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Should the diagnosis of major depression be made independent of or dependent upon the psychosocial context?

Published online by Cambridge University Press:  06 August 2009

K. S. Kendler ,
J. Myers  and
L. J. Halberstadt
K. S. Kendler*
Affiliation:
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
J. Myers
Affiliation:
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
L. J. Halberstadt
Affiliation:
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
*
*Address for correspondence: K. S. Kendler, M.D., Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Box 980126, 800 E. Leigh Street, Room 1-123, Richmond, VA 23298-0126, USA. (Email: [email protected])
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Abstract

Background

The diagnosis of certain psychiatric syndromes (e.g. panic attacks, post-traumatic stress disorder) is crucially dependent on the psychosocial context in which they arise. For other syndromes (e.g. schizophrenia), the context is generally irrelevant. Should the diagnosis of major depression (MD) be made dependent upon or independent of the psychosocial context in which it occurs?

Method

Twins were selected from a population-based registry who, on personal interview, reported developing a full depressive syndrome either ‘out of the blue’ or in response to stressful life events (SLEs) rated objectively as having mild, low moderate, high moderate or severe long-term contextual threat (LTCT).

Results

In these depressed subjects, no relationship was found between the level of adversity associated with onset and most indices of liability to depression, including risk of MD in co-twin and parents, level of neuroticism, risk for future depressive episodes, co-morbidity with other internalizing disorders and history of sexual abuse. Compared to the remainder of this epidemiologic cohort, subjects developing depression in response to the severe threat events had substantially elevated levels of all the examined indices of liability to MD.

Conclusions

Individuals who develop a full depressive syndrome in response to high-threat events do not have an appreciably lower liability to MD than those developing depression after exposure to low adversity and have much higher liability to depression than observed in their population cohort. These results support the hypothesis that, in general, MD can be diagnosed independently of the psychosocial context in which it arises.

Keywords

Diagnosismajor depressionstressful life events
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 5 , May 2010 , pp. 771 - 780
Copyright
Copyright © Cambridge University Press 2009

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References

APA (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association: Washington, DC.Google Scholar
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. American Psychiatric Association: Washington, DC.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. American Psychiatric Association: Washington, DC.Google Scholar
Brown, GW, Harris, TO (1989). Life Events and Illness. Guilford Press: New York.Google Scholar
Coryell, W, Winokur, G, Maser, JD, Akiskal, HS, Keller, MB, Endicott, J (1994). Recurrently situational (reactive) depression: a study of course, phenomenology and familial psychopathology. Journal of Affective Disorders 31, 203–210.CrossRefGoogle ScholarPubMed
Endicott, J, Andreasen, N, Spitzer, RL (1975). Family History Research Diagnostic Criteria. Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Eysenck, SBG, Eysenck, HJ, Barrett, P (1985). A revised version of the psychoticism scale. Personality and Individual Differences 6, 21–29.CrossRefGoogle Scholar
Fleiss, JS, Cohen, J, Everett, BS (1969). Large sample standard errors of kappa and weighted kappa. Psychological Bulletin 72, 323–327.CrossRefGoogle Scholar
Hirschfeld, RM (1981). Situational depression: validity of the concept. British Journal of Psychiatry 139, 297–305.CrossRefGoogle ScholarPubMed
Horwitz, AV, Wakefield, JC (2007). The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. Oxford University Press: USA.CrossRefGoogle Scholar
Jaspers, K (1963). General Psychopathology. University of Chicago Press: Chicago.Google Scholar
Joffe, RT, Levitt, AJ, Bagby, RM, Regan, JJ (1993). Clinical features of situational and nonsituational major depression. Psychopathology 26, 138–144.CrossRefGoogle ScholarPubMed
Kendler, KS (2008). Book review: The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. By A. V. Horwitz and J. C. Wakefield. Psychological Medicine 38, 148–150.CrossRefGoogle Scholar
Kendler, KS, Bulik, CM, Silberg, J, Hettema, JM, Myers, J, Prescott, CA (2000 a). Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Archives of General Psychiatry 57, 953–959.CrossRefGoogle ScholarPubMed
Kendler, KS, Gardner, CO, Prescott, CA (1999). Clinical characteristics of major depression that predict risk of depression in relatives. Archives of General Psychiatry 56, 322–327.CrossRefGoogle ScholarPubMed
Kendler, KS, Gardner, CO, Prescott, CA (2001). Panic syndromes in a population-based sample of male and female twins. Psychological Medicine 31, 989–1000.CrossRefGoogle Scholar
Kendler, KS, Gatz, M, Gardner, C, Pedersen, NL (2006). Personality and major depression: a Swedish longitudinal, population-based twin study. Archives of General Psychiatry 63, 1113–1120.CrossRefGoogle ScholarPubMed
Kendler, KS, Gatz, M, Gardner, CO, Pedersen, NL (2005). Age at onset and familial risk for major depression in a Swedish national twin sample. Psychological Medicine 35, 1573–1579.CrossRefGoogle Scholar
Kendler, KS, Karkowski, LM, Prescott, CA (1998). Stressful life events and major depression: risk period, long-term contextual threat, and diagnostic specificity. Journal of Nervous and Mental Disease 186, 661–669.CrossRefGoogle ScholarPubMed
Kendler, KS, Myers, J, Prescott, CA (2000 b). Parenting and adult mood, anxiety and substance use disorders in female twins: an epidemiological, multi-informant, retrospective study. Psychological Medicine 30, 281–294.CrossRefGoogle ScholarPubMed
Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ (1993). A longitudinal twin study of personality and major depression in women. Archives of General Psychiatry 50, 853–862.CrossRefGoogle ScholarPubMed
Kendler, KS, Prescott, CA (2006). Genes, Environment, and Psychopathology: Understanding the Causes of Psychiatric and Substance Use Disorders. Guilford Press: New York.Google Scholar
Kendler, KS, Prescott, CA, Myers, J, Neale, MC (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry 60, 929–937.CrossRefGoogle ScholarPubMed
McGuffin, P, Katz, R, Bebbington, P (1988). The Camberwell Collaborative Depression Study. III. Depression and adversity in the relatives of depressed probands. British Journal of Psychiatry 152, 775–782.CrossRefGoogle ScholarPubMed
Mendels, J, Cochrane, C (1968). The nosology of depression: the endogenous-reactive concept. American Journal of Psychiatry 124 (Suppl. 1), 1–11.CrossRefGoogle ScholarPubMed
Parker, G, Tupling, H, Brown, L (1979). A parental bonding instrument. British Journal of Medical Psychology 52, 1–10.CrossRefGoogle Scholar
SAS Publishing (2000). SAS/STAT User's Guide, Version 8. STATS Publishing Inc.: Cary, NC.Google Scholar
Spitzer, RL, Williams, JBW (1985). Structured Clinical Interview for DSM-III-R (SCID). Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Sullivan, PF, Neale, MC, Kendler, KS (2000). Genetic epidemiology of major depression: review and meta-analysis. American Journal of Psychiatry 157, 1552–1562.CrossRefGoogle ScholarPubMed
Whitehead, J (1993). Sample size calculations for ordered categorical data. Statistical Medicine 12, 2257–2271.CrossRefGoogle ScholarPubMed