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Subthreshold affective disorders: a useful concept in psychiatric epidemiology?

Published online by Cambridge University Press:  11 October 2011

Kerstin Schotte  and
Brian Cooper
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Summary

Objective - In recent years an extensive literature has grown up around the concepts of subthreshold, subsyndromal, minor and brief recurrent affective disorder and their applications in population-based research. The aim of this short review is to examine the definitions and current status of these proposed categories with special reference to depression, and to assess their potential contribution to psychiatric epidemiology. Method - A Medline search was carried out for the period 1965-1999, based on the above four terms. Relevant references found in all identified publications were also followed up. Results - In great measure these constructs have been developed as a reponse to deficiencies in the DSM classification system and to a lesser extent in the ICD. The groups are all defined by having fewer criterial symptoms, or a shorter duration of symptoms, than the ‘official’ diagnostic categories. Use of these definitions has resulted in widely varying prevalence estimates. Conclusion - Improved methods are badly needed for classifying all those persons in the wider community who are in need of medical treatment and help for psychological disorder, but do not satisfy operational criteria laid down in the official guidelines. This cannot, however, be achieved simply by lowering operational thresholds in these systems. Further research on clinical and psycho-social characteristics of the common mental disorders is called for, and in many societies a favourable setting is that of primary health care, where a move towards pragmatic, comprehensive classification of community health problems is already under way.

Riassunto

Scopo - Negli ultimi anni si è sviluppata una consistente letteratura sui concetti di disturbi affettivi sotto-soglia, sub-sindromici, minori, brevi e ricorrenti e sulle loro applicazioni nelle ricerche sulla popolazione generate. Lo scopo di questa breve revisione della letteratura è quello di esaminare le definizioni è lo stato corrente di queste categorie, proposte in riferimento soprattutto alia depressione e di valutare il loro potenziale contributo alia psichiatria epidemiologica. Metodo - È stata effettuata una ricerca Medline sui suddetti quattro termini per il periodo 1965-1999. Sono state esaminate anche le referenze bibliografiche rilevanti contenute in tutte le pubblicazioni identificate. Risultati - In larga misura questi concetti sono stati sviluppati come risposta ai limiti nel sistema di classificazione DSM e, in minor misura, in quello ICD. I gruppi sono stati identificati per aver meno sintomi rispondenti ai criteri o una minor durata dei sintomi rispetto alle categorie diagnostiche «ufficiali». L'uso di queste definizioni ha dato luogo a stime di prevalenza che variano in modo più esteso. Conclusioni - Sono indispensabili metodi perfezionati per la classificazione di tutte quelle persone nella popolazione generale, che hanno bisogno di trattamento medico e di aiuto per disturbi psicologici, ma che non soddisfano i criteri operativi indicati dalle linee guida ufficiali. Ciò, comunque, non può essere attuato semplicemente abbassando le soglie operative in questi sistemi. Sono necessarie ulteriori ricerche sulle caratteristiche cliniche e psicosociali dei disturbi psichiatrici comuni. In molte società un setting favorevole è quello della medicina di base, dove sono già in corso iniziative per una classificazione pragmatica e globale dei problemi di salute della popolazione.

Keywords

subthreshold depressionsubsybdromal depressionbrief recurrent depressionminor depressionpsychiatric epidemiologyprimary care psychiatry.depressione sotto-sogliadepressione sub-sindromicadepressione breve ricorrentedepressione minoreepidemiologia psichiatricadisturbi psichici nella medicina generale.
Type
Invited Paper
Information
Epidemiology and Psychiatric Sciences , Volume 8 , Issue 4 , December 1999 , pp. 255 - 261
Copyright
Copyright © Cambridge University Press 1999

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References

American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). American Psychiatric Association: Washington D.C.Google Scholar
Angst, J. (1992). Recurrent brief psychiatric symptoms of depression, hypomania, neurasthenia and anxiety from an epidemiological point of view. Neurology, Psychiatry and Brain Research 1, 5–12.Google Scholar
Angst, J. (1994). The history and concept of recurrent brief depression. European Archives of Psychiatry and Clinical Neuroscience 244, 171–173.CrossRefGoogle ScholarPubMed
Angst, J. & Dobler-Mikola, A. (1984). The Zurich study II. The continuum from normal to pathological depressive mood swings. European Archives of Psychiatry and Clinical Neuroscience 234, 21–29.Google ScholarPubMed
Angst, J., Merikangas, K.R. & Preisig, M. (1997). Subthreshold syndromes of depression and anxiety in the community. Journal of Clinical Psychiatry 58, suppl 8, 6–10.Google ScholarPubMed
Anthony, J.C. & Dryman, A. (1987). Analysis of discrepancy in lifetime diagnosis of mental disorders: results from the NIMH epidemiologic catchment area program. Unpublished MS: De-partment of Mental Hygiene, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD.Google Scholar
Barrett, J.E., Barrett, J.A., Oxman, T. & Gerker, P.D. (1988). The prevalence of psychiatric disorders in a primary care practice. Archives of General Psychiatry 45, 1100–1106.CrossRefGoogle Scholar
Bebbington, P., Katz, R., McGuffin, P., Tennant, C. & Hurry, J. (1989). The risk of minor depression before age 65: results from a community survey. Psychological Medicine 19, 393–400.CrossRefGoogle ScholarPubMed
Beck, D.A. & Koenig, H.G. (1996). Minor depression: a review of the literature. International Journal of Psychiatry in Medicine 26(2), 177–209.CrossRefGoogle ScholarPubMed
Broadhead, W.E., Blazer, D.G., George, L.K. & Tse, C.K. (1990). Depression, disability days, and days lost from work in a prospective epidemiological survey. Journal of the American Medical Association 264, 2524–2528.CrossRefGoogle Scholar
Coyne, J.C., Klinkman, M.S., Gallo, S.M. & Schwenk, T.L. (1997). Short-term outcomes of detected and undetected depressed primary care patients and depressed psychiatric patients. General Hospital Psychiatry 19, 333–343.CrossRefGoogle ScholarPubMed
Finlay-Jones, R. & Brown, G.W. (1981). Types of stressful liveevent and the onset of anxiety and depressive disorders. Psychological Medicine 11, 803–815.CrossRefGoogle ScholarPubMed
Goldberg, D. & Huxley, P. (1992). Common Mental Disorders: a Bio-social Model. Routledge: London.Google Scholar
Hofman-Okkes, I.M. & Lamberts, H. (1996). The international classification of primary care (ICPC): new applications in research and computer-based patient records in general practice. Family Practice 13, 294–302.CrossRefGoogle Scholar
Horwath, E., Johnson, J., Klerman, G.L. & Weissman, M.M. (1992). Depressive symptoms as relative and attributable risk factors for first-onset major depression. Archives of General Psychiatry 49, 817–823.CrossRefGoogle ScholarPubMed
Judd, L.L., Rapaport, M.H., Paulus, M.P. & Brown, J.L. (1994). Subsyndromal symptomanic depression: a new mood disorder? Journal of Clinical Psychiatry 55, suppl. 4, 18–28.Google ScholarPubMed
Judd, L.L., Akiskal, H.S. & Paulus, M.P. (1997). The role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder. Journal of Affective Disorders 45, 5–18.CrossRefGoogle ScholarPubMed
Kathol, R.G. & Petty, F. (1981). Relationship of depression to medical illness: a critical review. Journal of Affective Disorders 3, 111–121.CrossRefGoogle ScholarPubMed
Lepine, J.P., Pelissolo, A., Weiller, E., Boyer, P. & Lecrubier, Y. (1995). Recurrent brief depression: clinical and epidemiological issues. Psychopathology 28, suppl. 1, 86–94.Google ScholarPubMed
Maier, W., Herr, R. & Gansicke, M. (1994). Recurrent brief depression in general practice. Clinical features, co-morbidity with other disorders, and need for treatment. European Archives of Psychiatry and Clinical Neuroscience 244, 196–204.CrossRefGoogle ScholarPubMed
Maier, W., Gansicke, M. & Weiffenbach, O. (1997). The relationship between major and subthreshold variants of unipolar depression. Journal of Affective Disorders 45, 41–51.CrossRefGoogle ScholarPubMed
Montgomery, D.B., Roberts, A., Green, M., Bullock, T., Baldwin, D. & Montgomery, S.A. (1994). Lack of efficacy of fluoxetine in recurrent brief depression and suicidal attempts. European Archives of Psychiatry and Clinical Neuroscience 244, 211–215.CrossRefGoogle ScholarPubMed
Olfson, M., Broadhead, W.E., Weissman, M.M., Leon, A.C., Farber, L., Hoven, C. & Kathol, R. (1996). Subthreshold psychiatric symptoms in a primary care group practice. Archives of General Psychiatry 53, 880–886.CrossRefGoogle Scholar
Ormel, J., Oldehinkel, T., Brilman, E. & van den Brink, W. (1993). Outcome of depression and anxiety in primary care. A threewave 3.5 year study of psychopathology and disability. Archives of General Psychiatry 50, 759–766.CrossRefGoogle Scholar
Parker, G. (1987). Editorial: Are lifetime prevalence estimates in the ECA study accurate? Psychological Medicine 17, 275–282.CrossRefGoogle Scholar
Paykel, E.S., Hollyman, J.A., Freeling, P. & Sedgwick, P. (1988). Predictors of therapeutic benefit from amitriptyline in mild depression: a general practice placebo-controlled trial. Journal of Affective Disorders 14, 83–95.CrossRefGoogle ScholarPubMed
Romanoski, A.J., Folstein, M.F., Nestadt, G., Chahal, R., Merchant, A., Brown, C.H., Gruenberg, E.M. & McHugh, P.R. (1992). The epidemiology of psychiatrist-ascertained depression and DSMIII depressive disorders: results from the Eastern Baltimore Mental Health Survey Clinical Reappraisal. Psychological Medicine 22, 629–655.CrossRefGoogle ScholarPubMed
Sherbourne, C.D., Wells, K.B., Hays, R.D., Rogers, W., Burnam, M.A. & Judd, L.L. (1994). Subthreshold depression and depressive disorder: clinical characteristics of general medical and mental health specialty outpatients. American Journal of Psychiatry 151(12), 1777–1784.Google ScholarPubMed
Skodol, A.E., Schwartz, S., Dohrenwend, B.P., Levav, I. & Shrout, P.E. (1994). Minor depression in a cohort of young adults in Israel. Archives of General Psychiatry 51, 542–551.CrossRefGoogle Scholar
Spitzer, R.L., Endicott, J. & Robins, E. (1978). Research Diagnostic Criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Tarlov, A., Ware, J.E., Greenfield, S., Nelson, E.C., Perrin, E. & Zubkoff, M. (1989). The Medical Outcomes Study: an application of methods for monitoring the results of medical care. Journal of the American Medical Association 262, 925–930.CrossRefGoogle ScholarPubMed
Tiemens, B.G., Ormel, J. & Simon, G.E.. (1996). Occurrence, recognition, and outcome of psychological disorders in primary care. American Journal of Psychiatry 153, 636–644.Google ScholarPubMed
Ustun, T.B., Goldberg, D., Cooper, J., Simon, G.E. & Sartorius, N. (1995). New classification for mental disorders with management guidelines for use in primary care: ICD-10 PHC chapter five. British Journal of General Practice 45, 211–215.Google ScholarPubMed
Weber, A.C. & Scharfetter, C. (1984). The syndrome concept: history and statistical operationalizations. Psychological Medicine 14, 315–325.CrossRefGoogle ScholarPubMed
Weiller, E., Lecrubier, Y., Maier, W. & Ustun, T.B. (1994). The relevance of recurrent brief depression in primary care. A report from the WHO project on psychological problems in general health care conducted in 14 countries. European Archives of Psychiatry and Clinical Neurosciences 244, 182–189.CrossRefGoogle ScholarPubMed
Wells, K.B., Stewart, A., Hays, R.D., Burnam, M.A., Rogers, W., Daniels, M., Berry, S., Greenfield, S. & Ware, J. (1989). The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. Journal of the American Medical Association 262, 914–919.CrossRefGoogle ScholarPubMed
World Health Organization (WHO). (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.Google Scholar