Latent Class Analysis in Depression, Including Clinical and Functional Variables: Evidence of a Complex Depressive Subtype in Primary Care in Chile.

Marcin Rzeszutek,Carlos Serrano,Alfredo Cancino,Soledad Potthoff,Verónica Vitriol,Marcelo Leiva-Bianchi,Francisca Orellana,Carolina Salgado,Cristian Cáceres,Soledad Ballesteros,Marcela Ormazábal,Andrea Asenjo

doi:10.1155/2021/6629403

Abstract

Objective To establish differentiated depressive subtypes using a latent class analysis (LCA), including clinical and functional indicators in a sample of depressed patients consulted in Chilean Primary Health Care. Methods A LCA was performed on a sample of 297 depressed patients consulted in Chilean PHC. The Mini International Neuropsychiatric Interview, the Hamilton Depression Rating Scale, the Outcome Questionnaire -social role, and interpersonal subscales were as instruments. A regression analysis of the different subtypes with sociodemographic and adverse life experiences was performed. Results In a sample characterized by 87.5% of women, two, three, and four latent class models were obtained. The three-class model likely represents the best clinical implications. In this model, the classes were labeled: “complex depression” (CD) (58% of the sample), “recurrent depression” (RD) (34%), and “single depression episode” (SD) (8%). Members of CD showed a higher probability of history of suicide attempts, interpersonal, and social dysfunction. Psychiatric comorbidities differentiated the RD from SD. According to a multinomial regression model, childhood trauma experiences, recent stressful life experiences, and intimate partner violence events were associated with the CD class (p < 0.01). Limitations. The vast majority of participants were females from Chile and the sample studied was not random. So, the results may not necessarily represent outpatient clinics. Conclusions This study can provide additional evidence that depression, specifically in female gender, could be better understood as a complex heterogeneous disorder when clinical and functional indicators are studied. Furthermore, adverse life experiences starting in childhood could lead to a differentiated complex depressive subtype.

Highlights

Depression is a leading cause of disability worldwide [1]
In the Chilean health system, most of major depression (MD) patients (90%) are diagnosed and treated at primary health care (PHC) [2, 6]. At this level of care, among patients with MD, the prevalence of anxiety comorbidity and adverse life experiences is Depression Research and Treatment higher than 80% [7,8,9], associated with greater symptom severity [10] and lower clinical remission at 12 months [11]. These findings are consistent with the current knowledge in the field, [12,13,14,15,16,17], which shows that neither psychiatric comorbidities nor adverse life experiences are adequately screened in PHC clinical samples [18,19,20]
A latent class analysis (LCA) study performed in patients with posttraumatic stress disorder (PTSD) [61] revealed a more complex PTSD characterized by the presence of interpersonal difficulties, affective dysregulation, and alterations in self-esteem, associated with exposure to interpersonal adversities, childhood trauma experiences (CTEs) [62]

Summary

Introduction

Depression is a leading cause of disability worldwide [1]. In Chile, as in the world, this disorder constitutes a significant public health problem [2]. In the last year, 18.2% of the adult Chilean population present depressive symptoms and 6.2% meet the criteria for major depression (MD) [3, 4] It is the second leading cause of disability-adjusted life years (DALYs) and the first one among women between 20 and 44 years [2, 5]. In the Chilean health system, most of MD patients (90%) are diagnosed and treated at primary health care (PHC) [2, 6] At this level of care, among patients with MD, the prevalence of anxiety comorbidity and adverse life experiences is Depression Research and Treatment higher than 80% [7,8,9], associated with greater symptom severity [10] and lower clinical remission at 12 months [11]. These findings are consistent with the current knowledge in the field, [12,13,14,15,16,17], which shows that neither psychiatric comorbidities nor adverse life experiences are adequately screened in PHC clinical samples [18,19,20]

Methods

Results

Discussion

Conclusion