Sullivan P F, Kessler R C, Kendler K S
Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond 23298-0126, USA.
Am J Psychiatry. 1998 Oct;155(10):1398-406. doi: 10.1176/ajp.155.10.1398.
Although clinical trials have documented the importance of identifying individuals with major depression with atypical features, there are fewer epidemiological data. In a prior report, the authors used latent class analysis (LCA) to identify a distinctive atypical depressive subtype; they sought to replicate that finding in the current study.
Using the National Comorbidity Survey data, the authors applied LCA to 14 DSM-III-R major depressive symptoms in the participants' lifetime worst episodes (N=2,836). Validators of class membership included depressive disorder characteristics, syndrome consequences, demography, comorbidity, personality/attitudes, and parental psychiatric history.
The best-fitting LCA solution had six classes. Four were combinations of atypicality and severity: severe atypical, mild atypical, severe typical, and mild typical. Syndrome severity (severe atypical and typical versus mild atypical and typical classes) was associated with a pronounced pattern of more and longer episodes, worse syndrome consequences, increased psychiatric comorbidity, more deviant personality and attitudes, and parental alcohol/drug use disorder. Syndrome atypicality (severe and mild atypical versus severe and mild typical classes) was associated with decreased syndrome consequences, comorbid conduct disorder and social phobia, higher interpersonal dependency and lower self-esteem, and parental alcohol/drug use disorder.
As in prior reports, the atypical subtype of depression can be identified in epidemiological samples and, like typical depression, exists in mild and severe variants. Atypical depressive subtypes were characterized by several distinctive features. However, the correspondence between epidemiologically derived typologies of atypical depression and DSM-IV major depression with atypical features is not yet known.
尽管临床试验已证明识别具有非典型特征的重度抑郁症患者的重要性，但流行病学数据较少。在之前的一份报告中，作者使用潜在类别分析（LCA）来识别一种独特的非典型抑郁亚型；他们试图在当前研究中重现这一发现。
作者利用全国共病调查数据，对参与者一生中最严重发作期的14种DSM-III-R重度抑郁症状应用LCA（N=2836）。类别归属的验证指标包括抑郁障碍特征、综合征后果、人口统计学、共病情况、人格/态度以及父母的精神病史。
拟合度最佳的LCA解决方案有六个类别。其中四个是由非典型性和严重程度组合而成：重度非典型、轻度非典型、重度典型和轻度典型。综合征严重程度（重度非典型和典型与轻度非典型和典型类别相比）与发作次数更多、持续时间更长、综合征后果更差、精神共病增加、人格和态度更偏离正常以及父母有酒精/药物使用障碍的明显模式相关。综合征非典型性（重度和轻度非典型与重度和轻度典型类别相比）与综合征后果减轻、共病品行障碍和社交恐惧症、人际依赖性更高和自尊更低以及父母有酒精/药物使用障碍相关。
与之前的报告一样，在流行病学样本中可以识别出抑郁症的非典型亚型，并且与典型抑郁症一样，存在轻度和重度变体。非典型抑郁亚型具有几个独特的特征。然而，流行病学得出的非典型抑郁症类型与DSM-IV中具有非典型特征的重度抑郁症之间的对应关系尚不清楚。
