The Clinical Characteristics of Major Depression as Indices of the Familial Risk to Illness

1994 ◽  
Vol 165 (1) ◽  
pp. 66-72 ◽  
Author(s):  
Kenneth S. Kendler ◽  
Michael C. Neale ◽  
Ronald C. Kessler ◽  
Andrew C. Heath ◽  
Lindon J. Eaves
Keyword(s):  
Major Depression ◽  
Clinical Characteristics ◽  
Age At Onset ◽  
Familial Risk ◽  
Population Based ◽  
Treatment Seeking ◽  
Generalised Anxiety Disorder ◽  
Increased Risk ◽  
Co Morbidity ◽  
Familial Vulnerability

BackgroundFrom both a clinical and an aetiological perspective, major depression (MD) is probably a heterogeneous condition. We attempt to relate these two domains.MethodWe examined which of an extensive series of clinical characteristics in 646 female twins from a population-based register with a lifetime diagnosis of MD predicts the risk for MD in co-twins. MD was defined by DSM–III–R criteria.ResultsFour variables uniquely predicted an increased risk for MD in the co-twin: number of episodes, degree of impairment and co-morbidity with panic disorder or bulimia. One variable uniquely predicted decreased risk: co-morbidity with phobia. Variables that did not uniquely predict risk of MD in the co-twin included age at onset, number and kind of depressive symptoms, treatment seeking, duration of the longest episode and co-morbidity with generalised anxiety disorder and alcohol dependence.ConclusionsOur results suggest that the clinical features of MD can be meaningfully related to the familial vulnerability to illness, particularly with respect to recurrence, impairment and patterns of co-morbidity.

The temporal relationship of the onsets of alcohol dependence and major depression: using a genetically informative study design

2006 ◽  
Vol 36 (8) ◽  
pp. 1153-1162 ◽  
Author(s):  
PO-HSIU KUO ◽  
CHARLES O. GARDNER ◽  
KENNETH S. KENDLER ◽  
CAROL A. PRESCOTT
Keyword(s):  
Major Depression ◽  
Alcohol Dependence ◽  
Temporal Relationship ◽  
Causal Effect ◽  
Age At Onset ◽  
Familial Risk ◽  
Population Based ◽  
Structured Interviews ◽  
Self Medication ◽  
Relationship Of

Background. Although alcohol dependence (AD) and major depression (MD) are highly co-morbid, their causal relationship is unclear. In this longitudinal study, we used a genetically informative population-based twin sample to examine the age-at-onset distributions and the temporal relationship of AD and MD.Method. Our sample included 7477 twins, whose diagnoses of AD and MD and age-at-onset information were obtained from structured interviews. Individual-level survival analyses were conducted based on 2603 monozygotic (MZ) twins, and co-twin diagnosis was included in models as an index of familiar liability to AD and MD.Results. The age-at-onset distributions of AD and MD differed substantially. Most onsets of AD were in young adulthood, whereas MD had a flatter distribution across age. Most subjects, especially women, had an onset of MD preceding AD. Prior MD significantly affected risk for developing AD, and this risk decreased over time. By contrast, preceding AD had negligible effects on the risk for future MD. Familial risk was transmitted within disorders but there was little evidence of additional familial liability shared across disorders.Conclusions. Risk for developing AD was substantially increased by a prior episode of MD. The association was only partially accounted for by familial factors, providing support for a direct causal effect such as self-medication. The etiologic path from AD to MD was insignificant.

Age at onset and familial risk for major depression in a Swedish national twin sample

2005 ◽  
Vol 35 (11) ◽  
pp. 1573-1579 ◽  
Author(s):  
KENNETH S. KENDLER ◽  
MARGARET GATZ ◽  
CHARLES O. GARDNER ◽  
NANCY L. PEDERSEN
Keyword(s):  
Major Depression ◽  
Proportional Hazards ◽  
Age At Onset ◽  
Familial Risk ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
History Of ◽  
The Relationship

