Depression is more than the sum score of its parts: Individual DSM symptoms have different risk factors

E. I. Fried, Randolph Nesse, K. Zivin, C. Guille, S. Sen

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

Background For diagnostic purposes, the nine symptoms that compose the DSM-5 criteria for major depressive disorder (MDD) are assumed to be interchangeable indicators of one underlying disorder, implying that they should all have similar risk factors. The present study investigates this hypothesis, using a population cohort that shifts from low to elevated depression levels. Method We assessed the nine DSM-5 MDD criterion symptoms (using the Patient Health Questionnaire; PHQ-9) and seven depression risk factors (personal and family MDD history, sex, childhood stress, neuroticism, work hours, and stressful life events) in a longitudinal study of medical interns prior to and throughout internship (n = 1289). We tested whether risk factors varied across symptoms, and whether a latent disease model could account for heterogeneity between symptoms. Results All MDD symptoms increased significantly during residency training. Four risk factors predicted increases in unique subsets of PHQ-9 symptoms over time (depression history, childhood stress, sex, and stressful life events), whereas neuroticism and work hours predicted increases in all symptoms, albeit to varying magnitudes. MDD family history did not predict increases in any symptom. The strong heterogeneity of associations persisted after controlling for a latent depression factor. Conclusions The influence of risk factors varies substantially across DSM depression criterion symptoms. As symptoms are etiologically heterogeneous, considering individual symptoms in addition to depression diagnosis might offer important insights obfuscated by symptom sum scores.

Original languageEnglish (US)
Pages (from-to)2067-2076
Number of pages10
JournalPsychological Medicine
Volume44
Issue number10
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Major Depressive Disorder
Depression
Internship and Residency
Longitudinal Studies
Health
Population
Neuroticism

Keywords

  • Depression
  • Depressive symptoms
  • DSM
  • Heterogeneity
  • Psychiatric diagnosis
  • Residency

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology

Cite this

Depression is more than the sum score of its parts : Individual DSM symptoms have different risk factors. / Fried, E. I.; Nesse, Randolph; Zivin, K.; Guille, C.; Sen, S.

In: Psychological Medicine, Vol. 44, No. 10, 2014, p. 2067-2076.

Research output: Contribution to journalArticle

Fried, E. I. ; Nesse, Randolph ; Zivin, K. ; Guille, C. ; Sen, S. / Depression is more than the sum score of its parts : Individual DSM symptoms have different risk factors. In: Psychological Medicine. 2014 ; Vol. 44, No. 10. pp. 2067-2076.
@article{7771476fe9ae48e0acf722c64e1ee3b7,
title = "Depression is more than the sum score of its parts: Individual DSM symptoms have different risk factors",
abstract = "Background For diagnostic purposes, the nine symptoms that compose the DSM-5 criteria for major depressive disorder (MDD) are assumed to be interchangeable indicators of one underlying disorder, implying that they should all have similar risk factors. The present study investigates this hypothesis, using a population cohort that shifts from low to elevated depression levels. Method We assessed the nine DSM-5 MDD criterion symptoms (using the Patient Health Questionnaire; PHQ-9) and seven depression risk factors (personal and family MDD history, sex, childhood stress, neuroticism, work hours, and stressful life events) in a longitudinal study of medical interns prior to and throughout internship (n = 1289). We tested whether risk factors varied across symptoms, and whether a latent disease model could account for heterogeneity between symptoms. Results All MDD symptoms increased significantly during residency training. Four risk factors predicted increases in unique subsets of PHQ-9 symptoms over time (depression history, childhood stress, sex, and stressful life events), whereas neuroticism and work hours predicted increases in all symptoms, albeit to varying magnitudes. MDD family history did not predict increases in any symptom. The strong heterogeneity of associations persisted after controlling for a latent depression factor. Conclusions The influence of risk factors varies substantially across DSM depression criterion symptoms. As symptoms are etiologically heterogeneous, considering individual symptoms in addition to depression diagnosis might offer important insights obfuscated by symptom sum scores.",
keywords = "Depression, Depressive symptoms, DSM, Heterogeneity, Psychiatric diagnosis, Residency",
author = "Fried, {E. I.} and Randolph Nesse and K. Zivin and C. Guille and S. Sen",
year = "2014",
doi = "10.1017/S0033291713002900",
language = "English (US)",
volume = "44",
pages = "2067--2076",
journal = "Psychological Medicine",
issn = "0033-2917",
publisher = "Cambridge University Press",
number = "10",

