Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-22T19:37:58.297Z Has data issue: false hasContentIssue false
  • English
  • Français

Family study of subthreshold psychopathology in a community sample

Published online by Cambridge University Press:  15 October 2007

S. A. Shankman ,
D. N. Klein ,
P. M. Lewinsohn ,
J. R. Seeley  and
J. W. Small
S. A. Shankman*
Affiliation:
Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
D. N. Klein
Affiliation:
Department of Psychology, Stony Brook University, Stony Brook, NY, USA
P. M. Lewinsohn
Affiliation:
Oregon Research Institute, Eugene, OR, USA
J. R. Seeley
Affiliation:
Oregon Research Institute, Eugene, OR, USA
J. W. Small
Affiliation:
Oregon Research Institute, Eugene, OR, USA
*
*Address for correspondence: S. A. Shankman, Ph.D., Assistant Professor, Department of Psychology, and Clinical Assistant Professor, Department of Psychiatry, University of Illinois at Chicago, 1007 W. Harrison, Room 1062D; M/C 285, Chicago, IL 60607, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

There has been increasing interest in the validity and familial transmission of subthreshold psychiatric conditions and the relationship between subthreshold conditions and full syndrome (FS) disorders. However, most of these studies examined a single subthreshold condition and thus fail to take into account the high co-morbidity among subthreshold conditions and between subthreshold conditions and FS disorders.

Method

A family study of subthreshold psychiatric conditions was conducted with 739 community-drawn young adults and their 1744 relatives. We examined (1) whether relatives of probands with subthreshold major depression, bipolar disorder, anxiety disorders, alcohol use, substance use, and/or conduct disorder exhibited an increased rate of the corresponding (homotypic) FS disorder; (2) whether subthreshold disorders were associated with increased familial rates of other (heterotypic) FS disorders; (3) whether subthreshold and FS conditions are associated with similar familial liabilities; and (4) whether these homotypic and heterotypic associations persisted after controlling for co-morbidity.

Results

Significant homotypic associations were observed for subthreshold anxiety, alcohol, conduct, and a trend was observed for major depression. Only the homotypic association for alcohol and conduct remained after controlling for co-morbid subthreshold and FS conditions. Many heterotypic associations were observed and most remained after controlling for co-morbidity.

Conclusions

It is important to broaden the study of subthreshold psychopathology to multiple disorders. In particular cases, controlling for co-morbidity with other subthreshold and FS conditions altered the patterns of familial aggregation. Etiological processes that are common to particular disorders and subthreshold conditions are discussed.

