Abstract
ObjectivesThe heterogeneity and comorbidity of major mental disorders presenting in adolescents and young adults has fostered calls for trans-diagnostic research. This study examines early expressions of psychopathology and risk and trans-diagnostic caseness in a community cohort of twins and non-twin siblings.MethodsUsing data from the Brisbane Longitudinal Twin Study, we estimated median number of self-rated psychiatric symptoms, prevalence of subthreshold syndromes, family history of mood and/or psychotic disorders, and likelihood of subsequent trans-diagnostic caseness (individuals meeting diagnostic criteria for mood and/or psychotic syndromes). Next, we used cross-validated Chi-Square Automatic Interaction Detector (CHAID) analyses to identify the nature and relative importance of individual self-rated symptoms that predicted trans-diagnostic caseness. We examined the positive and negative predictive values (PPV; NPV) and accuracy of all classifications (Area under the Curve and 95% confidence intervals: AUC; 95% CI).ResultsOf 1815 participants (Female 1050, 58%; mean age 26.40), more than one in four met caseness criteria for a mood and/or psychotic disorder. Examination of individual factors indicated that the AUC was highest for subthreshold syndromes, followed by family history then self-rated psychiatric symptoms, and that NPV always exceeded PPV for caseness. In contrast, the CHAID analysis (adjusted for age, sex, twin status) generated a classification tree comprising six trans-diagnostic symptoms. Whilst the contribution of two symptoms (need for sleep; physical activity) to the model was more difficult to interpret, CHAID analysis indicated that four self-rated symptoms (sadness; feeling overwhelmed; impaired concentration; paranoia) offered the best discrimination between cases and non-cases. These four symptoms showed different associations with family history status.ConclusionsThe findings need replication in independent cohorts. However, the use of CHAID might provide a means of identifying specific subsets of trans-diagnostic symptoms representing clinical phenotypes that predict transition to caseness in individuals at risk of onset of major mental disorders.
Highlights
Unipolar, bipolar, and psychotic disorders are ranked as three of the four most burdensome conditions in individuals aged less than 25 [1]
The use of Chi-Square Automatic Interaction Detector (CHAID) might provide a means of identifying specific subsets of trans-diagnostic symptoms representing clinical phenotypes that predict transition to caseness in individuals at risk of onset of major mental disorders
It is argued that the high prevalence of longitudinal and concurrent co-occurrences of mood and psychotic symptoms and disorders means that comorbidity is the rule rather than the exception in adolescents and young adults [2,3,4,5,6]
Summary
Unipolar, bipolar, and psychotic disorders are ranked as three of the four most burdensome conditions in individuals aged less than 25 [1]. Many experts advocate the use of trans-diagnostic staging models as a more constructive strategy for research, prevention, and clinical treatments [5, 6] Before adopting this approach, we need a better understanding of the relative importance of trans-diagnostic expressions of psychopathology and risk that precede the onset of the first full-threshold episode of a major mental disorder (which we will refer to as ‘caseness’)
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