Depressive illness and morbid distress. Onset and development data examined against five-year outcome

A cluster analysis was done on items concerned with the onset and development (including life events) of depressive illness derived from standardised interviews on 70 in-patients with that diagnosis. The resulting groups were compared for symptoms derived from the Present State Examination (PSE) and outcome, five years later. New Groupings were sought, based on onset and development data, to test their predictive power, and to observe how closely they replicated existing binary classifications and whether or not suggestions emerged for narrowing the concept of depressive illness. The groups were clinically recognisable, and measures of five-year outcome differed significantly between the groups. They have been designated as forms of 'Somatic depression', type I 'Slow onset--depression of middle age'; type II 'Rapid onset--depression of middle age'; type III 'Slow onset--depression of younger age'; type IV 'Rapid onset--depression of younger age, and morbid distress. It is suggested that no simple binary classification is likely to prove as satisfactory for depression as a multi-axial method; the concept of 'morbid distress' is advanced as a way of narrowing the over-extended rubric of depressive illness.