title: Inching toward Bethlehem: mapping melancholia.
abstract: BACKGROUND
  As melancholia has resisted symptom-based definition, this report considers possible explanations and options for moving forward. Clinician-assigned melancholic and non-melancholic groups were initially compared to refine a candidate set of differentiating symptoms alone for examination against a set of non-clinical validators. Analyses then examined the capacity of both the refined symptom and validator sets to discriminate the assigned melancholic and non-melancholic subjects.
  
  
  METHODS
  Subjects completed measures assessing symptoms and correlates (putative validators) of diagnostic sub-type, and were assessed independently by two psychiatrists.
  
  
  RESULTS
  Analyses identified 14 severity-based symptoms as discriminating clinically-diagnosed groups - with melancholic subjects differing significantly from non-melancholic subjects across a number of validators. Such symptom-based discrimination was superior to DSM-IV and Newcastle Index assignment in a study sub-set. While the refined symptom set had an overall accurate classificatory rate of 68%, use of the combined sets of refined symptoms and validators improved classification to 80%.
  
  
  CONCLUSIONS
  Melancholia definition is improved by the use of correlates in addition to depressive symptoms, suggesting that melancholia may be mapped more precisely by use of multiple co-ordinates or data sources.
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, Australia. g.parker@blackdog.org.au
authors.forename: Gordon
authors.initials: G
authors.lastname: Parker
authors.forename: Kathryn
authors.initials: K
authors.lastname: Fletcher
authors.forename: Melissa
authors.initials: M
authors.lastname: Barrett
authors.forename: Howe
authors.initials: H
authors.lastname: Synnott
authors.forename: Michael
authors.initials: M
authors.lastname: Breakspear
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Rees
authors.forename: Dusan
authors.initials: D
authors.lastname: Hadzi-Pavlovic
mesh_terms: D000328:Adult; D015897:Comorbidity; D003866:Depressive Disorder / Q000145:classification* / Q000175:diagnosis* / Q000523:psychology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results