Subtypes of major depression: latent class analysis in depressed Han Chinese women.
Subtypes of major depression: latent class analysis in depressed Han Chinese women.
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DOI：
10.1017/s0033291714000749
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发表时间：
2014-11
影响因子：
6.9
通讯作者：
Kendler, K. S.
中科院分区：
文献类型：
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作者：
Li, Y.;Aggen, S.;Shi, S.;Gao, J.;Li, Y.;Tao, M.;Zhang, K.;Wang, X.;Gao, C.;Yang, L.;Liu, Y.;Li, K.;Shi, J.;Wang, G.;Liu, L.;Zhang, J.;Du, B.;Jiang, G.;Shen, J.;Zhang, Z.;Liang, W.;Sun, J.;Hu, J.;Liu, T.;Wang, X.;Miao, G.;Meng, H.;Li, Y.;Hu, C.;Li, Y.;Huang, G.;Li, G.;Ha, B.;Deng, H.;Mei, Q.;Zhong, H.;Gao, S.;Sang, H.;Zhang, Y.;Fang, X.;Yu, F.;Yang, D.;Liu, T.;Chen, Y.;Hong, X.;Wu, W.;Chen, G.;Cai, M.;Song, Y.;Pan, J.;Dong, J.;Pan, R.;Zhang, W.;Shen, Z.;Liu, Z.;Gu, D.;Wang, X.;Liu, X.;Zhang, Q.;Flint, J.;Kendler, K. S.
尽管有大量的研究，不确定性仍然存在的临床和病因的异质性抑郁症（MD）。是否可以识别出有意义和有效的亚型，它们在跨文化中是否稳定？对6008例年龄≥30岁、复发性DSM-IV MD的汉族女性患者进行结构化精神病学访谈，评估其一生中最严重抑郁发作时的症状。在Mplus中进行潜在类别分析（LCA）。使用9个DSM-IV MD症状A标准，14个分类的DSM-IV标准和所有独立评估的抑郁症状（n=27），最好的LCA模型分别确定了三个，四个和六个类。在所有溶液中均观察到重度和非自杀类，以及轻度/中度亚型。一个非典型的类出现一次双向神经植物性症状。非自杀类表现出低水平的无意识/内疚和绝望。不同亚型之间的共病模式、家族史、个性、环境因素、复发和体重指数（BMI）存在显著差异，其中非典型类尤为明显。MD是一种临床上复杂的综合征，具有几种可检测的亚型，具有不同的临床和人口统计学相关性。在我们的分析中，最一致地确定了三种亚型：重度、非典型和非自杀。在欧洲种族样本的多项既往研究中已确定重度和非典型MD。我们的非自杀亚型，具有低水平的内疚和绝望，可能代表了反映中国文化影响的病态变异。
Despite substantial research, uncertainty remains about the clinical and etiological heterogeneity of major depression (MD). Can meaningful and valid subtypes be identified and would they be stable cross-culturally? Symptoms at their lifetime worst depressive episode were assessed at structured psychiatric interview in 6008 women of Han Chinese descent, age ≥30 years, with recurrent DSM-IV MD. Latent class analysis (LCA) was performed in Mplus. Using the nine DSM-IV MD symptomatic A criteria, the 14 disaggregated DSM-IV criteria and all independently assessed depressive symptoms (n=27), the best LCA model identified respectively three, four and six classes. A severe and non-suicidal class was seen in all solutions, as was a mild/moderate subtype. An atypical class emerged once bidirectional neurovegetative symptoms were included. The non-suicidal class demonstrated low levels of worthlessness/guilt and hopelessness. Patterns of co-morbidity, family history, personality, environmental precipitants, recurrence and body mass index (BMI) differed meaningfully across subtypes, with the atypical class standing out as particularly distinct. MD is a clinically complex syndrome with several detectable subtypes with distinct clinical and demographic correlates. Three subtypes were most consistently identified in our analyses: severe, atypical and non-suicidal. Severe and atypical MD have been identified in multiple prior studies in samples of European ethnicity. Our non-suicidal subtype, with low levels of guilt and hopelessness, may represent a pathoplastic variant reflecting Chinese cultural influences.