Psychiatric Quarterly

, Volume 65, Issue 4, pp 323–337 | Cite as

What are the public health implications of subclinical depressive symptoms?

  • Ewald Horwath
  • Jim Johnson
  • Gerald L. Klerman
  • Myrna M. Weissman

Abstract

Longitudinal data from a community study of 9900 adults in the United States show that persons with depressive symptoms, as compared to those without such symptoms, were 4.4 times more likely to develop a first onset major depression over one year. The attributable risk, a measure which reflects both the relative risk associated with depressive symptoms (4.4) and the prevalence of exposure to that risk (24%) and is a useful measure for documenting burden of a risk to the community, indicated that more than 50% of first onset major depressions are associated with prior depressive symptoms. Since depressive symptoms have a high prevalence in the community, but are often unrecognized and untreated in clinical practice, we conclude that their identification and the development of effective treatments could have public health implications for the prevention of associated social morbidity, service utilization and major depression.

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References

  1. 1.
    Boyd JH, Weissman MM. Epidemiology of affective disorders. A reexamination and future directions. Arch Gen Psychiatry 38:1039–1046, 1981.PubMedGoogle Scholar
  2. 2.
    Johnson J, Weissman MM, Klerman GL. Service utilization and social morbidity associated with depressive symptoms in the community. JAMA 267:1478–1483, 1992.PubMedGoogle Scholar
  3. 3.
    Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, Berry S, Greenfield S, Ware J. The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. JAMA 262:914–919. 1989.PubMedGoogle Scholar
  4. 4.
    Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA 264:2524–2528. 1990.CrossRefPubMedGoogle Scholar
  5. 5.
    Essen-Moller E, Hagnell O. The frequency and risk of depression within a rural group in Scania. Acta Psychiatr Scand 162(suppl):28–32. 1961.Google Scholar
  6. 6.
    Hallstrom T. Mental disorder and sexuality in the climacteric. A study in psychiatric epidemiology. In: Forsman E, ed. Reports from the Psychiatric Research Centre, St. Jorgan's Hospital, University of Goteborg, Sweden, Vol. 6, Jacobs A, trans. Copenhagen: Scandinavian University Books, 1973.Google Scholar
  7. 7.
    Brown GW, Harris T. Social Orgins Of Depression. A Study of Psychiatric Disorder in Women. London: Tavistock Publications, 1978.Google Scholar
  8. 8.
    Eaton WW, Kramer M, Anthony JC, Dryman A, Shapiro S, Locke BZ. The incidence of specific DIS/DSM-III mental disorders: data from the NIMH Epidemiologic Catchment Area Program. Acta Psychiatr Scan 79:163–176. 1989.Google Scholar
  9. 9.
    Anthony JC, Petronic KR. Suspected risk factors for depression among adults 18–44 years old. Epidemiology 2:123–132, 1990.Google Scholar
  10. 10.
    Goldberg D, Steele J, Smith C, Spivey L. Training family doctors to recognize psychiatric illness with increased accuracy. Lancet 2:521–523. 1980.PubMedGoogle Scholar
  11. 11.
    Mausner JS, Bahn AK. Epidemiology. Philadelphia: WB Saunders, 322–324. 1974.Google Scholar
  12. 12.
    Doll R, Hill AB. Lung cancer and other causes of death in relation to smoking. Brit Med J 1071–1081. 1956.Google Scholar
  13. 13.
    Kelsey JL, Thompson WD, Evans AS. Methods in Observational Epidemiology. New York: Oxford University Press, 1986.Google Scholar
  14. 14.
    Julius S, Jamerson K, Mejia A, Krause L, Schork N, Jones K. The association of borderline hypertension with target organ changes and higher coronary risk. JAMA 264:354–358. 1990.CrossRefPubMedGoogle Scholar
  15. 15.
    Eaton WW, Kessler LG. Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program. Orlando, Fla: Academic Press Inc, 1985.Google Scholar
  16. 16.
    Regier DA, Myers JK, Kramer M, et al. The NIMH Epidemiologic Catchment Area Program: Historical context, major obstacles, and study population characteristics. Arch Gen Psychiatry 41:934–941. 1984.PubMedGoogle Scholar
