Skip to main content Accessibility help
×
Home
Hostname: page-component-568f69f84b-gcfkn Total loading time: 0.184 Render date: 2021-09-19T21:12:30.967Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

A simpler definition of major depressive disorder

Published online by Cambridge University Press:  23 July 2009

M. Zimmerman*
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Providence and Rhode Island Hospital, Providence, RI, USA
J. N. Galione
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Providence and Rhode Island Hospital, Providence, RI, USA
I. Chelminski
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Providence and Rhode Island Hospital, Providence, RI, USA
J. B. McGlinchey
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Providence and Rhode Island Hospital, Providence, RI, USA
D. Young
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Providence and Rhode Island Hospital, Providence, RI, USA
K. Dalrymple
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Providence and Rhode Island Hospital, Providence, RI, USA
C. J. Ruggero
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Providence and Rhode Island Hospital, Providence, RI, USA
C. Francione Witt
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Providence and Rhode Island Hospital, Providence, RI, USA
*Corresponding
*Address for correspondence: M. Zimmerman, M.D., Bayside Medical Center, 235 Plain Street, Providence, RI 02905, USA. (Email: mzimmerman@lifespan.org)

Abstract

Background

The DSM-IV symptom criteria for major depressive disorder (MDD) are somewhat lengthy, with many studies showing that treatment providers have difficulty recalling all nine symptoms. Moreover, the criteria include somatic symptoms that are difficult to apply in patients with medical illnesses. In a previous report, we developed a briefer definition of MDD that was composed of the mood and cognitive symptoms of the DSM-IV criteria, and found high levels of agreement between the simplified and full DSM-IV definitions. The goal of the present study was to replicate these findings in another large sample of psychiatric out-patients and to extend the findings to other patient samples.

Method

We interviewed 1100 psychiatric out-patients and 210 pathological gamblers presenting for treatment and 1200 candidates for bariatric surgery. All patients were interviewed by a diagnostic rater who administered a semi-structured interview. We inquired about all symptoms of depression for all patients.

Results

In all three samples high levels of agreement were found between the DSM-IV and the simpler definition of MDD. Summing across all 2510 patients, the level of agreement between the two definitions was 95.5% and the κ coefficient was 0.87.

Conclusions

After eliminating the four somatic criteria from the DSM-IV definition of MDD, a high level of concordance was found between this simpler definition and the original DSM-IV classification. This new definition offers two advantages over the current DSM-IV definition – it is briefer and it is easier to apply with medically ill patients because it is free of somatic symptoms.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2009