Background. In many biomedical disorders, early age at onset (AAO) is an index of high liability to illness which is manifest by an increased risk of illness in relatives. Most but not all prior studies report such a pattern for major depression (MD).Method. Lifetime MD and AAO were assessed at personal interview using modified DSM-III-R criteria in 13864 twin pairs, including 4229 onsets of MD, from the Swedish National Twin Registry. Analyses were conducted using Cox proportional hazards models.Results. Controlling for year of birth, gender, zygosity, co-twin history of MD and the interaction of zygosity and co-twin history, the best-fit model showed a significant main effect and a quadratic effect of AAO of MD in the co-twin on the log hazard ratio for MD in the index twin. When examined together, these effects predicted that from the ages of 15 to ~35 years, AAO of MD is moderately negatively related to risk of illness in relatives. However, past age 35, the function flattens out, with little change of risk in relatives with further increases of AAO. Even when the co-twin had a late AAO, the risk in the index twin substantially exceeded that seen when the co-twin had no history of MD.Conclusion. In this large sample, AAO is a meaningful, albeit modest, index of familial liability to MD. The relationship is nonlinear and results largely from an increased liability in individuals with an early AAO. These results should be interpreted in the context of the limitations of long-term recall.

scholarly journals Reliability of a lifetime history of major depression: implications for heritability and co-morbidity

1998 ◽  
Vol 28 (4) ◽  
pp. 857-870 ◽  
Author(s):  
D. L. FOLEY ◽  
M. C. NEALE ◽  
K. S. KENDLER
Keyword(s):  
Major Depression ◽  
Structural Equation ◽  
Structural Equation Models ◽  
Familial Risk ◽  
Ratio Test ◽  
Psychiatric Interview ◽  
Lifetime History ◽  
Co Morbidity ◽  
Familial Influences ◽  
History Of

Background. In unselected samples, the diagnosis of major depression (MD) is not highly reliable. It is not known if occasion-specific influences on reliability index familial risk factors for MD, or how reliability is associated with risk for co-morbid anxiety disorders.Methods. An unselected sample of 847 female twin pairs was interviewed twice, 5 years apart, about their lifetime history (LTH) of MD, generalized anxiety disorder (GAD) and panic disorder (PD). Familial influences on reliability were examined using structural equation models. Logistic regression was used to identify clinical features that predict reliable diagnosis. Co-morbidity was characterized using the continuation ratio test.Results. The reliability of a LTH of MD over 5 years was fair (κ=0·43). There was no evidence for occasion-specific familial influences on reliability, and heritability of reliably diagnosed MD was estimated at 66%. Subjects with unreliably diagnosed MD reported fewer symptoms and, if diagnosed with MD only at the first interview, less impairment and help seeking, or, if diagnosed with MD only at the second interview, fewer episodes and a longer illness. A history of co-morbid GAD or PD is more prevalent among subjects with reliably diagnosed MD.Conclusions. A diagnosis of MD based on a single psychiatric interview incorporates a substantial amount of measurement error but there is no evidence that transient influences on recall and diagnosis index familial risk for MD. Quantitative indices of risk for MD based on multiple interviews should reflect both the characteristics of MD and the temporal order of positive diagnoses.

scholarly journals Obsessive–compulsive disorder: subclassification based on co-morbidity

2008 ◽  
Vol 39 (9) ◽  
pp. 1491-1501 ◽  
Author(s):  
G. Nestadt ◽  
C. Z. Di ◽  
M. A. Riddle ◽  
M. A. Grados ◽  
B. D. Greenberg ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Obsessive Compulsive Disorder ◽  
Clinical Characteristics ◽  
Latent Class ◽  
Age At Onset ◽  
Separation Anxiety Disorder ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Co Morbidity ◽  
The Relationship