Keywords

Co-morbidityfamily studysubthreshold
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 2 , February 2008 , pp. 187 - 198
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Angst, J, Gamma, A, Benazzi, F, Ajdacic, V, Eich, D, Rossler, W (2003). Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. Journal of Affective Disorders 73, 133–146.CrossRefGoogle Scholar
Angst, J, Merikangas, KR, Preisig, M (1997). Subthreshold syndromes of depression and anxiety in the community. Journal of Clinical Psychiatry 58, 6–10.Google ScholarPubMed
Angst, J, Sellaro, R, Merikangas, KR (2000). Depressive spectrum diagnoses. Comprehensive Psychiatry 41, 39–47.CrossRefGoogle ScholarPubMed
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised (DSM-III-R). American Psychiatric Association: Washington, DC.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). American Psychiatric Association: Washington, DC.Google Scholar
Burke, JD, Loeber, R, Lahey, BB, Rathouz, PJ (2005). Developmental transitions among affective and behavioral disorders in adolescent boys. Journal of Child Psychology and Psychiatry 46, 1200–1210.CrossRefGoogle ScholarPubMed
Chung, T, Martin, C, Armstrong, T, Labouvie, EW (2002). Prevalence of DSM-IV alcohol diagnoses and symptoms in adolescent community and clinical samples. Journal of the American Academy of Child & Adolescent Psychiatry 41, 546–554.CrossRefGoogle ScholarPubMed
Cleckley, HM (1941). The Mask of Sanity: An Attempt to Clarify Some Issues About the So-Called Psychopathic Personality. CV Mosby Co: St Louis, MO.Google Scholar
Cornblatt, BA, Lencz, T, Smith, CW, Correll, CU, Auther, AM, Nakayama, E (2003). The schizophrenia prodrome revisited: a neurodevelopmental perspective. Schizophrenia Bulletin 29, 633–651.CrossRefGoogle ScholarPubMed
Fergusson, DM, Horwood, LJ, Ridder, EM, Beautrais, AL (2005). Subthreshold depression in adolescence and mental health outcomes in adulthood. Archives of General Psychiatry 62, 66–72.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). American Psychiatric Press: Washington, DC.Google Scholar
Flett, GL, Vredenburg, K, Krames, L (1997). The continuity of depression in clinical and nonclinical samples. Psychological Bulletin 121, 395–416.CrossRefGoogle ScholarPubMed
Gotlib, IH, Lewinsohn, PM, Seeley, JR (1995). Symptoms versus a diagnosis of depression: differences in psychosocial functioning. Journal of Consulting and Clinical Psychology 63, 90–100.CrossRefGoogle ScholarPubMed
Helmchen, H, Linden, M (2000). Subthreshold disorders in psychiatry: clinical reality, methodological artifact, and the double-threshold problem. Comprehensive Psychiatry 41, 1–7.CrossRefGoogle ScholarPubMed
Hicks, BM, Krueger, RF, Iacono, WG, McGue, M, Patrick, CJ (2004). Family transmission and heritability of externalizing disorders: a twin-family study. Archives of General Psychiatry 61, 922–928.CrossRefGoogle ScholarPubMed
Horwath, E, Johnson, J, Klerman, GL, Weissman, MM (1992). Depressive symptoms as relative and attributable risk factors for first-onset major depression. Archives of General Psychiatry 49, 817–823.CrossRefGoogle ScholarPubMed
Katerndahl, DA, Realini, JP (1998). Associations with subsyndromal panic and the validity of DSM-IV criteria. Depression and Anxiety 8, 33–38.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
Keller, MB, Lavori, PW, Friedman, B, Nielsen, E (1987). The longitudinal interval follow-up evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540–548.CrossRefGoogle ScholarPubMed
Kendler, KS, Gardner, CO (1998). Boundaries of major depression: an evaluation of DSM-IV criteria. American Journal of Psychiatry 155, 172–177.CrossRefGoogle ScholarPubMed
Kendler, KS, Heath, AC, Neale, MC, Kessler, RC, Eaves, LJ (1993). Alcoholism and major depression in women. A twin study of the causes of comorbidity. Archives of General Psychiatry 50, 690–698.CrossRefGoogle ScholarPubMed
Kendler, KS, Prescott, CA, Myers, J, Neale, MC (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry 60, 929–937.CrossRefGoogle ScholarPubMed
Kessler, RC, Wai, TC, Demler, O, Merikangas, KR, Walters, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.CrossRefGoogle ScholarPubMed
Kim-Cohen, J, Caspi, A, Moffitt, T, Harrington, H, Milne, BJ, Poulton, R (2003). Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry 60, 709–717.CrossRefGoogle ScholarPubMed
King, TM, Beaty, TH, Liang, KY (1996). Comparison of methods for survival analysis of dependent data. Genetic Epidemiology 13, 138–158.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Krueger, RF, Markon, KE (2006). Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology. Annual Review of Clinical Psychology 2, 111–133.CrossRefGoogle ScholarPubMed
LeBreton, JM, Binning, JF, Adorno, AJ (2006). Subclinical psychopaths. In Comprehensive Handbook of Personality and Psychopathology, Vol. 1 (ed. Thomas, J. C., Segal, D. L. and Hersen, M.), pp. 388–411. John Wiley: Hoboken, NJ.Google Scholar
Le Grange, D, Binford, RB, Peterson, CB, Crow, SJ, Crosby, RD, Klein, MH, Bardone-Cone, AM, Joiner, TE, Mitchell, JE, Wonderlich, SA (2006). DSM-IV threshold versus subthreshold bulimia nervosa. International Journal of Eating Disorders 39, 462–467.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Hops, H, Roberts, RE, Seeley, JR, Andrews, JA (1993). Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology 102, 133–144.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Klein, DN, Durbin, EC, Seeley, JR, Rohde, P (2003). Family study of subthreshold depressive symptoms: risk factor for MDD? Journal of Affective Disorders 77, 149–157.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Klein, DN, Seeley, JR (2000 b). Bipolar disorder during adolescence and young adulthood in a community sample. Bipolar Disorders 2, 281–293.CrossRefGoogle Scholar
