Abstract
Background: Agreement has not been achieved across symptom factor studies of major depressive disorder, and no studies have investigated depressive symptom structures in disaster-exposed samples. This study examined the symptom structure of major depression across two databases of 1,181 total survivors from 11 disasters studied using consistent research methods and full diagnostic assessment, addressing limitations of prior symptom scale studies. Methods: The sample included 808 directly-exposed survivors of 10 different disasters assessed 1-6 months of the disasters and 373 employees of 8 New York City organizations affected by the September 11, 2001 (9/11) terrorist attacks 3 years after the attacks. Depressive symptom profiles were compared across the two databases to determine the consistency of findings across different disasters and settings. Outcomes: Consistent symptom patterns predicting postdisaster major depression were not identified across the 10-disaster and 9/11 databases, and both database factor analyses suggested cohesive grouping of all 9 depression symptoms without separation into subgroups of symptoms clustering together. The 10-disaster and 9/11 databases identified different symptoms predicting postdisaster major depression. Interpretation: These findings do not suggest a starting point for identification of a subsample of symptoms that can be used to indicate the presence of major depression following a disaster or evidence to guide the construction and validation of a screening instrument for postdisaster major depression. This study surmounted prior methodologic challenges and provided initial findings to inform further studies needed to identify depressive symptom patterns and factors that can be used to improve detection and treatment of major depressive disorder. Funding Statement: This work was supported by the National Institute of Mental Health (Grants MH40025, MH68853, and MH094822). Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: Advance approval for the research was obtained from the Institutional Review Boards of the participating research institutions, and all members of the study sample provided written informed consent for participation.
Highlights
Major depressive disorder (MDD) is an important public health problem [1], and is a main source of disability worldwide [1,2]
This study examined the symptom structure of major depression across two databases representing a total of 1181 survivors from 11 disasters studied using consistent research methods with the collection of full diagnostic data
Different variables were found to be independently associated with major depression in the 9/11 database, including loss of interest or pleasure, appetite disturbance, sleep disturbance, and fatigue, but only loss of interest or pleasure and appetite disturbance were independently associated with incident postdisaster major depression
Summary
Major depressive disorder (MDD) is an important public health problem [1], and is a main source of disability worldwide [1,2] It is a major risk factor for suicide [3,4], and is associated with increased mortality worldwide [5]. MDD is the second most prevalent postdisaster disorder [6], found to occur in approximately 14–30% of disaster survivors in various studies [7,8] Despite this strong association, posttraumatic stress disorder (PTSD) has received the most focus in disaster mental health research, and remains the most prevalent disorder reported after disasters [9,10].
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