Associations Between Depression Subtype and Functional Impairment and Treatment Utilization in a National Sample of Adolescents

Published in: Journal of Affective Disorders, Volume 287, pages 26–33 (May 2021). doi: 10.1016/j.jad.2021.03.018

Posted on RAND.org on April 27, 2021

by Megan S. Schuler, Stephen E. Gilman, Rachel M. Burns, Elizabeth Roth, Joshua Breslau

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Background

Prior studies have characterized distinct major depressive episode (MDE) subtypes among adults, yet limited evidence exists regarding variation in MDE during adolescence.

Methods

Using 2008–2016 National Survey of Drug Use and Health data, latent class analysis (LCA) was used to characterize depression subtypes (based on symptom presentation) among 9,896 youth ages 12–17 with recent first-onset MDE. Logistic regression was used to estimate associations of MDE subtype with functional outcomes and treatment utilization, adjusting for demographic characteristics and depression severity (i.e., number of MDE diagnostic criteria and recurrence status).

Results

A 5-class LCA model provided optimal fit. Three distinct categories of MDE symptoms generally clustered together, which we termed "somatic," "cognitive," and "self-worth;" classes were differentiated by distinct combinations of symptoms across these 3 categories. Subtypes were characterized as: Highly Symptomatic (39% of youth); Somatic & Cognitive (24%), Somatic (22%), Diffuse Symptoms (8%), and Somatic & Self-Worth (6%). The majority of youth reported at least moderate impairment across multiple domains; subtype was a significant predictor of functional impairment. Only 34% of youth received any past-year depression-related treatment; treatment utilization was significantly higher for MDE subtypes with the highest prevalences of suicidal ideation.

Limitations

Due to cross-sectional data, we cannot establish causal directionality.

Conclusions

Subtype was significantly predictive of functional impairment and treatment utilization, above and beyond number of MDE diagnostic criteria or recurrence status. Understanding distinct profiles of adolescent depression, as well as potential differential associations with impairment, can inform prevention, diagnosis, and treatment of depression among youth.

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