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Identifying Depressive Subtypes in a Large Cohort Study: Results From the Netherlands Study of Depression and Anxiety (NESDA)
Abstract
OBJECTIVE: The heterogeneity of depression in the current classification system remains a point of discussion in the psychiatric field, despite previous efforts to subclassify depressive disorders. Data-driven techniques may help to come to a more empirically based classification. This study aimed to identify depressive subtypes within a large cohort of subjects with depression. METHOD: Baseline data from 818 persons with a DSM-IV diagnosis of current major depressive disorder or minor depression who participated in the Netherlands Study of Depression and Anxiety were used. Respondents were recruited in the community, in primary care, and in specialized mental health care from September 2004 through February 2007. Latent classes were derived from latent class analysis using 16 depressive symptoms from the Composite International Diagnostic Interview and the Inventory of Depressive Symptomatology. Classes were characterized using demographic, clinical psychiatric, psychosocial, and physical health descriptors. RESULTS: Three classes were identified: a severe melancholic class (prevalence, 46.3%), a severe atypical class (prevalence, 24.6%), and a class of moderate severity (prevalence, 29.1%). Both severe classes were characterized by more neuroticism (melancholic OR = 1.05 [95% CI, 1.01-1.10]; atypical OR = 1.07 [95% CI, 1.03-1.12]), more disability (melancholic OR = 1.07 [95% CI, 1.05-1.09]; atypical OR = 1.06 [95% CI, 1.04-1.07]), and less extraversion (melancholic OR = 0.95 [95% CI, 0.92-0.99]; atypical OR = 0.95 [95% CI, 0.92-0.99]) than the moderate class. Comparing the melancholic class with the atypical class revealed that the melancholic class had more smokers (atypical OR = 0.57 [95% CI, 0.39-0.84]) and more childhood trauma (atypical OR = 0.86 [95% CI, 0.74-1.00]), whereas the atypical class had more women (atypical OR = 1.52 [95% CI, 0.99-2.32]), a higher body mass index (atypical OR = 1.13 [95% CI, 1.09-1.17]), and more metabolic syndrome (atypical OR = 2.17 [95% CI, 1.38-3.42]). CONCLUSIONS: Both depression severity (moderate vs severe) and the nature of depressive symptoms (melancholic vs atypical) were found to be important differentiators between subtypes. Higher endorsement rates of somatic symptoms and more metabolic syndrome in the atypical class suggest the involvement of a metabolic component.
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“Large-scale cohort studies have documented that clinical populations have interindividual variability with substantial heterogeneity in types of comorbidity and aetiological risk (Lamers et al., 2010;Melartin et al., 2002;Sterling et al., 2008;Wessman et al., 2009).”
From Meta-analysis of the effects of intranasal oxytocin on interpretation and expression of emotions (2017) · cites this paper as Lamers et al., 2010
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“Another possible interpretation of the present findings is that there is substantial heterogeneity within and between clinical groups that could dilute the true effects of intranasal oxytocin on social threat processing among clinical populations (Lamers et al., 2010;Melartin et al., 2002;Wessman et al., 2009).”
From Meta-analytic review of the effects of a single dose of intranasal oxytocin on threat processing in humans (2018) · cites this paper as Lamers et al., 2010
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Molecular Mechanisms of Depression: Perspectives on New Treatment Strategies
Lang, U. E., & Borgwardt, S. (2013) · Cellular Physiology and Biochemistry · doi:10.1159/000350094 · Cited by 8,526
Fried, E. I., & Nesse, R. M. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.10.010 · Cited by 1,043
Penninx, B. W., Milaneschi, Y., Lamers, F., & Vogelzangs, N. (2013) · BMC Medicine · doi:10.1186/1741-7015-11-129 · Cited by 839
Self-citationUnderstanding heterogeneity in clinical cohorts using normative models: Beyond case-control studies
Marquand, A. F., Rezek, I., Buitelaar, J., & Beckmann, C. F. (2016) · Biological Psychiatry · doi:10.1016/j.biopsych.2015.12.023 · Cited by 683
Lamers, F., Vogelzangs, N., Merikangas, K. R., de Jonge, P., Beekman, A. T. F., & Penninx, B. W. J. H. (2013) · Molecular Psychiatry · doi:10.1038/mp.2012.144 · Cited by 691
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Metadata
- Authors
- Lamers, F., de Jonge, P., Nolen, W. A., Smit, J. H., Zitman, F. G., Beekman, A. T. F., & Penninx, B. W. J. H.
- Affiliations
- Amsterdam Public Health (NL)
- Leiden University (NL)
- Corresponding author
- Lamers, Femke
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2010-07-13
- Volume
- 71
- Issue
- 12
- Pages
- 1582-1589
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2096458622
- Cited by
- 264
- References
- 42
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 11 · 2023: 14 · 2022: 23 · 2021: 12 · 2020: 20 · 2019: 21 · 2018: 17 · 2017: 21 · 2016: 25 · 2015: 29 · 2014: 19 · 2013: 15 · 2012: 10
- FWCI
- 14.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- Research portal (Tilburg University) (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- VU Research Portal (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- depression subtypes, major depressive disorder, minor depression, endogenous depression, atypical depression, depressive symptoms, latent class analysis, neuroticism, extraversion, childhood trauma, smoking, body mass index, disability, sex differences, depression classification, NESDA, psychosocial factors
- MeSH terms
- Adolescent, Adult, Aged, Anxiety, Depression, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Life Change Events, Male, Middle Aged, Netherlands, Surveys and Questionnaires, Risk Factors, Severity of Illness Index, Sex Factors, Stress, Psychological, Cohort Studies, Comorbidity, Body Mass Index, Prevalence, Metabolic Syndrome, Diagnostic and Statistical Manual of Mental Disorders, Adult Survivors of Child Abuse
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