4.7 Article

Depression is more than the sum score of its parts: individual DSM symptoms have different risk factors

期刊

PSYCHOLOGICAL MEDICINE
卷 44, 期 10, 页码 2067-2076

出版社

CAMBRIDGE UNIV PRESS
DOI: 10.1017/S0033291713002900

关键词

Depression; depressive symptoms; DSM; heterogeneity; psychiatric diagnosis; residency

资金

  1. Cluster of Excellence 'Languages of Emotion' [EXC302]
  2. German Research Foundation
  3. Dahlem Research School Berlin
  4. National Institute of Mental Health [R01 MH101459, K23 MH095109]

向作者/读者索取更多资源

Background. For diagnostic purposes, the nine symptoms that compose the DSM-5 criteria for major depressive disorder (MDD) are assumed to be interchangeable indicators of one underlying disorder, implying that they should all have similar risk factors. The present study investigates this hypothesis, using a population cohort that shifts from low to elevated depression levels. Method. We assessed the nine DSM-5 MDD criterion symptoms (using the Patient Health Questionnaire; PHQ-9) and seven depression risk factors (personal and family MDD history, sex, childhood stress, neuroticism, work hours, and stressful life events) in a longitudinal study of medical interns prior to and throughout internship (n= 1289). We tested whether risk factors varied across symptoms, and whether a latent disease model could account for heterogeneity between symptoms. Results. All MDD symptoms increased significantly during residency training. Four risk factors predicted increases in unique subsets of PHQ-9 symptoms over time (depression history, childhood stress, sex, and stressful life events), whereas neuroticism and work hours predicted increases in all symptoms, albeit to varying magnitudes. MDD family history did not predict increases in any symptom. The strong heterogeneity of associations persisted after controlling for a latent depression factor. Conclusions. The influence of risk factors varies substantially across DSM depression criterion symptoms. As symptoms are etiologically heterogeneous, considering individual symptoms in addition to depression diagnosis might offer important insights obfuscated by symptom sum scores.

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