SUBTHRESHOLD DEPRESSION AND DEPRESSIVE DISORDER - CLINICAL CHARACTERISTICS OF GENERAL MEDICAL AND MENTAL-HEALTH SPECIALTY OUTPATIENTS

Objective: The authors examined the clinical significance of depressiv e symptoms below the threshold for depressive disorder in outpatient s amples. Method: The subjects were 775 adult patients with current depr essive disorder, 1,420 patients with subthreshold depression, and 1,76 7 hypertensive patients with and without depression, all of whom were visiting the offices of mental health specialists and general medical care providers in three U.S. cities. Data on demographic characteristi cs, severity of depression, extent of psychiatric and medical comorbid ity, family psychiatric history, and treatment history for the patient s with depressive disorder and those with subthreshold depression were compared. Results: The percentage of patients with subthreshold depre ssion who had a family history of depression (41%) was nearly as high as that of the patients with depressive disorder (59%). The two groups of patients had similar levels of medical and psychiatric comorbidity except for anxiety disorders, which were greater among the patients w ith depressive disorder. Among the hypertensive patients in the genera l medical sector, those with subthreshold depression were more similar to those with depressive disorder than to the nondepressed hypertensi ve patients. Treatment rates were considerably lower for patients with subthreshold depression than for patients with depressive disorder in the general medical sector, but they were similar in the mental healt h specialty sector. Conclusions: In these outpatients, subthreshold de pression appeared to be a variant of affective disorder and was treate d as such in the mental health specialty sector but not in the general medical sector. The findings emphasize the importance of treatment ou tcome studies of patients with subthreshold depression.