One promising avenue is the adoption of symptom-level, data-driven methods. Conversely, the Children Depression Rating Scale (CDRS), based on the Hamilton Depression Rating Scale, prioritizes somatic symptoms, common among hospitalized patients with depression.ĭespite the DSM’s binary approach to mental illness being undeniably relevant for decision-making in research and clinical settings, calls for better understanding of psychiatric symptomatology beyond categorical criteria have gained momentum in recent years. For instance, the Children’s Depression Inventory (CDI) features items on self-deprecation, pessimism and loneliness that are not explicitly present in the DSM criteria but, much like its original adult version (the Beck Depression Inventory), reflects Beck’s cognitive model. Scales frequently reflect clinically significant symptoms that represent authors’ clinical views. Commonly used instruments for assessing depression dimensionally reflect such heterogeneity.
Items listed in the DSM may not fully capture the experience of living with depression in youth, as, historically, the DSM is a consensus-based operationalization of psychopathology rather than an evidence- or data-driven one. Suboptimal outcomes may in part stem from an over-focus on criteria that do not adequately consider patient priorities. Furthermore, a non-negligible portion of people receiving psychotherapeutic and/or pharmacological interventions-strategies usually employed following a one-size-fits-all approach to treatment-only partially benefit from them. MDD’s multitude of symptom profiles also impacts its understanding from neurobiological and psychosocial perspectives. In adults, these criteria allow for over 200 symptom permutations that meet the current DSM diagnosis -though such analysis has not been performed among adolescents, even greater heterogeneity would be theoretically expected given the additional criterion of irritability.
#NETWORK ANALYSIS DEFINITION MANUAL#
The Diagnostic and Statistical Manual (5th edition DSM-5) criteria for MDD among adolescents requires the presence of at least five out of nine possible symptoms, with one of those being low/irritable mood or anhedonia. The heterogenous nature of major depressive disorder (MDD) poses, however, multiple challenges towards this goal. Understanding unique characteristics of depression during this period can be crucial for alleviating its life-long repercussions, especially in low- and middle-income settings, where the majority of global youth live, but the minority of mental health research is conducted. As a time of profound biopsychosocial changes, adolescence is an important period for the evaluation of mental health problems. Depression tends to have its onset in adolescence and is commonly chronic and recurrent, with lifetime cumulative prevalence estimates reaching 25%. A focus on symptoms might advance research on adolescent depression by enhancing our understanding of the disorder.ĭepressive disorders constitute a leading cause of health-related burden globally. Furthermore, analysis of the MFQ sample revealed DSM items not to be more frequent, severe or interconnected than non-DSM items, but rather part of a larger network of symptoms.
In the MFQ sample, self-hatred and loneliness, two non-DSM features, were the most central items and DSM and non-DSM items in this scale formed a highly interconnected network of symptoms. Sad mood and worthlessness items were the most central items in the network structure of the PHQ-A. Additionally, we compared centrality of items included (e.g., low mood, anhedonia) and not included in the DSM (e.g., low self-esteem, loneliness) in the MFQ. We conducted network analyses to study symptom structure and centrality estimates of the two scales.
We assessed dimensional depressive symptomatology using the PHQ-A in the first sample ( n = 7720) and the MFQ in the second sample ( n = 1070). We analyzed cross-sectional data from two similarly recruited samples of adolescents aged 14–16 years, as part of the Identifying Depression Early in Adolescence (IDEA) study in Brazil. We examined the prevalence and relevance of DSM and non-DSM depressive symptoms in two Brazilian school-based adolescent samples with two commonly used scales, the Patient Health Questionnaire (PHQ-A) and the Mood and Feelings Questionnaire (MFQ). Calls for refining the understanding of depression beyond diagnostic criteria have been growing in recent years.
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