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The role of sex on stability and change of depression symptom subtypes over 20 years: a latent transition analysis

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Abstract

Prospective studies investigating the long-term stability of depression symptom subtypes are rare. Moreover, sex has received little attention as a predictor. This study aimed to investigate the role of sex on stability and transition patterns of depressive symptom subtypes over 20 years. The data were drawn from three follow-ups (1988, 1999, and 2008) of the longitudinal Zurich Study. Latent transition analyses were fitted to the data of 322 subjects, using depressive symptoms from the face-to-face interviews. The stable classes were characterized by psychosocial correlates. Three subtypes were identified: ‘severe atypical,’ ‘severe typical,’ and ‘moderate.’ While stability of the severe atypical and moderate subtype was relatively high and increased over time (70–71; 45–90 %), stability of the severe typical subtype was lower (45–48 %). Females had a higher risk of being in the severe atypical subtype and exhibited more transitions, particularly with respect to the severe typical subtype. In contrast, males displayed more stable subtypes. The stable severe atypical subtype was associated with comorbid eating disorders as well as psychosis syndromes, whereas the stable severe typical subtype was associated only with psychosis syndromes. Our results provide first evidence for the notion that long-term stability and transition patterns differ by sex and depression subtypes. This finding has received too little attention in previous research and should be considered in treatments.

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References

  1. Angst J (2002) Historical aspects of the dichotomy between manic-depressive disorders and schizophrenia. Schizophr Res 57:5–13

    Article  PubMed  Google Scholar 

  2. Angst J, Dobler-Mikola A (1985) The Zurich study—a prospective epidemiological study of depressive, neurotic and psychosomatic syndromes. IV. Recurrent and nonrecurrent brief depression. Eur Arch Psychiatry Neurol Sci 234:408–416

    Article  PubMed  CAS  Google Scholar 

  3. Angst J, Dobler-Mikola A, Binder J (1984) The Zurich study—a prospective epidemiological study of depressive, neurotic and psychosomatic syndromes. I. Problem, methodology. Eur Arch Psychiatry Neurol Sci 234:13–20

    Article  PubMed  CAS  Google Scholar 

  4. Angst J, Gamma A, Benazzi F, Ajdacic V, Rössler W (2007) Melancholia and atypical depression in the Zurich study: epidemiology, clinical characteristics, course, comorbidity and personality. Acta Psychiatr Scand 115 (Suppl 433):72–84

    Google Scholar 

  5. Angst J, Gamma A, Benazzi F, Silverstein B, Ajdacic-Gross V, Eich D, Rössler W (2006) Atypical depressive syndromes in varying definitions. Eur Arch Psychiatry Clin Neurosci 256:44–54

    Article  PubMed  Google Scholar 

  6. Angst J, Gamma A, Neuenschwander M, Ajdacic-Gross V, Eich D, Rössler W, Merikangas KR (2005) Prevalence of mental disorders in the Zurich cohort study: a twenty year prospective study. Epidemiol Psichiatr Soc 14:68–76

    Article  PubMed  Google Scholar 

  7. Angst J, Gamma A, Sellaro R, Zhang H, Merikangas K (2002) Toward validation of atypical depression in the community: results of the Zurich cohort study. J Affect Disord 72:125–138

    Article  PubMed  Google Scholar 

  8. APA (1994) American psychiatric association: diagnostic and statistical manual of mental disorders, 4th edn. Washington, DC

    Google Scholar 

  9. APA (2013) American psychiatric association: diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington

    Google Scholar 

  10. Baumeister H, Parker G (2012) Meta-review of depressive subtyping models. J Affect Disord 139:126–140

    Article  Google Scholar 

  11. Benazzi F (1999) Prevalence and clinical features of atypical depression in depressed outpatients: a 467-case study. Psychiatry Res 86:259–265

    Article  PubMed  CAS  Google Scholar 

  12. Carragher N, Adamson G, Bunting B, McCann S (2009) Subtypes of depression in a nationally representative sample. J Affect Disord 113:88–99

    Article  PubMed  Google Scholar 

  13. Charney DS, Nelson JC (1981) Delusional and nondelusional unipolar depression: further evidence for distinct subtypes. Am J Psychiatry 138:328–333

    PubMed  CAS  Google Scholar 

  14. Chung H, Lanza ST, Loken E (2008) Latent transition analysis: inference and estimation. Stat Med 27:1834–1854

    Article  PubMed  PubMed Central  Google Scholar 

  15. Clayton PJ, Grove WM, Coryell W, Keller M, Hirschfeld R, Fawcett J (1991) Follow-up and family study of anxious depression. Am J Psychiatry 148:1512–1517

    PubMed  CAS  Google Scholar 

  16. Derogatis LR (1977) SCL-90. Administration, scoring and procedures manual-i for the r (revised) version and other instruments of the psychopathology rating scale series. Johns Hopkins University School of Medicine, Chicago

