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.

Aims: 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.

Conclusion: 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’.

Keywords:

• Major depressive disorder
• depressive symptom combinations
• polythetic definition
• diagnostic heterogeneity
• family resemblances

Disclosure statement

The authors report no conflicts of interest. The authors are responsible for the content and writing of the paper.

Additional information

Funding

This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI10C2020).The Ministry of Health and Welfare had no role in the study design; in the collection, analysis, and interpretation of data, in the writing of the report, or the decision to submit the paper for publication.