title: Subtypes of major depression: latent class analysis in depressed Han Chinese women.
abstract: BACKGROUND
  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?
  
  
  METHODS
  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. RESULTS; 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.
  
  
  CONCLUSIONS
  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.
authors: Wellcome Trust Centre for Human Genetics, Oxford,UK.
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authors: Department of Psychiatry,Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University,Richmond, VA,USA.
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authors: Shanghai Mental Health Center,P.R.C.
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authors: Shi
authors: Chinese Traditional Hospital of Zhejiang,Hangzhou,Zhejiang,P.R.C.
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authors: Gao
authors: No.1 Hospital of Zhengzhou University,Zhengzhou, Henan,P.R.C.
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authors: Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang,P.R.C.
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authors: No. 1 Hospital of Shanxi Medical University,Taiyuan, Shanxi,P.R.C.
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authors: ShengJing Hospital of China Medical University,Heping District, Shenyang, Liaoning,P.R.C.
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authors: No. 1 Hospital of Medical College of Xian Jiaotong University,Xian, Shaanxi,P.R.C.
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authors: Jilin Brain Hospital, Siping, Jilin,P.R.C.
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authors: The First Hospital of China Medical University,Heping District, Shenyang, Liaoning,P.R.C.
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authors: Mental Hospital of Jiangxi Province, Nanchang, Jiangxi,P.R.C.
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authors: Xian Mental Health Center, New Qujiang District, Xian, Shaanxi,P.R.C.
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authors: Beijing Anding Hospital of Capital University of Medical Sciences,Xicheng District, Beijing,P.R.C.
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authors: Shandong Mental Health Center, Jinan, Shandong,P.R.C.
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authors: No. 3 Hospital of Sun Yat-sen University,Tianhe District, Guangzhou, Guangdong,P.R.C.
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authors: No. 4 Hospital of Jiangsu University,Zhenjiang, Jiangsu,P.R.C.
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authors: Psychiatric Hospital of Henan Province, Xinxiang, Henan,P.R.C.
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authors: Nanjing Brain Hospital, Nanjing, Jiangsu,P.R.C.
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authors: Harbin Medical University,Nangang District, Haerbin, Heilongjiang,P.R.C.
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authors: Shenzhen Kang Ning Hospital, Luohu District, Shenzhen, Guangdong,P.R.C.
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authors: First Hospital of Hebei Medical University,Shijiazhuang, Hebei,P.R.C.
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authors: Guangzhou Brain Hospital(Guangzhou Psychiatric Hospital), Liwan District, Guangzhou, Guangdong,P.R.C.
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authors: No. 1 Hospital of Chongqing Medical University,Yuanjiagang, Yuzhong District, Chongqing,P.R.C.
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authors: Dalian No. 7 Hospital, Ganjingzi District, Dalian, Liaoning,P.R.C.
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authors: No. 3 Hospital of Heilongjiang Province, Beian, Heilongjiang,P.R.C.
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authors: Wuhan Mental Health Center, Wuhan, Hubei,P.R.C.
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authors: Sichuan Mental Health Center, Mianyang, Sichuan,P.R.C.
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authors: Mental Health Institute of Jining Medical College,Dai Zhuang, Bei Jiao, Jining, Shandong,P.R.C.
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authors: Liaocheng No. 4 Hospital, Liaocheng, Shandong,P.R.C.
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authors: Mental Health Center of West China Hospital of Sichuan University,Wuhou District, Chengdu, Sichuan,P.R.C.
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authors: Suzhou Guangji Hospital, Suzhou, Jiangsu,P.R.C.
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authors: No. 2 Hospital of Lanzhou University,Lanzhou, Gansu,P.R.C.
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authors: Fuzhou Psychiatric Hospital, Cangshan District, Fuzhou, Fujian,P.R.C.
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authors: Harbin No. 1 Special Hospital, Haerbin, Heilongjiang,P.R.C.
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authors: Jining Psychiatric Hospital, North Dai Zhuang, Rencheng District, Jining, Shandong,P.R.C.
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authors: No. 2 Xiangya Hospital of Zhongnan University,Furong District, Changsha, Hunan,P.R.C.
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authors: Xijing Hospital of No. 4 Military Medical University,Xian, Shaanxi,P.R.C.
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authors: Huzhou No. 3 Hospital, Huzhou, Zhejiang,P.R.C.
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authors: Mudanjiang Psychiatric Hospital of Heilongjiang Province, Xinglong, Mudanjiang, Heilongjiang,P.R.C.
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authors: Song
authors: No. 1 Hospital of Jinan University,Guangzhou, Guangdong,P.R.C.
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authors: Daqing No. 3 Hospital of Heilongjiang Province, Ranghulu district, Daqing, Heilongjiang,P.R.C.
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authors: Tangshan No. 5 Hospital, Lunan District, Tangshan, Hebei,P.R.C.
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authors: Weihai Mental Health Center, ETDZ, Weihai, Shandong,P.R.C.
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authors: Renmin Hospital of Wuhan University,Wuchang District, Wuhan, Hubei,P.R.C.
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authors: Tianjin First Center Hospital, Xinkai Road, Hedong District, Tianjin,P.R.C.
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authors: Hainan Anning Hospital, Haikou, Hainan,P.R.C.
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authors: Wellcome Trust Centre for Human Genetics, Oxford,UK.
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authors: Flint
authors: Department of Psychiatry,Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University,Richmond, VA,USA.
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authors: Kendler
mesh_terms: D000328:Adult; D003866:Depressive Disorder / Q000145:classification*; D003865:Major Depressive Disorder / Q000145:classification*; D005260:Female; D006801:Humans; D012720:Severity of Illness Index; D059020:Suicidal Ideation