  17. 17.
    Robins LN, Helzer JE, Croughan JL, Ratcliff KS. The NIMH Diagnostic Interview Schedule: Its history, characteristics, and validity. Arch Gen Psychiatry 38:381–389. 1981.PubMedGoogle Scholar
  18. 18.
    Weissman MM, Bruce ML, Leaf PJ, Florio LP, Holzer C. Affective disorders. In: Robins LN, Regier DE, eds. Psychiatric Disorders in America. New York: The Free Press, 1991.Google Scholar
  19. 19.
    Murphy JM, Sobol AM, Olivier DC, Monson RR, Leighton AH, Pratt LA. Prodromes of depression and anxiety: the Stirling County study. Br J Psychiatry 155:490–495. 1989.PubMedGoogle Scholar
  20. 20.
    Wells KB, Burnam MA, Rogers W, Hays R, Camp P. The course of depression in adult outpatients. Results from the Medical Outcomes Study. Arch Gen Psychiatry 49:788–794. 1992.PubMedGoogle Scholar
  21. 21.
    Warner V, Weissman MM, Fendrich M, Wickramaratne P, Moreau D. The course of major depression in the offspring of depressed parents. Incidence, recurrence and recovery. Arch Gen Psychiatry 49:795–801. 1992.PubMedGoogle Scholar
  22. 22.
    Akiskal HS. Subaffective disorders: Dysthymic, cyclothymic and bipolar II disorders in the “borderline” realm. Psychiatr Clin North Am 4:25–46. 1981.PubMedGoogle Scholar
  23. 23.
    Cohen P, Cohen J. The clinican's illusion. Arch Gen Psychiatry 41:1178–1182. 1984.PubMedGoogle Scholar
  24. 24.
    Chyou P, Nomura AMY, Stemmermann GN. A prospective study of the attributable risk of cancer due to cigarette smoking. Am J Public health 82:37–40. 1992.PubMedGoogle Scholar
  25. 25.
    Akiskal HS, McKinney WT. Depressive disorders: toward a unified hypothesis. Clinical, experimental, genetic, biochemical, and neurophysiological data are integrated. Science 182:20–29. 1973.PubMedGoogle Scholar
  26. 26.
    Cooke DJ, Hole DJ. The etiological importance of stressful life events. Brit J Psychiatry 143:397–400. 1983.Google Scholar
  27. 27.
    Weissman MM, Gershon ES, Kidd KK, Prusoff BA, Leckman JF, Dibble E, Hamovit J, Thompson WD, Pauls DL, Guroff JJ. Psychiatric disorder in relatives of probands with affective disorders: The Yale-NIMH collaborative family study. Arch Gen Psychiatry 41:13–21. 1984.PubMedGoogle Scholar
  28. 28.
    Dunn JE. Preliminary findings of the Memphis-Shelby County uterine cancer study and their interpretation. Amer J Public Health 48:861. 1958.PubMedGoogle Scholar
  29. 29.
    Shepherd M, Cooper B, Brown AC, Kalton G. Psychiatric illness in general practice, 2nd ed. Oxford: Oxford University Press, 1981.Google Scholar
  30. 30.
    Regier DA, Goldberg ID, Taube CA. The de facto US mental health services system. Arch Gen Psych 35:685–693. 1978.Google Scholar
  31. 31.
    Goldberg D. Detection and assessment of emotional disorders in a primary care setting. Int J Ment Health 8:30–48. 1979.Google Scholar
  32. 32.
    Clare AW, Blacker R. Some problems affecting the diagnosis and classification of depressive disorders in primary care. In: Shepherd M, Wilkinson G, Williams P (eds). Mental illness in primary care settings. London: Tavistock Publications, 1986.Google Scholar
  33. 33.
    Marks J, Goldberg D, Hillier VF. Determinants of the ability of general practitioners to detect psychiatric illness. Psychol Med 9:337–354. 1979.PubMedGoogle Scholar
  34. 34.
    Sharp D, Morrell D. The psychiatry of general practice. In: Williams P, Wilkinson G, Rawnsley K, eds. The Scope of Epidemiologic Psychiatry: Essays in Honour of Michael Shepherd. London, England: Routledge & Kegan Paul, 1989.Google Scholar
  35. 35.
    Klerman GL, Budman S, Berwick D, Weissman MM, Damico-White J, Demby A, Feldstein M. Efficacy of a brief psychosocial intervention for symptoms of stress and distress among patients in primary care. Med Care 25:1078–1088. 1987.PubMedGoogle Scholar

Copyright information

© Human Sciences Press, Inc. 1994

Authors and Affiliations

  • Ewald Horwath
    • 1
  • Jim Johnson
  • Gerald L. Klerman
  • Myrna M. Weissman
  1. 1.New York State Psychiatric InstituteNew York

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