BackgroundObsessive–compulsive disorder (OCD) is probably an etiologically heterogeneous condition. Many patients manifest other psychiatric syndromes. This study investigated the relationship between OCD and co-morbid conditions to identify subtypes.MethodSeven hundred and six individuals with OCD were assessed in the OCD Collaborative Genetics Study (OCGS). Multi-level latent class analysis was conducted based on the presence of eight co-morbid psychiatric conditions [generalized anxiety disorder (GAD), major depression, panic disorder (PD), separation anxiety disorder (SAD), tics, mania, somatization disorders (Som) and grooming disorders (GrD)]. The relationship of the derived classes to specific clinical characteristics was investigated.ResultsTwo and three classes of OCD syndromes emerge from the analyses. The two-class solution describes lesser and greater co-morbidity classes and the more descriptive three-class solution is characterized by: (1) an OCD simplex class, in which major depressive disorder (MDD) is the most frequent additional disorder; (2) an OCD co-morbid tic-related class, in which tics are prominent and affective syndromes are considerably rarer; and (3) an OCD co-morbid affective-related class in which PD and affective syndromes are highly represented. The OCD co-morbid tic-related class is predominantly male and characterized by high conscientiousness. The OCD co-morbid affective-related class is predominantly female, has a young age at onset, obsessive–compulsive personality disorder (OCPD) features, high scores on the ‘taboo’ factor of OCD symptoms, and low conscientiousness.ConclusionsOCD can be classified into three classes based on co-morbidity. Membership within a class is differentially associated with other clinical characteristics. These classes, if replicated, should have important implications for research and clinical endeavors.

The epidemiology of DSM-IV specific phobia in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions

2007 ◽  
Vol 37 (7) ◽  
pp. 1047-1059 ◽  
Author(s):  
FREDERICK S. STINSON ◽  
DEBORAH A. DAWSON ◽  
S. PATRICIA CHOU ◽  
SHARON SMITH ◽  
RISE B. GOLDSTEIN ◽  
...  
Keyword(s):  
Low Income ◽  
Adult Population ◽  
Age At Onset ◽  
Specific Phobia ◽  
Increased Risk ◽  
Co Morbidity ◽  
The Usa ◽  
Axis I ◽  
Dsm Iv ◽  
The Mean

Background. There is a lack of current detailed national data on the prevalence, correlates, disability and co-morbidity of DSM-IV specific phobia (SP), the prevalence of specific objects and situations feared, and associations between impairment, treatment and co-morbidity and the number of specific situations and objects feared, among adults in the USA.Method. The data were derived from a large (43093) representative sample of the adult population in the USA.Results. Prevalences of 12-month and lifetime DSM-IV SP were 7·1% and 9·4% respectively. Being female, young, and low income increased risk, while being Asian or Hispanic decreased risk (p<0·05). The mean age at onset of SP was 9·7 years, the mean duration of episode was 20·1 years and only 8·0% reported treatment specifically for SP. Most specific phobias involved multiple fears, and an increasing number of fears, regardless of content, was associated with greater disability and impairment, treatment seeking and co-morbidity with other Axis I and II disorders.Conclusions. SP is a highly prevalent, disabling and co-morbid disorder in the US adult population. The early onset of SP and the disorders most strongly associated with it highlights the need for longitudinal studies beginning in early childhood. Results suggest the existence of a generalized subtype of SP much like social phobia, which, once revealed, may lead to a classification of SP that is more etiologically and therapeutically meaningful.

scholarly journals Generalised anxiety disorder and hospital admissions: findings from a large, population cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e018539 ◽  
Author(s):  
Olivia Remes ◽  
Nicholas Wainwright ◽  
Paul Surtees ◽  
Louise Lafortune ◽  
Kay-Tee Khaw ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Service Use ◽  
Hospital Admissions ◽  
Late Onset ◽  
Large Population ◽  
Population Based ◽  
Generalised Anxiety Disorder ◽  
Increased Risk ◽  
Using Data ◽  
Administrative Health Databases

