Subthreshold conditions as precursors for full syndrome disorders: a 15‐year longitudinal study of multiple diagnostic classes
Open accessAbstract
Background: There has been increasing interest in the distinction between subthreshold and full syndrome disorders and specifically whether subthreshold conditions escalate or predict the onset of full syndrome disorders over time. Most of these studies, however, examined whether a single subthreshold condition escalates into the full syndrome form of that disorder. Equally important, though, is whether subthreshold conditions are likely to develop other full syndrome disorders and whether these associations are maintained after adjusting for comorbidity. Methods: A 15‐year longitudinal study of subthreshold psychiatric conditions was conducted with 1,505 community‐drawn young adults. We examined whether 1) subthreshold major depression, bipolar, anxiety disorders, alcohol use, substance use, conduct disorder and/or ADHD were precursors for the corresponding (homotypic) full syndrome disorder; 2) subthreshold conditions were precursors for other (heterotypic) full syndrome disorders; and 3) these homotypic and heterotypic precursors persisted after adjusting for comorbidity. Results: Subthreshold major depression, anxiety, alcohol use, substance use, and conduct all escalated into their corresponding full syndrome and nearly all homotypic developments were maintained after adjusting for comorbid subthreshold and full syndrome conditions. Many heterotypic associations were also observed and most remained after controlling for comorbidity, particularly among externalizing disorders (e.g., alcohol, substance, conduct/antisocial personality disorder). Conclusions: Many subthreshold conditions have predictive validity as they may represent precursors for full syndrome disorders. Alternatively, dimensional conceptualizations of psychopathology which include these more minor conditions may yield greater validity. Subthreshold conditions may represent good targets for preventive interventions.
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- Findingown data
Apart from subthreshold anxiety, every homotypic escalation remained significant after adjustment for comorbid subthreshold and full syndrome conditions.
“With the exception of subthreshold anxiety, all of the homotypic escalations from Table 2 remained significant after adjusting for comorbidity.”
Quote in the paperSubstantial claim - Findingown data
Externalizing subthreshold conditions generally did not predict later internalizing disorders (depression and anxiety).
“These disorders often predicted the development of the others, were occasionally bidirectional (subthreshold substance predicted FS alcohol and subthreshold alcohol predicted FS substance), and did not predict the development of internalizing disorders (depression and anxiety).”
Quote in the paperSubstantial claim - Findingown data
After comorbidity adjustment, subthreshold alcohol use no longer predicted full syndrome substance use disorder.
“subthreshold alcohol no longer predicting FS substance use disorder”
Quote in the paperNot a substantial claim - Findingown data
Subthreshold conduct disorder predicted later full syndrome bipolar, anxiety, alcohol use, and substance use disorders.
“Those with subthreshold conduct developed FS bipolar, anxiety, alcohol use, and substance use disorders.”
Quote in the paperSubstantial claim - Findingown data
The only heterotypic pathways crossing between internalizing and externalizing disorders were subthreshold conduct disorder predicting full syndrome bipolar and anxiety.
“The findings that subthreshold conduct disorder predicted FS bipolar and FS anxiety were the only heterotypic developments that ‘crossed’ between internalizing and externalizing disorders.”
Quote in the paperSubstantial claim
- Findingown data
Except for subthreshold bipolar disorder, homotypic escalation was found for the subthreshold conditions examined.
“With the exception of subthreshold bipolar disorder, homotypic escalations were observed as subthreshold conditions significantly predicted a first onset of the FS condition over time.”
Quote in the paperSubstantial claim - Findingown data
Subthreshold bipolar disorder predicted later full syndrome depressive and anxiety disorders.
“Those with subthreshold bipolar disorder developed FS depressive and anxiety disorders.”
Quote in the paperSubstantial claim - Findingown data
After comorbidity adjustment, subthreshold ADHD no longer predicted full syndrome alcohol use disorder.
“subthreshold ADHD no longer predicted FS alcohol use disorder”
Quote in the paperNot a substantial claim - Findingown data
No participant developed ADHD for the first time during the follow-up period.
“No participants developed ADHD for the first time at follow-up.”
Quote in the paperNot a substantial claim - Findingown data
The homotypic escalation from subthreshold anxiety did not remain significant after comorbidity adjustment.
“With the exception of subthreshold anxiety, all of the homotypic escalations from Table 2 remained significant after adjusting for comorbidity.”
Quote in the paperNot a substantial claim - Findingown data
After comorbidity adjustment, subthreshold conduct disorder no longer predicted full syndrome anxiety disorder.
“subthreshold conduct disorder no longer predicted FS anxiety disorder”
Quote in the paperNot a substantial claim - Findingown data
For five conditions-major depression, anxiety, alcohol use, substance use, and conduct-subthreshold presentations at baseline predicted later first onset of the matching full syndrome.
“Subthreshold major depression, anxiety, alcohol use, substance use, and conduct all escalated into their corresponding full syndrome”
Quote in the paperSubstantial claim - Findingown data
Subthreshold bipolar disorder did not significantly predict first onset of full syndrome bipolar disorder.
“With the exception of subthreshold bipolar disorder, homotypic escalations were observed as subthreshold conditions significantly predicted a first onset of the FS condition over time.”
Quote in the paperSubstantial claim - Interpretationcitation
Subthreshold conditions seem to act as precursors of full syndrome conditions.
“First, subthreshold conditions appear to be precursors of FS conditions”
Quote in the paperSubstantial claim - Study design and conductown data
Interrater reliability for the full syndrome diagnoses was good to excellent.
“a randomly selected sample of interviews indicated good to excellent interrater reliabilities for the FS diagnoses reported in this study”
Quote in the paperNot a substantial claim - Interpretationown data
Subthreshold and full syndrome conditions lie on a continuum.
