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The DSM-IV definition of severity of major depression: inter-relationship and validity

Published online by Cambridge University Press:  08 January 2010

V. Lux ,
S. H. Aggen  and
K. S. Kendler
V. Lux
Affiliation:
Department of Psychology, Free University Berlin, Germany
S. H. Aggen
Affiliation:
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
K. S. Kendler*
Affiliation:
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
*
*Address for correspondence: Dr K. S. Kendler, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Box 980126, Richmond, VA 23298-0126, USA. (Email: kendler@vcu.edu)
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Abstract

Background

Severity is an important characteristic of major depression (MD) and an ‘episode specifier’ in DSM-IV classifying depressive episodes as ‘mild’, ‘moderate’ or ‘severe’. These severity subtypes rely on three different measures of severity: number of criteria symptoms, severity of the symptoms and degree of functional disability. No prior empirical study has evaluated the coherence and validity of the DSM-IV definition of severity of MD.

Method

In a sample of 1015 (518 males, 497 females) Caucasian twins from a population-based registry who met criteria for MD in the year prior to interview, factor analysis and logistic regression were conducted to examine the inter-relationships of the three severity measures and their associations with a wide range of potential validators including demographic factors, risk for future episodes, risk of MD in the co-twin, characteristics of the depressive episode, the pattern of co-morbidity, and personality traits.

Results

Correlations between the three severity measures were significant but moderate. Factor analysis indicated the existence of a general severity factor, but the factor was not highly coherent. The three severity measures showed differential predictive ability for most of the validators.

Conclusions

Severity of MD as defined by the DSM-IV is a multifaceted and heterogeneous construct. The three proposed severity measures reflect partly overlapping but partly independent domains with differential validity as assessed by a wide range of clinical characteristics. Clinicians should probably use a combination of severity measures as proposed in DSM-IV rather than privileging one.

Keywords

DSM-IVmajor depressionpsychiatric diagnosisseverity
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 10 , October 2010 , pp. 1691 - 1701
Copyright
Copyright © Cambridge University Press 2010

