'Subthreshold' mental disorders. A review and synthesis of studies on minor depression and other 'brand names'.

Published on Apr 1, 1999in British Journal of Psychiatry 5.87
· DOI :10.1192/bjp.174.4.288
Harold Alan Pincus61
Estimated H-index: 61
(American Psychological Association),
Wendy W. Davis18
Estimated H-index: 18
(American Psychological Association),
Laurie E. McQueen3
Estimated H-index: 3
(American Psychological Association)
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.
  • References (44)
  • Citations (214)
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References44
Published on Jan 1, 1992in American Journal of Psychiatry 13.40
Harold Alan Pincus61
Estimated H-index: 61
,
Allen Frances57
Estimated H-index: 57
(American Psychological Association)
+ 2 AuthorsThomas A. Widiger70
Estimated H-index: 70
(American Psychological Association)
The authors discuss aspects of the decision-making process for including «new» diagnostic categories in DSM-IV. They detail the different kinds of new categories proposed for inclusion in DSM-IV and discuss the risks and benefits of incorporating them. The authors comment on whether new diagnostic categories should be included in official nosologies as a stimulus for research or as a culmination of research. They also highlight problems with «sunsetting» diagnoses
57 Citations Source Cite
Published on Jan 1, 1993in The Journal of Clinical Psychiatry 4.25
Hans-Ulrich Wittchen123
Estimated H-index: 123
(Max Planck Society),
Cecilia A. Essau35
Estimated H-index: 35
(Max Planck Society)
Recent epidemiologic studies (i.e., studies conducted since 1980) have consistently demonstrated, on the basis of standardized diagnostic assessments, that there is a substantial overlap between different types of anxiety and depressive disorders. The current literature, however, discusses this issue primarily within the concept of comorbidity and there are some controversies about the existence of a separate disorder of mixed anxiety-depression (MAD). MAD can be defined by the presence of mixed...
72 Citations
Published on Jan 1, 1995in American Journal of Psychiatry 13.40
Cathy D. Sherbourne68
Estimated H-index: 68
,
Kenneth B. Wells83
Estimated H-index: 83
+ 3 AuthorsLewis L. Judd52
Estimated H-index: 52
Objective: The authors examined the clinicalsignificance ofdepressive symptoms below the threshold for depressive disorder in outpatient samples. Method: The subjects were 775 adult patients with current depressive disorder, 1,420 patients with subthreshold depression, and 1,767 hypertensive patients with and without depression, all ofwhom were visiting the offices of mental health specialists and general medical care providers in three U.S. cities. Data on demographic characteristics, severity ...
170 Citations Source Cite
Published on Jan 1, 1995in American Journal of Psychiatry 13.40
Martin B. Keller113
Estimated H-index: 113
(Butler Hospital),
Daniel N. Klein71
Estimated H-index: 71
(Butler Hospital)
+ 8 AuthorsD. B. Marin1
Estimated H-index: 1
(Butler Hospital)
Objective: The DSM-IV mood disorders field trial, a multisite collaborative study, was designed to explore the reliability of a course-based diagnostic classification system for major depression, evaluate the symptom criteria for dysthymia, and explore the need for additional diagnostic categories for milder forms of mood disorder (e.g., minor and recurrent brief depression). Method : Five hundred twenty-four depressed subjects were recruited from inpatient, outpatient, and community settings at...
196 Citations Source Cite
Published on Apr 1, 1994in American Journal of Psychiatry 13.40
Harvey Max Chochinov39
Estimated H-index: 39
,
Keith G. Wilson9
Estimated H-index: 9
+ 1 AuthorsSheila Lander7
Estimated H-index: 7
Objective: Two issues that may influence the diagnosis ofdepression in the medically ill are 1) the severity with which symptoms must be expressed before they are considered clinically significant and 2) how to deal with somatic symptoms that may be caused by medical illness. This study used different approaches to case identification to examine prevalence rates for major and minor depression in a group of terminally ill cancer patients. Method: Semistructuned diagnostic interviews were conducte...
229 Citations Source Cite
Published on May 1, 1993in American Journal of Psychiatry 13.40
Laurence J. Kirmayer60
Estimated H-index: 60
,
James M. Robbins34
Estimated H-index: 34
+ 1 AuthorsMark J. Yaffe2
Estimated H-index: 2
Objective The authors examined the effect of patients'style of clinical presentation on primary care physicians'recognition of depression and anxiety. Method: The subjects were 685 patients attending family medicine clinics on self-initiated visits. They completed structured interviews assessing presenting complaints, self-report measures of symptoms and hypochondriacal worry, the Diagnostic Interview Schedule (DIS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Physician re...
