Community Sample Of Young Adults Research Articles

Impact of Psychosocial Adversity on Alcohol Intake in Young Adults: Moderation by the LL Genotype of the Serotonin Transporter Polymorphism

Evidence from animal studies supports a role for serotonin transporter gene promoter polymorphism (5-HTTLPR) gene-environment interaction (G x E) in the development of excessive alcohol intake. Few studies in humans have been conducted on this topic, yielding inconsistent results. The present study aims to further explore G x E between 5-HTTLPR and exposure to psychosocial adversity on alcohol consumption in a high-risk community sample of young adults. Data were collected as part of the Mannheim Study of Children at Risk, an ongoing epidemiological cohort study following the outcome of early risk factors from birth into young adulthood. At age 19 years, 309 participants (142 male participants, 167 female participants) were genotyped for the biallelic and triallelic 5-HTTLPR and were administered a 45-day alcohol timeline follow-back interview, providing measures of the total number of drinks and the number of binge drinking days. Psychosocial adversity was assessed at birth (family adversity) and at age 19 (negative life events). In contrast to various previous reports, a significant G x E emerged, indicating that, when exposed to high psychosocial adversity, individuals with the LL genotype of 5-HTTLPR exhibited more hazardous drinking than those carrying the S allele or those without exposure to adversity. This effect, which was confined to male participants, held both for different classifications of 5-HTTLPR and different types of adversity. One explanation for the discrepant results might be heterogeneity in alcohol phenotypes. While the L allele relates more strongly to early-onset alcoholism, the S allele may be linked more closely to alcohol use associated with anxiety and depression.

Interaction between the 5-HTTLPR serotonin transporter polymorphism and environmental adversity for mood and anxiety psychopathology: evidence from a high-risk community sample of young adults

Previous research examining gene-environment interaction (GxE) with regard to vulnerability to depression and anxiety has yielded conflicting results. The present study was designed to further investigate GxE between 5-HTTLPR and exposure to environmental adversity, using different phenotypic and genotypic characterizations as well as different types of adversity within a prospective study design. Data were available from an ongoing epidemiological cohort study following the outcome of early risk factors from birth to adulthood. At age 19 yr, 309 participants (142 males, 167 females) were characterized on measures of depression and anxiety through interview and questionnaire (DSM-IV diagnosis, Beck Depression Inventory, Harm Avoidance). Environmental adversity was assessed at birth (family adversity), and at age 19 yr (stressful life events). Bi- and tri-allelic 5-HTTLPR genotypes were obtained from genomic DNA. Results indicated that depression and anxiety in 19-yr-olds were strongly associated with both family adversity and stressful life events. Individuals with the LL genotype of 5-HTTLPR who were exposed to high family adversity displayed significantly higher rates of depressive or anxiety disorders and had more depressive symptoms than those without either condition. This GxE replicates recent findings from an epidemiological cohort study of adolescents but is in contrast to many previous reports suggesting an interaction with the S allele. No evidence for GxE was obtained with regard to current stressful life events and trait anxiety. One possible source for the conflicting findings might be attributed to heterogeneity in depression phenotypes and environmental adversity.

Does psychomotor agitation in major depressive episodes indicate bipolarity?

Kraepelin's partial interpretation of agitated depression as a mixed state of "manic-depressive insanity" (including the current concept of bipolar disorder) has recently been the focus of much research. This paper tested whether, how, and to what extent both psychomotor symptoms, agitation and retardation in depression are related to bipolarity and anxiety. The prospective Zurich Study assessed psychiatric and somatic syndromes in a community sample of young adults (N = 591) (aged 20 at first interview) by six interviews over 20 years (1979-1999). Psychomotor symptoms of agitation and retardation were assessed by professional interviewers from age 22 to 40 (five interviews) on the basis of the observed and reported behaviour within the interview section on depression. Psychiatric diagnoses were strictly operationalised and, in the case of bipolar-II disorder, were broader than proposed by DSM-IV-TR and ICD-10. As indicators of bipolarity, the association with bipolar disorder, a family history of mania/hypomania/cyclothymia, together with hypomanic and cyclothymic temperament as assessed by the general behavior inventory (GBI) [15], and mood lability (an element of cyclothymic temperament) were used. Agitated and retarded depressive states were equally associated with the indicators of bipolarity and with anxiety. Longitudinally, agitation and retardation were significantly associated with each other (OR = 1.8, 95% CI = 1.0-3.2), and this combined group of major depressives showed stronger associations with bipolarity, with both hypomanic/cyclothymic and depressive temperamental traits, and with anxiety. Among agitated, non-retarded depressives, unipolar mood disorder was even twice as common as bipolar mood disorder. Combined agitated and retarded major depressive states are more often bipolar than unipolar, but, in general, agitated depression (with or without retardation) is not more frequently bipolar than retarded depression (with or without agitation), and pure agitated depression is even much less frequently bipolar than unipolar. The findings do not support the hypothesis that agitated depressive syndromes are mixed states. The results are limited to a population up to the age of 40; bipolar-I disorders could not be analysed (small N).

