Symptom quality versus quantity in judging prognosis: Using NESARC predictive validators to locate uncomplicated major depression on the number-of-symptoms severity continuum

Jerome C. Wakefield, Mark F. Schmitz

    Research output: Contribution to journalArticle

    Abstract

    Background Uncomplicated major depressive disorder (UMDD) is defined as MDD that does not include any of six pathosuggestive features: more than six months duration, marked functional impairment, sense of worthlessness, suicidal ideation, psychotic ideation, and psychomotor retardation. Complicated MDD (CMDD) includes all episodes containing one or more of these features. UMDD has been shown to be lower than CMDD and indistinguishable from no-MDD-history on predictive pathology validators. This study's purpose is to establish where on the number-of-symptoms depressive continuum UMDD is located, using the criterion of predictive validity. Methods Using two-wave longitudinal community data, seven baseline depression history subgroups were identified: no MDD symptoms (n=23,214), one MDD screener symptom (n=609), subthreshold or “minor” depression (mD; 2–4 MDD symptoms; n=2,623), UMDD (n=505), and complicated MDD with 5–6 symptoms (n=1,106), 7 symptoms (n=1,200), and 8–9 symptoms (n=2,408). Predictive validity was evaluated by four follow-up variables: major depressive episode; generalized anxiety disorder; suicide attempt; and manic/hypomanic episode. Results UMDD predictive pathology validator rates are not significantly different from rates for subthreshold mD but significantly different from those for all other depression categories; UMDD is higher in symptoms but lower in validator levels than 5–6 symptom CMDD. Limitations Baseline and follow-up diagnoses were based on respondents’ fallible retrospective symptom reports in response to a lay-administered structured questionnaire, which may not yield diagnoses comparable to clinicians’ assessments. Conclusion Uncomplicated MDD's follow-up outcomes resemble subthreshold depression, not CMDD, even when CMDD has less symptoms. Clinical decisions should reflect the relatively benign prognosis of uncomplicated MDD.

    Original languageEnglish (US)
    Pages (from-to)325-329
    Number of pages5
    JournalJournal of Affective Disorders
    Volume208
    DOIs
    StatePublished - Jan 15 2017

    Fingerprint

    Major Depressive Disorder
    Depression
    Pathology
    Suicidal Ideation
    Anxiety Disorders
    Suicide
    History

    Keywords

    • Depressive disorders
    • Diagnostic criteria
    • Diagnostic validity
    • DSM-5
    • Harmful dysfunction
    • Major depression
    • Subthreshold depression
    • Uncomplicated depression

    ASJC Scopus subject areas

    • Clinical Psychology
    • Psychiatry and Mental health

    Cite this

    @article{e612c0b8bedc437090bb726d141e8cb1,
    title = "Symptom quality versus quantity in judging prognosis: Using NESARC predictive validators to locate uncomplicated major depression on the number-of-symptoms severity continuum",
    abstract = "Background Uncomplicated major depressive disorder (UMDD) is defined as MDD that does not include any of six pathosuggestive features: more than six months duration, marked functional impairment, sense of worthlessness, suicidal ideation, psychotic ideation, and psychomotor retardation. Complicated MDD (CMDD) includes all episodes containing one or more of these features. UMDD has been shown to be lower than CMDD and indistinguishable from no-MDD-history on predictive pathology validators. This study's purpose is to establish where on the number-of-symptoms depressive continuum UMDD is located, using the criterion of predictive validity. Methods Using two-wave longitudinal community data, seven baseline depression history subgroups were identified: no MDD symptoms (n=23,214), one MDD screener symptom (n=609), subthreshold or “minor” depression (mD; 2–4 MDD symptoms; n=2,623), UMDD (n=505), and complicated MDD with 5–6 symptoms (n=1,106), 7 symptoms (n=1,200), and 8–9 symptoms (n=2,408). Predictive validity was evaluated by four follow-up variables: major depressive episode; generalized anxiety disorder; suicide attempt; and manic/hypomanic episode. Results UMDD predictive pathology validator rates are not significantly different from rates for subthreshold mD but significantly different from those for all other depression categories; UMDD is higher in symptoms but lower in validator levels than 5–6 symptom CMDD. Limitations Baseline and follow-up diagnoses were based on respondents’ fallible retrospective symptom reports in response to a lay-administered structured questionnaire, which may not yield diagnoses comparable to clinicians’ assessments. Conclusion Uncomplicated MDD's follow-up outcomes resemble subthreshold depression, not CMDD, even when CMDD has less symptoms. Clinical decisions should reflect the relatively benign prognosis of uncomplicated MDD.",
    keywords = "Depressive disorders, Diagnostic criteria, Diagnostic validity, DSM-5, Harmful dysfunction, Major depression, Subthreshold depression, Uncomplicated depression",
    author = "Wakefield, {Jerome C.} and Schmitz, {Mark F.}",
    year = "2017",
    month = "1",
    day = "15",
    doi = "10.1016/j.jad.2016.09.015",
    language = "English (US)",
    volume = "208",
    pages = "325--329",
    journal = "Journal of Affective Disorders",
    issn = "0165-0327",
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    TY - JOUR

