Ari Solomon

Clinical implications of subthreshold depressive symptoms

There is active debate regarding whether diagnosable depression exists on a continuum with subthreshold depressive symptoms or represents a categorically distinct phenomenon. To address this question, multiple indexes of dysfunction (psychosocial difficulties, mental health treatment history, and future incidence of major depression and substance abuse/dependence) were examined as a function of the extent of depressive symptoms in 3 large community samples (adolescent, adult, and older adult; N = 3,003). Increasing levels of depressive symptoms were associated with increasing levels of psychosocial dysfunction and incidence of major depression and substance use disorders. These findings suggest that (a) the clinical significance of depressive symptoms does not depend on crossing the major depressive diagnostic threshold and (b) depression may best be conceptualized as a continuum. Limitations of the present study are discussed.

Is clinical depression distinct from subthreshold depressive symptoms? A review of the continuity issue in depression research

Resolving whether subthreshold depressive symptoms exist on a continuum with unipolar clinical depression is important for progress on both theoretical and applied issues. To date, most studies have found that individuals with subthreshold depressive symptoms resemble cases of major depressive disorder along many important dimensions (e.g., in terms of patterns of functional impairment, psychiatric and physical comorbidity, familiality, sleeping EEG, and risk of future major depression). However, such manifest similarities do not rule out the possibility of a latent qualitative difference between subthreshold and diagnosable depression. Formal taxonomic analyses, intended to resolve the possibility of a latent qualitative distinction, have so far yielded contradictory findings. Several large-sample latent class analyses (LCA) have identified latent clinical and nonclinical classes of unipolar depression, but LCA is vulnerable to identification of spurious classes. Paul Meehls taxometric methods provide a potentially conservative alternative way to identify latent classes. The one comprehensive taxometric analysis reported to date suggests that self-report depression symptoms occur along a latent continuum but exclusive reliance on self-report depression measures and incomplete information regarding sample base rates of depression makes it difficult to draw strong inferences from that report. We conclude that although most of the evidence at this time appears to favor both a manifest and latent continuum of unipolar depression symptomatology, several important issues remain unresolved. Complete resolution of the continuity question would be speeded by the application of both taxometric techniques and LCA to a single large sample with a known base rate of lifetime diagnosed depressives.

Experiences of anger in people who have recovered from depression and never-depressed people.

Previous research has linked anger suppression with depression. This study extended prior research by comparing people who had recovered from a major depression (RD) with those who had never been depressed (ND). The RD group significantly exceeded the ND group in the degree to which they reported holding anger in and being afraid to express it. Also, RD participants were more likely to endorse attitudes consistent with silencing the self theory, believing they must hide their feelings to preserve relationships. They were also more likely to have experienced an anger attack. Both silencing the self and a history of anger attacks were significantly correlated with fear of anger expression; future longitudinal or experimental studies are needed to determine whether these variables play a causal role in anger inhibition and in recurrence of depression.

Mood Dependency of Self-Rated Attachment Style

Previous research has established an association between depressive symptoms and self-rated insecure adult attachment styles. In this project we evaluated whether this association is an artifact of mood-dependent negative self-ratings. In Study 1 (N = 95, nonclinical sample), depressive symptoms correlated positively with Preoccupied and Fearful attachment style self-ratings, negatively with Secure attachment style. In Study 2 (N = 50 nondepressed adults, one-half with a history of major depression), recovered depressed people exceeded never-depressed adults on Preoccupied and Fearful styles, whereas the never-depressed scored higher on Secure attachment style. In Study 3 (N = 129), an unselected adult sample was randomly assigned to either depressed or elated musical mood induction. The two groups did not differ significantly on 3 of 4 attachment styles; theonly significant difference was that those in the depressed-mood condition scored lower on Fearful attachment. Taken together, the results are consistent with the possibility that insecure (particularly Preoccupied and Fearful) attachment is a stable vulnerability factor for depression and do not support the view that reporting insecure attachment is an artifact of current sad mood.

A taxometric investigation of unipolar depression in a large community sample.

