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Development of the 12-item questionnaire for quantitative assessment of depressive mixed state (DMX-12)

Authors Shinzato H, Koda M, Nakamura A, Kondo T

Received 12 May 2019

Accepted for publication 6 June 2019

Published 15 July 2019 Volume 2019:15 Pages 1983—1991

DOI https://doi.org/10.2147/NDT.S215478

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Taro Kishi


Hotaka Shinzato,1 Munenaga Koda,1 Akifumi Nakamura,1,2 Tsuyoshi Kondo1

1Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan; 2Department of Psychiatry, Akari Clinic, Okinawa, Japan

Background: Conventional categorical criteria have limitations in assessing the prevalence and severity of depressive mixed state (DMX). Thus, we have developed a new scale for screening and quantification of DMX and examined the symptomatological structure and severity of DMX in individuals with major depressive episode (MDE).
Methods: Subjects were 154 patients with MDE (57 males and 97 females; age 13–83 years). Our original Japanese version of the self-administered 12-item questionnaire to assess DMX (DMX-12), together with the Quick Inventory of Depressive Symptomatology Self-Report Japanese version (QIDS-SR-J) and global assessment of functioning, were administered to each participant. The symptomatological structure of the DMX-12 was examined by exploratory factor analysis. Multiple regression analyses were used to analyze factors contributing to the DMX-12 scale. The relationships of this scale with categorical diagnoses (mixed depression by Benazzi and mixed features by DSM-5) were also investigated.
Results: A three-factor model of the DMX-12 was extracted from exploratory factor analysis, namely, “spontaneous instability”, “vulnerable responsiveness”, and “disruptive emotion/behavior”. Multiple regression analyses revealed that age was negatively correlated with total DMX-12 score, while bipolarity and the QIDS-SR-J score were positively correlated. A higher score on the disruptive emotion/behavior subscale was observed in patients with mixed depression and mixed features.
Conclusion: The DMX-12 seems to be useful for screening DMX in conjunction with conventional categorical diagnoses. Severely depressed younger subjects with potential bipolarity are more likely to develop DMX. The disruptive emotion/behavior subscale of the DMX-12 may be the most helpful in distinguishing patients with DMX from non-mixed patients.

Keywords: major depressive episode, depressive mixed state, spontaneous instability, vulnerable responsiveness, disruptive emotion/behavior


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