The structure of the symptoms of major depression: exploratory and confirmatory factor analysis in depressed Han Chinese women.
BACKGROUND
The symptoms of major depression (MD) are clinically diverse. Do they form coherent factors that might clarify the underlying nature of this important psychiatric syndrome?


METHODS
Symptoms at 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. Exploratory factor analysis (EFA) and confirmatoryfactor analysis (CFA) were performed in Mplus in random split-half samples.


RESULTS
The preliminary EFA results were consistently supported by the findings from CFA. Analyses of the nine DSM-IV MD symptomatic A criteria revealed two factors loading on: (i) general depressive symptoms; and (ii) guilt/suicidal ideation. Examining 14 disaggregated DSM-IV criteria revealed three factors reflecting: (i) weight/appetite disturbance; (ii) general depressive symptoms; and (iii) sleep disturbance. Using all symptoms (n = 27), we identified five factors that reflected: (i) weight/appetite symptoms; (ii) general retarded depressive symptoms; (iii) atypical vegetative symptoms; (iv) suicidality/hopelessness; and (v) symptoms of agitation and anxiety.


CONCLUSIONS
MD is a clinically complex syndrome with several underlying correlated symptom dimensions. In addition to a general depressive symptom factor, a complete picture must include factors reflecting typical/atypical vegetative symptoms, cognitive symptoms (hopelessness/suicidal ideation), and an agitated symptom factor characterized by anxiety, guilt, helplessness and irritability. Prior cross-cultural studies, factor analyses of MD in Western populations and empirical findings in this sample showing risk factor profiles similar to those seen in Western populations suggest that our results are likely to be broadly representative of the human depressive syndrome.
Wellcome Trust Centre for Human Genetics, Oxford, UK.
Y
Y
Li
Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.
S
S
Aggen
Shanghai Mental Health Center, Shanghai, P.R. China (PRC).
S
S
Shi
Chinese Traditional Hospital of Zhejiang, Hangzhou, Zhejiang, PRC.
J
J
Gao
No. 1 Hospital of Zhengzhou University, Zhengzhou, Henan, PRC.
Y
Y
Li
Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang, PRC.
M
M
Tao
No. 1 Hospital of Shanxi Medical University, Taiyuan, Shanxi, PRC.
K
K
Zhang
ShengJing Hospital of China Medical University, Heping District, Shenyang, Liaoning, PRC.
X
X
Wang
No. 1 Hospital of Medical College of Xian Jiaotong University, Xian, Shaanxi, PRC.
C
C
Gao
Jilin Brain Hospital, Siping, Jilin, PRC.
L
L
Yang
The First Hospital of China Medical University, Heping District, Shenyang, Liaoning, PRC.
Y
Y
Liu
Mental Hospital of Jiangxi Province, Nanchang, Jiangxi, PRC.
K
K
Li
Xian Mental Health Center, New Qujiang District, Xian, Shaanxi, PRC.
J
J
Shi
Beijing Anding Hospital of Capital University of Medical Sciences, Deshengmen wai, Xicheng District, Beijing, PRC.
G
G
Wang
Shandong Mental Health Center, Jinan, Shandong, PRC.
L
L
Liu
No. 3 Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, Guangdong, PRC.
J
J
Zhang
Hebei Mental Health Center, Baoding, Hebei, PRC.
B
B
Du
Chongqing Mental Health Center, Jiangbei District, Chongqing, PRC.
G
G
Jiang
Tianjin Anding Hospital, Hexi District, Tianjin, PRC.
J
J
Shen
