title: Depression Dimensions: Integrating Clinical Signs and Symptoms from the Perspectives of Clinicians and Patients.
abstract: BACKGROUND
  Several studies have recognized that depression is a multidimensional construct, although the scales that are currently available have been shown to be limited in terms of the ability to investigate the multidimensionality of depression. The objective of this study is to integrate information from instruments that measure depression from different perspectives-a self-report symptomatic scale, a clinician-rated scale, and a clinician-rated scale of depressive signs-in order to investigate the multiple dimensions underlying the depressive construct.
  
  
  METHODS
  A sample of 399 patients from a mood disorders outpatient unit was investigated with the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HDRS), and the Core Assessment of Psychomotor Change (CORE). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to investigate underlying dimensions of depression, including item level analysis with factor loadings and item thresholds.
  
  
  RESULTS
  A solution of six depression dimensions has shown good-fit to the data, with no cross-loading items, and good interpretability. Item-level analysis revealed that the multidimensional depressive construct might be organized into a continuum of severity in the following ascending order: sexual, cognitive, insomnia, appetite, non-interactiveness/motor retardation, and agitation.
  
  
  CONCLUSIONS
  An integration of both signs and symptoms, as well as the perspectives of clinicians and patients, might be a good clinical and research alternative for the investigation of multidimensional issues within the depressive syndrome. As predicted by theoretical models of depression, the melancholic aspects of depression (non-interactiveness/motor retardation and agitation) lie at the severe end of the depressive continuum.
authors: Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors: Edgar Arrua
authors: EA
authors: Vares
authors: Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors: Giovanni Abrahão
authors: GA
authors: Salum
authors: Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Department of Psychiatry, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
authors: Lucas
authors: L
authors: Spanemberg
authors: Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors: Marco Antônio
authors: MA
authors: Caldieraro
authors: Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors: Marcelo P
authors: MP
authors: Fleck
mesh_terms: D003863:Depression / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology*; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D057566:Self Report; D012720:Severity of Illness Index