Lewinsohn, PM, Roberts, RE, Seeley, JR, Rohde, P, Gotlib, IH, Hops, H (1994). Adolescent psychopathology: II. Psychosocial risk factors for depression. Journal of Abnormal Psychology 103, 302–315.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Rohde, P, Seeley, JR (1995). Adolescent psychopathology: III. The clinical consequences of comorbidity. Journal of the American Academy of Child & Adolescent Psychiatry 34, 510–519.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Shankman, SA, Gau, JM, Klein, DN (2004). The prevalence and comorbidity of subthreshold psychiatric conditions. Psychological Medicine 34, 613–622.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Solomon, A, Seeley, JR, Zeiss, A (2000 a). Clinical implications of ‘subthreshold’ depressive symptoms. Journal of Abnormal Psychology 109, 345–351.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Striegel-Moore, R, Seeley, JR (2000 c). The epidemiology and natural course of eating disorders in young women from adolescence to young adulthood. Journal of the American Academy of Child and Adolescent Psychiatry 39, 1284–1292.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Zinbarg, R, Seeley, JR, Lewinsohn, MA, Sack, WH (1997). Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents. Journal of Anxiety Disorders 11, 377–394.CrossRefGoogle ScholarPubMed
Markon, KE, Krueger, RF (2005). Categorical and continuous models of liability to externalizing disorders: a direct comparison in NESARC. Archives of General Psychiatry 62, 1352–1359.CrossRefGoogle ScholarPubMed
McIntyre, RS, Soczynska, JK, Bottas, A, Bordbar, K, Konarski, JZ, Kennedy, SH (2006). Anxiety disorders and bipolar disorder: a review. Bipolar Disorders 8, 665–676.CrossRefGoogle ScholarPubMed
Messer, J, Goodman, R, Rowe, R, Meltzer, H, Maughan, B (2006). Preadolescent conduct problems in girls and boys. Journal of the American Academy of Child & Adolescent Psychiatry 45, 184–191.CrossRefGoogle ScholarPubMed
Middeldorp, CM, Cath, DC, Van Dyck, R, Boomsma, DI (2005). The co-morbidity of anxiety and depression in the perspective of genetic epidemiology: review of twin and family studies. Psychological Medicine 35, 611–624.CrossRefGoogle ScholarPubMed
Moffitt, TE, Harrington, H, Caspi, A, Kim-Cohen, J, Goldberg, D, Gregory, AM, Poulton, R (2007). Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Archives of General Psychiatry 64, 651–660.CrossRefGoogle Scholar
Olsen, KA, Rosenbaum, B (2006). Prospective investigations of the prodromal state of schizophrenia: review of studies. Acta Psychiatrica Scandinavica 113, 247–272.CrossRefGoogle ScholarPubMed
Orvaschel, H, Puig-Antich, J, Chambers, WJ, Tabrizi, MA, Johnson, R (1982). Retrospective assessment of prepubertal major depression with the Kiddie-SADS-E. Journal of the American Academy of Child Psychiatry 21, 392–397.CrossRefGoogle ScholarPubMed
Pincus, HA, McQueen, LE, Elinson, L (2003). Subthreshold mental disorders: nosological and research recommendations. In Advancing DSM: Dilemmas in Psychiatric Diagnosis (ed. Phillips, K. A., First, M. B. and Pincus, H. A.), pp. 129–144. American Psychiatric Association: Washington, DC.Google Scholar
Pollock, NK, Martin, CS (1999). Diagnostic orphans: adolescents with alcohol symptomatology who do not qualify for DSM-IV abuse or dependence diagnoses. American Journal of Psychiatry 156, 897–901.CrossRefGoogle ScholarPubMed
Rohde, P, Lewinsohn, PM, Seeley, JR (1996). Psychiatric comorbidity with problematic alcohol use in high school adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 35, 101–109.CrossRefGoogle Scholar
Rohde, P, Lewinsohn, PM, Seeley, JR (1997). Comparability of telephone and face-to-face interviews assessing Axis I and II disorders. American Journal of Psychiatry 154, 1593–1598.CrossRefGoogle ScholarPubMed
Rohde, P, Lewinsohn, PM, Seeley, JR, Klein, DN, Andrews, JA, Small, JW (2007). Psychosocial functioning of adults who experienced substance use disorders as adolescents. Psychology of Addictive Behaviors 21, 155–164.CrossRefGoogle ScholarPubMed
Rucci, P, Gherardi, S, Tansella, M, Piccinelli, M, Berardi, D, Bisoffi, G, Corsino, MA, Pini, S (2003). Subthreshold psychiatric disorders in primary care: prevalence and associated characteristics. Journal of Affective Disorders 76, 171–181.CrossRefGoogle ScholarPubMed
Saunders, JB, Lee, NK (2000). Hazardous alcohol use: its delineation as a subthreshold disorder, and approaches to its diagnosis and management. Comprehensive Psychiatry 41, 95–103.CrossRefGoogle ScholarPubMed
Sobin, E, Weissman, MM, Goldstein, RB, Adams, P (1993). Diagnostic interviewing for family studies: comparing telephone and face-to-face methods for the diagnosis of lifetime psychiatric disorders. Psychiatric Genetics 3, 227–233.CrossRefGoogle Scholar
Solomon, A, Haaga, DAF, Arnow, BA (2001). Is clinical depression distinct from subthreshold depressive symptoms? A review of the continuity issue in depression research. Journal of Nervous and Mental Disease 189, 498–506.CrossRefGoogle ScholarPubMed
Spitzer, RL, Endicott, J, Robins, E (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
van Honk, J, Hermans, EJ, Putman, P, Montagne, B, Schutter, DJ (2002). Defective somatic markers in sub-clinical psychopathy. Neuroreport 13, 1025–1027.CrossRefGoogle ScholarPubMed
Verona, E, Patrick, CJ, Joiner, TE (2001). Psychopathy, antisocial personality, and suicide risk. Journal of Abnormal Psychology 110, 462–470.CrossRefGoogle ScholarPubMed
Watson, D (2005). Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology 114, 522–536.CrossRefGoogle ScholarPubMed
Widiger, TA, Samuel, DB (2005). Diagnostic categories or dimensions? A question for the Diagnostic and Statistical Manual of Mental Disorders – fifth edition. Journal of Abnormal Psychology 114, 494–504.CrossRefGoogle ScholarPubMed
Zlotnick, C, Franklin, CL, Zimmerman, M (2002). Does ‘subthreshold’ posttraumatic stress disorder have any clinical relevance? Comprehensive Psychiatry 43, 413–419.CrossRefGoogle ScholarPubMed