Measuring melancholia: the utility of a prototypic symptom approach
- 16 September 2008
- journal article
- research article
- Published by Cambridge University Press (CUP) in Psychological Medicine
- Vol. 39 (6), 989-998
- https://doi.org/10.1017/s0033291708004339
Abstract
Background: Melancholia has long resisted classification, with many of its suggested markers lacking specificity. The imprecision of depressive symptoms, in addition to self-report biases, has limited the capacity of existing measures to delineate melancholic depression as a distinct subtype. Our aim was to develop a self-report measure differentiating melancholic and non-melancholic depression, weighting differentiation by prototypic symptoms and determining its comparative classification success with a severity-based strategy.Method: Consecutively recruited depressed out-patients (n=228) rated 32 symptoms by prototypic or ‘characteristic’ relevance (using the Q-sort strategy) and severity [using the Severity-based Depression Rating System (SDRS) strategy]. Clinician diagnosis of melancholic/non-melancholic depression was the criterion measure, but two other formal measures of melancholia (Newcastle and DSM-IV criteria) were also tested.Results: The prevalence of ‘melancholia’ ranged from 20.9% to 54.2% across the subtyping measures. The Q-sort measure had the highest overall correct classification rate in differentiating melancholic and non-melancholic depression (81.6%), with such decisions supported by validation analyses.Conclusions: In differentiating a melancholic subtype or syndrome, prototypic symptoms should be considered as a potential alternative to severity-based ratings.Keywords
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