“our results support the argument for a dimensional diagnostic system, in that they suggest that subthreshold and FS conditions fall on a continuum”
Quote in the paperSubstantial claim - Interpretationown data
Bipolar disorder may belong with the internalizing disorders.
“Our data suggest that bipolar disorder may belong with the internalizing disorders.”
Quote in the paperSubstantial claim - Study design and conductown data
Agreement between DSM-III-R and DSM-IV criteria sets was near perfect at T3, with kappas above .98.
“Kappas between the two criteria sets were >.98 at T3”
Quote in the paperSubstantial claim - Study design and conductown data
Power to detect homotypic escalation in subthreshold bipolar and ADHD groups was low.
“it was very difficult to detect homotypic escalation in the subthreshold ADHD and bipolar groups in our sample”
Quote in the paperSubstantial claim - Interpretationreasoning
For disorders with risk periods extending beyond age 30, the results may only generalize to early-onset cases.
“participants were only assessed through age 30 and may not have passed through the full period of risk for some disorders such as MDD. For these disorders, our results may therefore only generalize to those with an early onset.”
Quote in the paperSubstantial claim - Premisecitation
Psychopathologies cluster into broad internalizing and externalizing classes.
“Given the phenotypic and genotypic clustering of psychopathologies into broad classes of internalizing and externalizing disorders”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Kendler, Prescott, Myers, & Neale, 2003; Krueger & Markon, 2006
Not checked in the free run.
- Premisecitation
Similar impairment and treatment-use associations have been reported for subthreshold bipolar, anxiety, and alcohol/substance use disorders.
“Similar results have been found for subthreshold bipolar (Lewinsohn, Klein & Seeley, 2000b), anxiety (Batelaan, De Graaf, Van Balkom, Vollebergh, & Beekman, 2007), and alcohol and substance use disorders (Pollock & Martin, 1999).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Lewinsohn, Klein & Seeley, 2000b
Not checked in the free run.
- cites Batelaan, De Graaf, Van Balkom, Vollebergh, & Beekman, 2007
Not checked in the free run.
- cites Pollock & Martin, 1999
Not checked in the free run.
- May combine two claims. 13
- Classified as probably not a substantial claim. 9
May combine two claims.
Findingown dataSubthreshold depression and subthreshold anxiety did not predict the full syndrome form of the other condition.
“Even before adjusting for comorbidity, subthreshold depression and anxiety did not predict the FS version of the other.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataMost heterotypic associations seen for subthreshold conditions also appeared for full syndrome conditions, but full syndrome disorders were linked to more follow-up conditions.
“The majority of the heterotypic associations observed for subthreshold conditions were also found for FS conditions. However, FS disorders were associated with more conditions at follow-up than subthreshold conditions.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataSubthreshold substance use predicted later full syndrome alcohol use disorder and showed trends for bipolar and anxiety disorders.
“Those with subthreshold substance developed FS alcohol use disorders and a trend for bipolar and anxiety disorders.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataSubthreshold alcohol use predicted later full syndrome substance use disorder and conduct disorder/ASPD.
“Those with subthreshold alcohol developed FS substance use disorder and conduct disorder/ASPD.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataSubthreshold ADHD predicted later full syndrome alcohol and substance use disorders, and conduct disorder/ASPD.
“Those with subthreshold ADHD developed FS alcohol and substance use disorders, and conduct disorder/ASPD.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataNumerous heterotypic associations were found, and most persisted after comorbidity control, especially for externalizing disorders.
“Many heterotypic associations were also observed and most remained after controlling for comorbidity, particularly among externalizing disorders”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningEach subthreshold externalizing condition carries both unique and shared predictive validity.
“suggesting that each subthreshold externalizing condition has unique, as well as shared predictive validity.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductcitationThe proportional hazards assumption was tested by adding a Time X Predictor interaction term to each Cox model.
“The proportional hazards assumption was tested by including a Time X Predictor interaction term in each Cox model”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataInterrater reliability data for T1 subthreshold conditions could not be computed.
“Data to compute interrater reliabilities for T1 subthreshold conditions were not available.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataSubthreshold conditions have substantial predictive power for both homotypic and heterotypic full syndrome outcomes.
“In sum, our results suggest that subthreshold conditions have both important homotypic and heterotypic predictive power.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductown dataParticipants were weighted by their selection probability for the third assessment, and standard errors were adjusted in inferential tests.
“participants were weighted by their probability of selection for T3 (standard errors were adjusted in inferential statistics).”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningSome findings, especially heterotypic associations, may reflect Type I error due to multiple comparisons and need replication.
“due to the multiple comparisons, some findings (particularly some of the heterotypic associations), may have been due to a Type I error and thus require replication.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationSubthreshold conditions are common and linked to functional impairment.
“subthreshold conditions are common (Lewinsohn, Shankman, Gau & Klein, 2004), and are associated with functional impairment (Kessler, Zhao, Blazer, & Swartz, 1997)”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Lewinsohn, Shankman, Gau & Klein, 2004
Not checked in the free run.
- cites Kessler, Zhao, Blazer, & Swartz, 1997
Not checked in the free run.
May combine two claims.
PremisecitationSubthreshold depressive conditions are associated with significant impairment and greater treatment use.
“Subthreshold depressive conditions, such as minor depression or Brief Recurrent Depression, have been associated with significant impairment (Gotlib, Lewinsohn, & Seeley, 1995; Kessler et al., 1997), and increased treatment utilization (Judd, Paulus, Wells & Rapaport, 1996).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Gotlib, Lewinsohn, & Seeley, 1995; Kessler et al., 1997
Not checked in the free run.
