Diagnostic criteria for melancholia. The comparative validity of DSM-III and DSM-III-R.

The psychometric properties and validity of the DSM-III and DSM-III-R definitions of melancholia were examined in 60 depressed inpatients. The prevalence of melancholia was significantly higher according to the DSM-III-R criteria, and the kappa-coefficient of agreement between the two definitions was .40. For both criteria sets, the internal consistencies and item-scale correlations were low. Both definitions were associated with overall symptom severity and the melancholia symptom subscale; however, only DSM-III melancholics scored higher on the nonmelancholia symptom subscale. The DSM-III-R criteria were associated with more of the predicted correlates of endogenous subtyping. According to both definitions, melancholics were characterized by less stress, greater symptom severity, and less frequent nonserious suicide attempts prior to admission. The DSM-III-R melancholic subtyping was additionally associated with a family history of antisocial personality and substance abuse, presence of a premorbid personality disorder, age, and a tendency to blame others for the depression.