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Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies
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Objective: In order to examine whether the incidence of major depressive disorder (MDD) is increased in subjects with subthreshold depression, or sD (clinically relevant depressive symptoms, without meeting criteria for a full‐blown MDD), we conducted a review of prospective studies examining the incidence of MDD in subjects with sD. Method: A systematic literature search was conducted. For all studies, the relative risk of developing MDD was calculated, based on person‐years. Results: Twenty studies (23 comparisons) were found, based on community samples, general medical patients and high‐risk subjects. Most comparisons showed that subjects with sD had a consistently larger chance of developing MDD. The studies differed considerably in the definition of sD, the recency (occurrence of the last sD) and the in‐/exclusion of lifetime MDD. Conclusion: The incidence of MDD in subjects with sD is larger than in subjects without sD. Otherwise, the concept of sD is too broad to be used. In future studies, some consensus should be reached regarding the definition of sD.
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“Prospective epidemiologic studies report much higher lifetime prevalence of major depression in the range of 30-40%. 141”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [141]
In the citing paper
“Most estimates of lifetime prevalence of depression are based on retrospective reports and need to be interpreted with caution as they are likely to underestimate true lifetime prevalence. 141”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [141]
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“It is highly related to a subject’s mental state and the risk of developing depression [19,20].”
From Mobile Sensing and Support for People With Depression: A Pilot Trial in the Wild (2016) · cites this paper as [20]
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BackgroundResultDisseminating Self-Help: Positive Psychology Exercises in an Online Trial
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BackgroundScreening, evaluation and management of depression in people with diabetes in primary care
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“Although, at the individual level, disability from subclinical or mild-to-moderate depression is lower than for major depressive disorder (MDD), it is of major public health significance due to its greater prevalence (Judd et al., 2002) and associated increased risk of mortality (Cuijpers and Smit, 2002), coronary hea…”
BackgroundInfluentialDirek, N., Williams, S., Smith, J. A., Ripke, S., Air, T., Amare, A. T., Amin, N., Baune, B. T., Bennett, D. A. A., Blackwood, D., et al. (2016) · Biological Psychiatry · doi:10.1016/j.biopsych.2016.11.013 · Cited by 97
“In longitudinal studies, there is an increased risk of MDD in patients with minor depression and subthreshold depression (18, 19).”
BackgroundDetection of Minor and Major Depression through Voice as a Biomarker Using Machine Learning
Shin, D., Cho, W., Park, C. H. K., Rhee, S. Y., Kim, M. J., Lee, H., Kim, N., & Ahn, Y. M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10143046 · Cited by 98
Forman-Hoffman, V., McClure, E., McKeeman, J., Wood, C. T., Middleton, J. C., Skinner, A. C., Perrin, E. M., & Viswanathan, M. (2016) · Annals of Internal Medicine · doi:10.7326/m15-2259 · Cited by 93
“Although several studies have shown that subthreshold depression is a risk factor for MDD (45), its role in temporal progression to MDD is not well-understood.”
BackgroundPredictors of future depression in early and late adolescence
van Lang, N. D. J., Ferdinand, R. F., & Verhulst, F. C. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.06.007 · Cited by 93
“007 they showed that these symptoms are persistent and are a risk factor for future depressive disorder or suicide attempts (Cuijpers and Smit, 2004; Fergusson et al., 2005; Ge et al., 2001; Haavisto et al., 2004; Jaffee et al., 2002; Wilcox and Anthony, 2004).”
BackgroundRigabert, A., Motrico, E., Moreno-Peral, P., Resurrección, D. M., Conejo-Cerón, S., Cuijpers, P., Martín-Gómez, C., López-Del-Hoyo, Y., & Bellón, J. Á. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101931 · Cited by 92
Self-citationScars in depression: is a conceptual shift necessary to solve the puzzle?
Wichers, M., Geschwind, N., van Os, J., & Peeters, F. P. M. L. (2009) · Psychological Medicine · doi:10.1017/s0033291709990420 · Cited by 91
“This observation was described by Post (1992) as a process of behavioural ‘sensitization’ and electrophysiological ‘kindling ’, suggesting that a depressive episode leaves some traces that persist after remission and recovery, and render individuals vulnerable to the onset of new episodes under the…”
BackgroundMethodCortisol 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 99
Psychological issues in acquired facial trauma
Sousa, A. D. (2010) · Indian Journal of Plastic Surgery · doi:10.1055/s-0039-1699436 · Cited by 91
Self-help strategies that are helpful for sub-threshold depression: A Delphi consensus study
Morgan, A. J., & Jorm, A. F. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.08.004 · Cited by 91
“, 2004), increase the risk of developing major depressive disorder (Cuijpers and Smit, 2004), and have considerable economic costs (Cuijpers et al.”
