Hostname: page-component-cd4964975-ppllx Total loading time: 0 Render date: 2023-03-31T13:02:18.610Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Stability and transitions of depressive subtypes over a 2-year follow-up

Published online by Cambridge University Press:  17 February 2012

F. Lamers*
Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
D. Rhebergen
Department of Psychiatry/EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
K. R. Merikangas
Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
P. de Jonge
Interdisciplinary Center for Psychiatric Epidemiology (ICPE), Department of Psychiatry and Department of Internal Medicine, University Medical Center Groningen, University of Groningen, The Netherlands
A. T. F. Beekman
Department of Psychiatry/EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
B. W. J. H. Penninx
Department of Psychiatry/EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Interdisciplinary Center for Psychiatric Epidemiology (ICPE), Department of Psychiatry and Department of Internal Medicine, University Medical Center Groningen, University of Groningen, The Netherlands Department of Psychiatry, Leiden University Medical Center, The Netherlands
*Address for correspondence: Dr F. Lamers, Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, 35 Convent Drive, Room 1A108, MSC 3720, Bethesda, MD 20892-3720, USA. (Email:



Identifying depressive subtypes is an important tool in reducing the heterogeneity of major depressive disorder. However, few studies have examined the stability of putative subtypes of depression over time.


The sample included 488 persons from the Netherlands Study of Depression and Anxiety (NESDA) who had major depressive disorder at baseline and at the 2-year follow-up assessment. A latent transition analysis (LTA) was applied to examine the stability of depressive subtypes across time-points. Differences in demographic, clinical, psychosocial and health correlates between subtypes were evaluated in a subsample of persons with stable subtypes.


Three subtypes were identified at each time-point: a moderate subtype (prevalence T0 39%, T1 42%), a severe typical subtype (T0 30%, T1 25%), and a severe atypical subtype (T0 31%, T1 34%). The LTA showed 76% stability across the 2-year follow-up, with the greatest stability in the severe atypical class (79%). Analyses of correlates in the stable subtypes showed a predominance of women and more overweight and obesity in the severe atypical subtype, and a greater number of negative life events and higher neuroticism and functioning scores in the severe typical subtype.


Subtypes of major depressive disorder were found to be stable across a 2-year follow-up and to have distinct determinants, supporting the notion that the identified subtypes are clinically meaningful.

