Clinical Staging of Major Depressive Disorder: an empirical exploration

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We examined the construct and predictive validity of a clinical staging model for major depression that distinguishes eight consecutive stages (0,1A,1B,2,3A,3B,3C,4) based on severity and duration of symptoms, and number of episodes. At baseline 2334 Netherlands Study of Depression and Anxiety participants were assigned to the eight stages of the model, of them 2012 were followed-up after 2 years. For construct validity, differences between stages in clinical characteristics (e.g.: severity, age of onset, co-morbid anxiety) were studied. Predictive validity was measured by the extent to which baseline stages predicted 2-year follow-up outcomes (e.g. MDD presence). Most clinical characteristics and follow-up outcomes showed a significant linear trend across stages with later stages having worse outcomes than early stages, confirming validity of the model. Both construct and predictive validity analyses suggest that the model performs best in the early (mostly pre-clinical) stages (0,1A,1B,2). However, in the later (clinical) stages (2,3A,3B,3C,4), validity analyses showed no differences between each consecutive stage, but only between stages with long-lasting symptoms (3A,4) compared to stages differing in number of episodes (2,3B,3C). This study showed reasonable validity for a depression staging model that based its stages purely on clinical characteristics. Results suggest that, contrary to the number of episodes, duration of exposure to the depressed state best characterizes later stages.

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Presentation Date: 
January, 2015
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