title: Clinical and demographic factors associated with DSM-IV melancholic depression.
abstract: BACKGROUND
  The purpose of this paper is to use demographic and clinical data from a large diverse group of outpatients diagnosed with non-psychotic major depression to investigate the validity of the DSM-IV concept of melancholic depression.
  
  
  METHODS
  Baseline clinical and demographic data were collected on 1500 outpatients (1456 of whom melancholia could be determined) with non-psychotic major depressive disorder (MDD) participating in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Depressive symptom severity was assessed by clinical telephone interview using the 17-item Hamilton Rating Scale for Depression (HRS-D17) and the 30-item Inventory of Depressive Symptomatology (IDS-C30). The types and degrees of concurrent psychiatric symptoms were measured using a self report, the Psychiatric Diagnostic Screening Questionnaire (PDSQ), by recording the number of items relevant to each diagnostic category endorsed by study participants.
  
  
  RESULTS
  Adjusting for severity of depression (as measured by the total HRS-D17 scores), no differences were found in the rate of melancholic depression by race, marital status, education, employment status, family history of depression, primary care versus specialty care, monthly income, and degree of psychiatric and medical co-morbidity. Melancholic depression was significantly more likely in men than women. Melancholic depression after adjustment for severity was associated with a slightly younger age at study entry, as well as with greater illness severity, and slightly shorter duration of current episode. Hispanic ethnicity was associated with lower melancholic depression rates at the .06 level of significance.
  
  
  CONCLUSIONS
  Among outpatients with MDD, melancholic features were less likely in Hispanic patients, but more likely in slightly younger patients and in men. Melancholic features were also related to a slightly shorter current episode. These findings are consistent with the notion that external socio-demographic factors do not play an important role in the pathophysiology of melancholic depression.
authors.affiliation: University of Kansas School of Medicine-Wichita, Department of Psychiatry, Wichita, KS, USA. ahsan_khan@via-christi.org
authors.forename: Ahsan Y
authors.initials: AY
authors.lastname: Khan
authors.forename: Joe
authors.initials: J
authors.lastname: Carrithers
authors.forename: Sheldon H
authors.initials: SH
authors.lastname: Preskorn
authors.forename: Rex
authors.initials: R
authors.lastname: Lear
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: A
authors.initials: A
authors.lastname: John Rush
authors.forename: Diane
authors.initials: D
authors.lastname: Stegman
authors.forename: Colleen
authors.initials: C
authors.lastname: Kelley
authors.forename: Karen
authors.initials: K
authors.lastname: Kreiner
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
mesh_terms: D000328:Adult; D000367:Age Factors; D003710:Demography; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires