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J Affect Disord. 2016 Nov 1;204:24-31. doi: 10.1016/j.jad.2016.06.042. Epub 2016 Jun 15.

Differences in symptom expression between unipolar and bipolar spectrum depression: Results from a nationally representative sample using item response theory (IRT).

Author information

1
Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA; AP-HP, Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France. Electronic address: nico.hoertel@yahoo.fr.
2
Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA.
3
Assistance Publique Hôpitaux de Paris (APHP), Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, CNRS, EHESS, Paris, France.
4
Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA.
5
Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; Groupe Hospitalier Sainte-Anne, CMME, Paris, France.
6
AP-HP, Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.

Abstract

BACKGROUND:

The inclusion of subsyndromal forms of bipolarity in the fifth edition of the DSM has major implications for the way in which we approach the diagnosis of individuals with depressive symptoms. The aim of the present study was to use methods based on item response theory (IRT) to examine whether, when equating for levels of depression severity, there are differences in the likelihood of reporting DSM-IV symptoms of major depressive episode (MDE) between subjects with and without a lifetime history of manic symptoms.

METHODS:

We conducted these analyses using a large, nationally representative sample from the USA (n=34,653), the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions.

RESULTS:

The items sadness, appetite disturbance and psychomotor symptoms were better indicators of depression severity in participants without a lifetime history of manic symptoms, in a clinically meaningful way. DSM-IV symptoms of MDE were substantially less informative in participants with a lifetime history of manic symptoms than in those without such history.

LIMITATIONS:

Clinical information on DSM-IV depressive and manic symptoms was based on retrospective self-report

CONCLUSIONS:

The clinical presentation of depressive symptoms may substantially differ in individuals with and without a lifetime history of manic symptoms. These findings alert to the possibility of atypical symptomatic presentations among individuals with co-occurring symptoms or disorders and highlight the importance of continued research into specific pathophysiology differentiating unipolar and bipolar depression.

KEYWORDS:

Bipolar; Depression; Differential item functioning; Item response theory; Symptoms; Unipolar

PMID:
27318596
DOI:
10.1016/j.jad.2016.06.042
[Indexed for MEDLINE]

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