Lamotrigine during lactation

Premenstrual Dysphoric Disorder (PMDD) was recently included in DSM-5 as a full diagnostic category. Few studies have investigated PMDD in a community sample of young adults, especially in Brazil. Thus, the objective of this study was to evaluate the prevalence and the factors associated with PMDD in a community sample of 727 young adult women between the 18 and 24 years of age in southern Brazil. This was a cross-sectional population-based study. The data were collected from 2012 to 2014. PMDD was assessed using the Mini International Neuropsychiatry Interview (M.I.N.I. – Plus). The prevalence of PMDD was 17.6%. PMDD was significantly higher among older women, and in women from lower socio-economic status. A trend towards significance was found for women without a current occupation (study or work). The comorbidities significantly associated with PMDD were current major depression disorder, agoraphobia, bipolar disorder, current suicide risk, generalized anxiety disorder, social phobia, and specific phobia. The high prevalence found in the present study should be interpreted considering a retrospective report. However, our data showed that clinicians should be alert for PMDD symptoms, especially among young adult women.

The generalized anxiety spectrum: prevalence, onset, course and outcome

Generalized anxiety disorder (GAD) is generally considered to be a chronic condition, waxing and waning in severity; however prospective investigation of the course of GAD in community samples is lacking. This study seeks to fill that gap, by identifying the whole spectrum of generalized anxiety syndromes, sub-typing them according to their duration and frequency of occurrence, and evaluating their long-term course and outcome in the community. The prospective Zurich Study assessed psychiatric and somatic syndromes in a community sample of young adults (N = 591) (aged 20 years at first interview) by six interviews over a period of 20 years (1979-1999). GAD syndromes were defined by DSM-III symptom criteria without applying any exclusion criteria. A spectrum of generalized anxiety was defined by duration: 6 months (DSM-IV), 1 month (DSM-III), < or = 2 weeks (with weekly occurrence over one year), and anxiety symptoms. From 1978 (screening) to 1999 the annual presence of symptoms and treatment was assessed. Persistence of anxiety was defined by the almost daily presence of symptoms over the previous 12 months. The annual incidence of DSM-III GAD increased considerably between the ages of 20 and 40. The average age of onset of symptoms was 15.6 years; in 75% of cases it occurred before the age of 20. 75 of 105 DSM-III GAD cases had at least one follow-up. At their individual last follow-up, 12 of those 75 subjects (16%) were re-diagnosed as having GAD, 22 (29%) manifested subthreshold syndromes or anxiety symptoms, while 39 cases, the majority, (52%) were symptom-free; 5 of the 12 re-diagnosed GAD cases were persistent (corresponding to 7% of all 75 initial GAD cases). In their twenties they were treated at some time in 6% of all years, but in their thirties this figure rose to 12%. At their individual last follow-up 26% of 6-month GAD subjects and 22% of 1-month GAD subjects were still being treated. Treated vs. non-treated subjects did not differ in terms of gender but did differ in severity, persistence and in comorbidity with bipolar-II disorder, social phobia, obsessive-compulsive syndromes and substance-use disorders. Results are based on a relatively small sample and cannot be generalized to adults aged over 40 years. The course of DSM-III-defined GAD may not be chronic, as previously suggested, but mainly recurrent with intervening symptom-free periods of recovery in about half of cases. Over a period of 20 years there was more improvement than progression within the anxiety spectrum.

Prevalence, course, and comorbidity of insomnia and depression in young adults.

