The diagnostic validity of central symptoms for major depressive disorder in adults with
Yuan Gao1, Meirong Pan1, Ziqing Zhu1
1Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), and the Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, 100191, China.
Background:
An efficient and accurate diagnosis of MDD in adult ADHD is highly significant. Central symptoms identified through network analysis are considered to play a key role in diagnosis, potentially contributing to the achievement of this goal.
Methods:
ADHD and MDD symptoms were assessed using the ADHD Rating Scale and Zung Self-Rating Depression Scale (SDS) in a clinical cohort of 418 adults with ADHD, followed by network estimations. Symptoms with high expected influence (EI) in the network were identified as central symptoms and tested for diagnostic validity via ROC curve analysis. Imaging analyses were further adopted to verify the effectiveness of the identified central symptoms from the perspective of construct validity.
Results:
A five-symptom model was identified, including: "Depressed affect," "Personal devaluation," "Emptiness," "Agitation," and "Interest loss." The model exhibited strong diagnostic validity for MDD in adult ADHD, showing no significant difference compared to using all 20 SDS items. Moreover, significant functional alterations were detected in the left anterior cingulate cortex between groups classified by this model.
Conclusion:
A five-symptom model comprising "Depressed affect," "Personal devaluation," "Emptiness," "Agitation," and "Interest loss" showed strong diagnostic validity for MDD in adult ADHD, and proven effective in exploring its underlying neural mechanisms. These symptoms should be considered a priority in diagnosing MDD in adults with ADHD.
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