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Symptom-Based Subtypes of Depression: Latent Profile Analysis with Specific Problems Scales in MMPI-2-RF


This study explored the subtypes of depression based on various symptoms in multiple dimensions, through a person-centered approach. For this purpose, latent profile analysis of 473 depressive patients was conducted using specific problems scales of MMPI-2-RF, which consist of multidimensional variables such as somatic/cognitive scales, internalizing, externalizing, and interpersonal problems. As a result, a 5-class solution was adopted and the classes were labeled as the mild group, helplessness group, somatic group, avoidant group with anxiety, and irritable group with anxiety. Each group differed in their clinical characteristics. The mild group (22.6%) presented a low level of symptoms in all the dimensions and had lower comorbidity. The helplessness group (23.9%) experienced high hopelessness and self-doubt, but a lower level of other somatic/ cognitive or externalizing symptoms. The somatic group (27.9%) experienced elevated somatic/cognitive symptoms, whereas passivity and social avoidance in interpersonal scales were not as high as those of the helplessness group. The avoidant group with anxiety (19.0%) presented a high level of symptoms in all the internalizing scales, especially high passivity and social avoidance in interpersonal scales. The rate of co-occurrence with anxiety disorders was also high in this group. The irritable group with anxiety (6.6%) was characterized by high externalizing symptoms such as aggression and activation, in addition to overall high internalizing symptoms, and a high rate of alcohol use disorder. Based on these results, the implications and limitations of this study are discussed.

우울증 하위유형 증상 기반 잠재프로파일분석 MMPI-2-RF 특정문제척도 depression subtype latent profile analysis MMPI-2-RF specific problems scales



Alexandrino-Silva, C., Wang, Y. P., Viana, M. C., Bulhões, R. S., Martins, S. S., & Andrade, L. H. (2013). Gender difference in symptomatic profiles of depression: Results from the São Paulo Megacity Mental Health Survey. Journal of Affective Disorders, 147, 355-364.


Akaike, H. (1987). Factor analysis and AIC. Psychometrika, 52, 317-332.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorder (5th ed.). Washington, DC: American Psychiatric Association Press.


Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory-second edition manual. San Antonio, TX: The psychological Corporation.


Beck, A. T., Ward C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.


Benazzi, F., & Akiskal, H. (2005). Irritable-hostile depression: Further validation as a bipolar depressive mixed state. Journal of Affective Disorders, 84, 197-207.


Ben-Porach, Y. S., & Tellegen, A. (2008). Minnesota Multiphasic Personality Inventory-2 restructured form. Minneapolis, MN: University of Minnesota Press.


Bühler, J., Seemüller, F., & Läge, D. (2014). The predictive power of subgroups: An empirical approach to identify depressive symptom patterns that predict response to treatment. Journal of Affective Disorders, 163, 81-87.


Butcher, J. N., Graham, J. R., Ben-porath, Y. S., Tellegen, A., Dahlstrom, W. G., & Kaemmer, B. (2001). MMPI-2 (Minnesota Multiphasic Personality Inventory-2): Manual for administration, scoring, and interpretation, revised edition. Minneapolis, MN:University of Minnesota Press.


Carragher, N., Adamson, G., Bunting, B., & McCann, S. (2009). Subtypes of depression in a nationally representative sample. Journal of Affective Disorders, 113, 88-99.


Cassano, G. B., Benvenuti, A., Miniati, M., Calugi, S., Mula, M., Maggi, L., . . . Frank, E. (2009). The factor structure of lifetime depressive spectrum in patients with unipolar depression. Journal of Affective Disorder, 115, 87-99.


Contractor, A. A., Roley-Roberts, M. E., Lagdon, S., & Armour, C. (2017). Heterogeneity in patterns of DSM-5 posttraumatic stress disorder and depression symptoms: Latent profile analyses. Journal of Affective Disorder, 212, 17-24.


de Vos, S., Wardenaar, K. J., Bos, E. H., Wit, E. C., & de Jonge, P. (2015). Decomposing the heterogeneity of depression at the person-, symptom-, and time-level: latent variable models versus multimode principal component analysis. BMC Medical Research Methodology, 15, 88-98.


Hamilton, M. A. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56-62.


Han, K. H., Moon, K. J., Lee, J. Y., & Kim, J. H. (2011). The Korean Version of Minnesota Multiphasic Personality Inventory-2-RF Manual. Maumsarang Seoul: Korea.


Lamers, F., de Jone, P., Nolen, W. A., Smit, J. H., Zitman, F. G., Beekman, A. T. F., . . . Pennix, B.W. (2010). Identifying depressive subtypes in a large cohort study: Results from the Netherlands study of depression and anxiety (NESDA). Journal of Clinical Psychiatry, 71, 1582-1589.


Lanza, S. T., Collins, L. M., Lemmon, D. R., & Schafer, J. L. (2007). PROC LCA: A SAS procedure for latent class analysis. Structural Equation Modeling, 14, 671-694.


Lee, S. Y., Xue, Q., Spira, A. P., & Lee, H. B. (2014). Racial and ethnic differences in depressive subtypes and access to mental health care in the united states. Journal of Affective Disorders, 155, 130-137.


Lee, Y. H., & Song, J. Y. (1991). A study of the reliability and the validity of the BDI, SDS, and MMPI-D scales. Korean Journal of Clinical Psychology, 10, 98-112.


