Non-Gaussian Liability Distribution for Depression in the General Population

Unlike depression sum scores, the underlying risk for depression is typically assumed to be normally distributed across the general population. To assess the true empirical shape of depression risk, we created a continuous-valued estimate of the latent depression density, using the Davidian-Curve Item Response Theory (DC-IRT) and the National Health and Nutrition Examination Survey (NHANES) cohorts from 2005 to 2018 (n = 36,244 on the Nine-item Patient Health Questionnaire; PHQ-9). We conducted simulations to investigate the performance of DC-IRT for large samples and realistic items. The method can recover complex latent-risk distributions even when they are not evident from sum scores. However, estimation accuracy for different sample sizes depends on the method of model selection. In addition to full-data analysis, random samples of a few thousand observations were drawn for analysis. The latent shape of depression was left-skewed and bimodal in both investigations, indicating that the latent-normality assumption does not hold for depression.