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Predictive validation of single‐episode uncomplicated depression as a benign subtype of unipolar major depression
Author(s) -
Wakefield J. C.,
Schmitz M. F.
Publication year - 2014
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/acps.12184
Subject(s) - major depressive disorder , major depressive episode , depression (economics) , psychology , psychiatry , suicidal ideation , psychomotor retardation , anxiety , generalized anxiety disorder , clinical psychology , medicine , poison control , mood , injury prevention , alternative medicine , environmental health , pathology , economics , macroeconomics
Objective To evaluate the predictive validity of a proposed benign major depressive disorder ( MDD ) subtype, single‐episode ‘uncomplicated MDD ’, defined as MDD that remits within 6 months and lacks severe impairment, psychotic ideation, suicidal ideation, psychomotor retardation, and feeling worthless. Method Using two‐wave National Epidemiologic Survey on Alcohol and Related Conditions data, four groups differing in wave 1 lifetime MDD history (no history [ n = 27 609]; single‐episode uncomplicated [ n = 418]; other single‐episode [ n = 1943]; multiple episode [ n = 2473]) were evaluated for 3‐year follow‐up rates of major depressive episode ( MDE ), generalized anxiety disorder ( GAD ), and suicide attempt. Results Follow‐up rates for no‐ MDD ‐history, single‐episode uncomplicated MDD , other single‐episode MDD , and multiple‐episode MDD , respectively, were depressive episode 6.1%, 6.9%, 19.5%, 27.1%; GAD 2.7%, 4.3%, 7.8%, 11.2%; and suicide attempt 0.3%, 0.1%, 0.8%, 1.7%. For all validators, 3‐year rates for single‐episode uncomplicated cases were not significantly different from no‐ MDD ‐history rates, but significantly lower than both single‐ and multiple‐episode other‐ MDD rates. Mild MDD , defined by having only five or six symptoms, did not yield similarly benign results; logistic regression showed ‘uncomplicated’ provides incremental validity over ‘mild’ in explaining validator rates. Validator differences were not explainable by treatment‐rate differences. Conclusion Single‐episode uncomplicated MDD is a benign subtype lacking typical MDD negative sequelae. The planned DSM ‐5.1 revision should reinstitute an extended bereavement exclusion applied to all stressors.