Sociodemographic and psychosocial factors have demonstrated their utility as satisfactory predictive factors for the occurrence of major depressive disorder (MDD), but are inadequate variables for predicting the severity of an individual’s depression, according to a study published in the Journal of Affective Disorders.

The investigators sought to explore the association between psychosocial variables and severity of depression among Chinese patients with first-episode MDD compared with healthy controls. A multicenter, multistage, case-control study on the topic was conducted in 9 clinical sites located in 5 provinces/municipalities in China. Depressive symptoms, clinical features, and psychosocial variables were evaluated among the study participants. All of the participants were enrolled from December 2013 through

December 2016. To meet eligibility, patients needed to be between 18 and 55 years of age. The Chinese version of the Mini International Neuropsychiatric Interview (MINI), Version 5.0, was used to confirm the diagnostic criteria of MDD and to exclude the presence of other psychiatric disorders.

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Depression severity was assessed via use of the Hamilton Rating Scale of Depression with 17 items (HRSD-17). Based on the HRSD-17 scores, patients were classified into 4 subgroups: (1) those with scores from 0 to 7: not depressed; (2) those with scores from 8 to 17: mildly depressed; (3) those with scores from 18 to 24: moderately depressed; and (4) those with scores of ≥25: severely depressed.

A total of 598 patients with MDD and 467 healthy controls were included. The percentages of participants with mild, moderate, and severe depression were 29.5%, 50.2%, and 20.3%, respectively. Per logistic regression analysis, the sociodemographic and psychosocial factors could explain up to 50.6% of the total variance in the occurrence of MDD in the whole sample that included healthy controls.

In the subsample of participants with MDD, only older age (odds ratio [OR], 1.03; 95% CI, 1.02 to 1.05; P <.001), stressful social events (OR, 1.04; 95% CI, 1.02 to 1.06; P <.001), and melancholic feature (OR, 2.68; 95% CI, 1.91 to 3.74; P <.001) were significant risk factors for moderate and severe depression, but could explain only 10.2% of the total variance.

A limitation of the current study is its cross-sectional design, resulting in an inability of the causal effect of the model to be determined. Additionally, only those individuals with first-episode MDD were enrolled in this study, thus leaving the associated factors for the severity of recurrent depression not being examined.

The investigators concluded that future research should evaluate other factors that may impact the severity of depression among patients with MDD. Moreover, it remains to be established whether the division of depression based on severity categories adequately reflects the true nature of the condition.


Xiong N, Liu Q, Lv X, et al. Demographic and psychosocial variables could predict the occurrence of major depressive disorder, but not the severity of depression in patients with first-episode major depressive disorder in China. J Affect Disord. 2020;274:103-111.