Cited by 595Mental Health Treatment and AccessTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies

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Cuijpers, P., Smit, F.·2004·Acta Psychiatrica Scandinavica

DOI 10.1111/j.1600-0447.2004.00301.x

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Abstract

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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Xu, H., Li, J., Yang, Y., Liu, J., Zhang, J., Han, X., Reyila, A., Liu, Z., & Ge, P. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.1017907 · Cited by 1
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Wahlers, J. N., Wahlers, D. E., & Hart, W. (2024) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2024.43.3.227 · Cited by 1
Protocol for a nested case-control study: identifying neuroimaging biomarkers for the progression of subclinical depression and qi-stagnation constitution to major depressive disorder in adolescents
Wang, J., Zhang, C., Zhang, Y., Liu, Y., Zhang, J., Fang, X., Xia, W., Xie, Y., Lan, Z., Wang, J., et al. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1516846 · Cited by 1
Effects of Mindful Breathing Exercise on Attention Bias in Chinese College Students With Sub-Threshold Depression
Xu, T., Zhou, Y., & Wang, Y. (2025) · Mindfulness · doi:10.1007/s12671-025-02552-5 · Cited by 1
“While sub-threshold depression has a higher prevalence than MDD and nearly comparable impact on life quality (Volz et al., 2023), antidepressants show minimal effectiveness (Barbui et al., 2011; Fournier et al., 2010), high-lighting the need for alternative interventions.”
Influential
Time-shifting oriented balanced time perspective in college students with dysphoria: An exploration with the text reading and writing tasks
Yu, X., Jin, L., Wang, Y., Zhao, Y., Gong, J., Sun, J., Li, X., Hao, H., Wen, S., & Lyu, H. (2025) · Personality and Individual Differences · doi:10.1016/j.paid.2025.113264 · Cited by 1
Dynamic Changes in ALFF and DC in Subthreshold Depression Before and After ICBT Intervention
Wang, Y., Ying, Y., Zhu, Z., Wang, L., Yang, Y., Zhang, L., Yu, W., Liang, Y., Zhang, H., Ji, Y., et al. (2025) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s518526 · Cited by 1
The impact of adolescent clinical depression and depressive symptoms on moral thinking: based on process dissociation approach
Zheng, M., Ma, Z., & Jin, H. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1519595 · Cited by 2
“While it is a risk factor for clinical depression (Cuijpers and Smit, 2004, Kessler et al., 1997), it can also manifest in anxiety disorders, bipolar disorder, schizophrenia, and other psychiatric disorders.”
The association between mental health, cognitive functioning, and health-related quality of life in adults with chronic nontuberculous mycobacterial pulmonary disease
Schreiber, M., Quittner, A. L., & Henkle, E. M. (2025) · Therapeutic Advances in Respiratory Disease · doi:10.1177/17534666251396240 · Cited by 1
“…of anxiety and depression is crucial in evaluating HRQoL, as these symptoms— despite not reaching diagnostic thresholds—often represent the early stages of mental health conditions and, if left unaddressed, have a well-documented 32,33 potential to escalate into moderate or severe symptoms.”
VR-ACT: transforming clinical evidence of acceptance and commitment therapy through virtual reality for subthreshold depression
Kim, B., Jeong, D., Choi, Y., Kim, H., & Han, K. (2025) · Virtual Reality · doi:10.1007/s10055-025-01251-9 · Cited by 1
“Subthreshold depression (StD) refers to a condition in which individuals exhibit clinically significant depressive symptoms that do not meet the diagnostic criteria for major depressive disorder (MDD).”
Influential
Hippocampal subfield volumes associated with depression symptoms in older dementia caregivers
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The role of altered decision dynamics and dorsolateral prefrontal cortex to amygdala causal circuitry in the aberrant efficacy of emotion suppression in subthreshold depression
Niu, L., Toulopoulou, T., Song, X., Li, Q., Dai, H., Chen, K., Zhang, J., Chen, X., Chen, Z., Wang, X., et al. (2026) · Psychological Medicine · doi:10.1017/s0033291725103097 · Cited by 1
“…the number, severity, and duration of symptoms do not meet the diagnostic criteria of a major depressive episode (Rodríguez, Nuevo, Chatterji, & Ayuso-Mateos, 2012), which is the prodromal stage (Cuijpers & Smit, 2004) and an important risk indicator (Eaton, Badawi, & Melton, 1995) of depression.”