- cites Judd, Paulus, Wells & Rapaport, 1996
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataCox models were adjusted for gender and for comorbid conditions at T1.
“Cox models were conducted in two sets – 1) adjusting for gender (as gender related to the predictor and the outcome) and 2) adjusting for gender and comorbid conditions at T1.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationTelephone interviews generally produce results comparable to face-to-face interviews.
“Interviews at T3 and T4 were conducted by telephone, which generally yields comparable results to face-to-face interviews”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Rohde, Lewinsohn, & Seeley, 1997
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataBaseline age was not adjusted for because age differences were small.
“Because of the small differences in ages, we did not adjust for baseline age in the Cox models below.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationPrior work has shown that subthreshold depression, bipolar disorder, and anxiety disorder escalate into full syndrome conditions over time.
“Subthreshold depression (Fergusson, Horwood, Ridder & Beautrais, 2005; Lewinsohn et al., 2000a) bipolar disorder (Lewinsohn et al, 2000b; Regeer et al., 2006) and anxiety disorder (Merikangas et al., 2003) have been shown to escalate into the FS condition over time.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Fergusson, Horwood, Ridder & Beautrais, 2005; Lewinsohn et al., 2000a
Not checked in the free run.
- cites Lewinsohn et al, 2000b; Regeer et al., 2006
Not checked in the free run.
- cites Merikangas et al., 2003
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe definitions used for subthreshold conditions were somewhat arbitrary.
“although our definitions of subthreshold conditions were consistent with the literature, they are admittedly somewhat arbitrary.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationSubthreshold and full syndrome conditions show substantial comorbidity and familial co-aggregation.
“there is substantial comorbidity and familial co-aggregation among subthreshold and FS conditions”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Angst, Merikangas & Preisig, 1997; Lewinsohn et al., 2004; Shankman et al., 2008
Not checked in the free run.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Subclinical depression is associated with a two- to five-fold increased risk of full-syndrome depressive disorders.
“Further, subclinical depression is associated with a two- to five-fold increased risk of full-syndrome depressive disorders [10-13].”
From MoodHacker Mobile Web App With Email for Adults to Self-Manage Mild-to-Moderate Depression: Randomized Controlled Trial (2016) · cites this paper as [13]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Key points misstate the adjusted anxiety result
MajorThe key points say subthreshold anxiety predicted its full-syndrome counterpart after adjustment for comorbidity, but the results identify anxiety as the exception that did not remain significant.
“We found that subthreshold MDD, anxiety, alcohol, substance and conduct escalated into their cooresponding (FS) disorders, even after adjusting for comorbidity”
“With the exception of subthreshold anxiety, all of the homotypic escalations from Table 2 remained significant after adjusting for comorbidity.”
Externalizing summary overlooks the conduct-to-anxiety finding
MinorThe discussion says externalizing conditions did not predict internalizing disorders, whereas the results report that subthreshold conduct predicted full-syndrome anxiety before adjustment for comorbidity.
“These disorders often predicted the development of the others, were occasionally bidirectional (subthreshold substance predicted FS alcohol and subthreshold alcohol predicted FS substance), and did not predict the development of internalizing disorders (depression and anxiety).”
“Those with subthreshold conduct developed FS bipolar, anxiety, alcohol use, and substance use disorders.”
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“However, these studies have generally (McGee et al. 1992 ; Fergusson et al. 1993 ; Costello et al. 1996), although not always (Lieb et al. 2000 ; Shankman et al. 2009), focused on point prevalence in each wave or the cumulation of point prevalence estimates across multiple waves (Costello et al.…”
BackgroundLinking RDoC and HiTOP: A new interface for advancing psychiatric nosology and neuroscience
Michelini, G., Palumbo, I. M., DeYoung, C. G., Latzman, R. D., & Kotov, R. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.102025 · Cited by 285 · see citing works
The prevalence and burden of subthreshold generalized anxiety disorder: a systematic review
Haller, H., Cramer, H., Lauche, R., Gass, F., & Dobos, G. J. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-128 · Cited by 267 · see citing works
“Of these, 21 studies [22-42] were excluded because they reported outcome data only for mixed subthreshold diagnoses, for subthreshold diagnoses other than GAD or because they contained data analyzed in already included articles.”
BackgroundGoldstein, B. I., Birmaher, B. B., Carlson, G. A., DelBello, M. P., Findling, R. L., Fristad, M. A., Kowatch, R. A., Miklowitz, D. J., Nery, F. G., Algorta, G. P., et al. (2017) · Bipolar Disorders · doi:10.1111/bdi.12556 · Cited by 245 · see citing works
Pain and the onset of depressive and anxiety disorders
Gerrits, M. M. J. G., van Oppen, P., van Marwijk, H., Penninx, B. W. J. H., & van der Horst, H. E. (2013) · Pain · doi:10.1016/j.pain.2013.09.005 · Cited by 232 · see citing works
“We already know that such symptoms often are associated with disorder onset [15,47].”
BackgroundJonsson, U., Bohman, H., von Knorring, L., Olsson, G., Päären, A., & von Knorring, A. ‐. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.10.046 · Cited by 227 · see citing works
Funkhouser, C. J., Chacko, A., Correa, K. A., Kaiser, A. J. E., & Shankman, S. A. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13256 · Cited by 224 · see citing works
Self-citationSubthreshold depression in children and adolescents – a systematic review
Wesselhoeft, R. T., Sørensen, M. J., Heiervang, E. R., & Bilenberg, N. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.06.010 · Cited by 215 · see citing works
Lee, Y. Y., Stockings, E. A., Harris, M. G., Doi, S. A. R., Page, I. S., Davidson, S. K., & Barendregt, J. J. (2019) · Psychological Medicine · doi:10.1017/s0033291718000557 · Cited by 201 · see citing works
“…longitudinal studies – the largest study found the risk of first-onset major depression to be as high as 35.5% in people with subthreshold depression (Shankman et al. 2009), while another study found no statistically significant increase in risk among people with subthreshold depression (Jonsson…”
BackgroundMethodInfluentialMowlem, F. D., Agnew‐Blais, J. C., Taylor, E. A., & Asherson, P. J. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.12.128 · Cited by 204 · see citing works
Psychiatric disorders and sexual risk among adolescents in mental health treatment.
