Classifying patients with depressive and anxiety disorders according to symptom network structures: A Gaussian graphical mixture model-based clustering

PLoS One. 2021 Sep 1;16(9):e0256902. doi: 10.1371/journal.pone.0256902. eCollection 2021.

Abstract

Patients with mental disorders often suffer from comorbidity. Transdiagnostic understandings of mental disorders are expected to provide more accurate and detailed descriptions of psychopathology and be helpful in developing efficient treatments. Although conventional clustering techniques, such as latent profile analysis, are useful for the taxonomy of psychopathology, they provide little implications for targeting specific symptoms in each cluster. To overcome these limitations, we introduced Gaussian graphical mixture model (GGMM)-based clustering, a method developed in mathematical statistics to integrate clustering and network statistical approaches. To illustrate the technical details and clinical utility of the analysis, we applied GGMM-based clustering to a Japanese sample of 1,521 patients (Mage = 42.42 years), who had diagnostic labels of major depressive disorder (MDD; n = 406), panic disorder (PD; n = 198), social anxiety disorder (SAD; n = 116), obsessive-compulsive disorder (OCD; n = 66), comorbid MDD and any anxiety disorder (n = 636), or comorbid anxiety disorders (n = 99). As a result, we identified the following four transdiagnostic clusters characterized by i) strong OCD and PD symptoms, and moderate MDD and SAD symptoms; ii) moderate MDD, PD, and SAD symptoms, and weak OCD symptoms; iii) weak symptoms of all four disorders; and iv) strong symptoms of all four disorders. Simultaneously, a covariance symptom network within each cluster was visualized. The discussion highlighted that the GGMM-based clusters help us generate clinical hypotheses for transdiagnostic clusters by enabling further investigations of each symptom network, such as the calculation of centrality indexes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cluster Analysis
  • Comorbidity
  • Data Analysis
  • Datasets as Topic
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / epidemiology
  • Female
  • Humans
  • Japan / epidemiology
  • Male
  • Normal Distribution
  • Obsessive-Compulsive Disorder / diagnosis*
  • Obsessive-Compulsive Disorder / epidemiology
  • Panic Disorder / epidemiology
  • Phobia, Social / diagnosis*
  • Phobia, Social / epidemiology
  • Severity of Illness Index
  • Young Adult

Grants and funding

JK, YT, YK, and MI were supported by Japan Society for the Promotion of Science KAKENHI (Grant numbers: 20K14171, 19K14419, 20K20870, and 17H04788, respectively,). MI was supported also by Japan Agency for Medical Research and Development Grant (Reference number: JP20dk0307084) and by National Center of Neurology and Psychiatry (NCNP) Intramural Research Grant (Reference number: 30-2). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.