在一项大型队列研究中识别抑郁亚型：来自荷兰抑郁和焦虑研究（NESDA）的结果。

Identifying depressive subtypes in a large cohort study: results from the Netherlands Study of Depression and Anxiety (NESDA).

机构信息

Department of Psychiatry, VU University Medical Center Amsterdam, AJ Ernststraat 887, 1081 HL Amsterdam, The Netherlands.

出版信息

J Clin Psychiatry. 2010 Dec;71(12):1582-9. doi: 10.4088/JCP.09m05398blu. Epub 2010 Jul 13.

DOI:10.4088/JCP.09m05398blu

PMID:20673552

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.

摘要

目的

尽管先前曾尝试对抑郁障碍进行亚分类，但当前分类系统中的抑郁异质性仍是精神科领域讨论的一个焦点。数据驱动技术可能有助于建立更基于经验的分类。本研究旨在在一个有大量抑郁患者的队列中确定抑郁亚型。

方法

使用来自荷兰抑郁和焦虑研究的 818 名当前符合 DSM-IV 诊断的重度抑郁障碍或轻度抑郁患者的基线数据。2004 年 9 月至 2007 年 2 月期间，在社区、初级保健和专门的精神卫生保健机构招募了应答者。使用来自复合国际诊断访谈和抑郁症状清单的 16 个抑郁症状，通过潜在类别分析得出潜在类别。使用人口统计学、临床精神病学、心理社会和身体健康描述符来描述类别。

结果

确定了 3 个类别：严重忧郁类（患病率为 46.3%）、严重非典型类（患病率为 24.6%）和中度严重类（患病率为 29.1%）。两个严重类别都以更高的神经质（忧郁症 OR = 1.05 [95%CI，1.01-1.10]；非典型 OR = 1.07 [95%CI，1.03-1.12]）、更多的残疾（忧郁症 OR = 1.07 [95%CI，1.05-1.09]；非典型 OR = 1.06 [95%CI，1.04-1.07]）和更低的外向性（忧郁症 OR = 0.95 [95%CI，0.92-0.99]；非典型 OR = 0.95 [95%CI，0.92-0.99]）为特征，而非中度类别。将忧郁症类与非典型类进行比较发现，忧郁症类的吸烟者更多（非典型 OR = 0.57 [95%CI，0.39-0.84]），童年创伤更多（非典型 OR = 0.86 [95%CI，0.74-1.00]），而非典型类的女性更多（非典型 OR = 1.52 [95%CI，0.99-2.32]）、体重指数更高（非典型 OR = 1.13 [95%CI，1.09-1.17]）和更多的代谢综合征（非典型 OR = 2.17 [95%CI，1.38-3.42]）。