Brown, L. K., Hadley, W. S., Stewart, A. J., Lescano, C. M., Whiteley, L., Donenberg, G. R., & DiClemente, R. J. (2010) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0019632 · Cited by 204 · see citing works
“were included in the current study given that subthreshold conditions in adolescents have predictive validity as precursors for full syndrome disorders (Fergusson, Horwood, Ridder, & Beautrais, 2005; Klein, Shankman, Lewinsohn, & Seeley, 2009; Shankman et al., 2009), and studies have documented significant functional…”
BackgroundThe cortisol awakening response and major depression: examining the evidence
Dedovic, K., & Ngiam, J. (2015) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s62289 · Cited by 191 · see citing works
“56 Another study by Mangold et al investigated 55 Mexican– American males and females (18–38) with low, moderate, and high subclinical depression symptoms.”
Birney, A. J., Gunn, R., Russell, J. K., & Ary, D. V. (2016) · JMIR mHealth and uHealth · doi:10.2196/mhealth.4231 · Cited by 159 · see citing works
“Further, subclinical depression is associated with a two- to five-fold increased risk of full-syndrome depressive disorders [10-13].”
Van Meter, A. R., Burke, C., Youngstrom, E. A., Faedda, G. L., & Correll, C. U. (2016) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2016.04.017 · Cited by 174 · see citing works
Leadbeater, B. J. R., Thompson, K., & Gruppuso, V. (2012) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2012.694608 · Cited by 178 · see citing works
“Similar to studies of psychiatric disorders, past research also shows that subclinical symptoms of mental health problems in adolescence predict homotypical clinical disorders in adulthood (Shankman et al., 2009).”
ResultMurnane, E. L., Cosley, D., Chang, P., Guha, S., Frank, E., Gay, G., & Matthews, M. (2016) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocv165 · Cited by 134 · see citing works
“The distributions of BD subtypes in our study sample are representative of existing prevalence estimates,(25) except for the lower incidence of cyclothymia,(26) which, together with the high number of reported BD episodes, suggest that our respondents may have relatively severe BD presentations.(27)”
Faedda, G. L., Baldessarini, R. J., Marangoni, C., Bechdolf, A., Berk, M., Birmaher, B., Conus, P., DelBello, M. P., Duffy, A. C., Hillegers, M. H. J., et al. (2019) · Bipolar Disorders · doi:10.1111/bdi.12831 · Cited by 124 · see citing works
Clinical risk factors for bipolar disorders: A systematic review of prospective studies
Faedda, G. L., Serra, G., Marangoni, C., Salvatore, P., Sani, G., Vázquez, G. H., Tondo, L., Girardi, P., Baldessarini, R. J., & Koukopoulos, A. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.07.013 · Cited by 117 · see citing works
“01 Conduct disorder-subsyndromal Shankman et al., 2009 1505 14–20 DSM-IV/KSADS-E Community (OADP) 15 3.9 p¼0.05 Conduct disorder Morcillo et al., 2012 34,653 418 DSM-IV/ AUDADIS-IV Community (NESARC) (3) 2.04 M, 1.72 F Criminal behavior Zimmermann et al., 2009 2210 risk set 14–24 DSM-IV/M-CIDI…”
BackgroundResultInfluentialKovacs, M., & Lopez‐Duran, N. (2010) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2010.02230.x · Cited by 111 · see citing works
“…clinical interview (e.g., Georgiades, Lewinsohn, Monroe, & Seeley, 2006), when important variables were statistically controlled (e.g., Shankman et al., 2009), and appear to be specific to the prediction of depressive as compared to anxiety or substance use disorders (e.g., Shankman et al., 2009).”
BackgroundNon-suicidal self-injury disorder in a community sample of adults
Andover, M. S. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.06.001 · Cited by 112 · see citing works
“Similar to research on other subthreshold disorders (e.g., Shankman et al., 2009), individuals with subthreshold NSSI Disorder may experience significant impairment, and the subthreshold disorder may be a precursor for developing the full syndrome or another disorder.”
Rodriguez-Seijas, C. A., Eaton, N. R., & Krueger, R. F. (2015) · Journal of Personality Assessment · doi:10.1080/00223891.2015.1055752 · Cited by 104 · see citing works
“Indeed, milder forms of disorder represent a more valid conceptualization of the continuous or dimensional nature of psychopathology (Shankman et al., 2009), in contrast with the traditional categorical approach.”
BackgroundDepression in children and adolescents in the first 6 months after traumatic brain injury
Max, J. E., Keatley, E. S., Wilde, E. A., Bigler, E. D., Schachar, R. J., Saunders, A. E., Ewing‐Cobbs, L., Chapman, S. B., Dennis, M., Yang, T. T., et al. (2011) · International Journal of Developmental Neuroscience · doi:10.1016/j.ijdevneu.2011.12.005 · Cited by 111 · see citing works
“We chose to investigate subclinical depression and anxiety because of the compelling empirical data supporting the validity of these constructs and their relationship with corresponding full clinical disorders with naturalistic follow up (Klein et al., 2009; Shankman et al., 2009).”
