title: Tracing the associations between sex, the atypical and the combined atypical-melancholic depression subtypes: A path analysis.
abstract: BACKGROUND
  Numerous studies have examined determinants leading to preponderance of women in major depressive disorder (MDD), which is particularly accentuated for the atypical depression subtype. It is thus of interest to explore the specific indirect effects influencing the association between sex and established depression subtypes.
  
  
  METHODS
  The data of 1624 subjects with a lifetime diagnosis of MDD derived from the population-based PsyCoLaus data were used. An atypical (n=256), a melancholic (n=422), a combined atypical and melancholic features subtype (n=198), and an unspecified MDD group (n=748) were constructed according to the DSM-IV specifiers. Path models with direct and indirect effects were applied to the data.
  
  
  RESULTS
  Partial mediation of the female-related atypical and combined atypical-melancholic depression subtypes was found. Early anxiety disorders and high emotion-orientated coping acted as mediating variables between sex and the atypical depression subtype. In contrast, high Body Mass Index (BMI) served as a suppression variable, also concerning the association between sex and the combined atypical-melancholic subtype. The latter association was additionally mediated by an early age of MDD onset and early/late anxiety disorders.
  
  
  CONCLUSIONS
  The use of cross-sectional data does not allow causal conclusions.
  
  
  CONCLUSIONS
  This is the first study that provides evidence for a differentiation of the general mechanisms explaining sex differences of overall MDD by depression subtypes. Determinants affecting the pathways begin early in life. Since some of them are primarily of behavioral nature, the present findings could be a valuable target in mental health care.
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland. Electronic address: stephanie.rodgers@dgsp.uzh.ch.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Rodgers
authors.affiliation: Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Caroline L
authors.initials: CL
authors.lastname: Vandeleur
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
authors.forename: Vladeta
authors.initials: V
authors.lastname: Ajdacic-Gross
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
authors.forename: Aleksandra A
authors.initials: AA
authors.lastname: Aleksandrowicz
authors.affiliation: Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Marie-Pierre F
authors.initials: MF
authors.lastname: Strippoli
authors.affiliation: Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Enrique
authors.initials: E
authors.lastname: Castelao
authors.affiliation: Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland; Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Glaus
authors.affiliation: Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Aurélie M
authors.initials: AM
authors.lastname: Lasserre
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
authors.forename: Mario
authors.initials: M
authors.lastname: Müller
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Collegium Helveticum, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Brazil.
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
authors.forename: Jules
authors.initials: J
authors.lastname: Angst
authors.affiliation: Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Preisig
mesh_terms: D000328:Adult; D017668:Age of Onset; D001008:Anxiety Disorders / Q000453:epidemiology; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003863:Depression / Q000145:classification*; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D013557:Switzerland / Q000453:epidemiology
keywords: Atypical and melancholic subtypes; Depression; Epidemiology; Sex