The melancholic and atypical specifiers for a major depressive episode (MDE) are supposed to reduce heterogeneity in symptom presentation by requiring additional, specific features. Fried et al. (2020) recently showed that the melancholic specifier may increase the potential heterogeneity in presenting symptoms. In a large sample of outpatients with depression, our objective was to explore whether the melancholic and atypical specifiers reduced observed heterogeneity in symptoms. We used baseline data from the Inventory of Depression Symptoms (IDS), which was available for 3,717 patients, from the Sequenced Alternatives to Relieve Depression (STAR*D) trial. A subsample met criteria for MDE on the IDS (“IDS-MDE”; N =2,496). For patients with IDS-MDE, we differentiated between those with melancholic, non-melancholic, non-melancholic, atypical, and non-atypical depression. We quantified the observed heterogeneity between groups by counting the number of unique symptom combinations pertaining to their given diagnostic group (e.g., counting the melancholic symptoms for melancholic and non-melancholic groups), as well as the profiles of DSM-MDE symptoms (i.e., ignoring the specifier symptoms). When considering the specifier and depressive symptoms, there was more observed heterogeneity within the melancholic and atypical subgroups than in the IDS-MDE sample (i.e., ignoring the specifier subgroups). The differences in number of profiles between the melancholic and non-melancholic groups were not statistically significant, irrespective of whether focusing on the specifier symptoms or only the DSM-MDE symptoms. The differences between the atypical and non-atypical subgroups were smaller than what would be expected by chance. We found no evidence that the specifier groups reduce heterogeneity, as can be quantified by unique symptom profiles. Most symptom profiles, even in the specifier subgroups, had five or fewer individuals. We found no evidence that the atypical and melancholic specifiers create more symptomatically homogeneous groups. Indeed, the melancholic and atypical specifiers introduce heterogeneity by adding symptoms to the DSM diagnosis of MDE.

中文翻译：

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重度抑郁症及其忧郁和非典型特征的异质性：STAR*D 的二次分析

重度抑郁发作 (MDE) 的忧郁和非典型特征应该通过要求额外的特定特征来减少症状表现的异质性。弗里德等人。（2020 年）最近表明，忧郁说明符可能会增加呈现症状的潜在异质性。在大量门诊抑郁症患者样本中，我们的目标是探索忧郁和非典型说明是否减少了观察到的症状异质性。我们使用了抑郁症状清单 (IDS) 的基线数据，该数据可用于 3,717 名患者，来自 Sequenced Alternatives to Relieve Depression (STAR*D) 试验。子样本符合 IDS 上的 MDE 标准（“IDS-MDE”；N = 2,496）。对于 IDS-MDE 患者，我们区分了忧郁、非忧郁、非忧郁、非典型、和非典型抑郁症。我们通过计算与给定诊断组相关的独特症状组合的数量（例如，计算忧郁和非忧郁组的忧郁症状）以及 DSM-MDE 症状的概况（即，忽略说明符症状）。在考虑特定和抑郁症状时，与 IDS-MDE 样本相比，在忧郁和非典型亚组中观察到的异质性更多（即忽略特定亚组）。无论是关注特定症状还是仅关注 DSM-MDE 症状，忧郁症和非忧郁症组之间的特征数量差异均无统计学意义。非典型和非典型亚组之间的差异比偶然预期的要小。我们没有发现说明符组减少异质性的证据，这可以通过独特的症状特征进行量化。大多数症状概况，即使在说明子组中，也有五个或更少的个体。我们没有发现证据表明非典型和忧郁的说明符创造了更多症状同质的群体。事实上，忧郁和非典型的说明符通过在 MDE 的 DSM 诊断中添加症状来引入异质性。我们没有发现证据表明非典型和忧郁的说明符创造了更多症状同质的群体。事实上，忧郁和非典型的说明符通过在 MDE 的 DSM 诊断中添加症状来引入异质性。我们没有发现证据表明非典型和忧郁的说明符创造了更多症状同质的群体。事实上，忧郁和非典型的说明符通过在 MDE 的 DSM 诊断中添加症状来引入异质性。