Department of Psychology, Free University Berlin, Germany.
Psychol Med. 2010 Oct;40(10):1679-90. doi: 10.1017/S0033291709992157. Epub 2010 Jan 11.
The DSM-IV symptomatic criteria for major depression (MD) derive primarily from clinical experience with modest empirical support.
The sample studied included 1015 (518 males, 497 females) Caucasian twins from a population-based registry who met criteria for MD in the year prior to the interview. Logistic regression analyses were conducted to compare the associations of: (1) single symptomatic criterion, (2) two groups of criteria reflecting cognitive and neurovegetative symptoms, 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.
The individual symptomatic criteria showed widely varying associations with the pattern of co-morbidity, personality traits, features of the depressive episode and demographic characteristics. When examined separately, these two criteria groups showed robust differences in their patterns of association, with the validators with the cognitive criteria generally producing stronger associations than the neurovegetative.
Among depressed individuals, individual DSM-IV symptomatic criteria differ substantially in their predictive relationship with a range of clinical validators. These results challenge the equivalence assumption for the symptomatic criteria for MD and suggest a more than expected degree of 'covert' heterogeneity among these criteria. Part of this heterogeneity is captured by the distinction between cognitive versus neurovegetative symptoms, with cognitive symptoms being more strongly associated with most clinically relevant characteristics. Detailed psychometric evaluation of DSM-IV criteria is overdue.
DSM-IV 重度抑郁障碍（MD）的症状标准主要来源于对中等程度实证支持的临床经验。
本研究的样本包括 1015 名（518 名男性，497 名女性）来自基于人群的登记处的白种人双胞胎，他们在接受访谈前的一年中符合 MD 的标准。进行逻辑回归分析以比较：（1）单一症状标准；（2）反映认知和神经植物性症状的两组标准，与广泛的潜在有效验证因素相关，包括人口统计学因素、未来发作的风险、同卵双胞胎的 MD 风险、抑郁发作的特征、共病模式和人格特质。
个体症状标准与共病模式、人格特质、抑郁发作特征和人口统计学特征的相关性差异很大。当单独检查时，这两个标准组的关联模式存在显著差异，认知标准的验证因素通常比神经植物性标准产生更强的关联。
在抑郁个体中，DSM-IV 单一症状标准与一系列临床有效验证因素的预测关系存在显著差异。这些结果对 MD 症状标准的等价假设提出了挑战，并表明这些标准存在超出预期程度的“隐性”异质性。这种异质性的一部分由认知与神经植物性症状之间的区别所捕捉，认知症状与大多数相关临床特征的关联更为强烈。DSM-IV 标准的详细心理计量学评估已迫在眉睫。
