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The risk of developing major depression among individuals with subthreshold depression: a systematic review and meta-analysis of longitudinal cohort studies

Published online by Cambridge University Press:  13 March 2018

Y. Y. Lee Open the ORCID record for Y. Y. Lee [Opens in a new window] ,
E. A. Stockings Open the ORCID record for E. A. Stockings [Opens in a new window] ,
M. G. Harris ,
S. A. R. Doi Open the ORCID record for S. A. R. Doi [Opens in a new window] ,
I. S. Page ,
S. K. Davidson Open the ORCID record for S. K. Davidson [Opens in a new window]  and
J. J. Barendregt
Y. Y. Lee*
Affiliation:
School of Public Health, The University of Queensland, Herston, Queensland, Australia Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, Queensland, Australia
E. A. Stockings
Affiliation:
National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, New South Wales, Australia
M. G. Harris
Affiliation:
School of Public Health, The University of Queensland, Herston, Queensland, Australia Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, Queensland, Australia
S. A. R. Doi
Affiliation:
Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar
I. S. Page
Affiliation:
School of Public Health, The University of Queensland, Herston, Queensland, Australia Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, Queensland, Australia
S. K. Davidson
Affiliation:
Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Victoria, Australia
J. J. Barendregt
Affiliation:
School of Public Health, The University of Queensland, Herston, Queensland, Australia Epigear International Pty Ltd, Sunrise Beach, Queensland, Australia
*
Author for correspondence: Y. Y. Lee, E-mail: y.lee5@uq.edu.au
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Abstract

Background

Studies have consistently shown that subthreshold depression is associated with an increased risk of developing major depression. However, no study has yet calculated a pooled estimate that quantifies the magnitude of this risk across multiple studies.

Methods

We conducted a systematic review to identify longitudinal cohort studies containing data on the association between subthreshold depression and future major depression. A baseline meta-analysis was conducted using the inverse variance heterogeneity method to calculate the incidence rate ratio (IRR) of major depression among people with subthreshold depression relative to non-depressed controls. Subgroup analyses were conducted to investigate whether IRR estimates differed between studies categorised by age group or sample type. Sensitivity analyses were also conducted to test the robustness of baseline results to several sources of study heterogeneity, such as the case definition for subthreshold depression.

Results

Data from 16 studies (n = 67 318) revealed that people with subthreshold depression had an increased risk of developing major depression (IRR = 1.95, 95% confidence interval 1.28–2.97). Subgroup analyses estimated similar IRRs for different age groups (youth, adults and the elderly) and sample types (community-based and primary care). Sensitivity analyses demonstrated that baseline results were robust to different sources of study heterogeneity.

Conclusion

The results of this study support the scaling up of effective indicated prevention interventions for people with subthreshold depression, regardless of age group or setting.

Keywords

Incidencelongitudinal studiesmajor depressive disordermeta-analysisrisk factorssubthreshold depression
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 1 , January 2019 , pp. 92 - 102
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

†

Deceased on 4 June 2017.