(1) To describe the prevalence and prospective course of insomnia in a representative young-adult sample and (2) to describe the cross-sectional and longitudinal associations between insomnia and depression. Longitudinal cohort study. Community of Zurich, Switzerland. Representative stratified population sample. None. The Zurich Study prospectively assessed psychiatric, physical, and sleep symptoms in a community sample of young adults (n=591) with 6 interviews spanning 20 years. We distinguished 4 duration-based subtypes of insomnia: 1-month insomnia associated with significant distress, 2- to 3-week insomnia, recurrent brief insomnia, and occasional brief insomnia. The annual prevalence of 1-month insomnia increased gradually over time, with a cumulative prevalence rate of 20% and a greater than 2-fold risk among women. In 40% of subjects, insomnia developed into more chronic forms over time. Insomnia either with or without comorbid depression was highly stable over time. Insomnia lasting 2 weeks or longer predicted major depressive episodes and major depressive disorder at subsequent interviews; 17% to 50% of subjects with insomnia lasting 2 weeks or longer developed a major depressive episode in a later interview. "Pure" insomnia and "pure" depression were not longitudinally related to each other, whereas insomnia comorbid with depression was longitudinally related to both. This longitudinal study confirms the persistent nature of insomnia and the increased risk of subsequent depression among individuals with insomnia. The data support a spectrum of insomnia (defined by duration and frequency) comorbid with, rather than secondary to, depression.

Pretrauma and Posttrauma Neurocognitive Functioning and PTSD Symptoms in a Community Sample of Young Adults

Objective: The authors sought to assess whether neurocognitive deficits in people with the posttraumatic stress disorder (PTSD) symptoms of reexperiencing and arousal are a consequence of these symptoms or represent a preexisting vulnerability factor for developing these symptoms after exposure to a traumatic event. Method: A random sample of 2,097 young adults who participated in a longitudinal epidemiological study in 1999 and 2000 were reinterviewed in 2003 and 2004 after a major natural disaster (a widespread fire) had occurred in the region. At both interviews, participants completed a number of neurocognitive tests covering immediate and delayed word recall, digit span, coding speed, and vocabulary. Five pre- and posttrauma neurocognitive measures for 1,599 participants who were exposed to the fire were examined to assess the extent to which development of the PTSD symptoms of reexperiencing and arousal was associated with change in neurocognitive skills. Analyses adjusted for a number of potential confounding factors. Results: Higher levels of fire-related reexperiencing and arousal symptoms were associated with less improvement in word recall ability at the second interview. However, levels of these symptoms were more consistently associated with having poorer pretrauma scores on all five neurocognitive measures available for this study. Conclusions: The presence of the PTSD symptoms of reexperiencing and arousal may result in a relative decline in some measures of verbal memory over time. The more robust finding from this study is that poorer performance on some neurocognitive tests may be a vulnerability factor for developing symptoms of PTSD, not only an outcome of PTSD symptoms.

Pretrauma and Posttrauma Neurocognitive Functioning and PTSD Symptoms in a Community Sample of Young Adults

The authors sought to assess whether neurocognitive deficits in people with the posttraumatic stress disorder (PTSD) symptoms of reexperiencing and arousal are a consequence of these symptoms or represent a preexisting vulnerability factor for developing these symptoms after exposure to a traumatic event. A random sample of 2,097 young adults who participated in a longitudinal epidemiological study in 1999 and 2000 were reinterviewed in 2003 and 2004 after a major natural disaster (a widespread fire) had occurred in the region. At both interviews, participants completed a number of neurocognitive tests covering immediate and delayed word recall, digit span, coding speed, and vocabulary. Five pre- and posttrauma neurocognitive measures for 1,599 participants who were exposed to the fire were examined to assess the extent to which development of the PTSD symptoms of reexperiencing and arousal was associated with change in neurocognitive skills. Analyses adjusted for a number of potential confounding factors. Higher levels of fire-related reexperiencing and arousal symptoms were associated with less improvement in word recall ability at the second interview. However, levels of these symptoms were more consistently associated with having poorer pretrauma scores on all five neurocognitive measures available for this study. The presence of the PTSD symptoms of reexperiencing and arousal may result in a relative decline in some measures of verbal memory over time. The more robust finding from this study is that poorer performance on some neurocognitive tests may be a vulnerability factor for developing symptoms of PTSD, not only an outcome of PTSD symptoms.

