Research report Gender differences in symptomatic profiles of depression: Results from the S ~ ao Paulo Megacity Mental Health Survey Clo ´ vis Alexandrino-Silva a , Yuan-Pang Wang a , Maria Carmen Viana a , Rodrigo S. Bulh ~ oes b , Sı ´lvia S. Martins c,1 , Laura Helena Andrade a,n,1 a Section of Psychiatric Epidemiology–LIM 23, Department and Institute of Psychiatry, University of S ~ ao Paulo Medical School, S ~ ao Paulo, Brazil b Department of Statistics, Institute of Mathematics and Statistics, University of S ~ ao Paulo, S ~ ao Paulo, Brazil c Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA article info Article history: Received 29 October 2012 Accepted 20 November 2012 Available online 14 December 2012 Keywords: Subtypes of depression Depressive symptoms Depression Mental disorders Population-based study Gender differences abstract Background: Few studies have investigated symptomatic subtypes of depression and their correlates by gender. Methods: Data are from the S ~ ao Paulo Megacity Mental Health Survey. Symptom profiles of 1207 subjects (864 women; 343 men) based upon symptoms of the worst depressive episode in lifetime were examined through latent class analysis. Correlates of gender-specific latent classes were analyzed by logistic regression. Results: For both men and women, a 3-class model was the best solution. A mild class was found in both genders (41.1% in women; 40.1% in men). Gender differences appeared in the most symptomatic classes. In women, they were labeled melancholic (39.3%) and atypical (19.5%), differing among each other in somatic/vegetative symptoms. The melancholic class presented inhibition and eating/sleeping symptoms in the direction of decreasing, whereas the atypical class had increased appetite/weight, and hypersomnia. For men, symptoms that differentiate the two most symptomatic classes were related to psychomotor activity: a melancholic/psychomotor retarded (40.4%) and agitated depression (19.6%). The highest between-class proportion of agitation and racing thoughts was found among men in the agitated class, with similarity to bipolar mixed state. Limitations: Analyses were restricted to those who endorsed questions about their worst lifetime depressive episode; the standardized assessment by lay interviewers; the small male sample size. Conclusions: The construct of depression of current classifications is heterogeneous at the symptom level, where gender different subtypes can be identified. These symptom profiles have potential implications for the nosology and the therapeutics of depression. & 2012 Elsevier B.V. All rights reserved. 1. Introduction Depression is one of major contributors to the burden of disease in the general population. Current evidence of depression-related morbidity, disability, and mortality comes from surveys conducted in the community (Alonso et al., 2011; Bruffaerts et al., 2012; Eaton et al., 2008; Patten et al., 2011), where case identification relied on a priori defined categorical diagnostic criteria, in which subtype features are rarely emphasized by researchers. In-depth examina- tion of the heterogeneity of depression, in terms of symptom profiles, course, and severity (Halbreich, 2006; Joyce, 2008; Klein, 2008; Nandi et al., 2009; Parker, 2000; Parker, 2006; van Praag, 2008) can contribute to further enhance the identification of distinct phenotypes (Hasler et al., 2004) with potential implications for clinical management. The classical construct of depression, as a diagnostic entity, was dramatically changed since the operationalization of DSM-III criteria (APA, 1987). The prototypical description of major depres- sion is defined through a number of symptoms, in which their occurrence is sufficient to consider the presence of the disorder (e.g., at least 5 of a list of 9 depressive symptoms, according to DSM-IV). Within-category heterogeneity in symptom combina- tion and number of symptoms may have emerged as a by-product of this polythetic-categorical approach (Krueger and Bezdjian, 2009). In DSM-IV, this heterogeneity was handled by including catatonic, melancholic, and atypical features (APA, 1994). How- ever, this amendment was unsatisfactory to encompass earlier observations from European authors on concurrent symptoms of anxiety in depression (Sargant, 1960; West and Dally, 1959) and Contents lists available at SciVerse ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders 0165-0327/$ - see front matter & 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.jad.2012.11.041 n Corresponding author. Tel./fax: þ55 11 2661 6976. E-mail address: lhsgandr@usp.br (L.H. Andrade). 1 Dr. Andrade and Dr. Martins share senior authorship of this manuscript. Journal of Affective Disorders 147 (2013) 355–364