Y Li30, S Aggen2, S Shi3, J Gao4, Y Li30, M Tao6, K Zhang7, X Wang57, C Gao9, L Yang10, Y Liu11, K Li12, J Shi13, G Wang14, L Liu15, J Zhang16, B Du17, G Jiang18, J Shen19, Z Zhang20, W Liang21, J Sun22, J Hu23, T Liu43, X Wang57, G Miao26, H Meng27, Y Li30, C Hu29, Y Li30, G Huang31, G Li32, B Ha33, H Deng34, Q Mei35, H Zhong36, S Gao37, H Sang38, Y Zhang39, X Fang40, F Yu41, D Yang42, T Liu43, Y Chen44, X Hong45, W Wu46, G Chen47, M Cai48, Y Song49, J Pan50, J Dong51, R Pan52, W Zhang53, Z Shen54, Z Liu55, D Gu56, X Wang57, X Liu58, Q Zhang59, J Flint1, K S Kendler2. 1. Wellcome Trust Centre for Human Genetics, Oxford,UK. 2. Department of Psychiatry,Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University,Richmond, VA,USA. 3. Shanghai Mental Health Center,P.R.C. 4. Chinese Traditional Hospital of Zhejiang,Hangzhou,Zhejiang,P.R.C. 5. No.1 Hospital of Zhengzhou University,Zhengzhou, Henan,P.R.C. 6. Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang,P.R.C. 7. No. 1 Hospital of Shanxi Medical University,Taiyuan, Shanxi,P.R.C. 8. ShengJing Hospital of China Medical University,Heping District, Shenyang, Liaoning,P.R.C. 9. No. 1 Hospital of Medical College of Xian Jiaotong University,Xian, Shaanxi,P.R.C. 10. Jilin Brain Hospital, Siping, Jilin,P.R.C. 11. The First Hospital of China Medical University,Heping District, Shenyang, Liaoning,P.R.C. 12. Mental Hospital of Jiangxi Province, Nanchang, Jiangxi,P.R.C. 13. Xian Mental Health Center, New Qujiang District, Xian, Shaanxi,P.R.C. 14. Beijing Anding Hospital of Capital University of Medical Sciences,Xicheng District, Beijing,P.R.C. 15. Shandong Mental Health Center, Jinan, Shandong,P.R.C. 16. No. 3 Hospital of Sun Yat-sen University,Tianhe District, Guangzhou, Guangdong,P.R.C. 17. Hebei Mental Health Center, Baoding, Hebei,P.R.C. 18. Chongqing Mental Health Center, Jiangbei District, Chongqing,P.R.C. 19. Tianjin Anding Hospital, Hexi District, Tianjin,P.R.C. 20. No. 4 Hospital of Jiangsu University,Zhenjiang, Jiangsu,P.R.C. 21. Psychiatric Hospital of Henan Province, Xinxiang, Henan,P.R.C. 22. Nanjing Brain Hospital, Nanjing, Jiangsu,P.R.C. 23. Harbin Medical University,Nangang District, Haerbin, Heilongjiang,P.R.C. 24. Shenzhen Kang Ning Hospital, Luohu District, Shenzhen, Guangdong,P.R.C. 25. First Hospital of Hebei Medical University,Shijiazhuang, Hebei,P.R.C. 26. Guangzhou Brain Hospital(Guangzhou Psychiatric Hospital), Liwan District, Guangzhou, Guangdong,P.R.C. 27. No. 1 Hospital of Chongqing Medical University,Yuanjiagang, Yuzhong District, Chongqing,P.R.C. 28. Dalian No. 7 Hospital, Ganjingzi District, Dalian, Liaoning,P.R.C. 29. No. 3 Hospital of Heilongjiang Province, Beian, Heilongjiang,P.R.C. 30. Wuhan Mental Health Center, Wuhan, Hubei,P.R.C. 31. Sichuan Mental Health Center, Mianyang, Sichuan,P.R.C. 32. Mental Health Institute of Jining Medical College,Dai Zhuang, Bei Jiao, Jining, Shandong,P.R.C. 33. Liaocheng No. 4 Hospital, Liaocheng, Shandong,P.R.C. 34. Mental Health Center of West China Hospital of Sichuan University,Wuhou District, Chengdu, Sichuan,P.R.C. 35. Suzhou Guangji Hospital, Suzhou, Jiangsu,P.R.C. 36. Anhui Mental Health Center, Hefei, Anhui,P.R.C. 37. Ningbo Kang Ning Hospital, Zhenhai District, Ningbo, Zhejiang,P.R.C. 38. Changchun Mental Hospital, Changchun, Jilin,P.R.C. 39. No. 2 Hospital of Lanzhou University,Lanzhou, Gansu,P.R.C. 40. Fuzhou Psychiatric Hospital, Cangshan District, Fuzhou, Fujian,P.R.C. 41. Harbin No. 1 Special Hospital, Haerbin, Heilongjiang,P.R.C. 42. Jining Psychiatric Hospital, North Dai Zhuang, Rencheng District, Jining, Shandong,P.R.C. 43. No. 2 Xiangya Hospital of Zhongnan University,Furong District, Changsha, Hunan,P.R.C. 44. Xijing Hospital of No. 4 Military Medical University,Xian, Shaanxi,P.R.C. 45. Mental Health Center of Shantou University,Shantou, Guangdong,P.R.C. 46. Tongji University Hospital,Shanghai,P.R.C. 47. Huaian No. 3 Hospital, Huaian, Jiangsu,P.R.C. 48. Huzhou No. 3 Hospital, Huzhou, Zhejiang,P.R.C. 49. Mudanjiang Psychiatric Hospital of Heilongjiang Province, Xinglong, Mudanjiang, Heilongjiang,P.R.C. 50. No. 1 Hospital of Jinan University,Guangzhou, Guangdong,P.R.C. 51. Qingdao Mental Health Center, Shibei District, Qingdao, Shandong,P.R.C. 52. Guangxi Longquanshan Hospital, Yufeng District, Liuzhou,P.R.C. 53. Daqing No. 3 Hospital of Heilongjiang Province, Ranghulu district, Daqing, Heilongjiang,P.R.C. 54. Tangshan No. 5 Hospital, Lunan District, Tangshan, Hebei,P.R.C. 55. Anshan Psychiatric Rehabilitation Hospital, Lishan District, Anshan, Liaoning,P.R.C. 56. Weihai Mental Health Center, ETDZ, Weihai, Shandong,P.R.C. 57. Renmin Hospital of Wuhan University,Wuchang District, Wuhan, Hubei,P.R.C. 58. Tianjin First Center Hospital, Xinkai Road, Hedong District, Tianjin,P.R.C. 59. Hainan Anning Hospital, Haikou, Hainan,P.R.C.
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.
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.
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