Subjective Desistance and the Transition to Adulthood

This paper introduces two new conceptualizations of desistance based on individuals' personal assessments of their own movement away from crime. Drawing from qualitative accounts of changes in offending, we develop survey items indexing subjective desistance and reference group desistance. We then use a representative community sample of young adults to compare these new conceptualizations of desistance against more established measures derived from changes in arrest and self-reported crime. The results indicate that the prevalence and the predictors of desistance vary with these alternative conceptualizations. While relationship quality is consistently related to each desistance measure, the effects of prior crime, peer relationships, race, gender, and parental status depend upon the outcome under consideration. These results show both the generality of the desistance process and the utility of comparing subjective accounts of this process alongside official and self-reported behavioral measures.

Association Between Sleep Problems and Symptoms of Attention-Deficit/Hyperactivity Disorder in Young Adults

To examine the association between sleep-related problems and symptoms of attention-deficit/hyperactivity disorder (ADHD) in a community sample of young adults in Taiwan. A college-based cross-sectional survey. Two thousand two hundred eighty-four first-year college students (aged 18-20) in a university in Taiwan. Each student completed a questionnaire regarding sleep schedule (self-estimated total sleep duration and sleep need), sleep problems (dyssomnia, parasomnia, and snoring), and the Chinese version of the Adult ADHD Self-Report Scale. Subjects were grouped separately for the inattention and hyperactivity subscales into highly likely ADHD (2.3%, 0.7%), probable ADHD (21.3%, 5.7%), and probably non-ADHD (76.4%, 93.6%) groups according to the scoring scheme of the subscales of the Adult ADHD Self-Report Scale. Results showed that, for both inattention and hyperactivity symptoms, the highly likely ADHD and probable ADHD groups were more likely than the non-ADHD group to have a variety of current and lifetime sleep problems. No significant difference in sleep problems was found between the highly likely ADHD and probable ADHD groups. Inattention, but not hyperactivity, was associated with greater sleep need and greater difference between sleep need and self-estimated nocturnal sleep duration. Hyperactivity, but not inattention, was associated with decreased nocturnal sleep duration. Consistent with prior findings from children and adolescents, ADHD symptoms in young adults are related to sleep problems. Further studies on adults with ADHD should help to refine our understanding of the causal basis for any implications of this association.

Melancholia and atypical depression in the Zurich study: epidemiology, clinical characteristics, course, comorbidity and personality

A comparison of psychiatric, psychological and somatic characteristics in specified subgroups of major depressive episodes (MDE). In a stratified community sample of young adults investigated prospectively from age 20/21 to 40/41, we defined four MDE subgroups: i) DSM-IV melancholia or atypical depression (the 'combined group'), ii) pure melancholia, iii) pure atypical depression, and iv) unspecified MDE. The cumulative incidence rates of the four groups were 4.1%, 7.1%, 3.5% and 8.2% respectively. Women were over-represented in the combined and atypically depressed group. In 56 of 117 (47.9%) cases, melancholia was longitudinally associated with atypical MDE (n = 84) (OR = 11.9). Melancholic MDE was more severe than atypical MDE although the two groups shared many characteristics. The longitudinal overlap of melancholia with atypical depression in almost half of all cases calls for comparative analyses of combined, pure and unspecified MDE.

A mediated model of perfectionism, affect, and physical health

This study tested a structural model in which positive and negative affect mediate the relationship between perfectionism and physical health. A community sample of young adults completed questionnaires including the Multidimensional Perfectionism Scale (MPS-H; Hewitt & Flett, 1991b), the Positive and Negative Affect States Survey (PANAS; Watson, Clark, & Tellegen, 1988) and items assessing three aspects of physical health. Results supported a structural model in which self-oriented perfectionism was associated with better physical health and this relationship was fully mediated by high positive affect and low negative affect. In contrast, socially prescribed perfectionism was associated with poorer physical health and this relationship was partially mediated by low positive affect and high negative affect. These findings are discussed in terms of the adaptive and maladaptive aspects of perfectionism within a general context of linkages between personality and health.

Perfectionism, Ego Defense Styles, and Depression: A Comparison of Self‐Reports Versus Informant Ratings

The present study examined the associations among perfectionism, defense styles, and depression in an Israeli community sample of young adults. This study involved a comparison of self-reports and informant ratings on all measures. A community sample of 210 pairs of same-sex best friends from Israel completed the Multidimensional Perfectionism Scale, the Defense Styles Questionnaire - 40, and a depression measure. Analyses confirmed that socially prescribed perfectionism is associated with depression, not only in terms of self-reports but also in terms of informant ratings. In addition, informant ratings revealed a link between other-oriented perfectionism and depression. Both self-reports and informant ratings also indicated that socially prescribed perfectionism is associated with immature defense styles and neurotic defense styles. Further simultaneous Structural Equation Modeling (SEM) analyses of self-reports and informant ratings showed that maladaptive defense styles mediate the link between socially prescribed perfectionism and depression. The practical and theoretical implications of these findings are discussed.

