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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
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
Corresponding
E-mail address:

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2014 

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