    Google Scholar 

  17. Derogatis LR, Cleary PA (1977) Confirmation of the dimensional structure of the SCL-90-R: a study in construct validation. J Clin Psychol 33:981–989

    Article  Google Scholar 

  18. 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. Br J Psychiatry 155:48–54

    Article  PubMed  CAS  Google Scholar 

  19. Ebert D, Barocka A (1991) The early course of atypical depression. Eur Arch Psychiatry Clin Neurosci 241:131–132

    Article  PubMed  CAS  Google Scholar 

  20. Halbreich U, Kahn LS (2007) Atypical depression, somatic depression and anxious depression in women: are they gender-preferred phenotypes? J Affect Disord 102:245–258

    Article  PubMed  Google Scholar 

  21. Hausmann A, Rutz W, Benke U (2008) women seek for help—men die! Is depression really a female disease? Neuropsychiatr 22:43–48

    PubMed  Google Scholar 

  22. Helms PM, Smith RE (1983) Recurrent psychotic depression. Evidence of diagnostic stability. J Affect Disord 5:51–54

    Article  PubMed  CAS  Google Scholar 

  23. Kendell RE (1974) The stability of psychiatric diagnosis. Br J Psychiatry 124:352–356

    Article  PubMed  CAS  Google Scholar 

  24. 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. Arch Gen Psychiatry 53:391–399

    Article  PubMed  CAS  Google Scholar 

  25. Kessler RC, McGonagle KA, Swartz M, Blazer DG, Nelson CB (1993) Sex and depression in the national comorbidity survey. I: lifetime prevalence, chronicity and recurrence. J Affect Disord 29:85–96

    Article  PubMed  CAS  Google Scholar 

  26. Kuehner C (2003) Gender differences in unipolar depression: an update of epidemiological findings and possible explanations. Acta Psychiatr Scand 108:163–174

    Article  PubMed  CAS  Google Scholar 

  27. Lam RW, Stewart JN (1996) The validity of atypical depression in DSM-IV. Compr Psychiatry 37:375–383

    Article  PubMed  CAS  Google Scholar 

  28. 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. Br J Psychiatry 201:143–150

    Article  PubMed  PubMed Central  Google Scholar 

  29. 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). J Clin Psychiatry 71:1582–1589

    Article  PubMed  Google Scholar 

  30. Lamers F, Rhebergen D, Merikangas KR, de Jonge P, Beekman AT, Penninx BW (2012) Stability and transitions of depressive subtypes over a 2-year follow-up. Psychol Med 42:1–11

    Google Scholar 

  31. Leibenluft E (1997) Issues in the treatment of women with bipolar illness. J Clin Psychiatry 58(Suppl 15):5–11

    PubMed  Google Scholar 

  32. Levitan RD, Lesage A, Parikh SV, Goering P, Kennedy SH (1997) Reversed neurovegetative symptoms of depression: a community study of ontario. Am J Psychiatry 154:934–940

    PubMed  CAS  Google Scholar 

  33. Maj M, Pirozzi R, Di Caprio EL (1990) Major depression with mood-congruent psychotic features: a distinct diagnostic entity or a more severe subtype of depression? Acta Psychiatr Scand 82:439–444

    Article  PubMed  CAS  Google Scholar 

  34. Melartin T, Leskela U, Rytsala H, Sokero P, Lestela-Mielonen P, Isometsa E (2004) Co-morbidity and stability of melancholic features in DSM-IV major depressive disorder. Psychol Med 34:1443–1452

    Article  PubMed  Google Scholar 

  35. Muthén B (2004) Latent variable analysis: growth mixture modeling and related techniques for longitudinal data. In: Kaplan D (ed) Handbook of quantitative methodology for the social sciences. Sage Publications, Newbury Park, pp 345–368

    Google Scholar 

  36. Muthén B, Muthén LK (2000) Integrating person-centered and variable-centered analyses: growth mixture modeling with latent trajectory classes. Alcohol Clin Exp Res 24:882–891

    Article  PubMed  Google Scholar 

  37. Muthén LK, Muthén BO (1998–2012) Mplus user’s guide. Seventh edition. Muthén & Muthén, Los Angeles

  38. Nierenberg AA, Pava JA, Clancy K, Rosenbaum JF, Fava M (1996) Are neurovegetative symptoms stable in relapsing or recurrent atypical depressive episodes? Biol Psychiatry 40:691–696

    Article  PubMed  CAS  Google Scholar 

  39. Nylund K (2007) Latent transition analysis: modeling extensions and an application to peer victimization. Doctoral dissertation, University of California, Los Angeles

  40. O’Keane V, Frodl T, Dinan TG (2012) A review of atypical depression in relation to the course of depression and changes in HPA axis organization. Psychoneuroendocrinology 37:1589–1599