500 Citations Source Cite
Stuart A. Montgomery51
Estimated H-index: 51
(Imperial College London),
D. Montgomery6
Estimated H-index: 6
(Imperial College London)
+ 1 AuthorsMary Green3
Estimated H-index: 3
(Imperial College London)
Abstract 1. 1. It has been shown in placebo controlled studies of prophylactic treatment of suicidal behaviour in patients not suffering from major depression that brief episodes of depression predict further suicidal behaviour. 2. 2. In a prospective follow up study of patients with a history of repeated suicidal behaviour it appears that almost all suffered recurrent episodes of brief depression, mainly of moderate to severe intensity. Two thirds of the episodes lasted between two and four day...
32 Citations Source Cite
Published on Jan 1, 1995in Journal of General Internal Medicine 4.00
John W Williams66
Estimated H-index: 66
,
Caroline Kerber2
Estimated H-index: 2
+ 2 AuthorsChristine Aguilar25
Estimated H-index: 25
OBJECTIVES: To assess the relative prevalence of subsyndromal depression (SubD) and major depression (MDD) in primary care patients and describe their associated functional impairments, and to define the operating characteristics of a short depression screen (SDS).
131 Citations Source Cite
Published on May 17, 1995in Journal of Affective Disorders 3.79
Murray B. Stein108
Estimated H-index: 108
(University of Manitoba),
Peter Kirk2
Estimated H-index: 2
(University of Manitoba)
+ 2 AuthorsMary Terepa1
Estimated H-index: 1
(University of Manitoba)
Abstract To determine the prevalence and clinical significance of a mixed anxiety-depressive (MAD) syndrome in primary care, a two-stage sampling design was applied to 796 consecutive clinic attendees without known psychiatric illness. Among 78 systematically interviewed subjects, 10.3% ( n = 8) had a depressive disorder alone, 12.8% ( n = 10) had an anxiety disorder alone, 19.2% ( n = 15) had a comorbid anxiety and depressive disorder and 12.8% ( n = 10) had a combination of subsyndromal anxiet...
69 Citations Source Cite
Cited By214
Published on Mar 1, 2003in Hong Kong Journal of Psychiatry
Eddie So2
Estimated H-index: 2
(Hospital Authority),
I. Kam1
Estimated H-index: 1
+ 2 AuthorsL. Lam1
Estimated H-index: 1
Abstract Objective: To report on the reliability of the Chinese-bilingual Structured Clinical Interview for DSM-IV (Axis I, Patient version) Project (CB-SCID-I/P), stage 2: anxiety disorders, adjustment disorders, and 'No diagnosis'. Methods: Newly registered outpatients were consecutively recruited from 2 sites, the Li Ka Shing Psychiatric Centre and Alice Ho Mui Ling Nethersole Psychiatric Clinic. The reliability of the CB-SCID-I/P was assessed individually for anxiety disorders, adjustment di...
30 Citations
Published on Mar 1, 2004in Mental health in family medicine
Roderick Orner4
Estimated H-index: 4
,
Aloysius Niroshan Siriwardena11
Estimated H-index: 11
,
Jane Dyas11
Estimated H-index: 11
Patients who feel anxious and depressed often turn to primary care for initial professional help. However, systematic service evaluations allege poor standards of diagnosis and treatment, resulting in disappointing clinical outcomes. All the same, special educational and quality improvement initiatives have not raised standards significantly. Why this should be so and possible remedies are suggested by this article, on the basis that the empirical evidence base for criticising primary care stand...
2 Citations
Published on Jan 1, 2002in Nervenarzt 0.74
Frank Jacobi35
Estimated H-index: 35
(Dresden University of Technology),
Michael Höfler51
Estimated H-index: 51
(Dresden University of Technology)
+ 1 AuthorsHans-Ulrich Wittchen123
Estimated H-index: 123
(Dresden University of Technology)
Published on Dec 1, 2010in Wiener Medizinische Wochenschrift
Siegfried Kasper76
Estimated H-index: 76
(Medical University of Vienna),
Markus Gastpar21
Estimated H-index: 21
+ 4 AuthorsSandra Schläfke6
Estimated H-index: 6
We review the data on the efficacy and tolerability of silexan, a novel preparation from lavender oil for oral use, in the treatment of anxiety disorders and related condition with particular attention to subthreshold generalized anxiety disorder (GAD). Three randomized, double-blind clinical trials were identified which investigated the efficacy of silexan in subsynromal anxiety disorder (vs. placebo; 10 weeks' treatment), in GAD (vs. lorazepam; 6 weeks), and in restlessness and agitation (vs. ...