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References

Alexopoulos, GS, Bruce, ML, Hull, J, Sirey, JA, Kakuma, T (1999). Clinical determinants of suicidal ideation and behavior in geriatric depression. Archives of General Psychiatry 56, 1048–1053.CrossRefGoogle ScholarPubMed
Angst, J, Amrein, R, Stabl, M (1995). Moclobemide and tricyclic antidepressants in severe depression: meta-analysis and prospective studies. Journal of Clinical Psychopharmacology 15, S16–S23.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. American Psychiatric Association: Washington, DC.Google Scholar
Beck, AT, Steer, RA, Ball, R, Ranieri, W (1996). Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. Journal of Personality Assessment 67, 588–597.CrossRefGoogle Scholar
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.CrossRefGoogle ScholarPubMed
Bentler, PM (1990). Comparative fit indexes in structural models. Psychological Bulletin 107, 238–246.CrossRefGoogle ScholarPubMed
Blom, MB, Spinhoven, P, Hoffman, T, Jonker, K, Hoencamp, E, Haffmans, PM, van Dyke, R (2007). Severity and duration of depression, not personality factors, predict short term outcome in the treatment of major depression. Journal of Affective Disorders 104, 119–126.CrossRefGoogle Scholar
Carmody, TJ, Rush, AJ, Bernstein, I, Warden, D, Brannan, S, Burnham, D, Woo, A, Trivedi, MH (2006). The Montgomery Asberg and the Hamilton ratings of depression: a comparison of measures. European Neuropsychopharmacology 16, 601–611.CrossRefGoogle ScholarPubMed
Eysenck, SBG, Eysenck, HJ, Barrett, P (1985). A revised version of the psychoticism scale. Personality and Individual Differences 6, 21–29.CrossRefGoogle Scholar
Fagerström, KO (1978). Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addictive Behaviors 3, 235–241.CrossRefGoogle ScholarPubMed
Faravelli, C, Servi, P, Arends, JA, Strik, WK (1996). Number of symptoms, quantification, and qualification of depression. Comprehensive Psychiatry 37, 307–315.CrossRefGoogle ScholarPubMed
Foley, DL, Neale, MC, Gardner, C, Pickles, A, Kendler, KS (2003). Major depression and associated impairment: same or different genetic and environmental risk factors? American Journal of Psychiatry 160, 2128–2133.CrossRefGoogle ScholarPubMed
Gibbons, RD, Clark, DC, Kupfer, DJ (1993). Exactly what does the Hamilton Depression Rating Scale measure? Journal of Psychiatric Research 27, 259–273.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Hamilton, MA (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278–296.CrossRefGoogle ScholarPubMed
Hiroe, T, Kojima, M, Yamamoto, I, Nojima, S, Kinoshita, Y, Hashimoto, N, Watanabe, N, Maeda, T, Furukawa, TA (2005). Gradations of clinical severity and sensitivity to change assessed with the Beck Depression Inventory-II in Japanese patients with depression. Psychiatric Research 135, 229–235.CrossRefGoogle ScholarPubMed
Hirschfeld, RM (1999). Efficacy of SSRIs and newer antidepressants in severe depression: comparison with TCAs. Journal of Clinical Psychiatry 60, 326–335.CrossRefGoogle ScholarPubMed
Huang, FY, Chung, H, Kroenke, K, Spitzer, RL (2006). Racial and ethnic differences in the relationship between depression severity and functional status. Psychiatric Services 57, 498–503.CrossRefGoogle ScholarPubMed
Iannuzzo, RW, Jaeger, J, Goldberg, JF, Kafantaris, V, Sublette, ME (2006). Development and reliability of the HAM-D/MADRS interview: an integrated depression symptom rating scale. Psychiatric Research 145, 21–37.CrossRefGoogle ScholarPubMed
Kasper, S, Zivkov, M, Roes, KC, Pols, AG (1997). Pharmacological treatment of severely depressed patients: a meta-analysis comparing efficacy of mirtazapine and amitriptyline. European Neuropsychopharmacology 7, 115–124.CrossRefGoogle ScholarPubMed
Kendler, KS, Prescott, CA (1999). A population-based twin study of lifetime major depression in men and women. Archives of General Psychiatry 56, 39–44.CrossRefGoogle ScholarPubMed
Kendler, KS, Prescott, CA (2006). Genes, Environment, and Psychopathology: Understanding the Causes of Psychiatric and Substance Use Disorders. Guilford Press: New York.Google Scholar
Kennedy, N, Abbott, R, Paykel, ES (2004). Longitudinal syndromal and sub-syndromal symptoms after severe depression: 10-year follow-up study. British Journal of Psychiatry 184, 330–336.CrossRefGoogle ScholarPubMed
