RAND Corporation.
Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
J Affect Disord. 2021 May 15;287:26-33. doi: 10.1016/j.jad.2021.03.018. Epub 2021 Mar 11.
Prior studies have characterized distinct major depressive episode (MDE) subtypes among adults, yet limited evidence exists regarding variation in MDE during adolescence.
Using 2008-2016 National Survey of Drug Use and Health data, latent class analysis (LCA) was used to characterize depression subtypes (based on symptom presentation) among 9,896 youth ages 12-17 with recent first-onset MDE. Logistic regression was used to estimate associations of MDE subtype with functional outcomes and treatment utilization, adjusting for demographic characteristics and depression severity (i.e., number of MDE diagnostic criteria and recurrence status) RESULTS: A 5-class LCA model provided optimal fit. Three distinct categories of MDE symptoms generally clustered together, which we termed "somatic," "cognitive," and "self-worth;" classes were differentiated by distinct combinations of symptoms across these 3 categories. Subtypes were characterized as: Highly Symptomatic (39% of youth); Somatic & Cognitive (24%), Somatic (22%), Diffuse Symptoms (8%), and Somatic & Self-Worth (6%). The majority of youth reported at least moderate impairment across multiple domains; subtype was a significant predictor of functional impairment. Only 34% of youth received any past-year depression-related treatment; treatment utilization was significantly higher for MDE subtypes with the highest prevalences of suicidal ideation.
Due to cross-sectional data, we cannot establish causal directionality.
Subtype was significantly predictive of functional impairment and treatment utilization, above and beyond number of MDE diagnostic criteria or recurrence status. Understanding distinct profiles of adolescent depression, as well as potential differential associations with impairment, can inform prevention, diagnosis, and treatment of depression among youth.
先前的研究已经确定了成年人中不同的重度抑郁发作（MDE）亚型，但关于青少年时期 MDE 变化的证据有限。
使用 2008-2016 年全国药物使用与健康调查数据，通过潜在类别分析（LCA）对 9896 名年龄在 12-17 岁且近期首次发作 MDE 的青少年进行基于症状表现的抑郁亚型进行了特征描述。采用逻辑回归估计 MDE 亚型与功能结果和治疗利用的关联，调整了人口统计学特征和抑郁严重程度（即 MDE 诊断标准的数量和复发状况）。
5 类 LCA 模型提供了最佳拟合。一般来说，三种不同类别的 MDE 症状聚类在一起，我们将其称为“躯体”、“认知”和“自我价值感”；这些类别通过这些 3 个类别中不同的症状组合来区分。亚型的特征为：高度症状（39%的青少年）；躯体和认知（24%）、躯体（22%）、弥散症状（8%）和躯体与自我价值感（6%）。大多数青少年在多个领域报告了至少中度障碍；亚型是功能障碍的重要预测指标。只有 34%的青少年接受了过去一年任何与抑郁相关的治疗；有自杀意念的 MDE 亚型的治疗利用率明显更高。
由于横断面数据，我们无法确定因果关系。
亚型在功能障碍和治疗利用方面具有显著的预测性，超出了 MDE 诊断标准的数量或复发状况。了解青少年抑郁的不同特征，以及与功能障碍的潜在差异关联，可以为青少年抑郁的预防、诊断和治疗提供信息。