Abuse Experiences in a Community Sample of Young Adults: Relations with Psychiatric Disorders, Sexual Risk Behaviors, and Sexually Transmitted Diseases

This study documents significant associations among lifetime abuse experiences, psychiatric diagnoses, and sexual risk behaviors in a multiethnic community sample of young men and women (N = 1803) in South Florida. Self-report data were collected via structured interviews as part of a longitudinal follow-up of a larger school-based study. Participants were grouped according to extent of lifetime abuse experiences. Cumulative lifetime abuse experiences were associated with increased risk for a broad range of individual lifetime psychiatric disorders, as well as cumulative lifetime psychiatric disorders. Both cumulative abuse experiences and cumulative psychiatric disorders were independently associated with (a) higher levels of sexual risk behaviors and (b) higher risk for lifetime sexually transmitted diseases (STDs). Implications for selective prevention of sexual risk behaviors and STDs among young adults with histories of abuse and psychiatric disorders are discussed.

Family Study of Chronic Depression in a Community Sample of Young Adults

The validity of the distinctions between dysthymic disorder, chronic major depressive disorder, and episodic major depressive disorder was examined in a family study of a large community sample of young adults. First-degree relatives (N=2,615) of 30 probands with dysthymic disorder, 65 probands with chronic major depressive disorder, 313 probands with episodic major depressive disorder, and 392 probands with no history of mood disorder were assessed by using direct interviews and informant reports. The rates of major depressive disorder were significantly greater among the relatives of probands with dysthymic disorder and chronic major depressive disorder than among the relatives of probands with episodic major depressive disorder, who in turn exhibited a higher rate of major depressive disorder than the relatives of probands with no history of mood disorder. The relatives of probands with dysthymic disorder had a significantly higher rate of dysthymic disorder than the relatives of probands with no history of mood disorder, and the relatives of probands with chronic major depressive disorder had a significantly higher rate of chronic major depressive disorder than the relatives of probands with no history of mood disorder. However, the relatives of the three groups of probands with depression did not differ on rates of dysthymic disorder and chronic major depressive disorder. Chronic depression is distinguished from episodic depression by a more severe familial liability. This familial liability may contribute to the more pernicious course of chronic depression.

Cumulative adversity and posttraumatic stress disorder: evidence from a diverse community sample of young adults.

The authors hypothesized that a history of adversities, whether they were objectively traumatic or not, predicts risk for 1st onset of PTSD. Survival analysis in a community sample of 1,803 young adults revealed that risk is associated with retrospectively reported adverse experiences that occurred in years prior to the focal traumatic event. Analyses control for clustering of events proximal to onset. Implications for etiology and preventive intervention are noted.

Relationship between abdominal pain subgroups in the community and psychiatric diagnosis and personality: A birth cohort study

Introduction: It is unclear if there is a causal link between psychiatric disorders and unexplained chronic gastrointestinal (GI) symptomatology. The role of personality is also in dispute. We aimed to assess the association of these factors with functional GI symptoms in a birth cohort study. Methods: The Dunedin birth cohort is well characterised and has been followed-up prospectively to age 26 ( n=980). Measured were upper and lower GI symptoms over the prior year at age 26 using a validated questionnaire, psychiatric diagnoses at ages 18 and 21 by standardised interview applying DSM-III-R criteria, and personality at age 18 using the Multidimensional Personality Questionnaire (MPQ). Natural symptom groupings were identified using factor analysis and k-means clustering. The association of these clusters and psychiatric diagnoses or personality was assessed by logistic regression. Results: The k-means analysis produced a six-cluster solution, which was made up of a health group, and five “disease” clusters defined by higher than average scores on a single symptom. A diagnosis of depression at age 18 or 21 years was associated with increases in the odds of 1.69 (95% CI: 1.27–2.25) for all GI, of 2.16 (95% CI: 1.12–4.16) for dysmotility and of 2.07 (95% CI: 1.13–3.80) for constipation, but not with the other clusters. Similar results were observed with respect to anxiety disorders for the odds of GI overall (OR=1.42, 95% CI: 1.01–1.99) and constipation (OR=2.11, 95% CI: 1.17–3.79). The personality subscales were not strongly linked; membership of “any” diseased cluster was associated with a reduced odds of being in the fourth quartile for the well-being scale (OR=0.64, 95% CI: 0.46–0.88) but increased odds of being in the fourth quartile for the social potency scale (OR=1.64, 95% CI: 1.18–2.28). Conclusions: In a young adult community sample, unexplained GI symptoms appear to be linked to psychiatric disorders but personality differences were minimal.