BackgroundBlazer, D. G., & Wu, L.-T. T. (2011) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3182006a96 · Cited by 110 · see citing works
Friborg, M. K., Hansen, J. V., Aldrich, P. T., Folker, A. P., Kjær, S., Nielsen, M. B. D., Rugulies, R., & Madsen, I. E. H. (2017) · BMC Public Health · doi:10.1186/s12889-017-4669-x · Cited by 105 · see citing works
Subthreshold attention deficit hyperactivity in children and adolescents: a systematic review
Balázs, J., & Keresztény, Á. (2014) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-013-0514-7 · Cited by 108 · see citing works
“[23] found that subthreshold ADHD, when compared with those who had neither subthreshold ADHD nor fullsyndrome ADHD, significantly predicted a first onset of full-syndrome alcohol dependence, substance use disorder, and conduct disorder/antisocial personality disorder.”
MethodResultIs subthreshold depression in adolescence clinically relevant?
Noyes, B. K., Munoz, D. P., Khalid‐Khan, S., Brietzke, E. M., & Booij, L. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.04.067 · Cited by 103 · see citing works
Crockett, M. A., Martínez, V., & Jiménez-Molina, Á. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.03.111 · Cited by 100 · see citing works
“…MDD and progressing into a persistent depressive condition (Georgiades et al., 2006; Jonsson et al., 2011; Klein et al., 2009; Rohde et al., 2009; Shankman et al., 2009); in addition, they are more likely to develop https://doi.org/10.1016/j.jad.2020.03.111 Received 21 December 2019; Received in…”
BackgroundInfluentialCarrellas, N. W., Biederman, J., & Uchida, M. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.12.037 · Cited by 102 · see citing works
Duffy, A. C. (2012) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.11111725 · Cited by 103 · see citing works
Psychological distress and risk of long-term disability: population-based longitudinal study
Rai, D., Kosidou, K., Lundberg, M., Araya, R., Lewis, G., & Magnusson, C. (2011) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2010.119644 · Cited by 99 · see citing works
Lahey, B. B., Zald, D. H., Hakes, J. K., Krueger, R. F., & Rathouz, P. J. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.359 · Cited by 99 · see citing works
Kujawa, A., Hajcak, G., & Klein, D. N. (2018) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12944 · Cited by 97 · see citing works
“Subthreshold symptomsshouldbe strongpredictors of the later development of depressive disorders (Keenan et al., 2008; Shankman et al., 2009), and follow-up data with this sample will allow us to continue to explore these pathways across adolescence.”
BackgroundSelf-citationDear, B. F., Fogliati, V. J., Fogliati, R., Johnson, B., Boyle, O., Karin, E., Gandy, M., Kayrouz, R., Staples, L. G., & Titov, N. (2018) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867417738055 · Cited by 93 · see citing works
Whittle, S., Yap, M. B. H., Sheeber, L., Dudgeon, P., Yücel, M., Pantelis, C., Simmons, J. G., & Allen, N. B. (2011) · Development and Psychopathology · doi:10.1017/s0954579410000684 · Cited by 91 · see citing works
“We examined depressive symptoms rather than case-level disorder in this age group because of the well-established relationship between increasing symptoms and later disorder (Shankman et al., 2009).”
BackgroundDisguised Distress in Children and Adolescents “Flying Under The Radar”
Flett, G. L., & Hewitt, P. L. (2013) · Canadian Journal of School Psychology · doi:10.1177/0829573512468845 · Cited by 93 · see citing works
“While the primary focus of most research on subclinical conditions has been on subclinical depression, Shankman et al. (2009) noted that other types of symptoms are quite prevalent and involve substantial risk of escalation. For instance, Stice, Marti, Shaw, and Jaconis (2009) studied 496 adolescent girls and found th…”
BackgroundInfluentialCortisol Awakening Response and Hippocampal Volume: Vulnerability for Major Depressive Disorder?
Dedovic, K., Engert, V., Duchesne, A., Lue, S. D., Andrews, J., Efanov, S. I., Beaudry, T., & Pruessner, J. C. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.07.025 · Cited by 91 · see citing works
Bosman, R. C., ten Have, M., de Graaf, R., Muntingh, A., van Balkom, A. V., & Batelaan, N. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.01.018 · Cited by 85 · see citing works
Hartmann, J., McGorry, P. D., Destrée, L., Amminger, G. P., Chanen, A. M., Davey, C. G., Ghieh, R., Polari, A. R., Ratheesh, A., Yuen, H. P., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.553578 · Cited by 86 · see citing works
Prevalence of DSM-IV disorders, comorbidity and impairment in 3-year-old Spanish preschoolers
Ezpeleta, L., de la Osa, N., & Domènech, J. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-013-0683-1 · Cited by 89 · see citing works
Kirova, A.-M., Kelberman, C., Storch, B., DiSalvo, M., Woodworth, K. Y., Faraone, S. V., & Biederman, J. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.02.003 · Cited by 88 · see citing works
“All five longitudinal studies (Kadesjo and Gillberg, 2001; Shankman et al., 2009; Bussing et al., 2010; Fergusson et al., 2010; Noren Selinus et al., 2016) found that subthreshold ADHD and full threshold ADHD diagnoses in childhood and adolescence were associated with a number of negative outcomes in late adolescence…”
BackgroundInfluentialPrecursors of Bipolar Disorders
Faedda, G. L., Marangoni, C., Serra, G., Salvatore, P., Sani, G., Vázquez, G. H., Tondo, L., Girardi, P., Baldessarini, R. J., & Koukopoulos, A. (2015) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.13r08900 · Cited by 88 · see citing works
Leadbeater, B. J. R., & Homel, J. (2014) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-014-9908-3 · Cited by 89 · see citing works
Treatment use and barriers among adolescents with prescription opioid use disorders
Wu, L.-T. T., Blazer, D. G., Li, T., & WOODY, G. E. (2011) · Addictive Behaviors · doi:10.1016/j.addbeh.2011.07.033 · Cited by 85 · see citing works
“Subthreshold substance users (meeting 1–2 dependence criteria but no abuse criteria) could be good targets for early case identification and interventions because longitudinal data show that they escalate into substance use disorders (SUD) (Shankman et al., 2009).”
