Symptom profiles and psychosocial features in atypical depression:A comparative study

Background: Atypical depression (AD) has been proposed to be a specific subtype of major depressive disorder (MDD) that differs to other subtypes in symptom profiles and potentially in biological and psychosocial features. Relative to other subtypes, such as melancholic MDD (MEL), AD remains underexplored, particularly concerning psychosocial factors. This study aimed to examine psychosocial features in individuals reporting AD symptoms, in comparison to other MDD presentations. We also sought to assess whether specific features relate to functioning within each subgroup.<br/>Methods: 98 participants meeting DSM criteria for MDD were recruited including those with AD (n=36), MEL (n=37), or mixed/unspecified features (n=25, u-MDD). Participants completed self-report measures assessing depressive symptoms, anxiety, bipolar traits, somatic symptoms, trauma history, rejection sensitivity, personality traits, emotion regulation, coping, illness perceptions, quality of life, and functional impairment. <br/>Results: Of twelve pre-specified hypotheses, only one was supported. AD was distinguished from MEL by higher rejection sensitivity (p = .025), while no group differences were observed for anxiety, somatic symptoms, trauma exposure, emotion regulation, coping, personality traits, functioning, or quality of life. AD and MEL did not differ in overall depressive severity. Individuals with u-MDD reported lower symptom severity and less perceived illness impact. <br/>Conclusions: The findings indicate that AD was not associated with greater overall psychosocial burden than MEL. Instead, rejection sensitivity emerged as the primary feature distinguishing AD from other depressive presentations. The substantial overlap observed across most psychosocial domains suggests that differences between depressive subtypes may be narrower and more specific than previously proposed. <br/>