title: The identification of symptom-based subtypes of depression: A nationally representative cohort study.
abstract: BACKGROUND
  In recent years, researchers have used various techniques to elucidate the heterogeneity in depressive symptoms. This study seeks to resolve the extent to which variations in depression reflect qualitative differences between symptom categories and/or quantitative differences in severity.
  
  
  METHODS
  Data were used from the Netherlands Mental Health Survey and Incidence Study-2, a nationally representative face-to-face survey of the adult general population. In a subsample of respondents with a lifetime key symptom of depression at baseline and who participated in the first two waves (n=1388), symptom profiles at baseline were based on symptoms reported during their worst lifetime depressive episode. Depressive symptoms and DSM-IV diagnoses were assessed with the Composite International Diagnostic Interview 3.0. Three latent variable techniques (latent class analysis, factor analysis, factor mixture modelling) were used to identify the best subtyping model.
  
  
  RESULTS
  A latent class analysis, adjusted for local dependence between weight change and appetite change, described the data best and resulted in four distinct depressive subtypes: severe depression with anxiety (28.0%), moderate depression with anxiety (29.3%), moderate depression without anxiety (23.6%) and mild depression (19.0%). These classes showed corresponding clinical correlates at baseline and corresponding course and outcome indicators at follow-up (i.e., class severity was linked to lifetime mental disorders at baseline, and service use for mental health problems and current disability at follow-up).
  
  
  CONCLUSIONS
  Although the sample was representative of the population on most parameters, the findings are not generalisable to the most severely affected depressed patients.
  
  
  CONCLUSIONS
  Depression could best be described in terms of both qualitative differences between symptom categories and quantitative differences in severity. In particular anxiety was a distinguishing feature within moderate depression. This study stresses the central position anxiety occupies in the concept of depression.
authors.affiliation: Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, the Netherlands. Electronic address: mhave@trimbos.nl.
authors.forename: Margreet
authors.initials: M
authors.lastname: Ten Have
authors.affiliation: Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Center, Amsterdam, the Netherlands.
authors.forename: Femke
authors.initials: F
authors.lastname: Lamers
authors.affiliation: Faculty of Medical Sciences, Academic Centre of Psychiatry, University of Groningen, Groningen, the Netherlands.
authors.forename: Klaas
authors.initials: K
authors.lastname: Wardenaar
authors.affiliation: Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Center, Amsterdam, the Netherlands.
authors.forename: Aartjan
authors.initials: A
authors.lastname: Beekman
authors.affiliation: Faculty of Medical Sciences, Academic Centre of Psychiatry, University of Groningen, Groningen, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: de Jonge
authors.affiliation: Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, the Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: van Dorsselaer
authors.affiliation: Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, the Netherlands.
authors.forename: Marlous
authors.initials: M
authors.lastname: Tuithof
authors.affiliation: Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, the Netherlands.
authors.forename: Marloes
authors.initials: M
authors.lastname: Kleinjan
authors.affiliation: Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, the Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D063189:Symptom Assessment
keywords: Depressive subtypes; Depressive symptoms; Factor mixture model; Latent class analysis; Major depressive disorder; Population study