No. 4 Hospital of Jiangsu University, Zhenjiang, Jiangsu, PRC.
Z
Z
Zhang
Psychiatric Hospital of Henan Province, Xinxiang, Henan, PRC.
W
W
Liang
Nanjing Brain Hospital, Nanjing, Jiangsu, PRC.
J
J
Sun
Harbin Medical University, Nangang District, Haerbin, Heilongjiang, PRC.
J
J
Hu
Shenzhen Kang Ning Hospital, Luohu District, Shenzhen, Guangdong, PRC.
T
T
Liu
First Hospital of Hebei Medical University, Shijiazhuang, Hebei, PRC.
X
X
Wang
Guangzhou Brain Hospital (Guangzhou Psychiatric Hospital), Liwan District, Guangzhou, Guangdong, PRC.
G
G
Miao
No. 1 Hospital of Chongqing Medical University, Yuzhong District, Chongqing, PRC.
H
H
Meng
Dalian No. 7 Hospital, Ganjingzi District, Dalian, Liaoning, PRC.
Y
Y
Li
No. 3 Hospital of Heilongjiang Province, Beian, Heilongjiang, PRC.
C
C
Hu
Wuhan Mental Health Center, Wuhan, Hubei, PRC.
Y
Y
Li
Sichuan Mental Health Center, Mianyang, Sichuan, PRC.
G
G
Huang
Mental Health Institute of Jining Medical College, Dai Zhuang, Bei Jiao, Jining, Shandong, PRC.
G
G
Li
Liaocheng No. 4 Hospital, Liaocheng, Shandong, PRC.
B
B
Ha
Mental Health Center of West China Hospital of Sichuan University, Wuhou District, Chengdu, Sichuan, PRC.
H
H
Deng
Suzhou Guangji Hospital, Suzhou, Jiangsu, PRC.
Q
Q
Mei
Anhui Mental Health Center, Hefei, Anhui, PRC.
H
H
Zhong
Ningbo Kang Ning Hospital, Zhenhai District, Ningbo, Zhejiang, PRC.
S
S
Gao
Changchun Mental Hospital, Changchun, Jilin, PRC.
H
H
Sang
No. 2 Hospital of Lanzhou University, Lanzhou, Gansu, PRC.
Y
Y
Zhang
Fuzhou Psychiatric Hospital, Cangshan District, Fuzhou, Fujian, PRC.
X
X
Fang
Harbin No. 1 Special Hospital, Haerbin, Heilongjiang, PRC.
F
F
Yu
Jining Psychiatric Hospital, North Dai Zhuang, Rencheng District, Jining, Shandong, PRC.
D
D
Yang
No. 2 Xiangya Hospital of Zhongnan University, Furong District, Changsha, Hunan, PRC.
T
T
Liu
Xijing Hospital of No. 4 Military Medical University, Xian, Shaanxi, PRC.
Y
Y
Chen
Mental Health Center of Shantou University, Shantou, Guangdong, PRC.
X
X
Hong
Tongji University Hospital, Shanghai, PRC.
W
W
Wu
Huaian No. 3 Hospital, Huaian, Jiangsu, PRC.
G
G
Chen
Huzhou No. 3 Hospital, Huzhou, Zhejiang, PRC.
M
M
Cai
Mudanjiang Psychiatric Hospital of Heilongjiang Province, Xinglong, Mudanjiang, Heilongjiang, PRC.
Y
Y
Song
No. 1 Hospital of Jinan University, Guangzhou, Guangdong, PRC.
J
J
Pan
Qingdao Mental Health Center, Shibei District, Qingdao, Shandong, PRC.
J
J
Dong
Guangxi Longquanshan Hospital, Yufeng District, Liuzhou, PRC.
R
R
Pan
Daqing No. 3 Hospital of Heilongjiang Province, Ranghulu District, Daqing, Heilongjiang, PRC.
W
W
Zhang
Tangshan No. 5 Hospital, Lunan District, Tangshan, Hebei, PRC.
Z
Z
Shen
Anshan Psychiatric Rehabilitation Hospital, Lishan District, Anshan, Liaoning, PRC.
Z
Z
Liu
Weihai Mental Health Center, ETDZ, Weihai, Shandong, PRC.
D
D
Gu
Renmin Hospital of Wuhan University, Wuchang District, Wuhan, Hubei, PRC.
X
X
Wang
Tianjin First Center Hospital, Hedong District, Tianjin, PRC.
X
X
Liu
Hainan Anning Hospital, Haikou, Hainan, PRC.
Q
Q
Zhang
Wellcome Trust Centre for Human Genetics, Oxford, UK.
J
J
Flint
Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.
K S
KS
Kendler
D000328:Adult; D002681:China / Q000208:ethnology; D003865:Major Depressive Disorder / Q000208:ethnology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008875:Middle Aged