BACKGROUND The question of whether unipolar clinical depression differs categorically from limited depressive complaints has important implications for the disorders assessment, treatment and research. This crucial issue has proven difficult to resolve, in part because many studies to date have relied on self-report measures or on clinically homogeneous samples. We therefore applied Meehls taxometric method to a large, clinically heterogeneous sample, and examined the latent structure of depressive episodes using both self-report and structured clinical interview data. METHOD Data were derived from the Oregon Adolescent Depression Project, a large longitudinal community study. All analyses involved more than 1400 participants. MAXEIG (MAXimum EIGenvalue) and base rate estimation were performed separately for Beck Depression Inventory (BDI) items and for DSM-IV-based major depressive episode (MDE) symptoms. RESULTS MAXEIG analyses of the BDI and MDE indicator sets appeared to converge on a taxonic structure for unipolar depression. Base rate estimates overall implied a latent depressive episode class that occurs more frequently than diagnosable MDEs but less frequently than persistent depressed or anhedonic mood. CONCLUSIONS These findings provide tentative support for a categorical conceptualization and make it very clear that the continuity controversy regarding unipolar depression has not yet been decided in favor of dimensionality. To reconcile the conflicting reports to date, several data analytic and sampling issues need to be explored systematically.

The efficacy of divalproex sodium in the treatment of agitation associated with major depression.

Background: Agitation is both a feature of major depression and a common side effect of antidepressant treatment. Depressive agitation correlates with overall severity of illness and suicide risk, whereas treatment-emergent agitation may contribute to early discontinuation of pharmacotherapy. Thus, agitation merits investigation as a treatment target in clinical depression. Methods: In this study, adults with major depression were evaluated for change in agitation and other mood symptoms during adjunctive treatment with divalproex sodium. Twelve patients on antidepressants, who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for major depression, were given low doses of divalproex sodium and evaluated repeatedly for symptoms of depression, anxiety, and agitation. Agitation severity was evaluated using the Overt Agitation Severity Scale and the Stanford Scale for Agitation Symptoms. Mood symptoms were assessed with the Hamilton Anxiety and the Hamilton Depression Rating Scales. Results: Nine of 12 patients completed 4 weeks of treatment. All agitation scores decreased sharply, whereas depression (Hamilton Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale) symptoms decreased only modestly. Decreased agitation was not merely a function of decreases on the Hamilton Depression or Hamilton Anxiety Rating Scales. Relatively low doses of divalproex sodium appear to be useful in the treatment of agitation associated with major depression. Conclusions: The observation that decreases in agitation were not simply an artifact of overall change in depressive or anxiety symptoms is in keeping with the previous clinical impression that divalproex sodium has a specific effect on depressive agitation. Controlled clinical trials are needed to fully evaluate the utility and symptom specificity of divalproex sodium in depression.

Reconsideration of Self-Complexity as a Buffer Against Depression

Self-complexity (SC) theory proposes that a highly differentiated self-concept protects against the depressogenic impact of negative life events. Linvilles influential prospective study appeared to support this proposition (P. W. Linville, 1987). Subsequent reports have raised questions about the construct validity of Linvilles operationalization of self-complexity (defined by the degree to which self-reported personality descriptors are dispersed across self-aspects), as well as the robustness of a buffering effect of self-complexity. In the present replication, Linvilles SC measure was again found to moderate the impact of stress on depressive symptoms. However, contrary to SC theory, the form of the Stress × SC interaction was not clearly consistent with stress protection. Also contrary to SC theory, the interaction of stress and SC was entirely explained by the number of self-descriptive personality traits endorsed in the SC task. Both of these findings suggest that with regard to depressive symptoms, reports of a stress-buffering effect for self-complexity are premature.

Perceptions of Depression among Never-Depressed and Recovered-Depressed People

We assessed perceptions of the impact of depression among two groups of currently nondepressed adults (Beck Depression Inventory score ≤ 9). The recovered-depressed (RD) participants (n = 25) had a history of major depressive disorder but had been recovered for at least 2 months since the most recent depressive episode. Never-depressed (ND) participants (n = 25) had no history of major depressive disorder. Participants completed the Self-Appraisal Questionnaire (Coyne & Calarco, 1995) as an assessment of beliefs about the experience of having been depressed. RDs rated depression as having more severe aftereffects than did the NDs. They reported feeling more loss of energy, being a burden on others, need to hide depression symptoms, strength drawn from depression, need to maintain a balance in life, fear of relationships, fear of taking risks, fear of recurrence of depression, and sense of stigma. These results replicated the findings of Coyne and Calarco (1995) and extended them to a more fully recovered population. These perceptions are important to understand because a persons ideas about depression may influence treatment outcome and susceptibility to future episodes.