Clinical Predictors Of Familial Depression In Han Chinese Women

ObjectiveA number of clinical features potentially reflect an individual’s familial vulnerability to major depression (MD), including early age at onset, recurrence, impairment, episode duration, and the number and pattern of depressive symptoms. However these results are drawn from studies that have exclusively examined individuals from a European ethnic background. We investigated which clinical features of depressive illness index familial vulnerability in Han Chinese females with MD.Methods1. Study Subjects:The data for the present study were drawn from the ongoing CONVERGE study of major depression (MD). These analyses were based on a total of1,970cases recruited from51provincial mental health centres and psychiatric departments of general medical hospitals in40cities in21provinces. All cases were female and had four Han Chinese grandparents. Cases were excluded if they had a pre-existing history of bipolar disorder, any type of psychosis or mental retardation. Cases were aged between30and60, had two or more episodes of MD, with the first episode occurring between14and50and had not abused drug or alcohol before the first episode of MD. The study protocol was approved centrally by the Ethical Review Board of Oxford University and the ethics committee in participating hospitals in China.2. Measures:The diagnoses of Major Depressive Disorder were established with the Composite International Diagnostic Interview (CIDI)(WHO lifetime version2.1; Chinese version), which classifies diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. The interview was originally translated into Mandarin by a team of psychiatrists in Shanghai Mental Health Centre with the translation reviewed and modified by members of the CONVERGE team. The history of lifetime major depression in the parents and siblings was assessed using the Family History Research Diagnostic criteria which was translated by the CONVERGE team from the interview used in the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders (VATSPUD). The interview was fully computerized into a bilingual system of Mandarin and English developed in house in Oxford, and called SysQ. Interviews were administered by trained interviewers and entered offline in real time onto SysQ, which was installed in the laptops. All subjects were interviewed using SysQ, which lasted on average two hours for a case. All interviewers were trained by the CONVERGE team for a minimum of one week in the use of the interview. The interview includes assessment of psychopathology, demographic and personal characteristics, and psychosocial functioning. Interviews were tape-recorded and a proportion of them were listened to by the trained editors who provided feedback on the quality of the interviews.3. Statistical analysis:All statistical analyses were carried out with the SPSS package (version17.0, SPSS Inc., Chicago, IL). When taken one variable at a time, x2-test was used to compare family history of MD and categorical variables and logistic regression analysis was performed to investigate family history and continuous variables. When examined all positive variables, forward and backward stepwise logistic regression was performed to find the best predictors of familial MD.Results1. The sample comprised1,970patients with a lifetime history of MD. A total of69(3.5%) cases did not finish the family history section correctly and were therefore excluded, leaving a total of1901patients. Of these1,901patients,624(32.8%) reported that at least one of her first-degree relatives had a lifetime history of MD.2. When examined one variable at a time, a report by the patient that their most severe MD episode was not attributable to a known cause significantly predicted risk for MD in the relatives. We refer to this as "MD episode with no known cause" Endorsement of two DSM-IV criterions (A7:"worthlessness" and A8:"trouble concentrating") and two other symptoms (irritable/angry and anxious/nervous) also predicted risk of MD in the relatives with P-values<0.05. Of note, feeling helplessness, early age at onset in the patients and number of endorsed A criteria for MD were associated in our data with an increased risk for MD in relatives. However, the effects were small and only at a trend level of significance (P=0.05, P=0.07and P=0.08).3. When including all5individually significant variables in stepwise logistic regression analysis, the results showed that "MD episode with no known cause", a lack of symptoms of irritability or anger and a lack of symptoms of anxiety or nervousness predict greater risk in relatives of MD patients.Conclusions1. The association between family history of MD and the lack of a precipitating stressor, traditionally a characteristic of endogenous or biological depression, may reflect the association seen in other samples between recurrent MD and a positive family history.2. Two symptoms were experienced during the depressive episode to predict a lower risk for MD in relatives:irritability/anger and anxiety/nervousness.