Bipolar and ADHD comorbidity: Both artifact and outgrowth of shared mechanisms.
Youngstrom, E. A., Arnold, L. E., & Frazier, T. W. (2010) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2010.01226.x · Cited by 85 · see citing works
“Others do not show a manic episode, but often have a major depression (Shankman et al., 2009), leaving it uncertain whether the illness is a bipolar depression.”
BackgroundHartmann, J., Nelson, B., Ratheesh, A., Treen, D., & McGorry, P. D. (2018) · Psychological Medicine · doi:10.1017/s0033291718001435 · Cited by 79 · see citing works
“Stressful or adverse life events were identified as a psychosocial predictor of onset of MDD in offspring at high FHR for depression (Hammen et al., 1991; Rice et al., 2017).”
BackgroundInfluentialDeJong, M. (2010) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104510377705 · Cited by 82 · see citing works
“Follow up over time has indicated that many such presentations tend to escalate into full blown disorders (Shankman et al., 2009).”
BackgroundConsiderations toward an epigenetic and common pathways theory of mental disorder.
Nigg, J. T. (2023) · Journal of Psychopathology and Clinical Science · doi:10.1037/abn0000748 · Cited by 78 · see citing works
Longitudinal Assessment of Manic Symptoms (LAMS) Study
Horwitz, S. M., Demeter, C., Pagano, M. E., Youngstrom, E. A., Fristad, M. A., Arnold, L. E., Birmaher, B. B., Gill, M. K., Axelson, D., Kowatch, R. A., et al. (2010) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.09m05835yel · Cited by 79 · see citing works
“…in behavior, further, as pointed out by Youngstrom et al.55 in an extensive review of the evidence on the phenomenology of bipolar disorder in youth, these symptoms are highly specific to the disorder although, as reported by Shankman et al., 2009 59 the diagnostic evolution may not be homotypic.”
BackgroundCOURSE AND RISK FACTORS OF FUNCTIONAL IMPAIRMENT IN SUBTHRESHOLD DEPRESSION AND ANXIETY
Karsten, J., Penninx, B. W. J. H., Verboom, C. E., Nolen, W. A., & Hartman, C. A. (2012) · Depression and Anxiety · doi:10.1002/da.22021 · Cited by 77 · see citing works
“[9–11] But, in order to evaluate the future clinical relevance of subthreshold disorder, it is important to not only focus on the course of symptoms, but also on the course of associated functional impairment.”
Prevention of depression in childhood and adolescence
Mendelson, T., & Tandon, S. D. (2016) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2015.11.005 · Cited by 77 · see citing works
Ramadianto, A. S., Kusumadewi, I., Agiananda, F., & Raharjanti, N. W. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03745-1 · Cited by 107 · see citing works
“The risk is even more pronounced in late teenagers and young adults, the age range of respondents in this study [54, 55].”
BackgroundCyclothymic disorder: A critical review
Meter, A. V., Youngstrom, E. A., & Findling, R. L. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.02.001 · Cited by 68 · see citing works
“(Merikangas et al., 2007), and, in some cases, cyclothymic disorder may represent the prodrome to more severe presentations of bipolar disorder (Klein, Depue, & Slater, 1986; Shankman et al., 2009).”
BackgroundKujawa, A., Hajcak, G., Danzig, A. P., Black, S. R., Bromet, E. J., Carlson, G. A., Kotov, R., & Klein, D. N. (2015) · Biological Psychiatry · doi:10.1016/j.biopsych.2015.09.008 · Cited by 67 · see citing works
“Though subthreshold symptoms are a strong predictor of full-threshold disorders (70,71), additional work is needed to evaluate whether our results generalize to prediction of clinical disorders.”
Self-citationPredictors of the Course of Anxiety Disorders in Adolescents and Young Adults
Asselmann, E., & Beesdo‐Baum, K. (2015) · Current Psychiatry Reports · doi:10.1007/s11920-014-0543-z · Cited by 62 · see citing works
Selinus, E. N., Molero, Y., Lichtenstein, P., Anckarsäter, H. S., Lundström, S., Bottai, M., & Gumpert, C. H. (2016) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12655 · Cited by 60 · see citing works
“levels of ADHD and negative outcomes (26, 31, 37, 38, 45, 46, 84).”
ResultPhysical Activity, Sedentary Behavior, and Symptoms of Major Depression in Middle Childhood
Zahl‐Thanem, T., Steinsbekk, S., & Wichstrøm, L. (2017) · PEDIATRICS · doi:10.1542/peds.2016-1711 · Cited by 63 · see citing works
Ezpeleta, L., de la Osa, N., Granero, R., Domenech, J. M., & Reich, W. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2011.04.034 · Cited by 62 · see citing works
“precursor of full syndrome disorder (Shankman et al., 2009).”
BackgroundZhu, Y., Qi, S., Zhang, B., He, D., Teng, Y., Hu, J., & Wei, X. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00371 · Cited by 55 · see citing works
“It is not surprising to observe the insula and amygdala because they are the neuroanatomical core of MDD pathology and closely related to anxiety (27).”
