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Depression subtypes and their response to cognitive behavioral therapy: A latent transition analysis
Author(s) -
SimmondsBuckley Melanie,
Catarino Ana,
Delgadillo Jaime
Publication year - 2021
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.23161
Subject(s) - depression (economics) , clinical psychology , cognition , differential item functioning , psychology , latent class model , cognitive behavioral therapy , medicine , psychiatry , item response theory , psychometrics , statistics , mathematics , economics , macroeconomics
Background Depression is a heterogeneous condition, with multiple possible symptom‐profiles leading to the same diagnosis. Descriptive depression subtypes based on observation and theory have so far proven to have limited clinical utility. Aim To identify depression subtypes and to examine their time‐course and prognosis using data‐driven methods. Methods Latent transition analysis was applied to a large ( N = 8380) multi‐service sample of depressed patients treated with cognitive behavioral therapy (CBT) in outpatient clinics. Patients were classed into initial latent states based on their responses to the Patient Health Questionnaire‐9 of depression symptoms, and transition probabilities to other states during treatment were quantified. Qualitatively similar states were clustered into overarching depression subtypes and we statistically compared indices of treatment engagement and outcomes between subtypes using post hoc analyses. Results Fourteen latent states were clustered into five depression subtypes: mild (2.7%), severe (9.8%), cognitive‐affective (23.7%), somatic (21.4%), and typical (42.4%). These subtypes had high temporal stability, and the most common transitions during treatment were from severe toward milder states within the same subtype. Differential response to treatment was evident, with the highest improvement rate (63.6%) observed in the cognitive‐affective subtype. Conclusion Replicated evidence indicates that depression subtypes are temporally stable and associated with differential response to CBT.