Emotional subtypes in patients with depression: A cluster analysis

Major depressive disorder (MDD) is associated with deficits in emotion experience, expression and regulation. Whilst emotion regulation deficits prolong MDD, emotion expression influences symptomatic presentations, and anticipatory pleasure deficits predict recurrence risk. Profiling MDD patients from an emotion componential perspective can characterize subtypes with different clinical and functional outcomes. This study aimed to investigate emotional subtypes of MDD. A two-stage cluster analysis applied to 150 MDD patients. Clustering variables included emotion experience measured by Temporal Experience of Pleasure Scale, emotion expression measured by Toronto Alexithymia Scale, and emotion regulation measured by Emotion Regulation Questionnaire. We validated the resultant clusters by comparing their symptoms and functioning with that of 50 controls. Cluster 1 (n = 50) exhibited intact emotion experience and expression yet adopted reappraisal rather than suppression strategy, whereas Cluster 2 (n = 66) exhibited generalized emotional deficits. Cluster 3 (n = 34) exhibited emotion expression deficits and adopted both reappraisal and suppression strategies. On validation, Cluster 2 exhibited the worst, but Cluster 1 exhibited the least symptoms and social functioning impairments. Cluster 3 was intermediate among the two other subtypes. Our findings support the existence of different emotional subtypes in MDD patients, and have clinical and theoretical implications for developing future specific treatments for MDD.