BackgroundInfluentialTrends in Subthreshold Psychiatric Diagnoses for Youth in Community Treatment
Safer, D. J., Rajakannan, T., Burcu, M., & ZITO, J. M. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.1746 · Cited by 62 · see citing works
Hill, R. M., Pettit, J. W., Lewinsohn, P. M., Seeley, J. R., & Klein, D. N. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.02.011 · Cited by 58 · see citing works
“, 2009), although approximately 2/3 of adolescents who experience SubD never escalate to full syndrome MDD (Shankman et al., 2009).”
BackgroundMethodSelf-citationEstimating the burden of psychiatric disorders in adolescence: the impact of subthreshold disorders
Roberts, R. E., Fisher, P. W., Blake Turner, J., & Tang, M. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-0972-3 · Cited by 59 · see citing works
“Research suggests that subthreshold disorders are common among adolescents [24], are precursors in adolescence for full syndrome disorders in adulthood [25], and are associated with functional impairment [26].”
BackgroundDell’Acqua, C., Ghiasi, S., Benvenuti, S. M., Greco, A., Gentili, C., & Valenza, G. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.12.015 · Cited by 60 · see citing works
Leadbeater, B. J. R., Thompson, K., & Sukhawathanakul, P. (2014) · Development and Psychopathology · doi:10.1017/s0954579414000315 · Cited by 59 · see citing works
“Subclinical levels of these problems in adolescence also predict more serious disorders in adulthood (Klein et al., 2013; Shankman et al., 2009).”
BackgroundZur Komorbidität von aggressivem Verhalten und ADHS
Witthöft, J., Koglin, U., & Petermann, F. (2010) · Kindheit und Entwicklung · doi:10.1026/0942-5403/a000029 · Cited by 48 · see citing works
Nieman, D. H., & McGorry, P. D. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00221-7 · Cited by 51 · see citing works
Whittle, S., Yücel, M., Lorenzetti, V., Byrne, M. L., Simmons, J. G., Wood, S. J., Pantelis, C., & Allen, N. B. (2011) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2011.10.004 · Cited by 50 · see citing works
Ames, M. E., & Leadbeater, B. J. R. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.07.001 · Cited by 51 · see citing works
Starr, L. R., Stroud, C. B., & Li, Y. I. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.10.065 · Cited by 49 · see citing works
Psychological, endocrine and neural responses to social evaluation in subclinical depression.
Dedovic, K., Duchesne, A., Engert, V., Lue, S., Andrews, J., Efanov, S., Beaudry, T., & Pruessner, J. (2014) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nst151 · Cited by 49 · see citing works
“, 2001) and that it may represent the precursor for the full disorder (Shankman et al., 2009).”
BackgroundADHD in adults: a concept in evolution
Matte, B., Rohde, L., & Grevet, E. (2012) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-012-0077-3 · Cited by 50 · see citing works
“Shankman et al. (2009) followed a large group of adolescents until age 30.”
BackgroundHjarsbech, P. U., Andersen, R. V., Christensen, K. B., Aust, B., Borg, V., & Rugulies, R. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.07.033 · Cited by 48 · see citing works
The economic impact of subthreshold and clinical childhood mental disorders
Fatori, D., Salum, G., Itria, A., Pan, P., Alvarenga, P., Rohde, L. A., Bressan, R., Gadelha, A., de Jesus Mari, J., Conceição do Rosário, M., et al. (2018) · Journal of Mental Health · doi:10.1080/09638237.2018.1466041 · Cited by 47 · see citing works
“…diagnosis, however, they suffer impairment (Alvarenga et al., 2015; GonzálezTejera et al., 2005; Scahill et al., 1999) and are at greater risk for developing a clinical mental disorder later in life (Fergusson et al., 2005; Fullana et al., 2009; Hill et al., 2014; Shankman et al., 2009).”
BackgroundMaxwell, A. M., Harrison, K., Rawls, E., & Zilverstand, A. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.808776 · Cited by 44 · see citing works
Paillère-Martinot, M. L., Lemaître, H., Eric Artiges, A., Miranda, R., Goodman, R., Penttilä, J., Struve, M., Fadai, T., Kappel, V., Poustka, L., et al. (2013) · Molecular Psychiatry · doi:10.1038/mp.2013.44 · Cited by 44 · see citing works
Subthreshold body dysmorphic disorder in adolescents: Prevalence and impact
Schneider, S. C., Mond, J., Turner, C. M., & Hudson, J. L. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.01.085 · Cited by 44 · see citing works
“…depression, anxiety, and obsessive-compulsive disorder are linked to increased comorbidity, greater functional impairment, and higher risk of later full-syndrome disorders (Balázs et al., 2013; Haller et al., 2014; Shankman et al., 2009; Wesselhoeft et al., 2013; Wolitzky-Taylor et al., 2014).”
BackgroundAugustine, L., Lygnegård, F., & Granlund, M. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1955304 · Cited by 44 · see citing works
Holm‐Denoma, J. M., Hankin, B. L., & Young, J. F. (2014) · Eating Behaviors · doi:10.1016/j.eatbeh.2014.03.015 · Cited by 43 · see citing works
“…occur in self-report measurement methods have been well-documented (Paulhus, 1991); however, past research has demonstrated that self-report dimensional symptom scales predict subsequent, full-threshold diagnoses (Shankman et al., 2009) and psychosocial problems (Gotlib, Lewinsohn, & Seeley, 1995).”