Family study of co-morbidity between major depressive disorder and anxiety disorders

Numerous studies have documented high rates of co-morbidity between major depressive disorder (MDD) and the anxiety disorders (ANX). However, the reason for this is unclear. Family studies provide one potentially useful approach for addressing this issue. We explored six explanations of the co-morbidity between MDD and ANX using a family study of a large community sample of young adults and their first-degree relatives. Participants included 112 probands with a lifetime history of both MDD and one or more ANX, 290 probands with a history of MDD but no ANX, 43 probands with a history of one or more ANX but no MDD. 352 probands with no lifetime history of either MDD or ANX, and the probands' 2608 first-degree relatives. Probands were assessed using semi-structured diagnostic interviews on two occasions in adolescence and a third time at age 24. Diagnostic data on relatives were collected using both direct and family history interviews. Compared with controls, MDD aggregated in the families of probands with MDD, whether or not they had co-morbid ANX; ANX aggregated in the families of probands with ANX, regardless of whether they had co-morbid MDD; and co-morbid MDD/ANX aggregated only in the families of probands with both MDD and ANX. The relatives of probands with ANX alone had a significantly higher rate of ANX than the relatives of probands with MDD alone, although none of the other comparisons between the depressed and anxious groups were significant. This pattern of findings is largely, although not completely, consistent with the view that MDD and ANX are transmitted independently within families, and suggests that the comorbidity between MDD and ANX is caused by non-familial aetiological factors.

Patterns of sexual risk behaviors and psychiatric disorders in a community sample of young adults.

This cross-sectional study documents significant associations between patterns of sexual risk behaviors and psychiatric diagnoses in a multiethnic community sample of young adults (N = 1803) in South Florida. Self-report data regarding sexual behavior and psychiatric symptoms were collected in structured interviews in a follow-up of an earlier school-based study. Cluster analysis was used to group participants with regard to levels of sexual risk behaviors during the past year. Chi-square analysis and ANOVA identified significant associations between cluster membership and (a) lifetime and (b) past year diagnoses for affective disorders, conduct disorder, antisocial personality disorder, alcohol abuse/dependence, marijuana abuse/dependence, and other drug abuse/dependence. In addition, higher levels of sexual risk behaviors were associated with higher levels of cumulative lifetime psychiatric disorders. Implications for selected prevention of sexually transmitted diseases (STDs) and the treatment of psychiatric disorders in young adulthood are discussed.

Family study of subthreshold depressive symptoms: risk factor for MDD?

Background: Family study data from a large community sample of young adults and their first-degree relatives were used to examine three questions regarding the relation between subthreshold depression (SubD) and major depressive disorder (MDD): (a) is there an elevated rate of MDD in the relatives of probands with SubD? (b) does SubD aggregate in the families of probands with MDD and SubD? (c) is the relationship between SubD and familial psychopathology specific to MDD? Methods: A total of 941 probands were assessed twice during adolescence and then at age 24. Direct and informant information was obtained on 2750 first-degree relatives of 840 probands. Results: The rate of MDD in the relatives of probands with SubD (24.3%) was significantly lower than the relatives of probands with MDD (31.9%) but was significantly higher than the relatives of probands with no history of mood disorder (NMD; 20.2%). Relatives of MDD, SubD and NMD probands did not differ on rates of SubD (9.0, 9.4 and 9.0%, respectively). Familial aggregation of psychopathology in SubD probands was specific to MDD. Limitations: The primary limitation may be the absence of a standardized definition and assessment procedure for the SubD category. In addition, the sample size, although large, may have been inadequate to detect smaller associations or the moderating effects of sex. Conclusion: The results data support the view that SubD occupies a milder position on a continuum with MDD.