Functional inputs to the subgenual cingulate cortex differentiate levels of depressive symptom severity in neurotypical young adults: granger causality and clustering analyses
Li, H.-T., Chen, Y., Chaudhary, S., Ide, J. S., & Li, C. R. (2026) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyag005 · Cited by 1
“30,31 After identifying ROIs with significant sgACC inputs and outputs, we used connectivity strength ( F values) in cluster analysis to identify groups with distinct connectivity features.”
Alcohol Use, Demographics and Mental Health of Women Using a Digital Peer Support Program
Robinson, L. D., Ingram, I., Degan, T. J., van de Ven, K., & Lee, N. (2026) · Health Promotion Journal of Australia · doi:10.1002/hpja.70161 · Cited by 1
The Bidirectional Relationship Between Psychiatry and Type 2 Diabetes Mellitus
Rabie, M. (2011) · InTech eBooks · doi:10.5772/22212 · Cited by 3
“Subthreshold depression is clinically relevant and has been identified as a risk factor for subsequent major depressive disorder (Cuijpers and Smit, 2004).”
Background
Acceptance and commitment therapy for public mental health promotion. Effectiveness of the ?living to the full? programme
Fledderus, M. (2009) · Cited by 1
Preventie van depressie: een overzicht
Cuijpers, P. J., Smit, F., & Beekman, A. T. F. (2010) · Psychologie & gezondheid · doi:10.1007/bf03089341 · Cited by 1
“05 in subjects without subthreshold depression (Cuijpers and Smit, 2004).”
BackgroundInfluentialSelf-citation
Mental Health Problems in Family Medicine/General Practice
Lepeleire, J. D., Oud, M., & Buszewicz, M. (2012) · International Journal of Family Medicine · doi:10.1155/2012/794845 · Cited by 1
Can Behavioural Activation Be Used As An Alternative Treatment For Subthreshold Depression In Type 2 Diabetes?
Hardy, S., Shamari, B. K. A., Al-Mutawa, M. N. Q. H., Mathias, J., Ekers, D., Gellatly, J. L., Figgins, N., & Gray, R. J. (2015) · Mental Health in Family Medicine · doi:10.25149/1756-8358.1102008 · Cited by 1
“It is thought around eight percent of people with subthreshold depression progress to major depression within two years of developing symptoms [10,11] carried out a meta-analysis of 42 published studies that included 21,351 adults with diabetes.”
Background
Effects of Thought Suppression and Stressors on Depressive Rumination among Female College Students
Murayama, Y. (2013) · The Japanese Journal of Personality · doi:10.2132/personality.22.61 · Cited by 1
“2倍に増大している（厚生省大臣官房統計情報部，1998；厚生労働省大臣官房統計情報部，2012）。このことから，うつ病の発症や慢性化の要因やその特徴を明らかにすることは臨床的のみならず社会的な意義があると思われる。そして，健常者が示す閾値下の抑うつ症状は将来のうつ病発症リスクを高めることが報告されていること（Cuijpers & Smit, 2004）から，抑うつ症状やその中核である抑うつ感情の悪化や慢性化を引き起こす要因の性質を明らかにすることはうつ病の予防を図る上で重要であると考えられる。不適応な感情制御方略は抑うつの悪化や維持を…”
Effect of Metacognitive Awareness on Alleviating Depression in Female College Freshmen
Murayama, Y., & Okayasu, T. (2013) · The Japanese Journal of Health Psychology · doi:10.11560/jahp.26.1_28 · Cited by 1
“…words: metacognitive awareness, depressive symptoms, stressors, mediational e ect 問題と目的わが国におけるうつ病の生涯有病率は7%前後，12 カ月有病率は約 2%である（川上・大野・宇田・中根・竹島，2003）。世界保健機構（World Health Organization）は2020年までにうつ病は世界の精神保健を脅かす疾病の2番目としてリストアップしている（Murray & Lopez, 1998）。これらのことから，うつ病は現代社会に蔓延する精神疾患であると考えられ…”
Gripopjedip online
van der Linden, & van der Zanden, R. A. (2009) · TSG - Tijdschrift voor gezondheidswetenschappen · doi:10.1007/bf03082275 · Cited by 1
The role of self-help strategies as prevention for mental health problems
Takenaka, K. (2019) · Journal of Occupational Safety and Health · doi:10.2486/josh.00_12_josh-2019-0012-so · Cited by 1
Contemporary Genome-Wide Association Studies in Depression: The Critical Role of Phenotyping
Kasyanov, E. D., Rakitko, A., Rukavishnikov, G. V., Голимбет, В. Е., Shmukler, A. B., Ilinsky, V. V., Незнанов, Н. Г., Kibitov, A. O., & Mazo, G. E. (2022) · Neuroscience and Behavioral Physiology · doi:10.1007/s11055-022-01306-3 · Cited by 1
Is melancholia a distinct syndrome? Recurrence, chronicity, and severity give evidence in the 50 year follow-up of the Lundby Study
Nöbbelin, L., Bogren, M., Mattisson, C., Westling, S., & Brådvik, L. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1216431 · Cited by 1
The impact of reduced worry on general functioning: A mediation analysis from a randomized trial
Andersson, E., Mataix‐Cols, D., Lauri, K. O., de Schipper, E. J., Ljótsson, B., Aspvall, K., & Wahlund, T. (2023) · Stress and Health · doi:10.1002/smi.3319 · Cited by 1
Diet, physical activity, sedentary time and demographic variables differentiate among drinkers and former drinkers who suffer or not depression: a CRT analysis