    T1 - Symptom quality versus quantity in judging prognosis

    T2 - Using NESARC predictive validators to locate uncomplicated major depression on the number-of-symptoms severity continuum

    AU - Wakefield, Jerome C.

    AU - Schmitz, Mark F.

    PY - 2017/1/15

    Y1 - 2017/1/15

    N2 - Background Uncomplicated major depressive disorder (UMDD) is defined as MDD that does not include any of six pathosuggestive features: more than six months duration, marked functional impairment, sense of worthlessness, suicidal ideation, psychotic ideation, and psychomotor retardation. Complicated MDD (CMDD) includes all episodes containing one or more of these features. UMDD has been shown to be lower than CMDD and indistinguishable from no-MDD-history on predictive pathology validators. This study's purpose is to establish where on the number-of-symptoms depressive continuum UMDD is located, using the criterion of predictive validity. Methods Using two-wave longitudinal community data, seven baseline depression history subgroups were identified: no MDD symptoms (n=23,214), one MDD screener symptom (n=609), subthreshold or “minor” depression (mD; 2–4 MDD symptoms; n=2,623), UMDD (n=505), and complicated MDD with 5–6 symptoms (n=1,106), 7 symptoms (n=1,200), and 8–9 symptoms (n=2,408). Predictive validity was evaluated by four follow-up variables: major depressive episode; generalized anxiety disorder; suicide attempt; and manic/hypomanic episode. Results UMDD predictive pathology validator rates are not significantly different from rates for subthreshold mD but significantly different from those for all other depression categories; UMDD is higher in symptoms but lower in validator levels than 5–6 symptom CMDD. Limitations Baseline and follow-up diagnoses were based on respondents’ fallible retrospective symptom reports in response to a lay-administered structured questionnaire, which may not yield diagnoses comparable to clinicians’ assessments. Conclusion Uncomplicated MDD's follow-up outcomes resemble subthreshold depression, not CMDD, even when CMDD has less symptoms. Clinical decisions should reflect the relatively benign prognosis of uncomplicated MDD.

    AB - Background Uncomplicated major depressive disorder (UMDD) is defined as MDD that does not include any of six pathosuggestive features: more than six months duration, marked functional impairment, sense of worthlessness, suicidal ideation, psychotic ideation, and psychomotor retardation. Complicated MDD (CMDD) includes all episodes containing one or more of these features. UMDD has been shown to be lower than CMDD and indistinguishable from no-MDD-history on predictive pathology validators. This study's purpose is to establish where on the number-of-symptoms depressive continuum UMDD is located, using the criterion of predictive validity. Methods Using two-wave longitudinal community data, seven baseline depression history subgroups were identified: no MDD symptoms (n=23,214), one MDD screener symptom (n=609), subthreshold or “minor” depression (mD; 2–4 MDD symptoms; n=2,623), UMDD (n=505), and complicated MDD with 5–6 symptoms (n=1,106), 7 symptoms (n=1,200), and 8–9 symptoms (n=2,408). Predictive validity was evaluated by four follow-up variables: major depressive episode; generalized anxiety disorder; suicide attempt; and manic/hypomanic episode. Results UMDD predictive pathology validator rates are not significantly different from rates for subthreshold mD but significantly different from those for all other depression categories; UMDD is higher in symptoms but lower in validator levels than 5–6 symptom CMDD. Limitations Baseline and follow-up diagnoses were based on respondents’ fallible retrospective symptom reports in response to a lay-administered structured questionnaire, which may not yield diagnoses comparable to clinicians’ assessments. Conclusion Uncomplicated MDD's follow-up outcomes resemble subthreshold depression, not CMDD, even when CMDD has less symptoms. Clinical decisions should reflect the relatively benign prognosis of uncomplicated MDD.

    KW - Depressive disorders

    KW - Diagnostic criteria

    KW - Diagnostic validity

    KW - DSM-5

    KW - Harmful dysfunction

    KW - Major depression

    KW - Subthreshold depression

    KW - Uncomplicated depression

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    U2 - 10.1016/j.jad.2016.09.015

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    JO - Journal of Affective Disorders

    JF - Journal of Affective Disorders

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