References

Allen, NB, Hetrick, SE, Simmons, JG and Hickie, IB (2007) Early intervention for depressive disorders in young people: the opportunity and the (lack of) evidence. Medical Journal of Australia 187, S15–S17.Google Scholar
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn., Washington, DC: American Psychiatric Association.Google Scholar
Bartova, L and Pezawas, L (2015) Recurrent brief depressive disorder. In Stolerman, IP and Price, LH (eds). Encyclopedia of Psychopharmacology. Heidelberg, Germany: Springer-Verlag Berlin Heidelberg, pp. 1456–1459.Google Scholar
Beekman, AT, Geerlings, SW, Deeg, DJ, Smit, JH, Schoevers, RS, de Beurs, E and van Tilburg, W (2002) The natural history of late-life depression: a 6-year prospective study in the community. Archives of General Psychiatry 59, 605–611.Google Scholar
Bertha, EA and Balazs, J (2013) Subthreshold depression in adolescence: a systematic review. European Child and Adolescent Psychiatry 22, 589–603.Google Scholar
Briggs, A, Sculpher, M and Claxton, K (2006) Decision Modelling for Health Economic Evaluation. Oxford, UK: Oxford University Press.Google Scholar
Bruce, ML and Hoff, RA (1994) Social and physical health risk factors for first-onset major depressive disorder in a community sample. Social Psychiatry and Psychiatric Epidemiology 29, 165–171.Google Scholar
Crum, RM, Cooper-Patrick, L and Ford, DE (1994) Depressive symptoms among general medical patients: prevalence and one-year outcome. Psychosomatic Medicine 56, 109–117.Google Scholar
Cuijpers, P, de Graaf, R and van Dorsselaer, S (2004) Minor depression: risk profiles, functional disability, health care use and risk of developing major depression. Journal of Affective Disorders 79, 71–79.Google Scholar
Cuijpers, P and Smit, F (2004) Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies. Acta Psychiatrica Scandinavica 109, 325–331.Google Scholar
Cuijpers, P, Smit, F and van Straten, A (2007) Psychological treatments of subthreshold depression: a meta-analytic review. Acta Psychiatrica Scandinavica 115, 434–441.Google Scholar
Davidson, SK, Harris, MG, Dowrick, CF, Wachtler, CA, Pirkis, J and Gunn, JM (2015) Mental health interventions and future major depression among primary care patients with subthreshold depression. Journal of Affective Disorders 177, 65–73.Google Scholar
Doi, SAR, Barendregt, JJ, Khan, S, Thalib, L and Williams, GM (2015) Advances in the meta-analysis of heterogeneous clinical trials I: the inverse variance heterogeneity model. Contemporary Clinical Trials 45, 123–129.Google Scholar
Dowrick, C and Frances, A (2013) Medicalising unhappiness: new classification of depression risks more patients being put on drug treatment from which they will not benefit. British Medical Journal 347, f7140.Google Scholar
Duval, S and Tweedie, R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455–463.Google Scholar
EpiGear (2016) MetaXL (Version 5.3) [Online]. EpiGear International. (http://www.epigear.com/index_files/metaxl.html). Accessed 9 October 2016.Google Scholar
Erasmus University Rotterdam (2017) Snowball method [Online]. Erasmus University Rotterdam. (https://www.eur.nl/ub_informatievaardigheden/ul_instruction_oud/sfsi_me/searching/searching_by_following_up_references/snowball_method/). Accessed 9 October 2016.Google Scholar
Fava, GA (1999) Subclinical symptoms in mood disorders: pathophysiological and therapeutic implications. Psychological Medicine 29, 47–61.Google Scholar
Forsell, Y (2007) A three-year follow-up of major depression, dysthymia, minor depression and subsyndromal depression: results from a population-based study. Depression and Anxiety 24, 62–65.Google Scholar
Hermens, ML, van Hout, HP, Terluin, B, van der Windt, DA, Beekman, AT, van Dyck, R and de Haan, M (2004) The prognosis of minor depression in the general population: a systematic review. General Hospital Psychiatry 26, 453–462.Google Scholar
Higgins, J and Green, S (2011) Cochrane Handbook for Systematic Reviews of Interventions [Online]. The Cochrane Collaboration. (www.handbook.cochrane.org). Accessed 9 October 2016.Google Scholar
Horwath, E, Johnson, J, Klerman, GL and Weissman, MM (1992) Depressive symptoms as relative and attributable risk factors for first-onset major depression. Archives of General Psychiatry 49, 817–823.Google Scholar
Jackson, JL, Passamonti, M and Kroenke, K (2007) Outcome and impact of mental disorders in primary care at 5 years. Psychosomatic Medicine 69, 270–276.Google Scholar
Jinnin, R, Okamoto, Y, Takagaki, K, Nishiyama, Y, Yamamura, T, Okamoto, Y and Yamawaki, S (2017) Detailed course of depressive symptoms and risk for developing depression in late adolescents with subthreshold depression: a cohort study. Neuropsychiatric Disease and Treatment 13, 25–33.Google Scholar
Johnson, JG, Cohen, P and Kasen, S (2009) Minor depression during adolescence and mental health outcomes during adulthood. British Journal of Psychiatry 195, 264–265.Google Scholar