Original Articles
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Andrews, G, Peters, L (1998). The psychometric properties of the Composite International Diagnostic Interview. Social Psychiatry and Psychiatric Epidemiology 33, 8088.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A, Benazzi, F, Ajdacic, V, Rossler, W (2007). Melancholia and atypical depression in the Zurich study: epidemiology, clinical characteristics, course, comorbidity and personality. Acta Psychiatrica Scandinavica 155, 7284.CrossRefGoogle Scholar
Angst, J, Gamma, A, Benazzi, F, Silverstein, B, Ajdacic-Gross, V, Eich, D, Rossler, W (2006). Atypical depressive syndromes in varying definitions. European Archives of Psychiatry and Clinical Neuroscience 256, 4454.CrossRefGoogle ScholarPubMed
Baumeister, H, Parker, G (2011). Meta-review of depressive subtyping models. Journal of Affective Disorders. Published online: 31 August 2011. doi:10.1016/j.jad.2011.1007.1015.Google Scholar
Bech, P (2010). Struggle for subtypes in primary and secondary depression and their mode-specific treatment or healing. Psychotherapy and Psychosomatics 79, 331338.CrossRefGoogle ScholarPubMed
Brodaty, H, Luscombe, G, Parker, G, Wilhelm, K, Hickie, I, Austin, MP, Mitchell, P (1997). Increased rate of psychosis and psychomotor change in depression with age. Psycholgical Medicine 27, 12051213.CrossRefGoogle ScholarPubMed
Brugha, T, Bebbington, P, Tennant, C, Hurry, J (1985). The List of Threatening Experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine 15, 189194.CrossRefGoogle ScholarPubMed
Buist-Bouwman, MA, Ormel, J, De Graaf, R, Vilagut, G, Alonso, J, Van Sonderen, E, Vollebergh, WA (2008). Psychometric properties of the World Health Organization Disability Assessment Schedule used in the European Study of the Epidemiology of Mental Disorders. International Journal of Methods in Psychiatric Research 17, 185197.CrossRefGoogle ScholarPubMed
Chwastiak, LA, Von Korff, M (2003). Disability in depression and back pain: evaluation of the World Health Organization Disability Assessment Schedule (WHO DAS II) in a primary care setting. Journal of Clinical Epidemiology 56, 507514.CrossRefGoogle Scholar
Collins, LM, Wugalter, SE (1992). Latent class models for stage-sequential dynamic latent variables. Multivariate Behavioural Research 27, 131157.CrossRefGoogle Scholar
Coryell, W, Winokur, G, Shea, T, Maser, JD, Endicott, J, Akiskal, HS (1994). The long-term stability of depressive subtypes. American Journal of Psychiatry 151, 199204.Google ScholarPubMed
Costa, Jr. PT, McCrae, RR (1995). Domains and facets: hierarchical personality assessment using the revised NEO personality inventory. Journal of Personality Assessment 64, 2150.CrossRefGoogle ScholarPubMed
de Graaf, R, Bijl, RV, Smit, F, Vollebergh, WA, Spijker, J (2002). Risk factors for 12-month comorbidity of mood, anxiety, and substance use disorders: findings from the Netherlands Mental Health Survey and Incidence Study. American Journal of Psychiatry 159, 620629.CrossRefGoogle ScholarPubMed
Frank, E, Anderson, B, Reynolds, CF III, Ritenour, A, Kupfer, DJ (1994). Life events and the research diagnostic criteria endogenous subtype. A confirmation of the distinction using the Bedford College methods. Archives of General Psychiatry 51, 519524.CrossRefGoogle ScholarPubMed
Fyer, AJ, Weissman, MM (1999). Genetic linkage study of panic: clinical methodology and description of pedigrees. American Journal of Medical Genetics 88, 173181.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
Geiser, C, Lehmann, W, Eid, M (2006). Separating ‘rotators’ from ‘nonrotators’ in the Mental Rotations Test: a multigroup latent class analysis. Multivariate Behavioral Research 41, 261293.CrossRefGoogle ScholarPubMed
Gold, PW, Chrousos, GP (2002). Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states. Molecular Psychiatry 7, 254275.CrossRefGoogle ScholarPubMed