Kitamura, T, Nakagawa, Y, Machizawa, S (1993). Grading depression severity by symptom scores: is it a valid method for subclassifying depressive disorders? Comprehensive Psychiatry 34, 280–283.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL, Williams, JBW (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606–613.CrossRefGoogle ScholarPubMed
Licht, RW, Qvitzau, S, Allerup, P, Bech, P (2005). Validation of the Bech–Rafaelsen Melancholia Scale and the Hamilton Depression Scale in patients with major depression; is the total score a valid measure of illness severity? Acta Psychiatrica Scandinavica 111, 144–149.CrossRefGoogle Scholar
Melartin, TK, Rytsala, HJ, Leskela, US, Lestela-Mielonen, PS, Sokero, TP, Isometsa, ET (2004). Severity and comorbidity predict episode duration and recurrence of DSM-IV major depressive disorder. Journal of Clinical Psychiatry 65, 810–819.CrossRefGoogle ScholarPubMed
Mojtabai, R (2001). Impairment in major depression: implications for diagnosis. Comprehensive Psychiatry 42, 206–212.CrossRefGoogle ScholarPubMed
Montgomery, SA, Äsberg, M (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.CrossRefGoogle ScholarPubMed
Muthen, LK, Muthen, BO (2004). Mplus User's Guide. Muthen & Muthen: Los Angeles, CA.Google Scholar
Olsen, LR, Jensen, DV, Noerholm, V, Martiny, K, Bech, P (2003). The internal and external validity of the Major Depression Inventory in measuring severity of depressive states. Psychological Medicine 33, 351–356.CrossRefGoogle ScholarPubMed
Pettit, JW, Lewinsohn, PM, Roberts, RE, Seeley, JR, Monteith, L (2009). The long-term course of depression: development of an empirical index and identification of early adult outcomes. Psychological Medicine 39, 403–412.CrossRefGoogle ScholarPubMed
Rodriguez, BF, Bruce, SE, Pagano, ME, Keller, MB (2005). Relationships among psychosocial functioning, diagnostic comorbidity, and the recurrence of generalized anxiety disorder, panic disorder, and major depression. Journal of Anxiety Disorders 19, 752–766.CrossRefGoogle ScholarPubMed
Roy-Byrne, PP, Stang, P, Wittchen, HU, Ustun, B, Walters, EE, Kessler, RC (2000). Lifetime panic-depression comorbidity in the National Comorbidity Survey. Association with symptoms, impairment, course and help-seeking. British Journal of Psychiatry 176, 229–235.CrossRefGoogle ScholarPubMed
Rubenstein, LV, Rayburn, NR, Keeler, EB, Ford, DE, Rost, KM, Sherbourne, CD (2007). Predicting outcomes of primary care patients with major depression: development of a depression prognosis index. Psychiatric Services 58, 1049–1056.CrossRefGoogle ScholarPubMed
Santor, DA, Coyne, JC (2001). Examining symptom expression as a function of symptom severity: item performance on the Hamilton Rating Scale for Depression. Psychological Assessment 13, 127–139.CrossRefGoogle ScholarPubMed
SAS Institute (2005). SAS OnlineDoc Version 9.1.3. SAS Institute Inc.: Cary, NC.Google Scholar
Scheibe, S, Preuschhof, C, Cristi, C, Bagby, RM (2003). Are there gender differences in major depression and its response to antidepressants? Journal of Affective Disorders 75, 223–235.CrossRefGoogle ScholarPubMed
Sheehan, DV, Harnett-Sheehan, K, Raj, BA (1996). The measurement of disability. International Clinical Psychopharmacology 11 (Suppl. 3), 89–95.CrossRefGoogle ScholarPubMed
Strauss, JS, Carpenter, WT Jr. (1978). The prognosis of schizophrenia: rationale for a multidimensional concept. Schizophrenia Bulletin 4, 56–67.CrossRefGoogle ScholarPubMed
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.Google Scholar
WHO (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization: Geneva.Google Scholar
Zimmerman, M, Ruggero, CJ, Chelminski, I, Young, D, Posternak, MA, Friedman, M, Boerescu, D, Attiullah, N (2006). Developing brief scales for use in clinical practice: the reliability and validity of single-item self-report measures of depression symptom severity, psychosocial impairment due to depression, and quality of life. Journal of Clinical Psychiatry 67, 1536–1541.CrossRefGoogle ScholarPubMed
Zisook, S, Rush, AJ, Albala, A, Alpert, J, Balasubramani, GK, Fava, M, Husain, M, Sackeim, H, Trivedi, M, Wisniewski, S (2004). Factors that differentiate early vs. later onset of major depression disorder. Psychiatric Research 129, 127–140.CrossRefGoogle ScholarPubMed
Zung, WW (1965). A Self-Rating Depression Scale. Archives of General Psychiatry 12, 63–70.CrossRefGoogle ScholarPubMed