ObjectiveGeneralised anxiety disorder (GAD) is the most common anxiety disorder in the general population and has been associated with high economic and human burden. However, it has been neglected in the health services literature. The objective of this study is to assess whether GAD leads to hospital admissions using data from the European Prospective Investigation of Cancer-Norfolk. Other aims include determining whether early-onset or late-onset forms of the disorder, episode chronicity and frequency, and comorbidity with major depressive disorder (MDD) contribute to hospital admissions.DesignLarge, population study.SettingUK population-based cohort.Participants30 445 British participants were recruited through general practice registers in England. Of these, 20 919 completed a structured psychosocial questionnaire used to identify presence of GAD. Anxiety was assessed in 1996–2000, and health service use was captured between 1999/2000 and 2009 through record linkage with large, administrative health databases. 17 939 participants had complete data on covariates.Main outcome measurePast-year GAD defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.ResultsIn this study, there were 2.2% (393/17 939) of respondents with GAD. Anxiety was not independently associated with hospital admissions (incidence rate ratio (IRR)=1.04, 95% CI 0.90 to 1.20) over 9 years. However, those whose anxiety was comorbid with depression showed a statistically significantly increased risk for hospital admissions (IRR=1.23, 95% CI 1.02 to 1.49).ConclusionPeople with GAD and MDD comorbidity were at an increased risk for hospital admissions. Clinicians should consider that meeting criteria for a pure or individual disorder at one point in time, such as past-year GAD, does not necessarily predict deleterious health outcomes; rather different forms of the disorder, such as comorbid cases, might be of greater importance.

Childhood sexual abuse, stressful life events and risk for major depression in women

2004 ◽  
Vol 34 (8) ◽  
pp. 1475-1482 ◽  
Author(s):  
KENNETH S. KENDLER ◽  
JONATHAN W. KUHN ◽  
CAROL A. PRESCOTT
Keyword(s):  
Sexual Abuse ◽  
Major Depression ◽  
Childhood Sexual Abuse ◽  
Life Events ◽  
Stressful Life Events ◽  
Population Based ◽  
Stress Sensitivity ◽  
Stressful Life ◽  
Increased Risk

Background. In animals, early trauma can produce long-lasting changes in sensitivity to the pathogenic effects of stress. To explore whether similar processes occur in humans, we examine whether childhood sexual abuse (CSA) in women alters sensitivity in adulthood to the depressogenic effects of stressful life events (SLEs).Method. A history of CSA was obtained from a population-based sample of 1404 female adult twins. Cox Proportional hazard models were used to predict onsets of episodes of DSM-III-R major depression (MD) in the past year from previously assessed levels of neuroticism (N), CSA and past-year SLEs scored on long-term contextual threat.Results. In the best-fit model, onset of MD was predicted by CSA, SLEs and N. Individuals with CSA (and especially with severe CSA) had both an overall increased risk for MD and a substantially increased sensitivity to the depressogenic effects of SLEs. A ‘dose–response’ relationship between severity of CSA and sensitivity to SLEs was clearer in those with low to average levels of N than in those with high levels of N.Conclusion. As documented with physiological responses to a standardized laboratory stressor, CSA increases stress sensitivity in women in a more naturalistic setting. Both genetic and early environmental risk factors can produce long-term increase in the sensitivity of individuals to depressogenic life experiences.

scholarly journals Female Gender and Acne Disease Are Jointly and Independently Associated with the Risk of Major Depression and Suicide: A National Population-Based Study

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Yi-Chien Yang ◽  
Hung-Pin Tu ◽  
Chien-Hui Hong ◽  
Wei-Chao Chang ◽  
Hung-Chun Fu ◽  
...  
Keyword(s):  
Major Depression ◽  
Female Gender ◽  
Self Esteem ◽  
Population Based ◽  
Common Disease ◽  
Population Based Study ◽  
Increased Risk ◽  
Gender And Age ◽  
Additive Risk ◽  
And Gender

Acne is a common disease in adolescence with female preponderance. It could cause poor self-esteem and social phobia. Previous studies based on questionnaires from several thousands of adolescents showed that acne is associated with major depression and suicide. However, the gender- and age-specific risk of depression and suicide in patients with acne remain largely unknown. Using a database from the National Health Insurance, which included 98% of the population of Taiwan in 2006, we identified patients of acne, major depression, and suicide based on ICD-9-CM codes. Totally 47111 patients with acne were identified (16568 males and 30543 females) from 1 million subjects. The youths of 7–12 years had the highest prevalence of acne (14.39%). Major depression was more common in those with acne (0.77%) than controls (0.56% ,P< 0.0001) regardless of gender. Multiple logistic regression showed an increased risk of major depression in women without acne (OR = 1.85, 95% CI 1.75–1.96). The risk is additive in women with acne (OR = 2.78, 95% CI 2.43–3.17). Similar additive risk of suicide was noticed in women with acne. In conclusion, acne and gender, independently and jointly, are associated with major depression and suicide. Special medical support should be warranted in females with acne for the risk of major depression and suicide.