    Article  PubMed  Google Scholar 

  41. Parker G (2005) Beyond major depression. Psychol Med 35:467–474

    Article  PubMed  Google Scholar 

  42. Parker G, Roy K, Mitchell P, Wilhelm K, Malhi G, Hadzi-Pavlovic D (2002) Atypical depression: a reappraisal. Am J Psychiatry 159:1470–1479

    Article  PubMed  Google Scholar 

  43. Ramcharan S, Love EJ, Fick GH, Goldfien A (1992) The epidemiology of premenstrual symptoms in a population-based sample of 2650 urban women: attributable risk and risk factors. J Clin Epidemiol 45:377–392

    Article  PubMed  CAS  Google Scholar 

  44. Rössler W, Riecher-Rössler A, Angst J, Murray R, Gamma A, Eich D, van Os J, Gross VA (2007) Psychotic experiences in the general population: a twenty-year prospective community study. Schizophr Res 92:1–14

    Article  PubMed  Google Scholar 

  45. Rubin DB (1987) Multiple imputation for nonresponse in surveys. Wiley, New York

    Book  Google Scholar 

  46. Schafer JL (1997) Analysis of incomplete multivariate data. Chapman & Hall, London

    Book  Google Scholar 

  47. Scheibe S, Preuschhof C, Cristi C, Bagby RM (2003) Are there gender differences in major depression and its response to antidepressants? J Affect Disord 75:223–235

    Article  PubMed  CAS  Google Scholar 

  48. Schwartz A, Schwartz RM (1993) The formal diagnosis of depression, in depression: theories and treatments. Columbia University Press, New York

    Google Scholar 

  49. Schwarz G (1978) Estimating the dimension of a model. Ann Stat 6:461–464

    Article  Google Scholar 

  50. Sclove SL (1987) Application of model-selection criteria to some problems in multivariate analysis. Psychometrika 52:333–343

    Article  Google Scholar 

  51. Silverstein B (1999) Gender difference in the prevalence of clinical depression: the role played by depression associated with somatic symptoms. Am J Psychiatry 156:480–482

    PubMed  CAS  Google Scholar 

  52. Silverstein B, Edwards T, Gamma A, Ajdacic-Gross V, Rössler W, Angst J (2013) The role played by depression associated with somatic symptomatology in accounting for the gender difference in the prevalence of depression. Soc Psychiatry Psychiatr Epidemiol 48:257–263

    Google Scholar 

  53. Singer JD, Willet JB (2003) Applied longitudinal data analysis. Oxford University Press, New York

    Book  Google Scholar 

  54. Sullivan PF, Kessler RC, Kendler KS (1998) Latent class analysis of lifetime depressive symptoms in the national comorbidity survey. Am J Psychiatry 155:1398–1406

    PubMed  CAS  Google Scholar 

  55. Sullivan PF, Prescott CA, Kendler KS (2002) The subtypes of major depression in a twin registry. J Affect Disord 68:273–284

    Article  PubMed  Google Scholar 

  56. Tondo L, Baldessarini RJ (1998) Rapid cycling in women and men with bipolar manic-depressive disorders. Am J Psychiatry 155:1434–1436

    PubMed  CAS  Google Scholar 

  57. Weissman MM, Klerman GL (1977) Sex differences and the epidemiology of depression. Arch Gen Psychiatry 34:98–111

    Article  PubMed  CAS  Google Scholar 

  58. WHO (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization, Geneva

    Google Scholar 

  59. Young E, Korszun A (2010) Sex, trauma, stress hormones and depression. Mol Psychiatry 15:23–28

    Article  PubMed  CAS  Google Scholar 

  60. Young MA, Keller MB, Lavori PW, Scheftner WA, Fawcett JA, Endicott J, Hirschfeld RM (1987) Lack of stability of the RDC endogenous subtype in consecutive episodes of major depression. J Affect Disord 12:139–143

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was supported by the Swiss National Science Foundation (Grant No 32-50881.97). The authors thank Boris B. Quednow for his valuable remarks on an earlier draft of this manuscript.

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Authors and Affiliations

  1. Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, PO Box 1930, 8021, Zurich, Switzerland

    Stephanie Rodgers, Vladeta Ajdacic-Gross, Mario Müller, Michael P. Hengartner, Jules Angst & Wulf Rössler

  2. Department of Psychology, University of Zurich, Zurich, Switzerland

    Martin Grosse Holtforth

  3. Collegium Helveticum, A Joint Research Institute Between the University of Zurich and the Swiss Federal Institute of Technology, Zurich, Switzerland

    Wulf Rössler

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  1. Stephanie Rodgers
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  2. Vladeta Ajdacic-Gross
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Correspondence to Stephanie Rodgers.

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Rodgers, S., Ajdacic-Gross, V., Müller, M. et al. The role of sex on stability and change of depression symptom subtypes over 20 years: a latent transition analysis. Eur Arch Psychiatry Clin Neurosci 264, 577–588 (2014). https://doi.org/10.1007/s00406-013-0475-3

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  • DOI: https://doi.org/10.1007/s00406-013-0475-3

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