On the transience or stability of subthreshold psychopathology

Abstract

Symptoms of psychopathology lie on a continuum ranging from mental health to psychiatric disorders. Although much research has focused on progression along this continuum, for most individuals, subthreshold symptoms do not escalate into full-blown disorders. This study investigated how the stability of psychopathological symptoms (attractor strength) varies across severity levels (homebase). Data were retrieved from the TRAILS TRANS-ID study, where 122 at-risk young adults (mean age 23.6 years old, 57% males) monitored their mental states daily for a period of six months (± 183 observations per participant). We estimated each individual’s homebase and attractor strength using generalized additive mixed models. Regression analyses showed no association between homebases and attractor strengths (linear model: B = 0.02, p = 0.47, R2 < 0.01; polynomial model: B < 0.01, p = 0.61, R2 < 0.01). Sensitivity analyses where we (1) weighed estimates according to their uncertainty and (2) removed individuals with a DSM-5 diagnosis from the analyses did not change this finding. This suggests that stability is similar across severity levels, implying that subthreshold psychopathology may resemble a stable state rather than a transient intermediate between mental health and psychiatric disorder. Our study thus provides additional support for a dimensional view on psychopathology, which implies that symptoms differ in degree rather than kind.

Development, Validation, and Comparison of Self-Report Measures for Positive and Negative Affect in Intensive Longitudinal Research

“…There is no clear threshold of "sufficient" but the average observed within-person variance for affect measures in empirical studies is 53% (SD = .16) (Podsakoff et al, 2019). Another relevant and often used indicator of within-person variability is the person-specific standard deviation (iSD), reflecting intra-individual variability of affect (Schreuder et al, 2020).…”

Transdiagnostic symptom networks in relation to mental health service use in community youth

“…Considerable evidence exists that once mental disorders arise, treatment may only reduce small proportions of the burden caused thereof (Campion et al, 2012 ). In addition, many individuals experience subthreshold symptoms that may later develop into full‐blown disorders but in majority of cases stay at subthreshold levels (Schreuder et al, 2021 ). Subthreshold symptom and full‐threshold symptom expression share similar etiological factors and can improve with treatment (Schreuder et al, 2021 ); however, it is likely that early or subthreshold psychopathology may only result in help seeking behaviour and not necessarily treatment or treatment of longer duration.…”

“…In addition, many individuals experience subthreshold symptoms that may later develop into full‐blown disorders but in majority of cases stay at subthreshold levels (Schreuder et al, 2021 ). Subthreshold symptom and full‐threshold symptom expression share similar etiological factors and can improve with treatment (Schreuder et al, 2021 ); however, it is likely that early or subthreshold psychopathology may only result in help seeking behaviour and not necessarily treatment or treatment of longer duration. This not only indicates the importance of targeting individuals with subthreshold symptoms; it also highlights the need to study mechanisms of change and outcomes at different stages of MH service use.…”

There and back again: a dynamical perspective on psychological resilience

“…However, for many others, the change is gradual (280) and nonlinear (281), and it is unclear how to establish where one state ends and another begins. Moreover, there is evidence suggesting that not only "health" and fullblown "psychopathology" may exist as stable states but also subthreshold symptoms (294). This challenge to distinguish the different states may also explain the discrepancy between our results in Chapters 4 and 5.…”

“…The recovery speed indicator was built on complex systems theory. Although promising, future studies using the same theory will greatly benefit from establishing what can be considered similar or different states and how to assess the transitions between these states in the context of mental health (291,294).…”