ResultSpecificity of psychopathology across levels of severity: a transdiagnostic network analysis
Groen, R. N., Wichers, M., Wigman, J. T. W., & Hartman, C. A. (2019) · Scientific Reports · doi:10.1038/s41598-019-54801-y · Cited by 37 · see citing works
Diversity and the Hierarchical Taxonomy of Psychopathology (HiTOP)
Rodriguez-Seijas, C., Li, J. J., Balling, C. E., Brandes, C. M., Bernat, E. M., Boness, C. L., Forbes, M., Forbush, K. T., Joyner, K. J., Krueger, R., et al. (2023) · Nature Reviews Psychology · doi:10.1038/s44159-023-00200-0 · Cited by 27 · see citing works
Hendriks, A., Bartels, M., Colins, O., & Finkenauer, C. (2018) · Neuroscience and Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.03.021 · Cited by 38 · see citing works
Features preceding diagnosis of bipolar versus major depressive disorders
Serra, G., Koukopoulos, A., Chiara, L. D., Napoletano, F., Koukopoulos, A. E., Curto, M., Manfredi, G., Faedda, G. L., Girardi, P., & Baldessarini, R. J. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.10.050 · Cited by 41 · see citing works
“Some studies have found that: [a] a greater number (load), [b] persistence or recurrence of prodromal symptoms and [c] younger age at symptom-onset, themselves, may increase risk for later BD, perhaps even more than the presence of individual early symptoms (Akiskal et al., 1983; Burstein et al., 2014; Fiedorowicz et…”
BackgroundClinical and Environmental Risk Factors for Bipolar Disorder: Review of Prospective Studies
Marangoni, C., Faedda, G. L., & Baldessarini, R. J. (2018) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000161 · Cited by 40 · see citing works
Conducting psychopathology prevention research in the RDoC era.
Zalta, A. K., & Shankman, S. A. (2016) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12144 · Cited by 38 · see citing works
Self-citationLeadbeater, B. J. R., & Ames, M. E. (2016) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-016-0190-4 · Cited by 39 · see citing works
“However, our findings concur with previous research on depressive symptoms (Shankman et al. 2009), suggesting that subclinical symptoms of mental health problems in adolescence can be of considerable concern for academic and occupational functioning in young adulthood.”
ResultWeinberger, A. H., Pilver, C. E., Desai, R. A., Mazure, C. M., & McKee, S. A. (2012) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2012.06.028 · Cited by 38 · see citing works
Malhi, G. S., Das, P., Outhred, T., Bryant, R. A., & Calhoun, V. D. (2019) · The British Journal of Psychiatry · doi:10.1192/bjp.2019.10 · Cited by 38 · see citing works
Keerthy, D., Youk, A. O., Srinath, A. I., Malas, N., Bujoreanu, S. I., Bousvaros, A., Keljo, D. J., DeMaso, D. R., & Szigethy, E. (2016) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000001207 · Cited by 36 · see citing works
“It is important to include minor depression because it can often be a precursor to major depression if left untreated (35) and is associated with significant morbidity and functional impairment in adolescents (36–38).”
BackgroundJohnston, L., Dear, B. F., Gandy, M., Fogliati, V. J., Kayrouz, R., Sheehan, J., Rapee, R. M., & Titov, N. (2014) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867414527524 · Cited by 36 · see citing works
“Australian & New Zealand Journal of Psychiatry, 48(9) chronic mental health difficulties in later life and are associated with poorer workforce participation, income and living standards by age 30 (Gibb et al., 2010; Shankman et al., 2009).”
BackgroundGenc, S., Malpas, C. B., Gulenc, A., Sciberras, E., Efron, D., Silk, T., & Seal, M. (2020) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2020.100853 · Cited by 32 · see citing works
Staiano, A. E., Marker, A. M., Martin, C. K., & Katzmarzyk, P. T. (2016) · Obesity · doi:10.1002/oby.21567 · Cited by 34 · see citing works
“There is increasing interest to understand the health risks of subclinical mental health symptoms due to the high prevalence coupled with their predictive validity as precursors for clinically diagnosed mental health disorders (7).”
BackgroundZimmerman, M. A. (2012) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.11com07288 · Cited by 34 · see citing works
Mangold, D. L., Marino, E. N., & Javors, M. A. (2011) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2011.01.001 · Cited by 35 · see citing works
“Indeed, it is proposed that subclinical depressive symptomatology is a less severe condition that may be a precursor to the onset of a formal diagnosis of major depression (Cuijpers & Smit, 2004; Shankman et al., 2009).”
BackgroundGromball, J., Beschorner, F., Wantzen, C., et al. (2014) · Phytomedicine · doi:10.1016/j.phymed.2014.04.004 · Cited by 34 · see citing works
Kean, J. D., Sarris, J., Scholey, A., Silberstein, R., Downey, L. A., & Stough, C. (2017) · Psychopharmacology · doi:10.1007/s00213-016-4471-y · Cited by 32 · see citing works
- Authors
- Shankman, S. A., Lewinsohn, P. M., Klein, D. N., Small, J. W., Seeley, J. R., & Altman, S. E.
- Affiliations
- University of Illinois Chicago (US)
- Oregon Research Institute (US)
- Corresponding author
- Shankman, Stewart A.
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2009-11-05
- Volume
- 50
- Issue
- 12
- Pages
- 1485-1494
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- PMC
- PMC2804772
- OpenAlex
- W1974681461
- Cited by
- 300
- References
- 44
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 14 · 2023: 18 · 2022: 23 · 2021: 23 · 2020: 25 · 2019: 23 · 2018: 14 · 2017: 11 · 2016: 20 · 2015: 19 · 2014: 20 · 2013: 20 · 2012: 18
- FWCI
- 16.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH 50522, R01MH066023, R01MH050522)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- alcohol consumption, substance use, conduct disorder, attention deficit hyperactivity disorder, antisocial personality disorder, comorbidities, dimensional models of psychopathology, young adults, predictive validity, preventive interventions
- MeSH terms
- Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Mental Disorders, Major Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Severity of Illness Index, Syndrome, Comorbidity, Conduct Disorder, Substance-Related Disorders, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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