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Major Depression and Associated Impairment: Same or Different Genetic and Environmental Risk Factors?

OBJECTIVE: Impairment was added as a diagnostic criterion for many psychiatric disorders in DSM-IV. Does the addition of impairment influence only prevalence rates, or does it also introduce new etiological factors into psychiatric diagnoses? METHOD: A lifetime history of major depression and associated functional impairment was assessed by personal interview with 3,669 female and 4,377 male twins from the population-based Virginia Twin Registry. Structural equation modeling was used to estimate the correlation between risk factors for major depression and associated functional impairment. RESULTS: While the risk factors for major depression and associated functional impairment are substantially correlated, they are not identical. The most parsimonious model suggests that over a quarter of the variance in associated functional impairment is due to factors unrelated to risk for major depression. Of the variance unique to associated functional impairment, approximately one-third is familial. The relationship between associated functional impairment and major depression did not differ significantly between men and women. CONCLUSIONS: Risk factors for major depression and associated functional impairment are substantially but imperfectly correlated. The addition of associated functional impairment as a criterion for the diagnosis of major depression not only lowers prevalence estimates but also introduces a small set of new etiological factors into the diagnosis of major depression.

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				M. M. Weissman, P. Wickramaratne, Y. Nomura, V. Warner, H. Verdeli, D. J. Pilowsky, C. Grillon, and G. Bruder Families at High and Low Risk for Depression: A 3-Generation Study Arch Gen Psychiatry, January 1, 2005; 62(1): 29 - 36. [Abstract] [Full Text] [PDF]

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