title: The differential influence of life stress on individual symptoms of depression.
abstract: OBJECTIVE
  Life stress consistently increases the incidence of major depression. Recent evidence has shown that individual symptoms of major depressive disorder (MDD) differ in important dimensions such as their genetic and etiological background, but the impact of stress on individual MDD symptoms is not known. Here, we assess whether stress affects depression symptoms differentially.
  
  
  METHODS
  We used the chronic stress of medical internship to examine changes of the nine Diagnostic and Statistical Manual (DSM)-5 criterion symptoms for depression in 3021 interns assessed prior to and throughout internship.
  
  
  RESULTS
  All nine depression symptoms increased in response to stress (all P < 0.001), on average by 173%. Symptom increases differed substantially from each other (P < 0.001), with psychomotor problems (289%) and interest loss (217%) showing the largest increases, and suicidal ideation (146%) and sleep problems (52%) the smallest. Symptoms also differed in their severities under stress (P < 0.001): Fatigue, appetite problems and sleep problems were most prevalent; psychomotor problems and suicidal ideation were least prevalent.
  
  
  CONCLUSIONS
  Stress differentially affects the DSM-5 depressive symptoms. Analyses of individual symptoms reveal important insights obfuscated by sum-scores.
authors: Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.
authors: E I
authors: EI
authors: Fried
authors: School of Life Sciences, Arizona State University, Tempe, AZ, USA.
authors: R M
authors: RM
authors: Nesse
authors: Medical University of South Carolina, Charleston, SC, USA.
authors: C
authors: C
authors: Guille
authors: Department of Psychiatry, Molecular and Behavioral Neuroscience Institute, University of Michigan Medical School, Ann Arbor, MI, USA.
authors: S
authors: S
authors: Sen
mesh_terms: D000328:Adult; D001499:Bayes Theorem; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000473:pathology / Q000523:psychology*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000473:pathology / Q000523:psychology*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D012649:Self Concept; D013315:Stress, Psychological / Q000523:psychology*; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: depressive symptoms; internship; life stress; major depressive disorder
references: J Affect Disord. 2011 Dec;135(1-3):10-9
references: 21300408
references: Acta Psychiatr Scand. 2011 Dec;124(6):495-6
references: 21838736
references: Psychol Med. 2012 May;42(5):957-65
references: 22093641
references: J Affect Disord. 2012 Jul;139(2):126-40
references: 21885128
references: PLoS Med. 2012;9(10):e1001326
references: 23091423
references: Psychiatry Res. 2012 Aug 15;198(3):400-6
references: 22429480
references: Am J Psychiatry. 2013 Jan;170(1):59-70
references: 23111466
references: Biol Psychiatry. 2013 Apr 1;73(7):667-78
references: 23290196
references: Annu Rev Clin Psychol. 2013;9:91-121
references: 23537483
references: JAMA Psychiatry. 2013 Jun;70(6):599-607
references: 23740048
references: J Clin Epidemiol. 1994 May;47(5):555-64
references: 7730881
references: J Abnorm Psychol. 1989 Nov;98(4):460-7
references: 2592681
references: Arch Intern Med. 1988 Jun;148(6):1428-35
references: 3288162
references: J Affect Disord. 1985 Sep;9(2):143-8
references: 2932487
references: JAMA Psychiatry. 2013 Nov;70(11):1171-80
references: 24026579
references: Br J Psychiatry. 1981 Oct;139:297-305
references: 7326539
references: Acta Psychiatr Scand. 1975 Mar;51(3):161-70
references: 1136841
references: J Affect Disord. 2004 Jun;80(2-3):125-33
references: 15207925
references: Soc Psychiatry Psychiatr Epidemiol. 2002 Dec;37(12):592-8
references: 12545237
references: Psychol Aging. 2002 Jun;17(2):288-98
references: 12061413
references: Ann Intern Med. 2002 Mar 5;136(5):358-67
references: 11874308
references: Psychol Aging. 2000 Jun;15(2):232-40
references: 10879578
references: JAMA. 1999 Nov 10;282(18):1737-44
references: 10568646
references: J Affect Disord. 2015 Feb 1;172:96-102
references: 25451401
references: Psychol Med. 2014 Jul;44(10):2067-76
references: 24289852
references: J Affect Disord. 2014 Jul;163:18-24
references: 24836083
references: PLoS One. 2014;9(2):e90311
references: 24587318
references: J Affect Disord. 1979 Sep;1(3):195-211
references: 162503
references: Arch Gen Psychiatry. 1997 Nov;54(11):1016-24
references: 9366658
references: J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62
references: 14399272
references: Psychol Med. 2004 Nov;34(8):1443-52
references: 15724875
references: J Pers Soc Psychol. 2006 Aug;91(2):316-30
references: 16881767
references: J Nerv Ment Dis. 2006 Oct;194(10):785-90
references: 17041292
references: Annu Rev Clin Psychol. 2005;1:293-319
references: 17716090
references: Am J Psychiatry. 2007 Oct;164(10):1521-9; quiz 1622
references: 17898343
references: Am J Psychiatry. 2008 Mar;165(3):342-51
references: 18172020
references: Sleep. 2008 Apr;31(4):481-8
references: 18457235
references: CNS Drugs. 2009 Dec;23(12):1023-37
references: 19958040
references: Psychother Psychosom. 2010;79(3):131-5
references: 20185969
references: Arch Gen Psychiatry. 2010 Jun;67(6):557-65
references: 20368500
references: Psychother Psychosom. 2010;79(5):267-79
references: 20616621
references: Psychol Med. 2010 Oct;40(10):1679-90
references: 20059797