}

TY - JOUR

T1 - Depression is more than the sum score of its parts

T2 - Individual DSM symptoms have different risk factors

AU - Fried, E. I.

AU - Nesse, Randolph

AU - Zivin, K.

AU - Guille, C.

AU - Sen, S.

PY - 2014

Y1 - 2014

N2 - Background For diagnostic purposes, the nine symptoms that compose the DSM-5 criteria for major depressive disorder (MDD) are assumed to be interchangeable indicators of one underlying disorder, implying that they should all have similar risk factors. The present study investigates this hypothesis, using a population cohort that shifts from low to elevated depression levels. Method We assessed the nine DSM-5 MDD criterion symptoms (using the Patient Health Questionnaire; PHQ-9) and seven depression risk factors (personal and family MDD history, sex, childhood stress, neuroticism, work hours, and stressful life events) in a longitudinal study of medical interns prior to and throughout internship (n = 1289). We tested whether risk factors varied across symptoms, and whether a latent disease model could account for heterogeneity between symptoms. Results All MDD symptoms increased significantly during residency training. Four risk factors predicted increases in unique subsets of PHQ-9 symptoms over time (depression history, childhood stress, sex, and stressful life events), whereas neuroticism and work hours predicted increases in all symptoms, albeit to varying magnitudes. MDD family history did not predict increases in any symptom. The strong heterogeneity of associations persisted after controlling for a latent depression factor. Conclusions The influence of risk factors varies substantially across DSM depression criterion symptoms. As symptoms are etiologically heterogeneous, considering individual symptoms in addition to depression diagnosis might offer important insights obfuscated by symptom sum scores.

AB - Background For diagnostic purposes, the nine symptoms that compose the DSM-5 criteria for major depressive disorder (MDD) are assumed to be interchangeable indicators of one underlying disorder, implying that they should all have similar risk factors. The present study investigates this hypothesis, using a population cohort that shifts from low to elevated depression levels. Method We assessed the nine DSM-5 MDD criterion symptoms (using the Patient Health Questionnaire; PHQ-9) and seven depression risk factors (personal and family MDD history, sex, childhood stress, neuroticism, work hours, and stressful life events) in a longitudinal study of medical interns prior to and throughout internship (n = 1289). We tested whether risk factors varied across symptoms, and whether a latent disease model could account for heterogeneity between symptoms. Results All MDD symptoms increased significantly during residency training. Four risk factors predicted increases in unique subsets of PHQ-9 symptoms over time (depression history, childhood stress, sex, and stressful life events), whereas neuroticism and work hours predicted increases in all symptoms, albeit to varying magnitudes. MDD family history did not predict increases in any symptom. The strong heterogeneity of associations persisted after controlling for a latent depression factor. Conclusions The influence of risk factors varies substantially across DSM depression criterion symptoms. As symptoms are etiologically heterogeneous, considering individual symptoms in addition to depression diagnosis might offer important insights obfuscated by symptom sum scores.

KW - Depression

KW - Depressive symptoms

KW - DSM

KW - Heterogeneity

KW - Psychiatric diagnosis

KW - Residency

UR - http://www.scopus.com/inward/record.url?scp=84902302780&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902302780&partnerID=8YFLogxK

U2 - 10.1017/S0033291713002900

DO - 10.1017/S0033291713002900

M3 - Article

C2 - 24289852

AN - SCOPUS:84902302780

VL - 44

SP - 2067

EP - 2076

JO - Psychological Medicine

JF - Psychological Medicine

SN - 0033-2917

IS - 10

ER -