34 Citations Source Cite
Published on May 27, 2000in BMJ 23.56
Hugh Middleton17
Estimated H-index: 17
(University of Nottingham),
Ian Shaw24
Estimated H-index: 24
(University of Nottingham)
Two studies in the BMJ last year make challenging reading set alongside one another. Kessler et al reported that over half the patients attending general practice surgeries are depressed,1 and the Norwegian naturalistic treatment study of depression in general practice concluded that the best treatment for depression in primary care is a combination of antidepressant medication and counselling.2 Read uncritically, these findings imply that half of all general practice patients should be taking a...
40 Citations Source Cite
Published on Aug 1, 2009in Salud Mental 0.50
Ietza Bojorquez-Chapela12
Estimated H-index: 12
,
V. Nelly Salgado de Snyder14
Estimated H-index: 14
Depressive symptoms constitute a common mental health problem, with a relevant social and personal impact. These symptoms are present not only among the urban population in more economically developed countries, but also in rural areas in poor and middle development countries. In order to obtain reliable information on the frequency of depressive symptoms, their risk factors or the impact of preventive and clinical measures, valid measurement instruments are needed. Radloff’s Center for Epidemio...
16 Citations
Published on Mar 1, 2012in Clinical Psychology & Psychotherapy 2.51
Myrna M. Weissman126
Estimated H-index: 126
(Columbia University),
Helen Verdeli22
Estimated H-index: 22
Depression is highly prevalent and debilitating among medically ill patients. As high as one third of the primary practise patients screen positive for depression symptoms and over half of the patients diagnosed with major depressive disorder are treated in primary care. However, current primary care service arrangements do not efficiently triage patients who screen positive for depression into appropriate treatments that reflect their individual needs and preferences. In this paper, we describe...
5 Citations Source Cite
Published on Jan 1, 2011in Psychiatria Danubina 1.34
Johannes Wancata20
Estimated H-index: 20
(Medical University of Vienna),
Fabian Friedrich7
Estimated H-index: 7
(Medical University of Vienna)
Depression is a very common mental disorder which often results in relevant negative consequences ranging from impaired quality of life to an increased suicide rate. Unfortunately, non-psychiatric physicians frequently under-diagnose and under-treat depression. Nevertheless, sometime the diagnosis "depression" is used for mentally well and other mental disorders (i.e. sometimes depression is over-diagnosed). Screening tools were suggested to improve the recognition of mental disorders in everyda...
10 Citations
Published on May 1, 2009in Nervenarzt 0.74
Hegerl U1
Estimated H-index: 1
,
Schönknecht P1
Estimated H-index: 1
Minor depression, subsyndromal depression and subthreshold depression are frequent conditions in primary care which do not fulfil the criteria of a depressive disorder but are associated with functional disability, impairment of quality of life, and health care use. This paper reviews studies on the clinical evidence of pharmacotherapy, psychotherapy, and interventions to improve primary care. In this regard, whether clinical relevance of antidepressant therapies can be concluded from difference...
12 Citations Source Cite
Published on Jul 1, 2002in Nervenarzt 0.74
Frank Jacobi35
Estimated H-index: 35
(Dresden University of Technology),
Michael Höfler51
Estimated H-index: 51
(Dresden University of Technology)
+ 1 AuthorsHans-Ulrich Wittchen123
Estimated H-index: 123
(Dresden University of Technology)
Die Studie berichtet die Stichtags-Pravalenz depressiver Syndrome bei 20.421 unselegierter Patienten, die an einem Stichtag ihren Hausarzt aufsuchten. Zusatzlich wurde das hausarztliche Erkennungs- und Verschreibungsverhalten ermittelt. Im Rahmen einer Vorstudie wurden die teilnehmenden Arztpraxen (N=633) mittels Fragebogen charakterisiert. Am Erhebungstag erhielten alle Patienten Fragebogen, darunter den “Depression Screening Questionaire” (DSQ), um die Diagnose einer depressiven Storung gemas ...
37 Citations Source Cite