Skip to main content Accessibility help

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

  • Y. Li (a1), S. Aggen (a2), S. Shi (a3) (a4), J. Gao (a5), Y. Li (a6), M. Tao (a7), K. Zhang (a8), X. Wang (a9), C. Gao (a10), L. Yang (a11), Y. Liu (a12), K. Li (a13), J. Shi (a14), G. Wang (a15), L. Liu (a16), J. Zhang (a17), B. Du (a18), G. Jiang (a19), J. Shen (a20), Z. Zhang (a21), W. Liang (a22), J. Sun (a23), J. Hu (a24), T. Liu (a25), X. Wang (a26), G. Miao (a27), H. Meng (a28), Y. Li (a29), C. Hu (a30), Y. Li (a31), G. Huang (a32), G. Li (a33), B. Ha (a34), H. Deng (a35), Q. Mei (a36), H. Zhong (a37), S. Gao (a38), H. Sang (a39), Y. Zhang (a40), X. Fang (a41), F. Yu (a42), D. Yang (a43), T. Liu (a44), Y. Chen (a45), X. Hong (a46), W. Wu (a47), G. Chen (a48), M. Cai (a49), Y. Song (a50), J. Pan (a51), J. Dong (a52), R. Pan (a53), W. Zhang (a54), Z. Shen (a55), Z. Liu (a56), D. Gu (a57), X. Wang (a58), X. Liu (a59), Q. Zhang (a60), J. Flint (a1) and K. S. Kendler (a2)...



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?


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.


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.


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.


Corresponding author

* 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:


Hide All
Akaike, H (1987). Factor analysis and AIC. Psychometrika 52, 317332.
Andreasen, NC, Grove, WM (1982). The classification of depression: traditional versus mathematical approaches. American Journal of Psychiatry 139, 4552.
Beck, AT (1963). Thinking and depression. I. Idiosyncratic content and cognitive distortions. Archives of General Psychiatry 9, 324333.
Beck, AT (1967). Depression: Clinical, Experimental and Theoretical Aspects. Hoeber: New York.
Beck, AT, Alford, BA (2008). Depression: Causes and Treatment, 2nd edn. University of Pennsylvania Press: Philadelphia, PA.
Carragher, N, Adamson, G, Bunting, B, McCann, S (2009). Subtypes of depression in a nationally representative sample. Journal of Affective Disorders 113, 8899.
Cole, J, McGuffin, P, Farmer, AE (2008). The classification of depression: are we still confused? British Journal of Psychiatry 192, 8385.
Davidson, JR, Woodbury, MA, Zisook, S, Giller, EL Jr. (1989). Classification of depression by grade of membership: a confirmation study. Psychological Medicine 19, 987998.
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, 4854.
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, 113126.
Haslam, N, Beck, AT (1993). Categorization of major depression in an outpatient sample. Journal of Nervous and Mental Disease 181, 725731.
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, 387396.
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, 112.
Kendell, RE (1976). The classification of depressions: a review of contemporary confusion. British Journal of Psychiatry 129, 1528.
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, 391399.
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, 605616.
Kendler, KS, Prescott, CA (2006). Genes, Environment, and Psychopathology: Understanding the Causes of Psychiatric and Substance Use Disorders, 1st edn. Guilford Press: New York.
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, 143150.
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, 15821589.
Law, S, Liu, P (2008). Suicide in China: unique demographic patterns and relationship to depressive disorder. Current Psychiatry Reports 10, 8086.
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.
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, 380401.
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, 183196.
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, 817826.
McCutcheon, AL (1987). Latent Class Analysis. Sage Publications: Beverly Hills, CA.
Muthén, LK, Muthén, BO (1998–2010). Mplus User's Guide: Sixth Edition. Muthén & Muthén: Los Angeles, CA.
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, 610617.
Phillips, MR, Li, X, Zhang, Y (2002). Suicide rates in China, 1995–99. Lancet 359, 835840.
Qin, P, Mortensen, PB (2001). Specific characteristics of suicide in China. Acta Psychiatrica Scandinavica 103, 117121.
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, 181195.
Schwarz, G (1978). Estimating the dimension of a model. Annals of Statistics 6, 461464.
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.
Sullivan, PF, Kessler, RC, Kendler, KS (1998). Latent class analysis of lifetime depressive symptoms in the National Comorbidity Survey. American Journal of Psychiatry 155, 13981406.
Sullivan, PF, Prescott, CA, Kendler, KS (2002). The subtypes of major depression in a twin registry. Journal of Affective Disorders 68, 273284.
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, 22652275.
WHO (2013). WHO: Suicide Prevention ( Word Health Organization: Geneva.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed