Hostname: page-component-7c8c6479df-ws8qp Total loading time: 0 Render date: 2024-03-28T22:23:09.030Z Has data issue: false hasContentIssue false

‘Subthreshold’ mental disorders

A review and synthesis of studies on minor depression and other ‘brand names’

Published online by Cambridge University Press:  02 January 2018

Harold Alan Pincus*
Affiliation:
Office of Research, American Psychiatric Association, 1400 K Street NW Washington, DC 20005. USA
Wendy Wakefield Davis
Affiliation:
Office of Research, American Psychiatric Association, 1400 K Street NW Washington, DC 20005. USA
Laurie E. McQueen
Affiliation:
Office of Research, American Psychiatric Association, 1400 K Street NW Washington, DC 20005. USA
*
Dr Harold Pincus, Deputy Medical Director, American Psychiatric Association, 1400 K Street NW. Washington. DC 20005, USA

Abstract

Background

Subthreshold conditions (i. e. not meeting full diagnostic criteria for mental disorders in DSM–IV or ICD–10) are prevalent and associated with significant costs and disability. Observed more in primary care and community populations than in speciality settings, varying conceptualisations have been applied to define these conditions.

Aims

To examine definitional issues for subthreshold forms of depression (e. g. minor depression) and to suggest future directions for research and nosology in psychiatry and primary care.

Method

A Medline search was conducted. The relevant articles were reviewed with regard to specific categories of information.

Results

Studies applied a myriad of names and definitions for subthreshold depression with varying duration, symptom thresholds and exclusions. Prevalence rates also vary depending upon the definitions, settings and populations researched.

Conclusions

Future research needs to apply methodological and intellectual rigour and systematically consider a broader clinical and nosological context. In addition, collaboration between psychiatry and primary care on research and clinical issues is needed.

Type
Review Articles
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

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.)

Footnotes

Declaration of interest

Authors were employees of the American Psychiatric Association and no other funds were obtained.

References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.Google Scholar
American Psychiatric Association (1996) Diagnostic and Statistical Manual of Mental Disorders (4th edn) Primary Care Version (DSM–IV–PC). Washington. DC: APA Google Scholar
Angst, J. (1990) Recurrent brief depression: a new concept of depression. Pharmacopsychiatry, 23, 6366.Google Scholar
Angst, J., Merikenges, K., Scheiddeger, P., et al (1990) Recurrent brief depression: a new subtype of affective disorder. Journal of Affective Disorders, 19, 8798.CrossRefGoogle ScholarPubMed
Broadhead, W. E., Biazer, D. G., George, L. K., et al (1990) Depression, disability days, and days lost from work in a prospective epidemiologic survey. Journal of the American Medical Association, 264, 25242528.Google Scholar
Chochinov, H. M., Wilson, K. G., Enns, M., et al (1994) Prevalence of depression in the terminally ill: effects of diagnostic criteria and symptom threshold judgments. American Journal of Psychiatry, 151, 537540.Google Scholar
Coulehan, J. L., Schulberg, H. C., Block, M. R., et al (1990) Depressive symptomatology and medical co-morbidity in a primary care clinic. International Journal of Psychiatry, 20, 335347.Google Scholar
DeGruy, F. V. & Pincus, H. A. (1996) The DSM–IV–PC: a manual for diagnosing mental disorders in the primary care setting. Journal of the American Board of Family Practice, 9, 271281.Google Scholar
Frances, A. (1990) Problems in defining clinical significance in epidemiological studies. Archives of General Psychiatry, 55, 119.Google Scholar
Froom, J., Aoyama, H., Hermoni, D., et al (1995) Depressive disorder in three primary care populations: United States, Israel, Japan, Family Practice, 12, 274278.Google Scholar
Hance, M., Carney, R. M., Freedland, K. E., et al (1996) Depression in patients with coronary heart disease: a 12 month follow up. General Hospital Psychiatry, 18, 6165.CrossRefGoogle ScholarPubMed
Horwarth, E., Johnson, J., Klerman, G. L., et al (1992) Depressive symptoms as relative and attributable risk factors for first-onset major depression. Archives of General Psychiatry, 49, 817823.CrossRefGoogle Scholar
Hudziak, J. J., Heath, A. C., Madden, P. F., et al (1998) Latent class and factor analysis of DSM–IV ADHD: a twin study of female adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 848857.Google Scholar
Jaffa, A., Froom, J. & Galambos, N. (1994) Minor depression and functional impairment. Archives of Family Medicine. 3, 10811086.Google Scholar
Johnson, J., Weissman, M. M. & Klerman, G. L. (1992) Service utilization and social morbidity associated with depressive symptoms in the community. Journal of the American Medical Association, 267. 14781483.CrossRefGoogle ScholarPubMed
Judd, L. L., Rapaport, M. H., Paulus, M. P., et al (1994) Subsyndromal symptomatic depression: a new mood disorder? Journal of Clinical Psychiatry, 55, 1828.Google Scholar
Kasper, S., Rurhmann, S. Haase, T., et al (1992) Recurrent brief depression and its relationship to seasonal affective disorders. European Archives of Psychiatry and Clinical Neuroscience. 242, 2026.CrossRefGoogle Scholar
Kasper, S., Rurhmannn, S. Haase, T., et al (1994) Evidence for a seasonal form of recurrent brief depression, European Archives of Psychiatry and Clinical Neuroscience, 244, 205210.CrossRefGoogle ScholarPubMed
Katon, W., Lin, E., Von Korff, M., et al (1994) The predictors of persistence of depression in primary care. Journal of Affective Disorders, 31, 8190.Google Scholar
Keller, M. B., Klein, D. N., Hirschfeld, R. M., et al (1995) Results of the DSM – IV mood disorders field trial. American Journal of Psychiatry, 152, 843849.Google ScholarPubMed
Kirmayer, L. J., Robbins, J. M., Dworkind, M., et al (1993) Somatization and the recognition of depression and anxiety in primary care, American Journal of Psychiatry. 150, 734741.Google Scholar
Klinkman, M. S. (1997) Competing demands in psychosocial care: a model for the identification and treatment of depressive disorders in primary care. General Hospital Psychiatry, 19, 98111.CrossRefGoogle Scholar
Maizer, W., Lichtermann, D., Minges, J., et al (1992) The risk of minor depression in families of probands with major depression: sex differences and familiality. European Archives of Psychiatry and Clinical Neuroscience, 242, 8992.Google Scholar
Maizer, W., Herr, R., Lichtermann, D., et al (1994a) Brief depression among patients m general practice. Prevalence and variation by recurrence and severity. European Archives of Psychiatry and Clinical Neuroscience. 244, 190195.Google Scholar
Maizer, W., Herr, R., Gansicke, M., et al (1994b) Recurrent brief depression in general practice. Clinical features, comorbidity with other disorders, and need for treatment. European Archives of Psychiatry and Clinical Neuroscience, 244, 196204.Google Scholar
Mino, Y., Aoyama, H., Froom, J., et al (1994) Depressive disorders in Japanese primary care patients. Family Practice, 11, 363367 Google Scholar
Miranda, J. & Munoz, R. (1994) Intervention for minor depression in primary care patients. Psychosomatic Medicine, 56, 136141.Google Scholar
Montgomery, S. A., Montgomery, D., Baldwin, D., et al (1990) The duration, nature and recurrence rate of brief depressions. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 14, 729735.CrossRefGoogle ScholarPubMed
Olfson, M., Broadhead, W. E., Weissman, M. M., et al (1996) Subthreshold psychiatric conditions in a prepaid primary care group practice. Archives of General Psychiatry, 53, 880886.Google Scholar
Oxman, T. E., Barrett, J. E., Barrett, H. J., et al (1990) Symptomatology of late-life minor depression among primary care patients. Psychosomatics, 31, 174180.Google Scholar
Pincus, H. A., Frances, A. F., Davis, W. W., et al (1992) DSM–IV and new diagnostic categories: holding the line on proliferation. American Journal of Psychiatry 149, 112117.Google ScholarPubMed
Regier, D. A., Narrow, W. E., Rae, D. S., et al (1993) The de facto U.S. mental health and addictive disorders service system. Archives of General Psychiatry, 50, 8594.Google Scholar
Rost, K., Smith, R., Matthews, D. B., et al (1994) The deliberate misdiagnosis of major depression Archives of Family Medicine. 3, 333337.Google Scholar
Roy-Byrne, P., Katon, W., Broadhead, W. E., et al (1994) Subsyndromal (‘mixed’) anxiety–depression in primary care. Journal of General Internal Medicine. 9, 507512.Google Scholar
Sherbourne, C. D., Wells, K. B., Hays, R. D., et al (1994) Subthreshold depression and depressive disorder: clinical characteristics of general medical and mental health specialty outpatients. American Journal of Psychiatry, 151, 17771784.Google Scholar
Simon, G. E. & Von Korff, M. (1995) Recognition, management, and outcomes of depression in primary care. Archives of Family Medicine. 4, 99105.Google Scholar
Skodol, A. E., Schwartz, S., Dohrenwend, B. P., et el (1994) Minor depression in a cohort of young adults in Israel. Archives of General Psycharitry, 51, 542551.Google Scholar
Staner, L., De La Fuente, J. M., Kerkhofs, M., et al (1992) Biological and clinical features of recurrent brief depression: a comparison with major depressed and health subjects. Journal of Affectivc Disorders. 26, 241245 CrossRefGoogle Scholar
Stein, M. B., Kirk, P., & Prabhu, V., et al (1995) Mixed anxiety – depression in a primary care clinic. Journal of Affective Disorders, 34, 7984.Google Scholar
Sugar, C. A., Sturm, R., Lee, T. T., et al (1998) Empirically defined healths states for depresson from the SF-12. Health Services Research, 34. 911928.Google Scholar
Tollefson, G. D., Souetre, E., Thomander, L., et al (1993) Comorbid anxious signs and symptoms in major depression: impact on functional work capacity and comparative treatment outcomes, International Clinical Psychopharmacology, 8, 281293.Google Scholar
Tudor, S. & Zaharía, M. (1994) Comparative study of the treatment with tetracyclic and tricyclic antidepressants in patients with menor depressive disorders. Romanian Journal of Neurology and Psychiatry, 32, 185198.Google Scholar
Weiller, E., Boyer, P., Lepine, J. P., et al (1994a) Prevalence of recurrent brief depression in primary care. European Archives of Psychiatry and clinical Neuroscience, 244, 174181.Google Scholar
Weiller, E., LeCrubier, Y., Maier, W., et al (1994b) The relevance of recurrent brief depression in primary care: a report from the WHO protect on Psychological Problems in General Health Care conducted in 14 countries. Special issue: Recurrent brief depression. European Archives of Psychiatry and Clinical Neuroscience, 244, 182189.Google Scholar
Wells, K. B., Burnam, M. A., Rogers, W., et al (1992) The course of depression in adult outpatients. Archives of General Psychiatry, 489, 788794.Google Scholar
Williams, J. W., Kerber, C. A., Mulrow, C. D., et al (1995) Depressive disorders in primary care: prevalence, functional disability, and identification. Journal of General Internal Medicine, 10, 712.Google Scholar
Winter, P., Philipp, M., Buller, R., et al (1991) Identification of minor affective disorders and implications for psychopharmacotherapy. Journal of Affective Disorders, 22, 125133.CrossRefGoogle ScholarPubMed
Wittchen, H. U. & Essau, C. A. (1993) Comorbidity and mixed anxiety–depressive disorders: is there epidemiologic evidence? Journal of Clinical Psychiatry. 54. 915.Google Scholar
World Health Organization (1993) The ICD–10 Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research. Geneva: WHO.Google Scholar
World Health Organization (1996) Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD–10 Chapter V Primary Care Version. Göttingen, Germany: WHO/Hogrefe & Huber.Google Scholar
World Health Organization (1997) Classification of Dysthymia and Related Conditions in Neurological Diseases: Recommendations for the Clinical Descriptions and Criteria for Research: Version for Field Trials. Geneva: Division of Mental Health and Prevention of Substance Abuse, WHO.Google Scholar
Zinbarg, R. E., Barlow, D. H., Liebowitz, M., et al (1994) The DSM–IV field trial for mixed anxiety-depression. American Journal of Psychiatry. 151, 11531162.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.