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Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies
Open accessAbstract
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]
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“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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“Similarly, findings in a community setting and general medical patients suggest that minor or sub-threshold depression may predict subsequent major depression.(14) Chronic illness has also been associated with an increased risk for conversion from sub-threshold depression to major depression.”
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“At the same time, psychological distress is known as a strong predictor of the onset of MDE [14].”
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“Studies have shown that these states are likely to be precursors for subsequent clinical depression (Cuijpers et al., 2004; Cuijpers and Smit, 2004; Fogel et al., 2006; Shankman et al., 2009).”
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“StD is more prevalent than MDD in the elderly [18], which has been shown to seriously affect patients’ quality of life and daily functioning and also to increase health service burden [23, 24].”
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“The incidence of MDD in people with subthreshold depression is higher than in people without subthreshold depression (Cuijpers and Smit, 2004).”
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“Depressive symptoms at old age have a negative impact on wellbeing [1, 2], quality of life [3], daily functioning and mortality [4], and increase the risk of developing major depression [5].”
BackgroundNeural correlates of negative emotion processing in subthreshold depression
Zhang, S., Zhang, Y., Ma, W., Qi, Z., Wang, Y., & Tao, Q. (2022) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsac003 · Cited by 39
“People with SD constitute a high-risk group because they have been associated with an increased risk of developing major depression and other adverse outcomes (Cuijpers and Smit, 2004; Tuithof et al., 2018).”
Duffy, S. L., Lagopoulos, J., Cockayne, N. L., Lewis, S. J. G., Hickie, I. B., Hermens, D. F., & Naismith, S. L. (2015) · Nutrition · doi:10.1016/j.nut.2015.04.019 · Cited by 38
Karlsson, B., Johnell, K., Sigström, R., Sjöberg, L., & Fratiglioni, L. (2016) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2016.03.009 · Cited by 36
Clasen, P. C., Fisher, A. J., & Beevers, C. G. (2015) · PLoS ONE · doi:10.1371/journal.pone.0129774 · Cited by 37
“, those with sub-threshold symptoms [24]).”
Minor Depression: Midway between Major Depression and Euthymia
Kroenke, K. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-144-7-200604040-00013 · Cited by 37
“Although the study focused on late-life depression, adolescents and younger adults with minor depression have a similar prognosis (2, 9).”
BackgroundAssessing Interpersonal Subtypes in Depression
Simon, S., Cain, N. M., Samstag, L. W., Meehan, K. B., & Muran, J. C. (2015) · Journal of Personality Assessment · doi:10.1080/00223891.2015.1011330 · Cited by 36
Interpersonal perception as a mediator of the depression–interpersonal difficulties link: A review
Polack, R. G., & Rafaeli, E. (2015) · Personality and Individual Differences · doi:10.1016/j.paid.2015.07.023 · Cited by 46
“The first is that a history of depression, as well as elevated levels of depressive symptoms, are both risk factors to clinical depression (e.g., Cuijpers & Smit, 2004; Monroe & Harkness, 2011).”
BackgroundHypomania and depression associated with distinct neural activity for immediate and future rewards
Glazer, J. E., Kelley, N. J., Pornpattananangkul, N., & Nusslock, R. (2018) · Psychophysiology · doi:10.1111/psyp.13301 · Cited by 35
Backenstraß, M., Joest, K., Rosemann, T. J., & Szécsényi, J. (2007) · BMC Health Services Research · doi:10.1186/1472-6963-7-190 · Cited by 35
Chan, M. F., Ng, S. E., Tien, A., Ho, R., & Thayala, J. (2013) · Health & Social Care in the Community · doi:10.1111/hsc.12043 · Cited by 35
“Previous studies have indicated that the key © 2013 John Wiley & Sons Ltd 545 indicator for developing late-life clinical depression is the presence of depressive symptoms which have not yet met the diagnostic criteria for depression (Cuijpers & Smit 2004).”
Prevalence and treatment of common mental disorders in the English national population, 1993–2007
Spiers, N. A., Qassem, T., Bebbington, P., McManus, S., King, M., Jenkins, R., Meltzer, H., & Brugha, T. S. (2016) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.115.174979 · Cited by 38
“31,32 Thus, even if everyone with a CMD were treated with medication or psychological intervention (and they clearly are not), the prevalence would only decline by one in seven.”
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
“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 and Smit, 2004; Shankman et al., 2009).”
BackgroundPosttraumatic Stress Disorder Part III: Health Effects of Interpersonal Violence Among Women
Hegadoren, K., Lasiuk, G. C., & Coupland, N. J. (2006) · Perspectives In Psychiatric Care · doi:10.1111/j.1744-6163.2006.00078.x · Cited by 35
Johnson, J. C. S., Byrne, G. J., & Pelecanos, A. M. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03834-1 · Cited by 36
“This is a requirement in some studies on subthreshold depression but not in others, which has been contemplated for decades [32] and assessed in systematic reviews [5, 33].”