Pastor-Cisneros, R., Denche-Zamorano, Á. M., la Osa, A. R.-D., & Pereira-Payo, D. (2025) · Psychology Health & Medicine · doi:10.1080/13548506.2025.2496999 · Cited by 1
“However, not all depressive symptoms meet the criteria for a diagnosis of depression and therefore remain invisible to society (Morgan & Jorm, 2008), although they also have high costs (Cuijpers et al., 2007) and carry a risk of developing major depressive disorder (Cuijpers & Smit, 2004).”
Plasma neurofilament light chain mediates the effect of subsyndromal symptomatic depression on cognitive decline in older adults
Zhang, C., Li, B., Ng, K. P., Huang, G., Wang, X., Kong, M., & Ba, M. (2025) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2025.1547394 · Cited by 1
A Case Of Depression Screening In Schools
Miloseva, L. (2016) · i-manager’s Journal on Educational Psychology · doi:10.26634/jpsy.10.1.7067 · Cited by 1
“This cut off score is determined based on literature and world research the number of which is unfortunately very small (Cuijpers & Smit, 2004; Cuijpers, 2014).”
Method
Religiosity as a moderator of causal uncertainty’s mediational role in the parental–offspring dysphoria relationship.
Rounding, K. D., Jacobson, J. A., & Hart, K. E. (2015) · Psychology of Religion and Spirituality · doi:10.1037/a0039690 · Cited by 2
The influence of affective state on sensory and emotional perception: Application of the Sense’n Feel™ method
Rochet, M., El‐Hage, W., Dreyfuss, L., & Atanasova, B. (2020) · European Journal of Neuroscience · doi:10.1111/ejn.14844 · Cited by 1
“Furthermore, several studies have revealed that “subclinical depression” is a significant risk factor for major depression (Cuijpers & Smit, 2004; Kessler, Zhao, Blazer, & Swartz, 1997).”
Background
Acculturation and Depressive Symptoms Among Dominicans in New York City
Hagen, D., Goldmann, E., Parikh, N. S., Goodman, M. S., & Boden-Albala, B. M. (2021) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-021-01316-2 · Cited by 1
“Finally, there is strong evidence that subthreshold depressive symptoms are important risk factors for major depression [50], which suggests that symptoms below the threshold of diagnostic criteria should be considered in studies of depression in this population [51].”
Background
Massively Multiplayer Online Gamers: Motivations and Risks
Wolfe, A. (2022) · Digital Archive @ GSU · doi:10.57709/2393382 · Cited by 1
From vulnerability to resilience against depression : the value of daily-life positive emotions
Geschwind, N. (2011) · Research Publications (Maastricht University) · doi:10.26481/dis.20111207ng · Cited by 1
Depression, Anxiety, Psychiatric Comorbidity and Dimensions of Temperament and Personality
Jylhä, P. J. (2008) · Työväentutkimus Vuosikirja · Cited by 1
Early-onset depressive disorders,related mental health disorders and substance use-A prospective : longitudinal study of Finnish twins born 1983-1987
Sihvola, E. (2010) · Työväentutkimus Vuosikirja · Cited by 1
An Ounce of Prevention is worth a Pound of Cure: Help-seeking and the onset of depression in people with subclinical depression
van Zoonen, K. (2015) · Pure Amsterdam UMC · Cited by 1
Health‐related quality of life, depression, sleep and breathing disorders in the elderly : With focus on those with impaired systolic function/heart failure
Johansson, P. (2008) · DiVA (Linkoping University) · Cited by 1
Relationship satisfaction, emotional distress,and relationship dissolution: : a population-based study on pregnant women and their partners
Røsand, G.-M. B. (2011) · NORA - Norwegian Open Research Archives · Cited by 1
Uncertainty in economic evaluations: implications for healthcare decisions
Mohseninejad, L. (2013) · University of Groningen research database (University of Groningen / Centre for Information Technology) · Cited by 1
Characterising the Relationship between Fatigue and Depression
Corfield, E. C. (2017) · Queensland University of Technology · doi:10.5204/thesis.eprints.110722 · Cited by 1

Authors: Cuijpers, P., & Smit, F.
Affiliations: Trimbos Institute (NL)
Corresponding author: Cuijpers, P.
ORCID: Cuijpers, P.
Smit, F.
Venue: Acta Psychiatrica Scandinavica
Publisher: Wiley
Published: 2004-03-28
Volume: 109
Issue: 5
Pages: 325-331
ISSN: 0001-690X (ISSN-L)
1600-0447
DOI: 10.1111/j.1600-0447.2004.00301.x
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
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
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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Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies

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