Lo, Y., Mendell, N., & Rubin, D. (2001). Testing the number of components in a normal mixture. Biometika, 88, 767-778.


McCrae, J. S., Chapman, M. V., & Christ, S. L. (2006). Profile of children investigated for sexual abuse: Association with psychopathology symptoms and service. American Journal of Orthopsychiatry, 76, 468-481.


McLachlan, G. J. (1987). On bootstrapping the likelihood ratio test statistic for the number of components in a normal mixture. Applied Statistics, 36, 318-324.


Moritz, S., Göritz, A. S., McLean, B., Westermann, S., & Brodbeck, J. (2017). Do depressive symptoms predict paranoia or vice versa? Journal of Behavior Therapy and Experimental Psychiatry, 56, 113-121.


Muthén, B. O. (2004). Latent variable analysis: Growth mixture modeling and related techniques for longitudinal data. In D. Kaplan (Ed.), The Sage handbook of quantitative methodology for the social sciences (pp. 345-368). New York, NY: Sage.


Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structure Equation Modeling, 14, 535-569.


Pancheri, P., Picardi, A., Pasquini, M., Gaetano, P., & Biondi, M. (2002). Psychopathological dimensions of depression: A factor study of the 17-item Hamilton depression rating scale in unipolar depressed outpatients. Journal of Affective Disorder, 68, 41-47.


Parker, G., Wilheim, K., Mitchell, P., Roy, K., & Hadzi-Pavlovie, D. (1999). Subtyping depression: testing algorithms and identification of a tired model. Journal of Nervous and Mental Disease, 187, 610-617.


Parneix, M., Péricaud, M., & Clément, J. P. (2014). Irritability associated with major depressive episodes: Its relationship with mood disorders and temperament. Turkish Journal of Psychiatry, 25, 106-113.


Prisciandaro, J. J., & Roberts, J. E. (2009). A comparison of predictive abilities of dimensional and categorical model of unipolar depression in the national comorbidity survey. Psychological Medicine, 36, 1087-1096.


Rodgers, S., Ajdacic-Gross, V., Müller, M., Hengartner, M.P., Grosse Holtforth, M. G., Angst, J., & Röossler, W. (2014). The role of sex on stability and change of depression symptom subtypes over 20 years: A latent transition analysis. European Archives Psychiatry and Clinical Neuroscience, 264, 577-588.


Rodgers, S., Holtforth, M. G., Müller, M., Hengartner, M. P., Rössler, W., & Ajdacic-Gross, V. (2014). Symptom-based subtypes of depression and their psychosocial correlates: A personcentered approach focusing on the influence of sex. Journal of Affective Disorder, 156, 92-103.


Schrijvers, D., Hulstijn, W., & Sabbe, B. (2008). Psychomotor symptoms in depression: A diagnostic, pathophysiological and therapeutic tool. Journal of Affective Disorder, 109, 1-20.


Schwarz, G. (1978). Estimating the dimension of a model. Annals Statistics, 6, 461-464.


Sharpley, C., & Bitsika, V. (2013). Differences in neurological pathways of four “clinical contents” subtypes of depression. Behavioural Brain Research, 256, 368-376.


Simson, S., Cain, N. M., Samstag, L. W., Meehan, K. B., & Muran, J. C. (2015). Assessing interpersonal subtypes in depression. Journal of Personality Assessment, 97, 364-373.


Sullivan, P. F., Prescott, C. A., & Kendler, K. S. (2002). The subtypes of major depression in a twin registry. Journal of Affective Disorder, 68, 273-284.


Sunderland, M., Carragher, N., Wong, N., & Andrews, G. (2013). Factor mixture analysis of DSM-IV symptoms of major depression in a treatment seeking clinical population. Comprehensive Psychiatry, 54, 474-483.


ten Have, M., Lamers, F., Wardenaar, K., Beekman, A., de Jonge, P., van Dorsselaer, S., . . . de Graaf, R. (2016). The identification of symptom-based subtypes of depression: A nationally representative cohort study. Journal of Affective Disorder, 190, 395-406.


Ulbricht, C. M., Chrysanthopoulou, S. A., Levin, L., & Lapane, K. L. (2018). The use of latent class analysis for identifying subtypes of depression: A systemic review. Psychiatry Research, 266, 228-246.


Ulbricht, C. M., Rothschild, A. J., & Lapane, K. L. (2015). The association between latent depression subtypes and remission after treatment with citalopram: A latent class analysis with distal outcome. Journal of Affective Disorders, 188, 270-277.


van Loo, H. M., de Jonge, P., Romeijn, J. W., Kessler, R. C., & Schoevers, R. (2012). Data-driven subtypes of major depressive disorder:A systemic review. BMC Medicine, 10, 156-168.


van Praag, H. M. (1996). Faulty cortisol/serotonin interplay psychological and biological characteristics of a new hyphothetical depression subtype (SeCA depression). Psychiatry Research, 65, 143-157.


You, S. M., Lee, M. S., Jun, T. Y., Kim, H. C., Kim, J. M., Yim, H. W., & Hwang, S. B. (2011). Classification and characteristics of depression subtypes: Latent class analysis. Korean Journal of Clinical Psychology, 30, 553-570.