BackgroundLiao, D.-D., Dong, M., Ding, K., Hou, C., Tan, W., Ke, Y.-F., Jia, F., & Wang, S. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.02.069 · Cited by 35
Reducing the Burden of Depression
Andrews, G. (2008) · The Canadian Journal of Psychiatry · doi:10.1177/070674370805300703 · Cited by 34
Mixed anxiety and depressive disorder outcomes: prospective cohort study in primary care
Walters, K. R., Buszewicz, M., Weich, S., & King, M. (2011) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.110.085092 · Cited by 36
“8 A small number of studies have demonstrated an increased risk of major depression in those with either minor depression or ‘subsyndromal’ depressive symptoms 9,10 as defined by DSM–IV.”
van den Berg, M., Smit, F., Vos, T., & van Baal, P. H. M. (2011) · PLoS ONE · doi:10.1371/journal.pone.0022884 · Cited by 33
“An important reason for targeting prevention at people with sub-threshold (minor) depression is that they have an increased risk of developing major depression compared to persons not meeting the criteria of sub-threshold depression [8].”
BackgroundSelf-citationYasukawa, S., Tanaka, T., Yamane, K., Kano, R., Sakata, M., Noma, H., Furukawa, T. A., & Kishimoto, T. (2024) · BMJ Mental Health · doi:10.1136/bmjment-2023-300881 · Cited by 32
Jang, S.-H., Lee, J., Lee, H.-J., & Lee, S.-Y. (2018) · Journal of Korean Medical Science · doi:10.3346/jkms.2018.33.e88 · Cited by 32
Zhang, T., Zhao, B., Shi, C., Nie, B., Liu, H., Yang, X., Sun, Y., Li, P., Lin, L., Yang, X., et al. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.135 · Cited by 35
Gonzalez, F., Otero, P., Iglesias, Á. T., Hermida, E., Blanco, V., & Fernández, O. D. (2013) · Psicothema · doi:10.7334/psicothema2012.89 · Cited by 32
“This is a very relevant result since a high presence of subclinical symptoms has been consistently reported in the literature as the main risk factor for the appearance of a major depressive episode ( Cuijpers & Smit , 2004 ) .”
Smagula, S. F., Krafty, R. T., Taylor, B. J., Martire, L. M., Schulz, R., & Hall, M. H. (2017) · Journal of Sleep Research · doi:10.1111/jsr.12549 · Cited by 31
“Identifying the objective sleep–wake correlates of depression severity in this group is particularly important, because having subclinical depression symptoms strongly potentiates the risk for major depression (Cuijpers and Smit, 2004; Joling et al., 2012).”
BackgroundPsychological factors for the onset of depression: a meta-analysis of prospective studies
Fu, Z., Brouwer, M. E., Kennis, M., Williams, A. D., Cuijpers, P. J., & Bockting, C. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-050129 · Cited by 40
Self-citationYing, Y., Ji, Y., Kong, F., Wang, M., Chen, Q., Wang, L., Hou, Y., Yu, L., Zhu, L., Miao, P., et al. (2022) · Psychological Medicine · doi:10.1017/s0033291722000599 · Cited by 31
“…are more prevalent (Cuijpers, Huibers, Ebert, Koole, & Andersson, 2013), negatively impact subjective well-being and psychosocial function (Cuijpers & Smit, 2004), are related to increased use of health care services (Goldney, Fisher, Dal Grande, & Taylor, 2004) and immense economic costs…”
BackgroundLiao, Y., Zhang, H., Guo, L., Fan, B., Wang, W., Teopiz, K. M., Lui, L. M. W., Lee, Y. L., Li, L., Han, X., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.08.009 · Cited by 33
Voorhees, B. W. V., Ellis, J., Stuart, S. P., Fogel, J., & Ford, D. E. (2005) · PubMed Central · Cited by 31
Resting state functional connectivity as a marker of internalizing disorder onset in high-risk youth
Pawlak, M., Bray, S., & Kopala‐Sibley, D. C. (2022) · Scientific Reports · doi:10.1038/s41598-022-25805-y · Cited by 30
Jin, Z., Wang, J., Liu, X., Han, X., Qi, J., & Wang, J. (2022) · Land · doi:10.3390/land12010022 · Cited by 32
Unipolar depressive disorders have a common genotype
Edvardsen, J., Torgersen, S. O., Røysamb, E., Lygren, S., Skre, I., Onstad, S., & Øien, P. A. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.12.004 · Cited by 31
Li, H., Wei, D., Sun, J., Zhang, Q., & Qiu, J. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.01354 · Cited by 29
“Subthreshold depression (SubD), which was known as a risk factor of MDD (Cuijpers and Smit, 2004), has received considerable attention in recent years (Ma et al., 2013; Buntrock et al., 2016; Li et al., 2016).”
BackgroundDuagi, D., Carter, B., Farrelly, M., Lisk, S. C., Shearer, J., Byford, S., James, K., & Brown, J. S. L. (2024) · EClinicalMedicine · doi:10.1016/j.eclinm.2023.102382 · Cited by 42
Jimenez, D. E., Reynolds, C. F., Alegria, M. M., Harvey, P. D., & Bartels, S. J. (2015) · Trials · doi:10.1186/s13063-015-1113-3 · Cited by 30
“It is also a strong risk factor for major depression, and might increase the risk of death in older individuals [11, 12, 15].”
BackgroundMacLean, S. A., Lancaster, K. E., Lungu, T., Mmodzi, P., Hosseinipour, M. C., Pence, B. W., Gaynes, B. N., Hoffman, I., & Miller, W. C. (2017) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-017-9829-9 · Cited by 31
“risk for developing moderate depression (Cuijpers and Smit 2004; Rodriguez et al. 2012).”
Background
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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