Wardenaar K J, Monden R, Conradi H J, de Jonge P
University of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands.
University of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands.
J Affect Disord. 2015 Jul 1;179:38-46. doi: 10.1016/j.jad.2015.03.029. Epub 2015 Mar 26.
The course-heterogeneity of Major Depressive Disorder (MDD) hampers development of better prognostic models. Although latent class growth analyses (LCGA) have been used to explain course-heterogeneity, such analyses have failed to also account for symptom-heterogeneity of depressive symptoms. Therefore, the aim was to identify more specific data-driven subgroups based on patterns of course-trajectories on different depressive symptom domains.
In primary care MDD patients (n=205), the presence of the MDD criterion symptoms was determined for each week during a year. Weekly 'mood/cognition' (MC) and 'somatic' (SOM) scores were computed and parallel processes-LCGA (PP-LCGA) was used to identify subgroups based on the course on these domains. The classes׳ associations with baseline predictors and 2-/3-year outcomes were investigated.
PP-LCGA identified four classes: quick recovery, persisting SOM, persisting MC, and persisting SOM+MC (chronic). Persisting SOM was specifically predicted by higher baseline somatic symptomatology and somatization, and was associated with more somatic depressive symptomatology at long-term follow-up. Persisting MC was specifically predicted by higher depressive severity, thinking insufficiencies, neuroticism, loneliness and lower self-esteem, and was associated with lower mental health related quality of life and more mood/cognitive depressive symptomatology at follow-up.
The sample was small and contained only primary care MDD patients. The weekly depression assessments were collected retrospectively at 3-month intervals.
The results indicate that there are two specific prototypes of depression, characterized by either persisting MC or persisting SOM, which have different sets of associated prognostic factors and long-term outcomes, and could have different etiological mechanisms.
重度抑郁症（MDD）病程的异质性阻碍了更好的预后模型的开发。尽管潜在类别增长分析（LCGA）已被用于解释病程异质性，但此类分析未能同时考虑抑郁症状的症状异质性。因此，本研究旨在基于不同抑郁症状领域的病程轨迹模式识别更具体的数据驱动亚组。
在初级保健MDD患者（n = 205）中，确定一年中每周MDD标准症状的存在情况。计算每周的“情绪/认知”（MC）和“躯体”（SOM）评分，并使用并行过程-LCGA（PP-LCGA）基于这些领域的病程识别亚组。研究各亚组与基线预测因素及2/3年结局的关联。
PP-LCGA识别出四个亚组：快速康复组、持续存在躯体症状组、持续存在情绪/认知症状组和持续存在躯体+情绪/认知症状组（慢性组）。持续存在躯体症状组的特异性预测因素为较高的基线躯体症状和躯体化，且在长期随访中与更多的躯体抑郁症状相关。持续存在情绪/认知症状组的特异性预测因素为较高的抑郁严重程度、思维缺陷、神经质、孤独感和较低的自尊，且在随访中与较低的心理健康相关生活质量及更多的情绪/认知抑郁症状相关。
样本量小且仅包含初级保健MDD患者。每周的抑郁评估是每3个月回顾性收集一次。
结果表明存在两种特定的抑郁症原型，分别以持续存在情绪/认知症状或持续存在躯体症状为特征，它们具有不同的相关预后因素和长期结局集，且可能具有不同的病因机制。
