Sub-Grouping Non-Melancholic Major Depression Using Both Clinical and Aetiological Features

Abstract

Objective: In previous papers we have considered the extent to which two contrasting analytic approaches, examining reported clinical symptom variables alone and aetiological variables alone, assist definition of subgroups of non-melancholic major depression. Here, we address the same objective but combine both sets of variables, and contrast the combined solution with each of the contributing ones. Method: We study a sample of 185 subjects with a putative non-melancholic major depressive disorder, with analyses involving 13 aetiological and 38 symptom variables. Results: A four-class subgrouping was derived by use of a cluster analytic technique, with ‘neurotic depression’, non-anxious ‘depressed’, ‘situational’ and ‘residual’ groups. The largest group comprised ‘neurotic depression’ subjects, with characteristics compatible with a spectrum disorder encompassing both clinical features as well as an underlying temperament and personality style marked by anxiety. Conclusions: Comparative advantages and properties of the three differing analytic approaches to defining ‘meaningful’ non-melancholic major depressive subgroupings are considered. As a ‘neurotic depressive’ class has been consistently identified across those three approaches, but with quite varying numbers of subjects circumscribed, it is clearly a ‘fuzzy’ entity which may benefit from a dimensional approach to its measurement. As many of the non-melancholic groupings appear secondary to a substantive predisposing factor such as anxiety or disordered personality functioning, the clinical importance and treatment utility in identifying and circumscribing such classes are clearly supported.