title: How many different symptom combinations fulfil the diagnostic criteria for major depressive disorder? Results from the CRESCEND study.
abstract: BACKGROUND
  The polythetic nature of major depressive disorder (MDD) in DSM- IV and DSM-5 inevitably leads to diagnostic heterogeneity.
  
  
  OBJECTIVE
  This study aimed to identify the number of depressive symptom combinations actually fulfilling the DSM-IV diagnostic criteria that can be found in Korean MDD patients and the relative frequencies of each combination.
  
  
  METHODS
  Using the data from the Clinical Research Center for Depression (CRESCEND) study in South Korea, we enrolled 853 MDD patients diagnosed using DSM-IV and scored as 8 or more on the Hamilton Depression Rating Scale (HAMD). Descriptive statistical analyses were performed to reveal the degree of diagnostic heterogeneity of the MDD.
  
  
  RESULTS
  This study identified 119 different depressive symptom combinations. The most common combination consisted of all nine depressive symptom profiles, and nine different combinations were each present in more than 3% of the patients.
  
  
  CONCLUSIONS
  The findings support the criticism that the diagnosis of MDD is not based on a single mental process, but on a set of 'family resemblances'.
authors.affiliation: a Department of Psychiatry , Inje University Haeundae Paik Hospital , Busan , Republic of Korea.
authors.forename: Seon-Cheol
authors.initials: SC
authors.lastname: Park
authors.affiliation: b Department of Psychiatry , Chonnam National University School of Medicine , Gwangju , Republic of Korea.
authors.forename: Jae-Min
authors.initials: JM
authors.lastname: Kim
authors.affiliation: c Department of Psychiatry , Catholic University of Korea College of Medicine , Seoul , Republic of Korea.
authors.forename: Tae-Youn
authors.initials: TY
authors.lastname: Jun
authors.affiliation: d Department of Psychiatry , Korea University College of Medicine , Seoul , Republic of Korea.
authors.forename: Min-Soo
authors.initials: MS
authors.lastname: Lee
authors.affiliation: e Department of Psychiatry , Keimyung University School of Medicine , Daegu , Republic of Korea.
authors.forename: Jung-Bum
authors.initials: JB
authors.lastname: Kim
authors.affiliation: f Department of Preventive Medicine , Catholic University of Korea College of Medicine , Seoul , Republic of Korea.
authors.forename: Hyeon-Woo
authors.initials: HW
authors.lastname: Yim
authors.affiliation: g Department of Psychiatry , Hanyang University Guri Hospital , Guri , Republic of Korea.
authors.forename: Yong Chon
authors.initials: YC
authors.lastname: Park
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea
keywords: Major depressive disorder; depressive symptom combinations; diagnostic heterogeneity; family resemblances; polythetic definition