu, T, Wang, X, Miao, G, Meng, H, Li, Y, Huang, G, Li, G, Ha, B, Deng, H, Mei, Q, Zhong, H, Gao, S, Sang, H, Zhang, Y, Fang, X, Yu, F, Yang, D, Liu, T, Chen, Y, Hong, X, Wu, W, Chen, G, Cai, M, Song, Y, Pan, J, Dong, J, Pan, R, Zhang, W, Shen, Z, Liu, Z, Gu, D, Wang, X, Liu, X, Zhang, Q, Flint, J, Kendler, KS (2013). The structure of the symptoms of major depression: exploratory and confirmatory factor analysis in depressed Han Chinese women. Psychological Medicine. Published online: 2 August 2013 . doi:10.1017/S003329171300192X.Google ScholarPubMed
MacFadyen, HW (1975). The classification of depressive disorders. I. A review of statistically based classification studies. II. A review of historical and physiological classification studies. Journal of Clinical Psychology 31, 380–401.3.0.CO;2-1>CrossRefGoogle Scholar
Maes, M, Maes, L, Schotte, C, Cosyns, P (1992). A clinical and biological validation of the DSM-III melancholia diagnosis in men: results of pattern recognition methods. Journal of Psychiatric Research 26, 183–196.CrossRefGoogle ScholarPubMed
Matza, LS, Revicki, DA, Davidson, JR, Stewart, JW (2003). Depression with atypical features in the National Comorbidity Survey: classification, description, and consequences. Archives of General Psychiatry 60, 817–826.CrossRefGoogle ScholarPubMed
McCutcheon, AL (1987). Latent Class Analysis. Sage Publications: Beverly Hills, CA.CrossRefGoogle ScholarPubMed
Muthén, LK, Muthén, BO (1998–2010). Mplus User's Guide: Sixth Edition. Muthén & Muthén: Los Angeles, CA.Google Scholar
Parker, G, Wilhelm, K, Mitchell, P, Roy, K, Hadzi-Pavlovic, D (1999). Subtyping depression: testing algorithms and identification of a tiered model. Journal of Nervous and Mental Disease 187, 610–617.CrossRefGoogle ScholarPubMed
Phillips, MR, Li, X, Zhang, Y (2002). Suicide rates in China, 1995–99. Lancet 359, 835–840.CrossRefGoogle Scholar
Qin, P, Mortensen, PB (2001). Specific characteristics of suicide in China. Acta Psychiatrica Scandinavica 103, 117–121.CrossRefGoogle 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
Schwarz, G (1978). Estimating the dimension of a model. Annals of Statistics 6, 461–464.CrossRefGoogle Scholar
Spitzer, RL, Williams, JB, Gibbon, J (1987). Structured Clinical Interview for DSM-III-R – Patient Version (SCID-P) . New York State Psychiatric Institute: New York.Google Scholar
Sullivan, PF, Kessler, RC, Kendler, KS (1998). Latent class analysis of lifetime depressive symptoms in the National Comorbidity Survey. American Journal of Psychiatry 155, 1398–1406.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
Wang, L, Liu, L, Shi, S, Gao, J, Liu, Y, Li, Y, Zhang, Z, Wang, G, Zhang, K, Tao, M, Gao, C, Li, K, Wang, X, Lv, L, Jiang, G, Wang, X, Jia, H, Zhang, J, Lu, C, Li, Y, Li, K, Hu, C, Ning, Y, Li, Y, Sun, J, Liu, T, Zhang, Y, Ha, B, Tian, H, Meng, H, Hu, J, Chen, Y, Deng, H, Huang, G, Wu, W, Li, G, Fang, X, Pan, J, Hong, X, Gao, S, Li, X, Yang, D, Chen, G, Liu, T, Cai, M, Dong, J, Mei, Q, Shen, Z, Pan, R, Liu, Z, Wang, X, Tan, Y, Flint, J, Kendler, KS (2013). Cognitive trio: relationship with major depression and clinical predictors in Han Chinese women. Psychological Medicine 43, 2265–2275.CrossRefGoogle ScholarPubMed
WHO (2013). WHO: Suicide Prevention (http://www.who.int/mental_health/prevention/en/). Word Health Organization: Geneva.Google ScholarPubMed