• Stephanie Rodgers, Caroline L Vandeleur, Vladeta Ajdacic-Gross, Aleksandra A Aleksandrowicz, Marie-Pierre F Strippoli, Enrique Castelao, Jennifer Glaus, Aurélie M Lasserre, Mario Müller, Wulf Rössler, Jules Angst, and Martin Preisig.
• Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland. Electronic address: stephanie.rodgers@dgsp.uzh.ch.
• J Affect Disord. 2016 Jan 15; 190: 807-18.

BackgroundNumerous studies have examined determinants leading to preponderance of women in major depressive disorder (MDD), which is particularly accentuated for the atypical depression subtype. It is thus of interest to explore the specific indirect effects influencing the association between sex and established depression subtypes.MethodsThe data of 1624 subjects with a lifetime diagnosis of MDD derived from the population-based PsyCoLaus data were used. An atypical (n=256), a melancholic (n=422), a combined atypical and melancholic features subtype (n=198), and an unspecified MDD group (n=748) were constructed according to the DSM-IV specifiers. Path models with direct and indirect effects were applied to the data.ResultsPartial mediation of the female-related atypical and combined atypical-melancholic depression subtypes was found. Early anxiety disorders and high emotion-orientated coping acted as mediating variables between sex and the atypical depression subtype. In contrast, high Body Mass Index (BMI) served as a suppression variable, also concerning the association between sex and the combined atypical-melancholic subtype. The latter association was additionally mediated by an early age of MDD onset and early/late anxiety disorders.LimitationsThe use of cross-sectional data does not allow causal conclusions.ConclusionsThis is the first study that provides evidence for a differentiation of the general mechanisms explaining sex differences of overall MDD by depression subtypes. Determinants affecting the pathways begin early in life. Since some of them are primarily of behavioral nature, the present findings could be a valuable target in mental health care.Copyright © 2015 Elsevier B.V. All rights reserved.

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