Clinical implications of "subthreshold" depressive symptoms.

Lewinsohn, Peter M.; Solomon, Ari; Seeley, John R.; Zeiss, Antonette M.

doi:10.1037/0021-843x.109.2.345

Cited by 437 publications

(186 citation statements)

References 41 publications

(46 reference statements)

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“…Fava and Tossani [31] reviewed the evidence for this, drawing predominantly on association studies. The authors emphasized three key issues: (1) that anxiety and irritability are commonly observed in the prodromal phase of depression [30,32,33,34,35]; (2) that subthreshold or minor depression is implicated as a risk factor for the development of major depression, which reinforces the notion that depressive symptoms occur on a continuum rather than in discrete categories [36,37,38], and (3) that these symptoms are present in the first and subsequent episodes of major depression, which may inform efforts toward relapse prevention [31]. Building on Fava’s work, this notion of a prodrome has the potential to provide a recognizable point of intervention to prevent the onset of a first episode.…”

Section: A Prodrome Of Depressive Disordersmentioning

confidence: 94%

“…Increasingly specialized and intensive interventions, including the use of psychopharmacological treatments, can be reserved for those with more severe disorders and complex needs at later stages of illness, and are more suited to delivering in specialized settings [41] (table 1). Although guidelines for a stepped model of care, consistent with a staging model for depressive disorders, have been developed [37, 70,][71], the notion that interventions can be matched to a stage of illness has not yet been elaborated. In the remainder of the paper, we will present preliminary evidence to support this premise.…”

Section: Interventions In the Early Stages Of Depressive Disordermentioning

confidence: 99%

“…Not only is this group with subsyndromal depression significant due to the role of symptoms as risk factors for, or prodrome to, depressive disorders and poor prognosis but also because of its large size [67, 68] and the impact of symptoms on functioning [69]. Psychosocial and behavioral dysfunction in adolescents increases as a function of the number of depressive symptoms that are experienced [37]. Therefore, those with prodrome or subsyndromal symptoms of depression appear to be an important target for early intervention.…”

Section: Operationalizing the Early Stages Of Depressive Disordermentioning

confidence: 99%

See 2 more Smart Citations

Early Identification and Intervention in Depressive Disorders: Towards a Clinical Staging Model

Hetrick¹,

Parker²,

Ib³

et al. 2008

Psychother Psychosom

145

102

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Background: Depressive disorders are common and associated risks include the onset of secondary disorders, substance use disorders, impairment in social and occupational functioning, and an increase in suicidality. As the onset often occurs in youth, there is a clear imperative for early identification and intervention to ameliorate, if not prevent, associated distress. Methods: An extensive search of relevant databases and an ancestry search was undertaken. Results: There is a limited but growing body of literature on this topic that is discussed in relation to a clinical staging model, which may prove to be a useful framework for identifying where an individual lies along the continuum of the course of a depressive illness thus allowing interventions to be matched for that stage. The identification of a subsyndromal and prodromal stage of depressive disorders provides early intervention opportunities. Conclusions: It is argued that a clinical staging heuristic may increase the number of those treated early, which may in turn delay or prevent onset, reduce severity, or prevent progression in the course of depressive disorders.

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Section: A Prodrome Of Depressive Disordersmentioning

confidence: 94%

Section: Interventions In the Early Stages Of Depressive Disordermentioning

confidence: 99%

Section: Operationalizing the Early Stages Of Depressive Disordermentioning

confidence: 99%

See 1 more Smart Citation

Early Identification and Intervention in Depressive Disorders: Towards a Clinical Staging Model

Hetrick¹,

Parker²,

Ib³

et al. 2008

Psychother Psychosom

145

102

View full text Add to dashboard Cite

show abstract

“…Subthreshold symptoms have gained prominence as depression is increasingly recognised as being on a spectrum [17]. Studies in children and adolescent populations have generally used prospective epidemiological designs to measure subthreshold symptoms of depression and their predictive value, rather than the retrospective designs traditionally associated with prodrome research [10].…”

Section: Introductionmentioning

confidence: 99%

A Qualitative Study of the Prodrome to First-Episode Major Depressive Disorder in Adolescents

