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Subsyndromal depression in the United States: prevalence, course, and risk for incident psychiatric outcomes

Published online by Cambridge University Press:  31 October 2012

R. H. Pietrzak ,
J. Kinley ,
T. O. Afifi ,
M. W. Enns ,
J. Fawcett  and
J. Sareen
R. H. Pietrzak*
Affiliation:
National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
J. Kinley
Affiliation:
Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
T. O. Afifi
Affiliation:
Departments of Community Health Sciences, Psychiatry, and Family Social Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
M. W. Enns
Affiliation:
Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
J. Fawcett
Affiliation:
Department of Psychiatry, University of New Mexico School of Medicine, Santa Fe, NM, USA
J. Sareen
Affiliation:
Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
*
*Address for correspondence: R. H. Pietrzak, Ph.D., M.P.H., National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, Yale University School of Medicine, 950 Campbell Avenue 151E, West Haven, CT, 06516, USA. (Email: robert.pietrzak@yale.edu)
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Abstract

Background

Subsyndromal depression (SD) may increase risk for incident major depressive and other disorders, as well as suicidality. However, little is known about the prevalence, course, and correlates of SD in the US general adult population.

Method

Structured diagnostic interviews were conducted to assess DSM-IV Axis I and II disorders in a nationally representative sample of 34 653 US adults who were interviewed at two time-points 3 years apart.

Results

A total of 11.6% of US adults met study criteria for lifetime SD at Wave 1. The majority (9.3%) had <5 total symptoms required for a diagnosis of major depression; the remainder (2.3%) reported ⩾5 symptoms required for a diagnosis of major depression, but denied clinically significant distress or functional impairment. SD at Wave 1 was associated with increased likelihood of developing incident major depression [odds ratios (ORs) 1.72–2.05], as well as dysthymia, social phobia, and generalized anxiety disorder (GAD) at Wave 2 (ORs 1.41–2.92). Among respondents with SD at Wave 1, Cluster A and B personality disorders, and worse mental health status were associated with increased likelihood of developing incident major depression at Wave 2.

Conclusions

SD is prevalent in the US population, and associated with elevated rates of Axis I and II psychopathology, increased psychosocial disability, and risk for incident major depression, dysthymia, social phobia, and GAD. These results underscore the importance of a dimensional conceptualization of depressive symptoms, as SD may serve as an early prognostic indicator of incident major depression and related disorders, and could help identify individuals who may benefit from preventive interventions.

Keywords

Co-morbiditydepressiondisabilityepidemiologyincidence
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 7 , July 2013 , pp. 1401 - 1414
Creative Commons
This work is of the U.S. Government and is not subject to copyright protection in the United States
Copyright
Copyright © Cambridge University Press 2012

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