title: The potential relationship between levels of perceived stress and subtypes of major depressive disorder (MDD).
abstract: OBJECTIVE
  We wanted to explore whether major depressive disorder (MDD) subtypes (melancholic depression, atypical depression, double depression, and MDD with anger attacks) were related to levels of perceived stress, as measured by the Perceived Stress Scale (PSS).
  
  
  METHODS
  Our sample [n = 298; female = 163 (55%); mean age 40.1 +/- 10.5 years] consisted of out-patients with MDD. The Structured Clinical Interview for DSM-III-R, the 17-item Hamilton Rating Scale for Depression, the Anger Attack Questionnaire, and the PSS were administered prior to initiating treatment.
  
  
  RESULTS
  Depressed women had significantly higher levels of perceived stress (P = 0.02) than depressed men. Greater severity of depression at baseline was significantly related to higher levels of perceived stress (P < 0.0001). After adjusting for age, gender, and severity of depression at baseline, higher levels of perceived stress were significantly related to the presence of anger attacks (P < 0.0001; t = -4.103) as well as to atypical depression (P = 0.0013; t = 3.26).
  
  
  CONCLUSIONS
  Out-patients with MDD who are more irritable and/or present with atypical features have higher levels of perceived stress, indicating a potential reactive component to their depression.
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA WAC 812, USA. afarabaugh@partners.org
authors.forename: A H
authors.initials: AH
authors.lastname: Farabaugh
authors.forename: D
authors.initials: D
authors.lastname: Mischoulon
authors.forename: M
authors.initials: M
authors.lastname: Fava
authors.forename: C
authors.initials: C
authors.lastname: Green
authors.forename: W
authors.initials: W
authors.lastname: Guyker
authors.forename: J
authors.initials: J
authors.lastname: Alpert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003865:Major Depressive Disorder / Q000145:classification / Q000453:epidemiology / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012938:Social Perception; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*