New insights into the correlation structure of DSM-IV depression symptoms in the general population v. subsamples of depressed individuals

Epidemiol Psychiatr Sci. 2018 Jun;27(3):288-300. doi: 10.1017/S2045796016001086. Epub 2017 Jan 9.


Aims: Previous research failed to uncover a replicable dimensional structure underlying the symptoms of depression. We aimed to examine two neglected methodological issues in this research: (a) adjusting symptom correlations for overall depression severity; and (b) analysing general population samples v. subsamples of currently depressed individuals.

Methods: Using population-based cross-sectional and longitudinal data from two nations (Switzerland, 5883 young men; USA, 2174 young men and 2244 young women) we assessed the dimensions of the nine DSM-IV depression symptoms in young adults. In each general-population sample and each subsample of currently depressed participants, we conducted a standardised process of three analytical steps, based on exploratory and confirmatory factor and bifactor analysis, to reveal any replicable dimensional structure underlying symptom correlations while controlling for overall depression severity.

Results: We found no evidence of a replicable dimensional structure across samples when adjusting symptom correlations for overall depression severity. In the general-population samples, symptoms correlated strongly and a single dimension of depression severity was revealed. Among depressed participants, symptom correlations were surprisingly weak and no replicable dimensions were identified, regardless of severity-adjustment.

Conclusions: First, caution is warranted when considering studies assessing dimensions of depression because general population-based studies and studies of depressed individuals generate different data that can lead to different conclusions. This problem likely generalises to other models based on the symptoms' inter-relationships such as network models. Second, whereas the overall severity aligns individuals on a continuum of disorder intensity that allows non-affected individuals to be distinguished from affected individuals, the clinical evaluation and treatment of depressed individuals should focus directly on each individual's symptom profile.

Keywords: Classification; depressive disorder; diagnosis; epidemiology; factor analysis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Depression / classification*
  • Depression / diagnosis
  • Depression / epidemiology
  • Depressive Disorder / classification*
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Factor Analysis, Statistical
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Population Surveillance
  • Prevalence
  • Severity of Illness Index
  • Switzerland / epidemiology
  • United States / epidemiology
  • Young Adult