Data-driven subtypes of major depressive disorder: a systematic review

Abstract

Background: According to current classification systems, patients with major depressive disorder (MDD) may have very different combinations of symptoms. This symptomatic diversity hinders the progress of research into the causal mechanisms and treatment allocation. Theoretically founded subtypes of depression such as atypical, psychotic, and melancholic depression have limited clinical applicability. Data-driven analyses of symptom dimensions or subtypes of depression are scarce. In this systematic review, we examine the evidence for the existence of data-driven symptomatic subtypes of depression.

Methods: We undertook a systematic literature search of MEDLINE, PsycINFO and Embase in May 2012. We included studies analyzing the depression criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) of adults with MDD in latent variable analyses.

Results: In total, 1176 articles were retrieved, of which 20 satisfied the inclusion criteria. These reports described a total of 34 latent variable analyses: 6 confirmatory factor analyses, 6 exploratory factor analyses, 12 principal component analyses, and 10 latent class analyses. The latent class techniques distinguished 2 to 5 classes, which mainly reflected subgroups with different overall severity: 62 of 71 significant differences on symptom level were congruent with a latent class solution reflecting severity. The latent class techniques did not consistently identify specific symptom clusters. Latent factor techniques mostly found a factor explaining the variance in the symptoms depressed mood and interest loss (11 of 13 analyses), often complemented by psychomotor retardation or fatigue (8 of 11 analyses). However, differences in found factors and classes were substantial.

Conclusions: The studies performed to date do not provide conclusive evidence for the existence of depressive symptom dimensions or symptomatic subtypes. The wide diversity of identified factors and classes might result either from the absence of patterns to be found, or from the theoretical and modeling choices preceding analysis.

Figure 1

Flow chart of the review.

Figure 2

Latent class analyses.

Figure 3

General results from latent class analyses. Abbreviations: tot., total significant differences in scores on disaggregated symptoms; exc., exceptions on ordering based on severity.

Figure 4

Principal component and exploratory factor analyses.

Figure 5

Pairwise common factor loadings. The x- and z-axes show disaggregated depressive symptoms, while the y-axis shows the proportion of pairwise common factor loadings.

Figure 6

Frequencies of symptom combinations loading on a common factor. The x-axis shows all symptom combinations loading on a common factor, while the y-axis shows the number of times this specific common factor has been identified.