BackgroundDimensionality and the category of major depressive episode
Andrews, G., Brugha, T. S., Thase, M. E., Duffy, F. F., Rucci, P., & Slade, T. N. (2007) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.216 · Cited by 91
“Cuijpers and Smit (2004) have assembled a series of studies that show that people with subthreshold symptoms have, compared to people without symptoms, a fi ve-fold increase in risk of developing MDE.”
BackgroundThe mutual relationship between shift work and depressive complaints – a prospective cohort study
Driesen, K., Jansen, N., van Amelsvoort, L. G. P. M., & Kant, I. (2011) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.3158 · Cited by 92
“Additionally, subjects with symptoms of a depressive disorder or mild depressive complaints face a higher risk of developing a depressive disorder compared to those without such symptoms (11, 12).”
BackgroundFonseca, A., Alves, S., Monteiro, F., Gorayeb, R., & Canavarro, M. C. (2020) · Behavior Therapy · doi:10.1016/j.beth.2019.09.007 · Cited by 82
Jang, S.-H., Kang, S.-Y., Lee, H.-J., & Lee, S.-Y. (2016) · EXPLORE · doi:10.1016/j.explore.2016.06.003 · Cited by 87
Yang, J., Yao, S., Zhu, X., Zhang, C., Ling, Y., Abela, J. R. Z., Esseling, P. G., & McWhinnie, C. M. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.04.023 · Cited by 85
“They defined the situationwhen a person has clinically relevant depressive symptoms with functional impairments, without meeting criteria for major depressive disorder (MDD; Cuijpers and Smit, 2004), as subthreshold depression (sD).”
BackgroundInfluentialZhou, T., Li, X., Pei, Y., Gao, J., & Kong, J. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-1061-9 · Cited by 89
“depression has been considered as a risk factor for the development of major depression and other psychiatric disorders [6, 15].”
BackgroundWomen, anxiety and mood: a review of nomenclature, comorbidity and epidemiology
Alexander, J. L., Dennerstein, L., Kotz, K. J., & Richardson, G. (2007) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.7.11s.s45 · Cited by 87
Emotion-regulation ability, role stress and teachers’ mental health
Mérida‐López, S., Extremera, N., & Rey, L. (2017) · Occupational Medicine · doi:10.1093/occmed/kqx125 · Cited by 85
Pitceathly, C., Maguire, P., Fletcher, I., Parle, M., Tomenson, B., & Creed, F. (2009) · Annals of Oncology · doi:10.1093/annonc/mdn708 · Cited by 84
“Evidence from the noncancer field suggests that prevention is most likely to be successful if a ‘high-risk’ group is targeted for treatment; the strongest evidence relates to cognitive behavioural interventions used to prevent anxiety or depressive disorders [14].”
BackgroundMinor depression during adolescence and mental health outcomes during adulthood
Johnson, J. G., Cohen, P., & Kasen, S. (2009) · British Journal of Psychiatry · doi:10.1192/bjp.bp.108.054239 · Cited by 84
Depression and cancer: An unexplored and unresolved emergent issue in elderly patients
Spoletini, I., Gianni, W., Repetto, L., Bria, P., Caltagirone, C., Bossù, P., & Spalletta, G. (2008) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2007.10.005 · Cited by 84
“In particular, subthreshold symptoms of depression have een considered in literature in different ways: as prodromes, ecause they have been found to predict the onset of an pisode of major depression [21], or as residual symptoms fter recovery from an earlier episode; finally, the subthreshld depression may constitute…”
BackgroundFurukawa, T. A., Horikoshi, M., Kawakami, N., Kadota, M., Sasaki, M., Sekiya, Y., Hosogoshi, H., Kashimura, M., Asano, K., Terashima, H., et al. (2012) · PLoS ONE · doi:10.1371/journal.pone.0035330 · Cited by 89
“Subthreshold depression is also a strong risk factor for major depression both in the short [7] and long [8] terms.”
BackgroundKullik, A., & Petermann, F. (2013) · Child Psychiatry & Human Development · doi:10.1007/s10578-012-0347-5 · Cited by 99
“Furthermore, depressive symptoms were assessed using a self-report instrument which restricts interpretation and at best indicates or precedes a depressive disorder [87].”
MethodCho, S.-C., Kim, B., Kim, J.-W., Rohde, L. A., Hwang, J., Chungh, D.-S., Shin, M., Lyoo, I. K., Bock-Ja, G., Lee, S., et al. (2009) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-009-0755-7 · Cited by 80
“depression also carry a high risk for developing major depressive disorder [23, 25].”