Jonsson, U, Bohman, H, von Knorring, L, Olsson, G, Paaren, A and von Knorring, AL (2011) Mental health outcome of long-term and episodic adolescent depression: 15-year follow-up of a community sample. Journal of Affective Disorders 130, 395–404.Google Scholar
Lee, YY, Barendregt, JJ, Stockings, EA, Ferrari, AJ, Whiteford, HA, Patton, GA and Mihalopoulos, C (2017) The population cost-effectiveness of delivering universal and indicated school-based interventions to prevent the onset of major depression among youth in Australia. Epidemiology and Psychiatric Sciences 26, 545–564.Google Scholar
Lyness, JM, Caine, ED, King, DA, Conwell, Y, Duberstein, PR and Cox, C (2002) Depressive disorders and symptoms in older primary care patients: one-year outcomes. American Journal of Geriatric Psychiatry 10, 275–282.Google Scholar
McLeod, GF, Horwood, LJ and Fergusson, DM (2016) Adolescent depression, adult mental health and psychosocial outcomes at 30 and 35 years. Psychological Medicine 46, 1401–1412.Google Scholar
Meeks, TW, Vahia, IV, Lavretsky, H, Kulkarni, G and Jeste, DV (2011) A tune in ‘a minor’ can ‘b major’: a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. Journal of Affective Disorders 129, 126–142.Google Scholar
Merry, SN, Hetrick, SE, Cox, GR, Brudevold-Iversen, T, Bir, JJ and McDowell, H (2011) Psychological and educational interventions for preventing depression in children and adolescents. Cochrane Database of Systematic Reviews 12, CD003380.Google Scholar
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG and Group, P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. British Medical Journal 339, b2535.Google Scholar
National Collaborating Centre for Mental Health (2010) Depression: The Treatment and Management of Depression in Adults (Updated Edition). Leicester, UK: The British Psychological Society and the Royal College of Psychiatrists.Google Scholar
Oldehinkel, AJ, Wittchen, HU and Schuster, P (1999) Prevalence, 20-month incidence and outcome of unipolar depressive disorders in a community sample of adolescents. Psychological Medicine 29, 655–668.Google Scholar
Onitilo, AA, Doi, SAR and Barendregt, JJ (2013) Meta-analysis II: interpretation and use of outputs. In Doi, S and Williams, G (eds). Methods of Clinical Epidemiology. Heidelberg, Germany: Springer-Verlag Berlin Heidelberg, pp. 253–266.Google Scholar
Peters, AT, Shankman, SA, Deckersbach, T and West, AE (2015) Predictors of first-episode unipolar major depression in individuals with and without sub-threshold depressive symptoms: a prospective, population-based study. Psychiatry Research 230, 150–156.Google Scholar
Pietrzak, RH, Kinley, J, Afifi, TO, Enns, MW, Fawcett, J and Sareen, J (2013) Subsyndromal depression in the United States: prevalence, course, and risk for incident psychiatric outcomes. Psychological Medicine 43, 1401–1414.Google Scholar
Rodriguez, MR, Nuevo, R, Chatterji, S and Ayuso-Mateos, JL (2012) Definitions and factors associated with subthreshold depressive conditions: a systematic review. BMC Psychiatry 12, 181.Google Scholar
Shankman, SA, Lewinsohn, PM, Klein, DN, Small, JW, Seeley, JR and Altman, SE (2009) Subthreshold conditions as precursors for full syndrome disorders: a 15-year longitudinal study of multiple diagnostic classes. Journal of Child Psychology and Psychiatry and Allied Disciplines 50, 1485–1494.Google Scholar
StataCorp (2009) Stata Statistical Software: Release 11. College Station, TX: StataCorp LP.Google Scholar
Stockings, EA, Degenhardt, L, Dobbins, T, Lee, YY, Erskine, HE, Whiteford, HA and Patton, G (2016) Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective and indicated prevention. Psychological Medicine 46, 11–26.Google Scholar
van Zoonen, K, Buntrock, C, Ebert, DD, Smit, F, Reynolds, CF III, Beekman, AT and Cuijpers, P. (2014) Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. International Journal of Epidemiology 43, 318–329.Google Scholar
Wagner, HR, Burns, BJ, Broadhead, WE, Yarnall, KS, Sigmon, A and Gaynes, BN (2000) Minor depression in family practice: functional morbidity, co-morbidity, service utilization and outcomes. Psychological Medicine 30, 1377–1390.Google Scholar
Wells, G, Shea, B, O'Connell, D, Peterson, J, Welch, V, Losos, M and Tugwell, P (2008) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Online]. Ottawa Hospital Research Institute. (http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp). Accessed 9 October 2016.Google Scholar
Wesselhoeft, R, Sorensen, MJ, Heiervang, ER and Bilenberg, N (2013) Subthreshold depression in children and adolescents – a systematic review. Journal of Affective Disorders 151, 7–22.Google Scholar
Willemse, GR, Smit, F, Cuijpers, P and Tiemens, BG (2004) Minimal-contact psychotherapy for sub-threshold depression in primary care. Randomised trial. British Journal of Psychiatry 185, 416–421.Google Scholar
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