Sheriff

McGorry²,

Cotton³

et al. 2015

Psychopathology

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Background: Currently, we lack a clear picture of the evolution of major depressive disorder (MDD) in adolescents. The period of disturbance preceding MDD can be conceptualised as the prodrome. The aim of the study was to explore the prodrome of first-episode MDD retrospectively in a group of help-seeking adolescents using qualitative methodologies. Sampling and Methods: Consecutively referred adolescents (15-18 years of age) with first-episode MDD were recruited for this study from Orygen Youth Health, Melbourne, Vic., Australia. After using quantitative methodologies to confirm the index episode of MDD and measure the extent of recovery, the prodrome was investigated in depth using qualitative techniques. Results: Twenty-nine adolescents (20 females and 9 males) and 7 informants (6 mothers and 1 grandmother) participated. All 29 participants had a prodrome of varying lengths (between 6 days and 4 years). The most noticeable symptoms initially were perplexity and confusion and, thereafter, sadness and irritability. A common pattern was a reduction in their ability to fulfil their role accompanied by guilt, self-blame and reduced self-esteem. Around half of the participants had increased thoughts of suicide and increased anxiety. There were gender differences in the patterns of symptoms noticed, with males more commonly noticing a change in how they related to the world and females more commonly noticing a change in the way that they related to others. All informants noticed a prodrome of varying lengths; in 2 cases longer, in 2 cases shorter and in 3 cases around the same time period as that noticed by the participant. The changes most commonly noticed by informants were sadness, upset, irritability and reduced self-esteem. The symptoms were fewer in number and sometimes varied from those noticed by the adolescents themselves. Conclusions: Whilst we recognise that this study is vulnerable to autobiographical bias, we took all reasonable measures to minimise this. Symptoms not included in the diagnostic criteria for depression were the earliest changes noticed by the adolescents themselves and are, therefore, potentially important in informing prevention strategies, as is the finding that there are gender differences in the patterns of changes noticed. In addition, parents may provide an additional avenue to help seeking.

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“…Depressive disorders are highly associated with behavioral problems, somatic complaints, and other psychiatric disorders and behaviors, such as anxiety, suicide attempts, conduct disorder, and substance abuse (Birmaher et al, 1996;Eapen & Cˇrnc ˇ ec, 2012). However, not only clinically significant depression but also 'subthreshold' depressive symptoms have connections to psychosocial impairment and the use of mental health services, and therefore the conceptualization of depression as a continuum is necessary (Angold, Costello, Farmer, Burns, & Erkanli, 1999;Lewinsohn, Solomon, Seeley, & Zeiss, 2000). In additional to the short-term problems, depression can have a negative longterm impact on mental health, including increased risk of suicide, abuse of alcohol and other substances, physical problems, disturbances in global functioning and interpersonal relationships, and the recurrence of depression in later adolescence and adulthood (Birmaher et al, 1996;Lewinsohn et al, 1994).…”

mentioning

confidence: 99%

Associations between school-related factors and depressive symptoms among children: A comparative study, Finland and Norway

Minkkinen

2013

School Psychology International

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This study compares school-related associations in depressive symptoms among children aged between 9–13 years from four schools in Finland and Norway. A total of 523 pupils participated in the cross-sectional survey. The connections between depressive symptoms and school factors were analysed using hierarchical regression analyses. School variables were self-perceived peer victimization, teacher and peer social support, school performance, and teachers’ reports on competence in core subjects; these variables explain 30% of the variance of the children’s depressive symptoms in Norway and 26% in Finland beyond that afforded by differences in the background characteristics and protective factors in the family. A trend was found in the Norwegian data which showed that poor relationships at school are connected more strongly with depressive symptoms than poor school performance, but the Finnish data did not confirm this. The results support the importance of taking various school factors into account with children suffering depressive symptoms, and not merely a dysfunctional domestic situation. The implications for school psychology practice are also discussed.

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Clinical implications of "subthreshold" depressive symptoms.

Cited by 437 publications

References 41 publications

Early Identification and Intervention in Depressive Disorders: Towards a Clinical Staging Model

Early Identification and Intervention in Depressive Disorders: Towards a Clinical Staging Model

A Qualitative Study of the Prodrome to First-Episode Major Depressive Disorder in Adolescents

Associations between school-related factors and depressive symptoms among children: A comparative study, Finland and Norway

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