Heterogeneiety of depression: a scoping review
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Date
2023
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Abstract
Background: Major depressive disorder (MDD) represents the leading cause of disability worldwide. Even though there are evidence-based treatments, their effectiveness still lacks. One potential explanation pertains to the diagnostic heterogeneity MDD carries from its polythetic definition and it is also found in empirical studies. Depression subtypes, endophenotypes and sources of heterogeneity have been identified, but there are no studies that organize this information in a broad manner. Objective: To systematically map the existing evidence on heterogeneity of depression, summarizing its main findings and gaps in theoretical and empirical studies. Design: A scoping review was conducted. Four electronic databases were searched for published papers (Embase, CINAHL, PsycInfo, PubMed) on the subject between the years 2010 and 2023. Results: After eligibility assessment, 226 articles were included in the review. 197 Empirical studies were found, 29 reviews, 1 meta-analysis and 1 theoretical article. 214 Unique MDD subtypes were identified in the literature, then clustered into 14 main categories: Symptom prominent, DSM/ICD, Age-at-onset, Severity, Timecourse, Comorbidity, Life-event, Endophenotype, Personality and interpersonal style, Treatment response, Core-concept MDD, Culture, Gender, Unspecific. A total of 60 unique endophenotypes were identified, with two main categories further subdivided: (1) Physiological structures: Brain-related structures, Genetics, Systems, Neurophysiology, Proteins, Hormones; (2) Metapsychological structures: Reward regulation system, Decision-making, Cognitive processing. 129 Unique sources of heterogeneity were identified and narrowed into 14 categories: Endophenotypes, Age-at-onset, Demographic, Life events, Comorbidities, Severity, Culture, Timecourse, Symptom network, Personality and interpersonal style, Measurement, Theoretical, Therapeutic Alliance, Etiology. Conclusions: Findings are consistent on concluding heterogeneity of depression as an urgent need to be addressed by investigation to create better treatments. Future research should develop bridges between evidence-based subtypes, endophenotypes and sources of heterogeneity, to develop MDD models able to address case-sensitive specificities.
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Tesis (Magíster en Psicología Clínica)--Pontificia Universidad Católica de Chile, 2023.
Keywords
Heterogeneity, Depression, Subtypes, Scoping, Review