BackgroundEfficacy of Silexan in mixed anxiety–depression – A randomized, placebo-controlled trial
Kasper, S. F., Volz, H., Dienel, A., & Schläfke, S. (2015) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2015.12.002 · Cited by 82
“, 2000), bear the risk of exacerbation to a syndromal disorder (e.g. Aune and Stiles, 2009; Cuijpers and Smit, 2004; Forsell, 2007; Haller et al., 2014), and thus warrant clinical recognition and require appropriate treatment (Roy-Byrne et al.”
BackgroundReciprocal relationships between parent and adolescent internalizing symptoms.
Hughes, E. K., & Gullone, E. (2010) · Journal of Family Psychology · doi:10.1037/a0018788 · Cited by 79
“First, although elevated symptomatology can impact significantly upon individual functioning (Gotlib, Lewinsohn, & Seeley, 1995) and may be a precursor to later disorder (Cuijpers & Smit, 2004), the current findings might not generalize to clinical populations.”
BackgroundMitchell, A. J., Hussain, N., Grainger, L., & Symonds, P. R. (2010) · Psycho-Oncology · doi:10.1002/pon.1815 · Cited by 79
COURSE 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
“[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.”
Kuczynski, A. M., Halvorson, M. A., Slater, L. R., & Kanter, J. W. (2021) · Journal of Social and Personal Relationships · doi:10.1177/02654075211045717 · Cited by 78
“Research suggests that subthreshold depressive symptoms are associated with clinically meaningful levels of distress and dysfunction (Cuijpers & Smit, 2004; Lewinsohn et al., 2000), and that because depression is most accurately conceptualized as a dimensional construct (Kendler & Gardner, 1998;…”
BackgroundGellis, Z. D., & Bruce, M. L. (2010) · The American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181b21442 · Cited by 76
Classification and treatment of sub-threshold depression
Rowe, S. K., & Rapaport, M. H. (2005) · Current Opinion in Psychiatry · doi:10.1097/01.yco.0000194148.26766.ba · Cited by 76
Depression and episodic memory across the adult lifespan: A meta-analytic review.
James, T., Weiss-Cowie, S., Hopton, Z. W., Verhaeghen, P., Dotson, V. M., & Duarte, A. (2021) · Psychological Bulletin · doi:10.1037/bul0000344 · Cited by 93
“Subthreshold depression is quite prevalent in the population, with estimates ranging from 1.4% to 17.2%, and is associated with increased risk of developing major depression (Cuijpers & Smit, 2004; Karsten et al., 2011; Tuithof et al., 2018).”
BackgroundInfluentialEmotional Functioning in Children and Adolescents with Elevated Depressive Symptoms
Hughes, E. K., Gullone, E., & Watson, S. (2011) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-011-9220-2 · Cited by 73
“Although elevated symptomatology impacts significantly on individual functioning (Gotlib et al. 1995), may indicate the presence of depressive disorder, or may be a precursor to later disorder (Cuijpers and Smit 2004), the study of clinical samples would greatly strengthen future research.”
BackgroundCuijpers, P. J., Smit, F., & Willemse, G. (2004) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2004.00416.x · Cited by 73
“Virtually all of the many studies that have examined the incidence rates of major depression in subjects with subthreshold depression compared with those without, confirm that the incidence rate is greatly increased in subthreshold depression (2).”
ResultSelf-citationDepression in Age-Related Macular Degeneration
Casten, R. J., & Rovner, B. W. (2008) · Journal of Visual Impairment & Blindness · doi:10.1177/0145482x0810201003 · Cited by 73
Metadata
- Authors
- Cuijpers, P., & Smit, F.
- Affiliations
- Trimbos Institute (NL)
- Corresponding author
- Cuijpers, P.
- ORCID
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2004-03-28
- Volume
- 109
- Issue
- 5
- Pages
- 325-331
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W2139095467
- Cited by
- 595
- References
- 35
- Citations by year
- 2026: 34 · 2025: 40 · 2024: 32 · 2023: 26 · 2022: 41 · 2021: 36 · 2020: 29 · 2019: 28 · 2018: 21 · 2017: 35 · 2016: 30 · 2015: 37 · 2014: 24 · 2013: 27 · 2012: 27
- FWCI
- 1.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- subthreshold depression, major depressive disorder, depression incidence, risk factors, prospective study, relative risk, community sample, vulnerable populations
- MeSH terms
- Major Depressive Disorder, Depressive Disorder, Major, Humans, Prospective Studies, Risk Factors, Severity of Illness Index
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