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Problematic features of episode-based definitions of depression and a preliminary proposal for their replacement
Episodes of depression are constructed by imposing temporal and symptom-severity thresholds onto symptom levels that vary over time, resulting in a loss of information. Consequently, it is widely acknowledged that binary categorization of depressive episodes is problematic. Binary classification can...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10050379/ https://www.ncbi.nlm.nih.gov/pubmed/37009098 http://dx.doi.org/10.3389/fpsyt.2023.1121524 |
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author | Patten, Scott B. |
author_facet | Patten, Scott B. |
author_sort | Patten, Scott B. |
collection | PubMed |
description | Episodes of depression are constructed by imposing temporal and symptom-severity thresholds onto symptom levels that vary over time, resulting in a loss of information. Consequently, it is widely acknowledged that binary categorization of depressive episodes is problematic. Binary classification can make similar symptom levels appear different and different symptom levels appear similar. Furthermore, symptom severity is only one of several thresholds that are applied in the construction of depressive episodes in DSM-5 and ICD-11, others being: a minimum duration of symptoms, the application of a “no significant symptoms” threshold for remission, and time requirements (e.g., 2 months) for remission. Application of each of these thresholds leads to a loss of information. The joint occurrence of these four thresholds creates a complex set of circumstances in which similar patterns of symptoms may be categorized differently and different patterns may be categorized as similar. The ICD-11 definition can be expected to lead to better classification than the DSM-5 approach since it does not require two symptom-free months for remission, eliminating one of four problematic thresholds. A more radical change would be to adopt a truly dimensional perspective which would need to incorporate new elements to reflect time spent at various levels of depression. Such an approach, however, seems feasible both in clinical practice and research. |
format | Online Article Text |
id | pubmed-10050379 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-100503792023-03-30 Problematic features of episode-based definitions of depression and a preliminary proposal for their replacement Patten, Scott B. Front Psychiatry Psychiatry Episodes of depression are constructed by imposing temporal and symptom-severity thresholds onto symptom levels that vary over time, resulting in a loss of information. Consequently, it is widely acknowledged that binary categorization of depressive episodes is problematic. Binary classification can make similar symptom levels appear different and different symptom levels appear similar. Furthermore, symptom severity is only one of several thresholds that are applied in the construction of depressive episodes in DSM-5 and ICD-11, others being: a minimum duration of symptoms, the application of a “no significant symptoms” threshold for remission, and time requirements (e.g., 2 months) for remission. Application of each of these thresholds leads to a loss of information. The joint occurrence of these four thresholds creates a complex set of circumstances in which similar patterns of symptoms may be categorized differently and different patterns may be categorized as similar. The ICD-11 definition can be expected to lead to better classification than the DSM-5 approach since it does not require two symptom-free months for remission, eliminating one of four problematic thresholds. A more radical change would be to adopt a truly dimensional perspective which would need to incorporate new elements to reflect time spent at various levels of depression. Such an approach, however, seems feasible both in clinical practice and research. Frontiers Media S.A. 2023-03-15 /pmc/articles/PMC10050379/ /pubmed/37009098 http://dx.doi.org/10.3389/fpsyt.2023.1121524 Text en Copyright © 2023 Patten. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Psychiatry Patten, Scott B. Problematic features of episode-based definitions of depression and a preliminary proposal for their replacement |
title | Problematic features of episode-based definitions of depression and a preliminary proposal for their replacement |
title_full | Problematic features of episode-based definitions of depression and a preliminary proposal for their replacement |
title_fullStr | Problematic features of episode-based definitions of depression and a preliminary proposal for their replacement |
title_full_unstemmed | Problematic features of episode-based definitions of depression and a preliminary proposal for their replacement |
title_short | Problematic features of episode-based definitions of depression and a preliminary proposal for their replacement |
title_sort | problematic features of episode-based definitions of depression and a preliminary proposal for their replacement |
topic | Psychiatry |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10050379/ https://www.ncbi.nlm.nih.gov/pubmed/37009098 http://dx.doi.org/10.3389/fpsyt.2023.1121524 |
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