Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-23T00:19:35.907Z Has data issue: false hasContentIssue false
  • English
  • Français

Is seeking treatment for depression predicted by a history of depression in relatives? Implications for family studies of affective disorder

Published online by Cambridge University Press:  09 July 2009

Kenneth S. Kendler
Kenneth S. Kendler*
Affiliation:
Department of Psychiatry and Human Genetics, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA, USA
*
1Address for Correspondence: Dr Kenneth K. Kendler, Department of Psychiatry, MCV/VCU, Box 980710, Richmond, VA 23298–0710. USA.
Get access Rights & Permissions [Opens in a new window]

Synopsis

Most family studies of psychiatric illness ascertain probands through treatment facilities. If psychiatric illness in relatives influences the probability of treatment seeking, then the risk of illness in the relatives of treated probands will not be representative of the risk of illness in all probands. We have investigated this question in a population-based sample of female twins with lifetime history of DSM-III-R defined major depression (MD) (N = 753), 36% of whom reported seeking professional help for their depression. Logistic and Cox regression methods were used. Treatment seeking for MD was significantly associated with age, education, comorbidity with anxiety disorders, degree of impairment and number of symptoms. Controlling for these predictors, treatment seeking was significantly predicted by the presence of one or more relatives with a lifetime diagnosis of MD (OR = 1·62). The probability of treatment seeking for MD in the proband was significantly increased if the affected relative: (i) had an onset of their MD prior that of the proband and; (ii) themselves sought treatment for their depression. Seeking treatment in this epidemiological sample of depressed women was associated with a 32% increase in risk of MD in relatives. Selecting probands for family studies from treated populations may select for families with an increased rate of illness. For MD, this artefact can explain only a modest proportion of the familial aggregation observed in prior family studies that utilized treated probands.

Type
Original Articles
Information
Psychological Medicine , Volume 25 , Issue 4 , July 1995 , pp. 807 - 814
Copyright
Copyright © Cambridge University Press 1995

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

American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association: Washington, DC.Google Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn Revised. American Psychiatric Association: Washington, DC.Google Scholar
Bandura, A. (1986). Social Foundations of Thought and Action: A Social Cognitive Theory. Prentice-Hall: Englewood Cliffs, NJ.Google Scholar
Baron, M., Gruen, R., Rainer, J. D., Kane, J., Asnis, L. & Lord, A. (1985). A family study of schizophrenia and normal control probands: implications for the spectrum concept of schizophrenia. American Journal of Psychiatry 142, 447–455.Google ScholarPubMed
Berkson, J. (1946). Limitations of the application of fourfold table analysis to hospital data. Biometrics Bulletin 2, 47–53.Google Scholar
Book, J. A. (1953). A genetic and neuropsychiatric investigation of a North-Swedish population with special regard to schizophrenia and mental deficiency. Acta Genetica Statistica Medica 4, 1–100.Google Scholar
Bucholz, K. K. & Robins, L. N. (1987). Who talks to a doctor about existing depressive illness? Journal of Affective Disorders 12, 241–250.CrossRefGoogle ScholarPubMed
Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement 20, 37–46.CrossRefGoogle Scholar
Cox, D. R. (1972). Regression models and life tables (with discussion). Journal of the Royal Statistical Society, Series B 34, 187–220.Google Scholar
Dew, M. A., Dunn, L. O., Bromet, E. J. & Schulberg, H. C. (1988). Factors affecting help-seeking during depression in a community sample. Journal of Affective Disorders 14, 223–234.Google Scholar
Dew, M. A., Bromet, E. J., Schulberg, H. C. & Parkinson, D. K. (1991). Factors affecting service utilization for depression in a white collar population. Social Psychiatry and Psychiatric Epidemiology 26, 230–237.Google Scholar
Gershon, E. S., Hamovit, J., Guroff, J. J., Dibble, E., Leckman, J. F., Sceery, W., Targum, S. D., Nurnberger, J. I., Goldin, L. R. & Bunney, W. E. (1982). A family study of schizoaffective, bipolar I, bipolar II, unipolar, and normal control probands. Archives of General Psychiatry 39, 1157–1167.Google Scholar
Hallgren, B. & Sjögren, T. (1959). A Clinical and Genetico-Statistical Study of Schizophrenia and Low-Grade Mental Deficiency in a Large Swedish Rural Population. Acta Psychiatrica et Neurologica Scandinavica, 35, Supplement 140: Copenhagen.Google Scholar
Kadushin, C. (1969). Why People Go to Psychiatrists. Atherton Press: New York.Google Scholar
Kendler, K. S. (1994). Methods of proband ascertainment in psychiatric genetics: an historical and epidemiologic perspective. International Journal of Methods in Psychiatric Research 4, 108.1–108.11.Google Scholar
Kendler, K. S., Neale, M. C., Kessler, R. C., Heath, A. C. & Eaves, L. J. (1992 a). A population based twin study of major depression in women: the impact of varying definitions of illness. Archives of General Psychiatry 49, 257–266.Google Scholar
Kendler, K. S., Neale, M. C., Kessler, R. C., Heath, A. C. & Eaves, L. J. (1992 b). Generalized anxiety disorder in women: a population based twin study. Archives of General Psychiatry 49, 267–272.CrossRefGoogle ScholarPubMed
Kendler, K. S., Neale, M. C., Kessler, R. C., Heath, A. C. & Eaves, L. J. (1992 c). The genetic epidemiology of phobias in women: the inter-relationship of agoraphobia, social phobia, situational phobia and simple phobia. Archives of General Psychiatry 49, 273–281.CrossRefGoogle Scholar
Kendler, K. S., Heath, A. C., Neale, M. C., Kessler, R. C. & Eaves, L. J. (1992 d). A population-based twin study of alcoholism in women. Journal of the American Medical Association 268, 1877–1882.CrossRefGoogle ScholarPubMed
Kish, L. & Frankel, M. R. (1974). Inferences from complex samples. Journal of the Royal Statistical Society, Series B 36, 1–37.Google Scholar
Link, B. & Dohrenwend, B. P. (1980). Formulation of hypotheses about the ratio of untreated to treated cases in the true prevalence studies of functional psychiatric disorders in adults in the United States. In Mental Illness in the United States: Epidemiological Estimates (ed. Dohrenwend, B. P., Dohrenwend, B. S., Gould, M. S., Link, B., Neugebauer, R. and Wunsch-Hitzig, R.), pp. 133–149. Praeger: New York, NY.Google Scholar
McGuffin, P. & Katz, R. (1993). Genes, adversity, and depression. In Nature, Nurture & Psychology (ed. Plomin, R. and McClearn, G. E.), pp. 217–230. American Psychological Association: Washington, DC.Google Scholar
Maier, W., Lichtermann, D., Minges, J., Hallmayer, J., Heun, R., Benkert, O. & Levinson, D. F. (1993). Continuity and discontinuity of affective disorders and schizophrenia: results of a controlled family study. Archives of General Psychiatry 50, 871–883.Google Scholar
Robins, L. N. & Helzer, J. E. (1985). Diagnostic Interview Schedule (DIS): Version III-A. Washington University School of Medicine: St Louis, MO.Google Scholar
Robins, L. N. & Regier, D. A., eds. (1991). Psychiatric Disorders in America. The Free Press: New York.Google Scholar
Rüdin, E. (1916). Studien über Vererbung und entstehung geistiger Störungen. I. Zur vererbung und neuentstehung der Dementia praecox. (Studies on the inheritance and origin of mental illness. I. The problem of the inheritance and primary origin of dementia praecox.) In Monographien aus dem Gesamtgebiet der Neurologie und Psychiatrie, Number 12. Springer: Berlin.Google Scholar
SAS Institute (1990). SAS/STAT User's Guide, Version 6, Fourth Edition, vols. 1 and 2. SAS Institute Incorporated: Cary, NC.Google Scholar
Shapiro, S., Skinner, E. A., Kessler, L. G., Von Korff, M., German, P. S., Tischler, G. L., Leaf, P. J., Benham, L., Cottler, L. & Regier, D. A. (1984). Utilization of health and mental health services: three epidemiologic catchment area sites. Archives of General Psychiatry 41, 971–978.CrossRefGoogle ScholarPubMed
Sjögren, T. (1935). Investigations of the heredity of psychoses and mental deficiency in two North Swedish parishes. Annals of Eugenics 6, 253–318.Google Scholar
Spence, J. E., Corey, L. A., Nance, W. E., Marazita, M. L., Kendler, K. S. & Schieken, R. M. (1988). Molecular analysis of twin zygosity using VNTR DNA probes. American Journal of Human Genetics 43, A159.Google Scholar
Spitzer, R. L., Williams, J. B. & Gibbon, M. (1987). Structured Clinical Interview for DSM-III-R. Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Szatmari, P., Boyle, M. H. & Offord, D. R. (1993). Familial aggregation of emotional and behavioral problems of childhood in the general population. American Journal of Psychiatry 150, 1398–1403.Google ScholarPubMed
Tsuang, M. T., Winokur, G. & Crowe, R. R. (1980). Morbidity risks of schizophrenia and affective disorders among first-degree relatives of patients with schizophrenia, mania, depression and surgical conditions. British Journal of Psychiatry 137, 497–504.CrossRefGoogle ScholarPubMed
Veroff, J., Kulka, R. A. & Douvan, E. (1981). Mental Health in America: Patterns of Help-seeking from 1957 to 1976. Basic Books: New York.Google Scholar
Weissman, M. M., Gershon, E. S., Kidd, K. K., Prusoff, B. A., Leckman, J. F., Dibble, E., Hamovit, J., Thompson, W. D., Pauls, D. L. & Guroff, J. J. (1984). Psychiatric disorders in the relatives of probands with affective disorders: The Yale University National Institute of Mental Health Collaborative Study. Archives of General Psychiatry 41, 13–21.Google Scholar
Weissman, M. M., Wickramaratne, P., Adams, P., Lish, J. D., Horwath, E., Charney, D., Woods, S. W., Leeman, E. & Frosch, E. (1993). The relationship between panic disorder and major depression. Archives of General Psychiatry 50, 767–780.CrossRefGoogle ScholarPubMed