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

Akechi, T, Nakano, T, Akizuki, N, Okamura, M, Sakuma, K, Nakanishi, T, Yoshikawa, E, Uchitomi, Y (2003). Somatic symptoms for diagnosing major depression in cancer patients. Psychosomatics 44, 244248.CrossRefGoogle ScholarPubMed
Andrews, G, Slade, T, Sunderland, M, Anderson, T (2007). Issues for DSM-V: simplifying DSM-IV to enhance utility: the case of major depressive disorder. American Journal of Psychiatry 164, 17841785.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, 3rd edn, revised. American Psychiatric Association: Washington, DC.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, revised. American Psychiatric Association: Washington, DC.Google Scholar
Bowers, J, Jorm, AF, Henderson, S, Harris, P (1992). General practitioners' reported knowledge about depression and dementia in elderly patients. Australian and New Zealand Journal of Psychiatry 26, 168174.CrossRefGoogle ScholarPubMed
Breslau, N, Davis, G (1985). Refining DSM-III criteria in major depression. An assessment of the descriptive validity of criterion symptoms. Journal of Affective Disorders 9, 199206.CrossRefGoogle ScholarPubMed
Buchwald, A, Rudick-Davis, D (1993). The symptoms of major depression. Journal of Abnormal Psychology 102, 197205.CrossRefGoogle ScholarPubMed
Cavanaugh, S (1995). Depression in the medically ill. Psychosomatics 36, 4859.CrossRefGoogle Scholar
Chochinov, H, Wilson, K, Enns, M, Lander, S (1994). Prevalence of depression in the terminally ill: effects of diagnostic criteria and symptom threshold judgments. American Journal of Psychiatry 151, 537540.Google ScholarPubMed
Feighner, JP, Robins, E, Guze, SB, Woodruff, RA, Winokur, G, Munoz, R (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 5767.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1995). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient edition (SCID-I/P, version 2.0). Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Gerrity, M, Cole, S, Dietrich, A, Barrett, J (1999). Improving the recognition and management of depression: is there a role for physician education? Journal of Family Practice 48, 949957.Google Scholar
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 5662.CrossRefGoogle Scholar
Kathol, R, Mutgi, A, Williams, J, Clamon, G, Noyes, R Jr. (1990 a). Diagnosis of major depression in cancer patients according to four sets of criteria. American Journal of Psychiatry 147, 10211024.Google ScholarPubMed
Kathol, R, Noyes, JR, Williams, J, Mutgi, A, Carroll, B, Perry, P (1990 b). Diagnosing depression in patients with medical illness. Psychosomatics 31, 434440.CrossRefGoogle ScholarPubMed
Keller, MB, Klein, DN, Hirschfeld, RM, Kocsis, JH, McCullough, JP, Miller, I, First, MB, Holzer, CP, Keitner, GI, Marin, DB, Shea, MT (1995). Results of the DSM-IV mood disorders field trial. American Journal of Psychiatry 152, 843849.Google ScholarPubMed
Kendler, K, Gardner, C (1998). Boundaries of major depression: an evaluation of DSM-IV criteria. American Journal of Psychiatry 155, 172177.Google ScholarPubMed
Koenig, H, George, L, Peterson, B, Pieper, C (1997). Depression in medically ill hospitalized older adults: prevalence, characteristics, and course of symptoms according to six diagnostic schemes. American Journal of Psychiatry 154, 13761383.Google ScholarPubMed
Krupinski, J, Tiller, J (2001). The identification and treatment of depression by general practitioners. Australian and New Zealand Journal of Psychiatry 35, 827832.CrossRefGoogle ScholarPubMed
Kupfer, D (1995). Sleep research in depressive illness: clinical implications – a tasting menu. Biological Psychiatry 38, 391403.CrossRefGoogle ScholarPubMed
Learman, L, Gerrity, M, Field, D, van Blaricom, A, Romm, J, Choe, J (2003). Effects of a depression education program on residents' knowledge, attitudes, and clinical skills. Obstetrics and Gynecology 101, 167174.Google ScholarPubMed
Medow, M, Borowsky, S, Dysken, S, Hillson, S, Woods, S, Wilt, T (1999). Internal medical residents' ability to diagnose and characterize major depression. Western Journal of Medicine 170, 3540.Google ScholarPubMed
Parker, G, Brotchie, H (1992). Psychomotor change as a feature of depressive disorders: an historical overview. Australian and New Zealand Journal of Psychiatry 26, 146155.CrossRefGoogle Scholar
Posternak, MA, Zimmerman, M, Solomon, DA (2002). Integrating outcomes research into clinical practice: a pilot study. Psychiatric Services 53, 335336.CrossRefGoogle Scholar
Rapp, S, Davis, K (1989). Geriatric depression: physicians' knowledge, perceptions, and diagnostic practices. Gerontologist 29, 252257.CrossRefGoogle ScholarPubMed
Rush, A (1998). DSM-IV mood disorders: final overview. In DSM-IV Sourcebook (ed. Widiger, T., Frances, A., Pincus, H., Ross, R., First, M., Davis and, W.Kline, M.), pp. 10191033. American Psychological Association: Washington, DC.Google Scholar
Spitzer, RL, Endicott, J, Robins, E (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773782.CrossRefGoogle ScholarPubMed
Zimmerman, M (2003). Integrating the assessment methods of researchers in routine clinical practice: The Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project. In Standardized Evaluation in Clinical Practice (ed. First, M.), pp. 2974. American Psychiatric Publishing, Inc.: Washington, DC.Google Scholar
Zimmerman, M, Chelminski, I, McGlinchey, JB, Young, D (2006 a). Diagnosing major depressive disorder X: can the utility of the DSM-IV symptom criteria be improved? Journal of Nervous and Mental Disease 194, 893897.CrossRefGoogle ScholarPubMed
Zimmerman, M, Galione, J (in press). Psychiatrists' reported use of the DSM-IV criteria for major depressive disorder. Journal of Clinical Psychiatry.Google Scholar
Zimmerman, M, Mattia, JI, Posternak, MA (2002). Are subjects in pharmacological treatment trials of depression representative of patients in routine clinical practice? American Journal of Psychiatry 159, 469473.CrossRefGoogle ScholarPubMed
Zimmerman, M, McGlinchey, JB, Young, D, Chelminski, I (2006 b). Diagnosing major depressive disorder I: a psychometric evaluation of the DSM-IV symptom criteria. Journal of Nervous and Mental Disease 194, 158163.CrossRefGoogle ScholarPubMed
28
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

A simpler definition of major depressive disorder
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

A simpler definition of major depressive disorder
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

A simpler definition of major depressive disorder
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *