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Deconstructing major depression: a validation study of the DSM-IV symptomatic criteria

  • V. Lux (a1) and K. S. Kendler (a2)
  • DOI:
  • Published online: 11 January 2010

The DSM-IV symptomatic criteria for major depression (MD) derive primarily from clinical experience with modest empirical support.


The sample studied included 1015 (518 males, 497 females) Caucasian twins from a population-based registry who met criteria for MD in the year prior to the interview. Logistic regression analyses were conducted to compare the associations of: (1) single symptomatic criterion, (2) two groups of criteria reflecting cognitive and neurovegetative symptoms, with a wide range of potential validators including demographic factors, risk for future episodes, risk of MD in the co-twin, characteristics of the depressive episode, the pattern of co-morbidity and personality traits.


The individual symptomatic criteria showed widely varying associations with the pattern of co-morbidity, personality traits, features of the depressive episode and demographic characteristics. When examined separately, these two criteria groups showed robust differences in their patterns of association, with the validators with the cognitive criteria generally producing stronger associations than the neurovegetative.


Among depressed individuals, individual DSM-IV symptomatic criteria differ substantially in their predictive relationship with a range of clinical validators. These results challenge the equivalence assumption for the symptomatic criteria for MD and suggest a more than expected degree of ‘covert’ heterogeneity among these criteria. Part of this heterogeneity is captured by the distinction between cognitive versus neurovegetative symptoms, with cognitive symptoms being more strongly associated with most clinically relevant characteristics. Detailed psychometric evaluation of DSM-IV criteria is overdue.

Corresponding author
*Address for correspondence: Dr K. S. Kendler, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Box 980126, Richmond, VA 23298–0126, USA. (Email:
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HS Akiskal , WT McKinney Jr. (1975). Overview of recent research in depression. Integration of ten conceptual models into a comprehensive clinical frame. Archives of General Psychiatry 32, 285305.

J Angst , A Dobler-Mikola (1984). Do the diagnostic criteria determine the sex ratio in depression? Journal of Affective Disorders 7, 189198.

J Balazs , F Benazzi , Z Rihmer , A Rihmer , KK Akiskal , HS Akiskal (2006). The close link between suicide attempts and mixed (bipolar) depression: implications for suicide prevention. Journal of Affective Disorders 91, 133138.

N Carragher , G Adamson , B Bunting , S McCann (2009). Subtypes of depression in a nationally representative sample. Journal of Affective Disorders 113, 8899.

WL Cassidy , NB Flanagan , M Spellman , ME Cohen (1957). Clinical observations in manic-depressive disease: a quantitative study of one hundred manic-depressive patients and fifty medically sick controls. Journal of the American Medical Association 164, 15351546.

LS Chen , WW Eaton , JJ Gallo , G Nestadt (2000). Understanding the heterogeneity of depression through the triad of symptoms, course and risk factors: a longitudinal, population-based study. Journal of Affective Disorders 59, 111.

SBG Eysenck , HJ Eysenck , P Barrett (1985). A revised version of the psychoticism scale. Personality and Individual Differences 6, 2129.

KO Fagerström (1978). Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addictive Behaviors 3, 235241.

C Faravelli , P Servi , JA Arends , WK Strik (1996). Number of symptoms, quantification, and qualification of depression. Comprehensive Psychiatry 37, 307315.

JP Feighner , E Robins , SB Guze , RA Woodruff Jr., G Winokur , R Munoz (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 5763.

H Feild , A Armenakis (1974). On use of multiple tests of significance in psychological research. Psychological Reports 35, 427431.

CF Hybels , DG Blazer , CF Pieper , LR Landerman , DC Steffens (2009). Profiles of depressive symptoms in older adults diagnosed with major depression: latent cluster analysis. American Journal of Geriatric Psychiatry 17, 387396.

MC Keller , MC Neale , KS Kendler (2007). Association of different adverse life events with distinct patterns of depressive symptoms. American Journal of Psychiatry 164, 15211529.

KS Kendler , LJ Eaves , EE Walters , MC Neale , AC Heath , RC Kessler (1996). The identification and validation of distinct depressive syndromes in a population-based sample of female twins. Archives of General Psychiatry 53, 391399.

KS Kendler , CA Prescott (1999). A population-based twin study of lifetime major depression in men and women. Archives of General Psychiatry 56, 3944.

AA Khan , CO Gardner , CA Prescott , KS Kendler (2002). Gender differences in the symptoms of major depression in opposite-sex dizygotic twin pairs. American Journal of Psychiatry 159, 14271429.

LG Kiloh , RF Garside (1963). The independence of neurotic depression and endogenous depression. British Journal of Psychiatry 109, 451463.

HG Koenig , HJ Cohen , DG Blazer , KR Krishnan , TE Sibert (1993). Profile of depressive symptoms in younger and older medical inpatients with major depression. Journal of the American Geriatric Society 41, 11691176.

AM Leventhal , WC Francione , M Zimmerman (2008). Associations between depression subtypes and substance use disorders. Psychiatry Research 161, 4350.

JB McGlinchey , M Zimmerman , D Young , I Chelminski (2006). Diagnosing major depressive disorder VIII: are some symptoms better than others? Journal of Nervous and Mental Disease 194, 785790.

KR Merikangas , W Wicki , J Angst (1994). Heterogeneity of depression. Classification of depressive subtypes by longitudinal course. British Journal of Psychiatry 164, 342348.

G Parker (2000). Classifying depression: Should paradigms lost be regained? American Journal of Psychiatry 157, 11951203.

G Parker , K Wilhelm , A Asghari (1998). Depressed mood states and their inter-relationship with clinical depression. Social Psychiatry and Psychiatric Epidemiology 33, 1015.

CK Schotte , M Maes , R Cluydts , P Cosyns (1997). Cluster analytic validation of the DSM melancholic depression. The threshold model: integration of quantitative and qualitative distinctions between unipolar depressive subtypes. Psychiatric Research 71, 181195.

RL Spitzer , J Endicott , E Robins (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773782.

RL Spitzer , JL Fleiss (1974). A re-analysis of the reliability of psychiatric diagnosis. British Journal of Psychiatry 125, 341347.

TT Stone , BC Burris (1950). Melancholia; clinical study of 50 selected cases. Journal of the American Medical Association 142, 165168.

PF Sullivan , CA Prescott , KS Kendler (2002). The subtypes of major depression in a twin registry. Journal of Affective Disorders 68, 273284.

HM van Praag (2000). Nosologomania: a disorder of psychiatry. World Journal of Biological Psychiatry 1, 151158.

M Zimmerman , JB McGlinchey , D Young , I Chelminski (2006 a). Diagnosing major depressive disorder III: can some symptoms be eliminated from the diagnostic criteria? Journal of Nervous and Mental Disease 194, 313317.

M Zimmerman , JB McGlinchey , D Young , I Chelminski (2006 b). Diagnosing major depressive disorder introduction: an examination of the DSM-IV diagnostic criteria. Journal of Nervous and Mental Disease 194, 151154.

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