Email updates

Keep up to date with the latest news and content from BMC Psychiatry and BioMed Central.

Open Access Research article

Major depression epidemiology from a diathesis-stress conceptualization

Scott B Patten

Author Affiliations

Department of Community Health Sciences, Department of Psychiatry & Mathison Centre for Mental Health Research and Education, 4th Floor TRW Building, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada

BMC Psychiatry 2013, 13:19  doi:10.1186/1471-244X-13-19

Published: 11 January 2013

Abstract

Background

Major depression is a widely used diagnostic category but there is increasing dissatisfaction with its performance. The diathesis-stress model is an alternative approach that does not require the (sometimes arbitrary) imposition of categories onto the spectrum of depressive morbidity. However, application of this model has not been well explored and its consistency with available epidemiologic data is uncertain.

Methods

Simulation provides an opportunity to explore these issues. In this study, a simulation model based on an intuitive representation of diathesis-stress interaction was developed. Both diathesis and stress were represented using continuous distributions, without categorization. A diagnostic threshold was then applied to the simulation output to create nominal categories and to explore their consistency with available information.

Results

An apparently complex epidemiologic pattern emerged from the diathesis-stress interaction when thresholds were applied: incidence was time dependent, recurrence depended on the number of past episodes, baseline symptoms were associated with an increased risk of subsequent episodes and the remission rate declined with increasing episode duration.

Conclusions

A diathesis-stress conceptualization coupled with application of a threshold-based diagnostic definition may explain several of the apparent complexities of major depression epidemiology. Some of these complexities may be artifacts of the nominal diagnostic approach. These observations should encourage an empirical exploration of whether diathesis-stress interactions provide a more parsimonious framework for understanding depression than current approaches.

Keywords:
Mood disorder; Major depressive disorder; Epidemiology; Mathematical models; Simulation