Casting wider nets for anxiety and depression: disability-driven cross-diagnostic subtypes in a large cohort

R. B. K. Wanders, H. M. Van Loo, J. K. Vermunt, R. R. Meijer, C. A. Hartman, R. A. Schoevers, K. J. Wardenaar, P. De Jonge

Research output: Contribution to journalArticleScientificpeer-review

Abstract

In search of empirical classifications of depression and anxiety, most subtyping studies focus solely on symptoms and do so within a single disorder. This study aimed to identify and validate cross-diagnostic subtypes by simultaneously considering symptoms of depression and anxiety, and disability measures.
A large cohort of adults (Lifelines, n = 73 403) had a full assessment of 16 symptoms of mood and anxiety disorders, and measurement of physical, social and occupational disability. The best-fitting subtyping model was identified by comparing different hybrid mixture models with and without disability covariates on fit criteria in an independent test sample. The best model's classes were compared across a range of external variables.
The best-fitting Mixed Measurement Item Response Theory model with disability covariates identified five classes. Accounting for disability improved differentiation between people reporting isolated non-specific symptoms [‘Somatic’ (13.0%), and ‘Worried’ (14.0%)] and psychopathological symptoms [‘Subclinical’ (8.8%), and ‘Clinical’ (3.3%)]. Classes showed distinct associations with clinically relevant external variables [e.g. somatization: odds ratio (OR) 8.1–12.3, and chronic stress: OR 3.7–4.4]. The Subclinical class reported symptomatology at subthreshold levels while experiencing disability. No pure depression or anxiety, but only mixed classes were found.
An empirical classification model, incorporating both symptoms and disability identified clearly distinct cross-diagnostic subtypes, indicating that diagnostic nets should be cast wider than current phenomenology-based categorical systems.
Original languageEnglish
Pages (from-to)3371-3382
JournalPsychological Medicine
Volume46
Issue number16
DOIs
Publication statusPublished - 1 Dec 2016

Fingerprint

Depression
Odds Ratio
Medically Unexplained Symptoms

Cite this

Wanders, R. B. K., Van Loo, H. M., Vermunt, J. K., Meijer, R. R., Hartman, C. A., Schoevers, R. A., ... De Jonge, P. (2016). Casting wider nets for anxiety and depression: disability-driven cross-diagnostic subtypes in a large cohort. Psychological Medicine, 46(16), 3371-3382. https://doi.org/10.1017/S0033291716002221
Wanders, R. B. K. ; Van Loo, H. M. ; Vermunt, J. K. ; Meijer, R. R. ; Hartman, C. A. ; Schoevers, R. A. ; Wardenaar, K. J. ; De Jonge, P. / Casting wider nets for anxiety and depression: disability-driven cross-diagnostic subtypes in a large cohort. In: Psychological Medicine. 2016 ; Vol. 46, No. 16. pp. 3371-3382.
@article{6c0186a65d254d0f879d662643fa8f2a,
title = "Casting wider nets for anxiety and depression: disability-driven cross-diagnostic subtypes in a large cohort",
abstract = "In search of empirical classifications of depression and anxiety, most subtyping studies focus solely on symptoms and do so within a single disorder. This study aimed to identify and validate cross-diagnostic subtypes by simultaneously considering symptoms of depression and anxiety, and disability measures.A large cohort of adults (Lifelines, n = 73 403) had a full assessment of 16 symptoms of mood and anxiety disorders, and measurement of physical, social and occupational disability. The best-fitting subtyping model was identified by comparing different hybrid mixture models with and without disability covariates on fit criteria in an independent test sample. The best model's classes were compared across a range of external variables.The best-fitting Mixed Measurement Item Response Theory model with disability covariates identified five classes. Accounting for disability improved differentiation between people reporting isolated non-specific symptoms [‘Somatic’ (13.0{\%}), and ‘Worried’ (14.0{\%})] and psychopathological symptoms [‘Subclinical’ (8.8{\%}), and ‘Clinical’ (3.3{\%})]. Classes showed distinct associations with clinically relevant external variables [e.g. somatization: odds ratio (OR) 8.1–12.3, and chronic stress: OR 3.7–4.4]. The Subclinical class reported symptomatology at subthreshold levels while experiencing disability. No pure depression or anxiety, but only mixed classes were found.An empirical classification model, incorporating both symptoms and disability identified clearly distinct cross-diagnostic subtypes, indicating that diagnostic nets should be cast wider than current phenomenology-based categorical systems.",
author = "Wanders, {R. B. K.} and {Van Loo}, {H. M.} and Vermunt, {J. K.} and Meijer, {R. R.} and Hartman, {C. A.} and Schoevers, {R. A.} and Wardenaar, {K. J.} and {De Jonge}, P.",
year = "2016",
month = "12",
day = "1",
doi = "10.1017/S0033291716002221",
language = "English",
volume = "46",
pages = "3371--3382",
journal = "Psychological Medicine",
issn = "0033-2917",
publisher = "CAMBRIDGE UNIV PRESS",
number = "16",

