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A distress-continuum, disorder-threshold model of depression: a mixed-methods, latent class analysis study of slum-dwelling young men in Bangladesh
BACKGROUND: Binary categorical approaches to diagnosing depression have been widely criticized due to clinical limitations and potential negative consequences. In place of such categorical models of depression, a ‘staged model’ has recently been proposed to classify populations into four tiers accor...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178879/ https://www.ncbi.nlm.nih.gov/pubmed/34088289 http://dx.doi.org/10.1186/s12888-021-03259-2 |
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author | Wahid, Syed Shabab Sandberg, John Sarker, Malabika Arafat, A. S. M. Easir Apu, Arifur Rahman Rabbani, Atonu Colón-Ramos, Uriyoán Kohrt, Brandon A. |
author_facet | Wahid, Syed Shabab Sandberg, John Sarker, Malabika Arafat, A. S. M. Easir Apu, Arifur Rahman Rabbani, Atonu Colón-Ramos, Uriyoán Kohrt, Brandon A. |
author_sort | Wahid, Syed Shabab |
collection | PubMed |
description | BACKGROUND: Binary categorical approaches to diagnosing depression have been widely criticized due to clinical limitations and potential negative consequences. In place of such categorical models of depression, a ‘staged model’ has recently been proposed to classify populations into four tiers according to severity of symptoms: ‘Wellness;’ ‘Distress;’ ‘Disorder;’ and ‘Refractory.’ However, empirical approaches to deriving this model are limited, especially with populations in low- and middle-income countries. METHODS: A mixed-methods study using latent class analysis (LCA) was conducted to empirically test non-binary models to determine the application of LCA to derive the ‘staged model’ of depression. The study population was 18 to 29-year-old men (n = 824) from an urban slum of Bangladesh, a low resource country in South Asia. Subsequently, qualitative interviews (n = 60) were conducted with members of each latent class to understand experiential differences among class members. RESULTS: The LCA derived 3 latent classes: (1) Severely distressed (n = 211), (2) Distressed (n = 329), and (3) Wellness (n = 284). Across the classes, some symptoms followed a continuum of severity: ‘levels of strain’, ‘difficulty making decisions’, and ‘inability to overcome difficulties.’ However, more severe symptoms such as ‘anhedonia’, ‘concentration issues’, and ‘inability to face problems’ only emerged in the severely distressed class. Qualitatively, groups were distinguished by severity of tension, a local idiom of distress. CONCLUSIONS: The results indicate that LCA can be a useful empirical tool to inform the ‘staged model’ of depression. In the findings, a subset of distress symptoms was continuously distributed, but other acute symptoms were only present in the class with the highest distress severity. This suggests a distress-continuum, disorder-threshold model of depression, wherein a constellation of impairing symptoms emerge together after exceeding a high level of distress, i.e., a tipping point of tension heralds a host of depression symptoms. |
format | Online Article Text |
id | pubmed-8178879 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-81788792021-06-07 A distress-continuum, disorder-threshold model of depression: a mixed-methods, latent class analysis study of slum-dwelling young men in Bangladesh Wahid, Syed Shabab Sandberg, John Sarker, Malabika Arafat, A. S. M. Easir Apu, Arifur Rahman Rabbani, Atonu Colón-Ramos, Uriyoán Kohrt, Brandon A. BMC Psychiatry Research BACKGROUND: Binary categorical approaches to diagnosing depression have been widely criticized due to clinical limitations and potential negative consequences. In place of such categorical models of depression, a ‘staged model’ has recently been proposed to classify populations into four tiers according to severity of symptoms: ‘Wellness;’ ‘Distress;’ ‘Disorder;’ and ‘Refractory.’ However, empirical approaches to deriving this model are limited, especially with populations in low- and middle-income countries. METHODS: A mixed-methods study using latent class analysis (LCA) was conducted to empirically test non-binary models to determine the application of LCA to derive the ‘staged model’ of depression. The study population was 18 to 29-year-old men (n = 824) from an urban slum of Bangladesh, a low resource country in South Asia. Subsequently, qualitative interviews (n = 60) were conducted with members of each latent class to understand experiential differences among class members. RESULTS: The LCA derived 3 latent classes: (1) Severely distressed (n = 211), (2) Distressed (n = 329), and (3) Wellness (n = 284). Across the classes, some symptoms followed a continuum of severity: ‘levels of strain’, ‘difficulty making decisions’, and ‘inability to overcome difficulties.’ However, more severe symptoms such as ‘anhedonia’, ‘concentration issues’, and ‘inability to face problems’ only emerged in the severely distressed class. Qualitatively, groups were distinguished by severity of tension, a local idiom of distress. CONCLUSIONS: The results indicate that LCA can be a useful empirical tool to inform the ‘staged model’ of depression. In the findings, a subset of distress symptoms was continuously distributed, but other acute symptoms were only present in the class with the highest distress severity. This suggests a distress-continuum, disorder-threshold model of depression, wherein a constellation of impairing symptoms emerge together after exceeding a high level of distress, i.e., a tipping point of tension heralds a host of depression symptoms. BioMed Central 2021-06-04 /pmc/articles/PMC8178879/ /pubmed/34088289 http://dx.doi.org/10.1186/s12888-021-03259-2 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Wahid, Syed Shabab Sandberg, John Sarker, Malabika Arafat, A. S. M. Easir Apu, Arifur Rahman Rabbani, Atonu Colón-Ramos, Uriyoán Kohrt, Brandon A. A distress-continuum, disorder-threshold model of depression: a mixed-methods, latent class analysis study of slum-dwelling young men in Bangladesh |
title | A distress-continuum, disorder-threshold model of depression: a mixed-methods, latent class analysis study of slum-dwelling young men in Bangladesh |
title_full | A distress-continuum, disorder-threshold model of depression: a mixed-methods, latent class analysis study of slum-dwelling young men in Bangladesh |
title_fullStr | A distress-continuum, disorder-threshold model of depression: a mixed-methods, latent class analysis study of slum-dwelling young men in Bangladesh |
title_full_unstemmed | A distress-continuum, disorder-threshold model of depression: a mixed-methods, latent class analysis study of slum-dwelling young men in Bangladesh |
title_short | A distress-continuum, disorder-threshold model of depression: a mixed-methods, latent class analysis study of slum-dwelling young men in Bangladesh |
title_sort | distress-continuum, disorder-threshold model of depression: a mixed-methods, latent class analysis study of slum-dwelling young men in bangladesh |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178879/ https://www.ncbi.nlm.nih.gov/pubmed/34088289 http://dx.doi.org/10.1186/s12888-021-03259-2 |
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