{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:45:14Z","timestamp":1790790314313,"version":"4.1.0"},"reference-count":51,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T00:00:00Z","timestamp":1622764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T00:00:00Z","timestamp":1622764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Psychiatry"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Binary categorical approaches to diagnosing depression have been widely criticized due to clinical limitations and potential negative consequences. In place of such categorical models of depression, a \u2018staged model\u2019 has recently been proposed to classify populations into four tiers according to severity of symptoms: \u2018Wellness;\u2019 \u2018Distress;\u2019 \u2018Disorder;\u2019 and \u2018Refractory.\u2019 However, empirical approaches to deriving this model are limited, especially with populations in low- and middle-income countries.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A mixed-methods study using latent class analysis (LCA) was conducted to empirically test non-binary models to determine the application of LCA to derive the \u2018staged model\u2019 of depression. The study population was 18 to 29-year-old men (<jats:italic>n<\/jats:italic>\u2009=\u2009824) from an urban slum of Bangladesh, a low resource country in South Asia. Subsequently, qualitative interviews (<jats:italic>n<\/jats:italic>\u2009=\u200960) were conducted with members of each latent class to understand experiential differences among class members.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The LCA derived 3 latent classes: (1) Severely distressed (<jats:italic>n<\/jats:italic>\u2009=\u2009211), (2) Distressed (<jats:italic>n<\/jats:italic>\u2009=\u2009329), and (3) Wellness (<jats:italic>n<\/jats:italic>\u2009=\u2009284). Across the classes, some symptoms followed a continuum of severity: \u2018levels of strain\u2019, \u2018difficulty making decisions\u2019, and \u2018inability to overcome difficulties.\u2019 However, more severe symptoms such as \u2018anhedonia\u2019, \u2018concentration issues\u2019, and \u2018inability to face problems\u2019 only emerged in the severely distressed class. Qualitatively, groups were distinguished by severity of <jats:italic>tension<\/jats:italic>, a local idiom of distress.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The results indicate that LCA can be a useful empirical tool to inform the \u2018staged model\u2019 of depression. In the findings, a subset of distress symptoms was continuously distributed, but other acute symptoms were only present in the class with the highest distress severity. This suggests a distress-continuum, disorder-threshold model of depression, wherein a constellation of impairing symptoms emerge together after exceeding a high level of distress, i.e., a tipping point of <jats:italic>tension<\/jats:italic> heralds a host of depression symptoms.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12888-021-03259-2","type":"journal-article","created":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T17:02:51Z","timestamp":1622826171000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["A distress-continuum, disorder-threshold model of depression: a mixed-methods, latent class analysis study of slum-dwelling young men in Bangladesh"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0355-0537","authenticated-orcid":false,"given":"Syed Shabab","family":"Wahid","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Sandberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malabika","family":"Sarker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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