}

Wanders, RBK, Van Loo, HM, Vermunt, JK, Meijer, RR, Hartman, CA, Schoevers, RA, Wardenaar, KJ & De Jonge, P 2016, 'Casting wider nets for anxiety and depression: disability-driven cross-diagnostic subtypes in a large cohort', Psychological Medicine, vol. 46, no. 16, pp. 3371-3382. https://doi.org/10.1017/S0033291716002221

Casting wider nets for anxiety and depression: disability-driven cross-diagnostic subtypes in a large cohort. / Wanders, R. B. K.; Van Loo, H. M.; Vermunt, J. K.; Meijer, R. R.; Hartman, C. A.; Schoevers, R. A.; Wardenaar, K. J.; De Jonge, P.

In: Psychological Medicine, Vol. 46, No. 16, 01.12.2016, p. 3371-3382.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Casting wider nets for anxiety and depression: disability-driven cross-diagnostic subtypes in a large cohort

AU - Wanders, R. B. K.

AU - Van Loo, H. M.

AU - Vermunt, J. K.

AU - Meijer, R. R.

AU - Hartman, C. A.

AU - Schoevers, R. A.

AU - Wardenaar, K. J.

AU - De Jonge, P.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - In search of empirical classifications of depression and anxiety, most subtyping studies focus solely on symptoms and do so within a single disorder. This study aimed to identify and validate cross-diagnostic subtypes by simultaneously considering symptoms of depression and anxiety, and disability measures.A large cohort of adults (Lifelines, n = 73 403) had a full assessment of 16 symptoms of mood and anxiety disorders, and measurement of physical, social and occupational disability. The best-fitting subtyping model was identified by comparing different hybrid mixture models with and without disability covariates on fit criteria in an independent test sample. The best model's classes were compared across a range of external variables.The best-fitting Mixed Measurement Item Response Theory model with disability covariates identified five classes. Accounting for disability improved differentiation between people reporting isolated non-specific symptoms [‘Somatic’ (13.0%), and ‘Worried’ (14.0%)] and psychopathological symptoms [‘Subclinical’ (8.8%), and ‘Clinical’ (3.3%)]. Classes showed distinct associations with clinically relevant external variables [e.g. somatization: odds ratio (OR) 8.1–12.3, and chronic stress: OR 3.7–4.4]. The Subclinical class reported symptomatology at subthreshold levels while experiencing disability. No pure depression or anxiety, but only mixed classes were found.An empirical classification model, incorporating both symptoms and disability identified clearly distinct cross-diagnostic subtypes, indicating that diagnostic nets should be cast wider than current phenomenology-based categorical systems.

AB - In search of empirical classifications of depression and anxiety, most subtyping studies focus solely on symptoms and do so within a single disorder. This study aimed to identify and validate cross-diagnostic subtypes by simultaneously considering symptoms of depression and anxiety, and disability measures.A large cohort of adults (Lifelines, n = 73 403) had a full assessment of 16 symptoms of mood and anxiety disorders, and measurement of physical, social and occupational disability. The best-fitting subtyping model was identified by comparing different hybrid mixture models with and without disability covariates on fit criteria in an independent test sample. The best model's classes were compared across a range of external variables.The best-fitting Mixed Measurement Item Response Theory model with disability covariates identified five classes. Accounting for disability improved differentiation between people reporting isolated non-specific symptoms [‘Somatic’ (13.0%), and ‘Worried’ (14.0%)] and psychopathological symptoms [‘Subclinical’ (8.8%), and ‘Clinical’ (3.3%)]. Classes showed distinct associations with clinically relevant external variables [e.g. somatization: odds ratio (OR) 8.1–12.3, and chronic stress: OR 3.7–4.4]. The Subclinical class reported symptomatology at subthreshold levels while experiencing disability. No pure depression or anxiety, but only mixed classes were found.An empirical classification model, incorporating both symptoms and disability identified clearly distinct cross-diagnostic subtypes, indicating that diagnostic nets should be cast wider than current phenomenology-based categorical systems.

U2 - 10.1017/S0033291716002221

DO - 10.1017/S0033291716002221

M3 - Article

VL - 46

SP - 3371

EP - 3382

JO - Psychological Medicine

JF - Psychological Medicine

SN - 0033-2917

IS - 16

ER -