%0 Journal Article
%T Major depression epidemiology from a diathesis-stress conceptualization
%A Scott B Patten
%J BMC Psychiatry
%D 2013
%I BioMed Central
%R 10.1186/1471-244x-13-19
%X Simulation provides an opportunity to explore these issues. In this study, a simulation model based on an intuitive representation of diathesis-stress interaction was developed. Both diathesis and stress were represented using continuous distributions, without categorization. A diagnostic threshold was then applied to the simulation output to create nominal categories and to explore their consistency with available information.An apparently complex epidemiologic pattern emerged from the diathesis-stress interaction when thresholds were applied: incidence was time dependent, recurrence depended on the number of past episodes, baseline symptoms were associated with an increased risk of subsequent episodes and the remission rate declined with increasing episode duration.A diathesis-stress conceptualization coupled with application of a threshold-based diagnostic definition may explain several of the apparent complexities of major depression epidemiology. Some of these complexities may be artifacts of the nominal diagnostic approach. These observations should encourage an empirical exploration of whether diathesis-stress interactions provide a more parsimonious framework for understanding depression than current approaches.Depressive symptoms can be measured using rating scales, which provide an assessment of symptom severity on an ordinal or continuous scale. However, such ratings do not capture important aspects of the concept of a depressive disorder, as this is currently understood. Disorder definitions, and hence most available epidemiologic data, derive from nominal classifications (e.g. major depression (MD) as a named category rather than a scaled rating) that incorporate symptom severity but also thresholds for duration and severity of symptoms and require features such as dysfunction, distress or danger [1]. Diagnostic categories typically play a larger role than symptom ratings in medical practice because they align more closely with clinical decision-making.
%K Mood disorder
%K Major depressive disorder
%K Epidemiology
%K Mathematical models
%K Simulation
%U http://www.biomedcentral.com/1471-244X/13/19