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Major depression epidemiology from a diathesis-stress conceptualization - PubMed

  • ️Tue Jan 01 2013

Major depression epidemiology from a diathesis-stress conceptualization

Scott B Patten. BMC Psychiatry. 2013.

Abstract

Background: Major depression is a widely used diagnostic category but there is increasing dissatisfaction with its performance. The diathesis-stress model is an alternative approach that does not require the (sometimes arbitrary) imposition of categories onto the spectrum of depressive morbidity. However, application of this model has not been well explored and its consistency with available epidemiologic data is uncertain.

Methods: 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.

Results: 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.

Conclusions: 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.

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Figures

Figure 1
Figure 1

Schematic depicting an individual (agent) moving over patches. * see equation 2. ** see equation 1.

Figure 2
Figure 2

Typical output from model 2* (screen capture). * model parameters: diathesis = 1.4, stress_sd = 0.75, duration constant = 3, threshold = 15, remission stringency = 0.5. s = start of episode. e = end of episode.

Figure 3
Figure 3

A screen capture from model 1*, near the end of a simulation. * See

http://people.ucalgary.ca/~patten/model_1.html

.

Figure 4
Figure 4

Incidence* over 10 years of a 3652 day simulation run. * incidence is the slope of the Kaplan-Meier curve.

Figure 5
Figure 5

Recurrence in year 10, by number of episodes in years 1–9.

Figure 6
Figure 6

Incidence over 10 years, by elevated* depressive symptoms at baseline. * scores > 6 (approximately 50% of the diagnostic threshold) were considered elevated.

Figure 7
Figure 7

Simulated cumulative recovery from MD episodes, by month.

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