Does Subclinical Depression Always Lead to Clinical Depression?

Major depression is a global health concern and affects approximately one in five people throughout the world at some point in their lifetime. But subsyndromal depression (SD), or depression that does not meet clinical levels, can be just as concerning as it may lead to other mental health problems and increase the risk for development of major depression, mood issues, and even suicide.

“However, little is known about the prevalence, course, and correlates of SD in the US general adult population,” said Robert H. Pietzrak of the National Center for Posttraumatic Stress Disorder at the Veterans Affairs Connecticut Healthcare System. Pietzrak wanted to see how prevalent SD was and if nonclinical depressive symptoms would increase risk of major depression.

Pietzrak recently conducted a study exploring this relationship in a sample of over 34,000 adults. The participants were assessed twice over a 3-year period. Each time, Pietzrak evaluated them for symptoms of SD, major depression, and other mental health issues including anxiety and substance abuse.

He found that of all the participants, over 11% were classified with SD at the Time 1 and were more likely to develop major depression at Time 2 than those without SD. He also found evidence of a strong association between SD at Time 1 and anxiety issues at Time 2, including generalized anxiety, social phobia, and panic. In general, the participants with the most distress and most severe SD symptoms at Time 1 were at the greatest risk of comorbidity or major depression at Time 2.

One unexpected finding from this study was the lack of substance misuse in those with SD. Pietzrak theorized that SD, especially distressing and severe SD at Time 1, would increase the risk of substance misuse at Time 2, but that theory was not supported in this study. However, Pietzrak did find personality distortions were associated with SD and increased vulnerability for major depression.

In sum, the results of this study suggest that apart from the nearly 20% of individuals with major depression, another 11% may be at risk of developing clinical levels of depression as well. Efforts aimed at identifying those individuals and treatments designed to minimize risk should be increased to reduce the global burden of major depression.

Pietrzak, R. H., et al. (2013). Subsyndromal depression in the United States: Prevalence, course, and risk for incident psychiatric outcomes. Psychological Medicine 43.7 (2013): 1401-14. ProQuest. Web.

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  • Beth


    June 28th, 2013 at 3:58 AM

    This does give us something to be on the lookout for, if someone is experiencing this the there could be a good chance that they could then become clinically depressed. This isn’t the only factor to be watching for but it is a good starting point for some who might otherwise fall thru the cracks.

  • Selena


    June 29th, 2013 at 12:55 AM

    The biggest problem here is that there could be a vast number of such people who do not meet the clinical levels but do have depression.The fact that it only gets worse with time amplifies the problem.So unless people do voluntarily go in to get themselves checked nothing can really be done!

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