Graham, JW, Collins, LM, Wugalter, SE, Chung, NK, Hansen, WB (1991). Modeling transitions in latent stage-sequential processes: a substance use prevention example. Journal of Consulting and Clinical Psychology 59, 4857.CrossRefGoogle ScholarPubMed
Harkness, KL, Monroe, SM (2002). Childhood adversity and the endogenous versus nonendogenous distinction in women with major depression. American Journal of Psychiatry 159, 387393.CrossRefGoogle ScholarPubMed
Hasler, G, Pine, DS, Kleinbaum, DG, Gamma, A, Luckenbaugh, D, Ajdacic, V, Eich, D, Rossler, W, Angst, J (2005). Depressive symptoms during childhood and adult obesity: the Zurich Cohort Study. Molecular Psychiatry 10, 842850.CrossRefGoogle ScholarPubMed
Hirschfeld, RM, Williams, JB, Spitzer, RL, Calabrese, JR, Flynn, L, Keck, PE Jr., Lewis, L, McElroy, SL, Post, RM, Rapport, DJ, Russell, JM, Sachs, GS, Zajecka, J (2000). Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. American Journal of Psychiatry 157, 18731875.CrossRefGoogle ScholarPubMed
Hoekstra, HA, Ormel, J, de Fruyt, F (1996). Handleiding NEO persoonlijkheidsvragenlijsten NEO-PI-R en NEO-FFI [Manual NEO personality questionnaires NEO-PI-R and NEO-FFI]. Swets Test Services: Lisse.Google Scholar
IDS/QIDS (2012). Instruments in English and Multiple Translations ( Accessed 6 January 2012.Google Scholar
Kleinjan, M, Wanner, B, Vitaro, F, Van den Eijnden, RJ, Brug, J, Engels, RC (2010). Nicotine dependence subtypes among adolescent smokers: examining the occurrence, development and validity of distinct symptom profiles. Psychology of Addictive Behaviors 24, 6174.CrossRefGoogle ScholarPubMed
Lamers, F, de Jonge, P, Nolen, WA, Smit, JH, Zitman, FG, Beekman, AT, Penninx, BW (2010). Identifying depressive subtypes in a large cohort study: results from the Netherlands Study of Depression and Anxiety (NESDA). Journal of Clinical Psychiatry 71, 15821589.CrossRefGoogle Scholar
Lamers, F, Hoogendoorn, AW, Smit, JH, van Dyck, R, Zitman, FG, Nolen, WA, Penninx, BWJH (2012). Socio-demographic and psychiatric determinants of attrition in the Netherlands Study of Depression and Anxiety (NESDA). Comprehensive Psychiatry 53, 6370.CrossRefGoogle Scholar
Lewinsohn, PM, Pettit, JW, Joiner, TE Jr., Seeley, JR (2003). The symptomatic expression of major depressive disorder in adolescents and young adults. Journal of Abnormal Psychology 112, 244252.CrossRefGoogle ScholarPubMed
Lichtenberg, P, Belmaker, RH (2010). Subtyping major depressive disorder. Psychotherapy and Psychosomatics 79, 131135.CrossRefGoogle ScholarPubMed
Luppino, FS, de Wit, LM, Bouvy, PF, Stijnen, T, Cuijpers, P, Penninx, BW, Zitman, FG (2010). Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry 67, 220229.CrossRefGoogle ScholarPubMed
Lyketsos, CG, Nestadt, G, Cwi, J, Heithoff, K, Eaton, WW (1994). The Life Chart Interview: a standardized method to describe the course of psychopathology. International Journal of Methods in Psychiatric Research 4, 143155.Google Scholar
Matza, LS, Revicki, DA, Davidson, JR, Stewart, JW (2003). Depression with atypical features in the National Comorbidity Survey: classification, description, and consequences. Archives of General Psychiatry 60, 817826.CrossRefGoogle ScholarPubMed
Minor, KL, Champion, JE, Gotlib, IH (2005). Stability of DSM-IV criterion symptoms for major depressive disorder. Journal of Psychiatric Research 39, 415420.CrossRefGoogle ScholarPubMed
Muthén, LK, Muthén, BO (1998–2010). Mplus User's Guide, 6th edn. Muthén, Muthén: Los Angeles, CA.Google Scholar
Nierenberg, AA, Pava, JA, Clancy, K, Rosenbaum, JF, Fava, M (1996). Are neurovegetative symptoms stable in relapsing or recurrent atypical depressive episodes? Biological Psychiatry 40, 691696.CrossRefGoogle ScholarPubMed
Nylund, K (2007). Latent transition analysis: modeling extensions and an application to peer victimization. Doctoral dissertation, University of California, Los Angeles.Google Scholar
Nylund, KL, Asparouhov, T, Muthen, B (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Structural Equation Modeling 14, 535569.CrossRefGoogle Scholar
Oquendo, MA, Barrera, A, Ellis, SP, Li, S, Burke, AK, Grunebaum, M, Endicott, J, Mann, JJ (2004). Instability of symptoms in recurrent major depression: a prospective study. American Journal of Psychiatry 161, 255261.CrossRefGoogle ScholarPubMed
Parker, G, Roy, K, Hadzi-Pavlovic, D, Wilhelm, K, Mitchell, P (2001). The differential impact of age on the phenomenology of melancholia. Psychological Medicine 31, 12311236.CrossRefGoogle ScholarPubMed
Paykel, ES, Prusoff, BA, Tanner, J (1976). Temporal stability of symptom patterns in depression. British Journal of Psychiatry 128, 369374.CrossRefGoogle ScholarPubMed
Penninx, BWJH, Beekman, ATF, Smit, JH, Zitman, FG, Nolen, WA, Spinhoven, P, Cuijpers, P, de Jong, PJ, van Marwijk, HWJ, Assendelft, WJJ, van der Meer, K, Verhaak, P, Wensing, M, de Graaf, R, Hoogendijk, WJ, Ormel, J, van Dyck, R; NESDA Research Consortium (2008). The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectives and methods. International Journal of Methods in Psychiatric Research 17, 121140.CrossRefGoogle ScholarPubMed
Rivera, M, Cohen-Woods, S, Kapur, K, Breen, G, Ng, MY, Butler, AW, Craddock, N, Gill, M, Korszun, A, Maier, W, Mors, O, Owen, MJ, Preisig, M, Bergmann, S, Tozzi, F, Rice, J, Rietschel, M, Rucker, J, Schosser, A, Aitchison, KJ, Uher, R, Craig, IW, Lewis, CM, Farmer, AE, McGuffin, P (2011). Depressive disorder moderates the effect of the FTO gene on body mass index. Molecular Psychiatry. Published online: 19 April 2011. doi:10.1038/mp.2011.1045.Google ScholarPubMed
Rush, AJ, Gullion, CM, Basco, MR, Jarrett, RB, Trivedi, MH (1996). The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychological Medicine 26, 477486.CrossRefGoogle ScholarPubMed
Stoolmiller, M, Kim, HK, Capaldi, DM (2005). The course of depressive symptoms in men from early adolescence to young adulthood: identifying latent trajectories and early predictors. Journal of Abnormal Psychology 114, 331345.CrossRefGoogle ScholarPubMed
Stunkard, AJ, Fernstrom, MH, Price, A, Frank, E, Kupfer, DJ (1990). Direction of weight change in recurrent depression. Consistency across episodes. Archives of General Psychiatry 47, 857860.CrossRefGoogle ScholarPubMed
Sullivan, PF, Kessler, RC, Kendler, KS (1998). Latent class analysis of lifetime depressive symptoms in the National Comorbidity Survey. American Journal of Psychiatry 155, 13981406.CrossRefGoogle ScholarPubMed
Sullivan, PF, Prescott, CA, Kendler, KS (2002). The subtypes of major depression in a twin registry. Journal of Affective Disorders 68, 273284.CrossRefGoogle Scholar
Vogelzangs, N, Beekman, AT, Boelhouwer, IG, Bandinelli, S, Milaneschi, Y, Ferrucci, L, Penninx, BW (2011). Metabolic depression: a chronic depressive subtype? Findings from the InCHIANTI study of older persons. Journal of Clinical Psychiatry 72, 598604.CrossRefGoogle ScholarPubMed
Von Korff, M (2001). Epidemiologic and survey methods: chronic pain assessment. In Handbook of Pain Assessment , 2nd edn (ed. Turk, D. C. and Melzack, R.), pp. 603618. Guilford Press: New York.Google Scholar
West, ED, Dally, PJ (1959). Effects of iproniazid in depressive syndromes. British Medical Journal 1, 14911494.CrossRefGoogle ScholarPubMed
WHO (1997). Composite International Diagnostic Interview, Core Version 2.1: Interviewer's Manual. World Health Organization: Sydney, Australia.Google Scholar
Yang, CC (2006). Evaluating latent class analysis models in qualitative phenotype identification. Computational Statistics and Data Analysis 50, 10901104.CrossRefGoogle Scholar
Young, MA, Fogg, LF, Scheftner, WA, Fawcett, JA (1990). Concordance of symptoms in recurrent depressive episodes. Journal of Affective Disorders 20, 7985.CrossRefGoogle ScholarPubMed
Young, MA, Keller, MB, Lavori, PW, Scheftner, WA, Fawcett, JA, Endicott, J, Hirschfeld, RM (1987). Lack of stability of the RDC endogenous subtype in consecutive episodes of major depression. Journal of Affective Disorders 12, 139143.CrossRefGoogle ScholarPubMed