scholarly journals Features of childhood sexual abuse and the development of psychiatric and substance use disorders

2001 ◽  
Vol 179 (5) ◽  
pp. 444-449 ◽  
Author(s):  
Cynthia M. Bulik ◽  
Carol A. Prescott ◽  
Kenneth S. Kendler
Keyword(s):  
Sexual Abuse ◽  
Logistic Regression ◽  
Childhood Sexual Abuse ◽  
Psychiatric Disorders ◽  
Use Of Force ◽  
Population Based ◽  
Generalised Anxiety Disorder ◽  
Increased Risk ◽  
Increase Risk ◽  
Predictive Relationships

BackgroundChildhood sexual abuse (CSA) is associated with an increased risk of subsequent psychiatric disorders.AimsTo explore the risk associated with features of CSA and examine whether specific associations exist between particular profiles of CSA and the development of specific syndromes.MethodIn a population-based sample of adult female twins, we used logistic regression to explore the association between features of CSA (reported by the twin and her co-twin) and lifetime major depression, generalised anxiety disorder, bulimia nervosa, panic disorder and alcohol and drug dependence.ResultsIn univariate and stepwise multiple regressions, patterns of predictors differed, although not significantly, across diagnoses. Greater risk was associated with attempted or completed intercourse, the use of force or threats, abuse by a relative, and a negative response by someone who was told about the abuse. Similar patterns were observed with co-twin reports.ConclusionsSpecific features of CSA differentially increase risk of later psychopathology; however, there do not appear to be unique predictive relationships between features of CSA and the emergence of specific psychiatric disorders.

Childhood parental loss and risk for first-onset of major depression and alcohol dependence: the time-decay of risk and sex differences

2002 ◽  
Vol 32 (7) ◽  
pp. 1187-1194 ◽  
Author(s):  
K. S. KENDLER ◽  
K. SHETH ◽  
C. O. GARDNER ◽  
C. A. PRESCOTT
Keyword(s):  
Sex Differences ◽  
Major Depression ◽  
Alcohol Dependence ◽  
Time Course ◽  
Conditional Logistic Regression ◽  
Population Based ◽  
Parental Loss ◽  
Proportional Hazard ◽  
Increased Risk ◽  
The Impact

Background. Whereas a number of studies have suggested that parental loss is associated with increased risk for major depression (MD), much less is known about possible gender differences, diagnostic specificity and the time course of the impact of loss.Method. First-onsets for MD and alcohol dependence (AD) were assessed at personal interviews in 5070 twins from same-sex (SS) and 2118 from opposite-sex (OS) twin pairs ascertained from a population-based registry. Cox Proportional Hazard (PH) and Non-Proportional Hazard (NPH) models, examining first onsets of MD and AD, were used with twins from SS pairs and conditional logistic regression for OS pairs. Parent–child separations prior to age 17 were divided into death and separation from other causes.Results. The PH assumptions of constant increased risk were rejected for the impact of loss on risk for MD but not for AD. NPH models found significantly increased risk for MD after both death and separation with the risk lasting much longer for separations. For AD, the PH model found significantly increased risk after parental separation but not death. In both SS and OS twin pairs, no sex differences were seen in the impact of parental loss on risk for MD whereas the association between separation and risk for AD was significantly stronger in females than in males.Conclusion. Consistent sex differences in the association with parental loss were seen for AD but not MD. The analysis of the time-course of increased risk after loss suggests three different patterns which may reflect different relationships: parental death and MD (return to baseline within ∼12 years), separation and MD (return to baseline within ∼30 years) and separation and AD (no change in risk over time).

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